title: Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July-October 2014.
abstract: BACKGROUND
  Enterovirus D68 (EV-D68) caused a widespread outbreak of respiratory illness in the United States in 2014, predominantly affecting children. We describe EV-D68 rates, spectrum of illness, and risk factors from prospective, population-based acute respiratory illness (ARI) surveillance at a large US pediatric hospital.
  
  
  METHODS
  Children <13 years of age with ARI and residence in Hamilton County, Ohio were enrolled from the inpatient and emergency department (ED) settings at a children's hospital in Cincinnati, Ohio, from 1 July to 31 October 2014. For each participant, we interviewed parents, reviewed medical records, and tested nasal and throat swabs for EV-D68 using real-time reverse- transcription polymerase chain reaction assay.
  
  
  RESULTS
  EV-D68 infection was detected in 51 of 207 (25%) inpatients and 58 of 505 (11%) ED patients. Rates of EV-D68 hospitalization and ED visit were 1.3 (95% confidence interval [CI], 1.0-1.6) and 8.4 per 1000 children <13 years of age, respectively. Preexisting asthma was associated with EV-D68 infection (adjusted odds ratio, 3.2; 95% CI, 2.0-5.1). Compared with other ARI, children with EV-D68 were more likely to be admitted from the ED (P ≤ .001), receive supplemental oxygen (P = .001), and require intensive care unit admission (P = .04); however, mechanical ventilation was uncommon (2/51 inpatients; P = .64), and no deaths occurred.
  
  
  CONCLUSIONS
  During the 2014 EV-D68 epidemic, high rates of pediatric hospitalizations and ED visits were observed. Children with asthma were at increased risk for medically attended EV-D68 illness. Preparedness planning for a high-activity EV-D68 season in the United States should take into account increased healthcare utilization, particularly among children with asthma, during the late summer and early fall.
authors.affiliation: National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Holly M
authors.initials: HM
authors.lastname: Biggs
authors.affiliation: Infectious Diseases.
authors.forename: Monica
authors.initials: M
authors.lastname: McNeal
authors.affiliation: National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: W Allan
authors.initials: WA
authors.lastname: Nix
authors.affiliation: Pulmonology, Cincinnati Children's Hospital Medical Center, Ohio.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Kercsmar
authors.affiliation: National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Curns
authors.affiliation: Infectious Diseases.
authors.forename: Beverly
authors.initials: B
authors.lastname: Connelly
authors.affiliation: Infectious Diseases.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Rice
authors.affiliation: National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Shur-Wern Wang
authors.initials: SW
authors.lastname: Chern
authors.affiliation: National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Mila M
authors.initials: MM
authors.lastname: Prill
authors.affiliation: Infectious Diseases.
authors.forename: Nancy
authors.initials: N
authors.lastname: Back
authors.affiliation: National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: M Steven
authors.initials: MS
authors.lastname: Oberste
authors.affiliation: National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Susan I
authors.initials: SI
authors.lastname: Gerber
authors.affiliation: Infectious Diseases.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Staat
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001249:Asthma / Q000150:complications; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D030016:Enterovirus D, Human / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000821:virology; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records; D009666:Nose / Q000821:virology; D009820:Ohio / Q000453:epidemiology; D010614:Pharynx / Q000821:virology; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012621:Seasons
keywords: acute respiratory illness; enterovirus D68; respiratory virus