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Clinical Characterization of Children Presenting to the Hospital with Enterovirus D68 Infection During the 2014 Outbreak in St. Louis

Orvedahl, Anthony MD, PhD; Padhye, Amruta MD; Barton, Kevin MD; O’Bryan, Kevin MD; Baty, Jack BA; Gruchala, Nancy MD; Niesen, Angela BS, MPH; Margoni, Angeliki MD; Srinivasan, Mythili MD, PhD

The Pediatric Infectious Disease Journal: May 2016 - Volume 35 - Issue 5 - p 481–487
doi: 10.1097/INF.0000000000001060
Original Studies

Background: The largest known outbreak of enterovirus D68 (EV-D68) infections occurred during 2014. The goal of our study is to characterize the illness severity and clinical presentation of children infected with EV-D68 in comparison to non-EV-D68-human rhinoviruses/enteroviruses (HRV/EV).

Method: Our study is a retrospective analysis of severity level, charges and length of stay of children who presented to St. Louis Children’s Hospital from August 8, 2014 to October 31, 2014 and tested positive for EV-D68 in comparison to non-EV-D68-HRV/EV–infected patients. Chart review was performed for all EV-D68–infected patients and age and severity matched non-EV-D68-HRV/EV–infected patients.

Result: There was a striking increase in hospital census in August of 2014 in our hospital with simultaneous increase in the number of patients with EV-D68 infection. There was no significant difference in severity of illness, length of stay or total charges between EV-D68–infected and non-EV-D68-HRV/EV–infected children. EV-D68 infection was characterized by presenting complaints of difficulty breathing (80%) and wheezing (67%) and by findings of tachypnea (65%), wheezing (71%) and retractions (65%) on examination. The most common interventions were albuterol (79%) and corticosteroid (68%) treatments, and the most common discharge diagnosis was asthma exacerbation (55%).

Conclusion: EV-D68 caused a significant outbreak in 2014 with increased hospital admissions and associated increased charges. There was no significant difference in severity of illness caused by EV-D68 compared with non-EV-D68-HRV/EV infections suggesting that the impact from EV-D68 was because of increased number of infected children presenting to the hospital and not necessarily due to increased severity of illness.

From the *Department of Pediatrics and Division of Biostatistics, Washington University School of Medicine, St. Louis, MO; and ‡St. Louis Children’s Hospital, St. Louis, MO.

Accepted for publication October 7, 2015.

No funding was obtained for this study. Use of REDCap was supported by Clinical and Translational Science Award (CTSA) Grant [UL1 TR000448] and Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842. The authors have no funding or conflicts of interest to disclose.

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Address for correspondence: Mythili Srinivasan, MD, PhD, Department of Pediatrics, Washington University School of Medicine, One Children’s Place, St. Louis, MO 63110. E-mail

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