Enterovirus D68 in Hospitalized Children: Sequence Variation, Viral Loads and Clinical OutcomesReportar como inadecuado

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An outbreak of enterovirus D68 EV-D68 caused severe respiratory illness in 2014. The disease spectrum of EV-D68 infections in children with underlying medical conditions other than asthma, the role of EV-D68 loads on clinical illness, and the variation of EV-D68 strains within the same institution over time have not been described. We sought to define the association between EV-D68 loads and sequence variation, and the clinical characteristic in hospitalized children at our institution from 2011 to 2014.


May through November 2014, and August to September 2011 to 2013, a convenience sample of nasopharyngeal specimens from children with rhinovirus RV-EV respiratory infections were tested for EV-D68 by RT-PCR. Clinical data were compared between children with RV-EV-non-EV-D68 and EV-D68 infections, and among children with EV-D68 infections categorized as healthy, asthmatics, and chronic medical conditions. EV-D68 loads were analyzed in relation to disease severity parameters and sequence variability characterized over time.


In 2014, 44% 192-438 of samples tested positive for EV-D68 vs. 10% 13-130 in 2011–13 p<0.0001. PICU admissions p<0.0001 and non-invasive ventilation p<0.0001 were more common in children with EV-D68 vs. RV-EV-non-EV-D68 infections. Asthmatic EV-D68+ children, required supplemental oxygen administration p = 0.03 and PICU admissions p <0.001 more frequently than healthy children or those with chronic medical conditions; however oxygen duration p<0.0001, and both PICU and total hospital stay p<0.01 were greater in children with underlying medical conditions, irrespective of viral burden. By phylogenetic analysis, the 2014 EV-D68 strains clustered into a new sublineage within clade B.


This is one of the largest pediatric cohorts described from the EV-D68 outbreak. Irrespective of viral loads, EV-D68 was associated with high morbidity in children with asthma and co-morbidities. While EV-D68 circulated before 2014, the outbreak isolates clustered differently than those from prior years.

Autor: Katherine Moyer , Huanyu Wang , Douglas Salamon, Amy Leber , Asuncion Mejias

Fuente: http://plos.srce.hr/


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