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2015 ; 3
(11
): 879-87
Nephropedia Template TP
gab.com Text
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English Wikipedia
Severe respiratory illness associated with a nationwide outbreak of enterovirus
D68 in the USA (2014): a descriptive epidemiological investigation
#MMPMID26482320
Midgley CM
; Watson JT
; Nix WA
; Curns AT
; Rogers SL
; Brown BA
; Conover C
; Dominguez SR
; Feikin DR
; Gray S
; Hassan F
; Hoferka S
; Jackson MA
; Johnson D
; Leshem E
; Miller L
; Nichols JB
; Nyquist AC
; Obringer E
; Patel A
; Patel M
; Rha B
; Schneider E
; Schuster JE
; Selvarangan R
; Seward JF
; Turabelidze G
; Oberste MS
; Pallansch MA
; Gerber SI
Lancet Respir Med
2015[Nov]; 3
(11
): 879-87
PMID26482320
show ga
BACKGROUND: Enterovirus D68 (EV-D68) has been infrequently reported historically,
and is typically associated with isolated cases or small clusters of respiratory
illness. Beginning in August, 2014, increases in severe respiratory illness
associated with EV-D68 were reported across the USA. We aimed to describe the
clinical, epidemiological, and laboratory features of this outbreak, and to
better understand the role of EV-D68 in severe respiratory illness. METHODS: We
collected regional syndromic surveillance data for epidemiological weeks 23 to
44, 2014, (June 1 to Nov 1, 2014) and hospital admissions data for
epidemiological weeks 27 to 44, 2014, (June 29 to Nov 1, 2014) from three states:
Missouri, Illinois and Colorado. Data were also collected for the same time
period of 2013 and 2012. Respiratory specimens from severely ill patients
nationwide, who were rhinovirus-positive or enterovirus-positive in hospital
testing, were submitted between Aug 1, and Oct 31, 2014, and typed by molecular
sequencing. We collected basic clinical and epidemiological characteristics of
EV-D68 cases with a standard data collection form submitted with each specimen.
We compared patients requiring intensive care with those who did not, and
patients requiring ventilator support with those who did not. Mantel-Haenszel
?(2) tests were used to test for statistical significance. FINDINGS: Regional and
hospital-level data from Missouri, Illinois, and Colorado showed increases in
respiratory illness between August and September, 2014, compared with in 2013 and
2012. Nationwide, 699 (46%) of 1529 patients tested were confirmed as EV-D68.
Among the 614 EV-D68-positive patients admitted to hospital, age ranged from 3
days to 92 years (median 5 years). Common symptoms included dyspnoea (n=513
[84%]), cough (n=500 [81%]), and wheezing (n=427 [70%]); 294 (48%) patients had
fever. 338 [59%] of 574 were admitted to intensive care units, and 145 (28%) of
511 received ventilator support; 322 (52%) of 614 had a history of asthma or
reactive airway disease; 200 (66%) of 304 patients with a history of asthma or
reactive airway disease required intensive care compared with 138 (51%) of 270
with no history of asthma or reactive airway disease (p=0·0004). Similarly, 89
(32%) of 276 patients with a history of asthma or reactive airway disease
required ventilator support compared with 56 (24%) of 235 patients with no
history of asthma or reactive airway disease (p=0·039). INTERPRETATION: In 2014,
EV-D68 caused widespread severe respiratory illness across the USA,
disproportionately affecting those with asthma. This unexpected event underscores
the need for robust surveillance of enterovirus types, enabling improved
understanding of virus circulation and disease burden. FUNDING: None.
|*Enterovirus D, Human
[MESH]
|Adolescent
[MESH]
|Adult
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Asthma/complications/virology
[MESH]
|Child
[MESH]
|Child, Preschool
[MESH]
|Colorado/epidemiology
[MESH]
|Cough/epidemiology/virology
[MESH]
|Critical Care/statistics & numerical data
[MESH]
|Disease Outbreaks/*statistics & numerical data
[MESH]