Epidemiology of Enterovirus D68 in Ontario

Abstract

In August 2014, children’s hospitals in Kansas City, Missouri and Chicago, Illinois notified the Centers for Disease Control and Prevention (CDC) about increased numbers of pediatric patients hospitalized with severe respiratory illness (SRI). In response to CDC reports, Public Health Ontario Laboratories (PHOL) launched an investigation of patients being tested for enterovirus D-68 (EV-D68) in Ontario, Canada. The purpose of this investigation was to enhance our understanding of EV-D68 epidemiology and clinical features. Data for this study included specimens submitted for EV-D68 testing at PHOL from September 1, 2014 to October 31, 2014. Comparisons were made between patients who tested positive for the virus (cases) and those testing negative (controls). EV-D68 was identified in 153/907 (16.8%) of patients tested. In the logistic regression model adjusting for age, sex, setting and time to specimen collection, individuals younger than 20 years of age were more likely to be diagnosed with EV-D68 compared to those 20 and over, with peak positivity at ages 5–9 years. Cases were not more likely to be hospitalized than controls. Cases were more likely to be identified in September than October (OR 8.07; 95% CI 5.15 to 12.64). Routine viral culture and multiplex PCR were inadequate methods to identify EV-D68 due to poor sensitivity and inability to differentiate EV-D68 from other enterovirus serotypes or rhinovirus. Testing for EV-D68 in Ontario from July to December, 2014 detected the presence of EV-D68 virus among young children during September-October, 2014, with most cases detected in September. There was no difference in hospitalization status between cases and controls. In order to better understand the epidemiology of this virus, surveillance for EV-D68 should include testing of symptomatic individuals from all treatment settings and patient age groups, with collection and analysis of comprehensive clinical and epidemiological data.

Global Distribution and Evolutionary History of Enterovirus D68, with Emphasis on the 2014 Outbreak in Ontario, Canada

“…Cases were not more likely to be hospitalized than controls, and were more likely to be identified in September than October (OR 8.07; 95% CI 5.15 to 12.64). There was no difference in hospitalization status between cases and controls ( Peci et al, 2015 ).…”

The association between acute flaccid myelitis (AFM) and Enterovirus D68 (EV-D68) – what is the evidence for causation?

“…The first detected large-scale outbreak of EV-D68 was reported in the US and Canada in 2014 [ 3 , 22 , 23 ] and was associated with severe respiratory symptoms [ 13 ]. The outbreak occurred from August 2014 to January 2015 (autumn/winter), with a total of 1,153 cases in 49 US states [ 13 ].…”

Enterovirus genotypes among patients with severe acute respiratory illness, influenza‐like illness, and asymptomatic individuals in South Africa, 2012‐2014

“…Enteroviruses (EV) can cause symptoms similar to a mild cold, but have also been associated with severe respiratory infection requiring hospitalisation and may be fatal . An outbreak of a re‐emerging EV‐D68 lineage causing severe acute respiratory illness (SARI) occurred in the USA and Canada in 2014, and these lineages were also detected in Europe, Asia, and South America from 2012 to 2013 samples . Though EVs have been associated with SARI and influenza‐like illness (ILI), these viruses have been less well characterized in South Africa.…”