905. Epidemiology of Enterovirus D68 in the US: New Vaccine Surveillance Network, 2017–2022

• Published in: Open forum infectious diseases 2023-11, Vol.10 (Supplement_2)
• Main Authors: Clopper, Benjamin R, Moline, Heidi L, Midgley, Claire, Lopez, Adriana S, Ng, Terry Fei Fan, Perez, Ariana, Staat, Mary A, Schlaudecker, Elizabeth P, Sahni, Leila C, Boom, Julie A, Schuster, Jennifer E, Selvarangan, Rangaraj, Halasa, Natasha B, Stewart, Laura S, Hickey, Robert, Michaels, Marian G, Weinberg, Geoffrey A, Szilagyi, Peter G, Klein, Eileen J, Englund, Janet A
• Format: Article
• Language: English
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofad500.950

Abstract Background Provisional US data indicated that enterovirus D68 (EV-D68) circulated during summer 2022. However, in contrast to 2018 (a previous high circulation year), EV-D68 circulation in 2022 was associated with unusual increases in asthma-specific healthcare visits and a lack of concomitant increases in acute flaccid myelitis (AFM). To explore these distinctions by year, we characterized respiratory EV-D68 circulation in 2022 and compared patient characteristics in 2022 to 2018. Methods We enrolled children aged < 18 years with acute respiratory illness (ARI) seeking care in an emergency department (ED) or as an inpatient (IP) across 7 US medical centers in the New Vaccine Surveillance Network (NVSN). Data sources included parent interview, medical chart review, and collection of a respiratory swab for molecular virus testing. Swabs were tested for EV-D68 from Jul–Nov 2017–2020, and year-round from Jul 2021. A convenience sample of EV-D68-positive swabs was sequenced. We assessed monthly EV-D68 percent positivity among children with ARI. We examined demographics, underlying conditions, and severity markers among children with EV-D68 in 2018 and 2022, by care setting (ED vs IP) and used 0.05 as a threshold of statistical significance. Results Between 2017–2022, there were 994 ED and IP EV-D68 detections at NVSN sites, with distinct peaks during the Jul-Nov testing periods in 2018 and 2022 (Figure). All viruses sequenced in 2018 and 2022 were lineage B3. Compared to 2018, IPs with EV-D68 in 2022 less frequently reported any underlying medical condition or a history of asthma, yet more frequently required supplemental oxygen or intubation (Table). Supplemental oxygen use was also more common among ED patients in 2022 than 2018 (13% vs 6%; p=0.028). Asthma exacerbation was a common primary discharge diagnosis among IPs but was less common in 2022 than 2018 (43% vs 53%; p=0.030). Conclusion EV-D68 circulation was high in 2018, appeared to be disrupted in 2020, and returned with early and high circulation in 2022. Compared to 2018, EV-D68 may have caused more severe respiratory disease in 2022, including in otherwise healthy children. The lack of AFM observed in 2022 despite high EV-D68 circulation needs further investigation. Disclosures Mary A. Staat, MD, MPH, CDC: Grant/Research Support|Cepheid: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|Pfizer: Grant/Research Support|Up-To-Date: Honoraria Elizabeth P. Schlaud