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Background: In 2014, the largest cohort of pediatric EV-D68 disease in the U.S. was reported by a large mid-west free-standing children’s hospital. Shortly after, reports of increased EV-D68 around the world were announced. Since then, EV-D68 has circulated even years during the summer to fall months. In June 2022, an increase in Rhinovirus/Enterovirus (RV/EV) infections with symptoms resembling EV-D68 outbreaks were noted earlier than usual in Kansas City’s clinical setting. Common symptoms of EV-D68 infection resemble asthma and severe EV-D68 infection has been linked to those with a history of asthma. Our aim was to investigate the rate of EV-D68 infections in children enrolled in the Center of Disease Control and Prevention (CDC)’s New Vaccine Surveillance Network (NVSN) acute respiratory infections (ARI) study.

Methods: Between January-December 2022, children < 18 years old seen at the hospital with symptoms of respiratory infection were enrolled into the CDC’s NVSN ARI study. Nasal samples collected in universal transport media were tested by NxTAG® Respiratory Pathogen Panel (Luminex) multiplex assay that can simultaneously detect 20 respiratory pathogens. Those with RV/EV detections were further tested by a real-time EV-D68 RT-PCR. Demographic and clinical information were also collected throughout the season.

Results: A total of 2,514 samples were tested; RV/EV was detected in 27% (n=690). EV-D68 was detected in 13.5% (n=93/690) of positive RV/EV samples, with an overall 3.7% (n=93/2514) rate of EV-D68 detection. EV-D68 was found highest in Black/African Americans (50%); in children ages 1-4 years (66%) and in males (57%). EV-D68 was more prevalent in subjects enrolled in the emergency department setting (57%) compared to the inpatient (30%) and clinic settings (13%). The most common symptoms reported by subjects and their families were coughing (97%), nasal congestion (90%), and rapid shallow breathing (77%). All 93 EV-D68 positives were detected in the summer to fall months (June to September).

Conclusions: The detection of EV-D68 within the CDC’s surveillance network brought an early awareness to the symptoms and diagnosis of this illness. These findings were reported to the CDC and in September 2022, a health advisory stating the increase in EV-D68 prevalence in hospitals and clinics nationwide was reported. Data gathered and presented here can contribute to early detection and preparedness for future outbreaks.

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Detection of Enterovirus D68 in Samples Enrolled in the New Vaccine Surveillance Network from January to December 2022