Top 5 Takeaways

1. EV-D68 Detection Trends: EV-D68 detections among children with ARI varied significantly over the study period, with 382 detections in 2018, six in 2019, and 30 in 2020.
2. Demographic Disparities: In 2020, a significant proportion of EV-D68 detections were among non-Hispanic Black children (73%), highlighting potential health disparities.
3. Impact of COVID-19 Mitigation: The lower-than-expected EV-D68 circulation in 2020 may have been influenced by COVID-19 mitigation measures such as mask-wearing and social distancing.
4. Clinical Severity: Approximately half of the children with EV-D68 in 2020 required inpatient care, with common symptoms including nasal congestion, cough, and wheezing.
5. Need for Continued Monitoring: Ongoing surveillance of EV-D68 is crucial for preparedness against both respiratory illness and the associated risk of acute flaccid myelitis (AFM).

Original Article Author and Citation

Corresponding Author

Melisa M. Shah, bgn3@cdc.gov

Suggested Citation

Shah MM, Perez A, Lively JY, et al. Enterovirus D68-Associated Acute Respiratory Illness ─ New Vaccine Surveillance Network, United States, July–November 2018–2020. MMWR Morb Mortal Wkly Rep 2021;70:1623–1628. DOI: http://dx.doi.org/10.15585/mmwr.mm7047a1

Summary

This article reports on the detection of Enterovirus D68 (EV-D68) in children with acute respiratory illness (ARI) across seven sites in the New Vaccine Surveillance Network (NVSN) from July to November in 2018, 2019, and 2020. The study found significant year-to-year variations in EV-D68 detections, with a notable decrease in 2019 and a slight increase in 2020. The data also highlighted demographic disparities, with a higher proportion of detections among non-Hispanic Black children in 2020. The study suggests that COVID-19 mitigation measures may have impacted EV-D68 circulation in 2020.

Methods

Active, population-based surveillance was conducted at seven medical institutions within the NVSN. Respiratory specimens were collected from pediatric patients with ARI and tested for EV-D68 using a CDC-developed real-time reverse transcription–polymerase chain reaction assay. Data on demographics and clinical characteristics were collected from medical charts or enrollment interviews. Statistical analyses were performed to compare characteristics across the years.

Discussion

The study observed low EV-D68 detections in 2019 and 2020 compared to 2018, with variations by site and month. The lower circulation in 2020 might be attributed to COVID-19 mitigation measures. Despite the low detection rates, severe respiratory illness was noted among infected children, with a significant proportion requiring inpatient care. The study also highlighted potential health disparities, with a higher incidence among non-Hispanic Black children in 2020.

Conclusion

EV-D68 circulation in 2020 was lower than anticipated, potentially due to COVID-19 mitigation measures. Continued monitoring of EV-D68 is essential for preparedness against associated respiratory illnesses and AFM. The study underscores the need for further research to understand the impact of health disparities on EV-D68 infection rates.

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