Prevalence of β 2 -agonist inhalation for outpatients in a pediatric emergency center during enterovirus D68 epidemic

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Abstract

Background

Enterovirus D68 (EV-D68) has been reported to have caused severe bronchial asthma attacks and hospitalization epidemics in Japan in September 2015.

Objective

To investigate the prevalence of β ₂-agonist inhalation in a pediatric emergency center during a period of increased hospitalization for bronchial asthma, which was suggested to be associated with EV-D68.

Methods

We investigated the prevalence of β ₂-agonist inhalation in a pediatric emergency center in Saga city, Japan, from April 2013 to October 2015, and also clarified the trends in bronchial asthma hospitalization in the same area during that time.

Results

The prevalence of β ₂-agonist inhalation in the pediatric emergency center, September 2015 was highest when EV-D68 became widespread. The monthly average for β ₂-agonist inhalation during the study period was 91 cases, but the count in September 2015 was 255 cases. Hospitalized cases of bronchial asthma in September 2015 were increased for age ≥3 years and not increased for age <3 years, but the prevalence of β ₂-agonist inhalation at the pediatric emergency center was increased even under the age of 3 years.

Conclusion

During the epidemic period for EV-D68, cases requiring β ₂-agonist inhalation were increased. The EV-D68 epidemic may be related to not only severe cases requiring hospitalization, but also exacerbation of relatively mild symptoms of bronchial asthma.

Related collections

Most cited references 7

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Global emergence of enterovirus D68: a systematic review.

Charlotte Carina Holm-Hansen, Sofie Midgley, Thea Kølsen Fischer (2016)

Since its discovery in California in 1962, reports of enterovirus D68 have been infrequent. Before 2014, infections were confirmed in only 699 people worldwide. In August, 2014, two paediatric hospitals in the USA reported increases in the number of patients with severe respiratory illness, with an over-representation in children with asthma. Shortly after, the authorities recognised a nationwide outbreak, which then spread to Canada, Europe, and Asia. In 2014, more than 2000 cases of enterovirus D68 were reported in 20 countries. Concurrently, clusters of children with acute flaccid paralysis of unknown cause were reported in several US states and in Europe. Enterovirus D68 infection was confirmed in some of the paralysed children, but not all. Complications in patients who were severely neurologically affected resemble those caused by poliomyelitis. In this paper we systematically review reports on enterovirus D68 to estimate its global epidemiology and its ability to cause respiratory infections and neurological damage in children. We extracted data from 70 papers to report on prevalence, symptoms, hospitalisation and mortality, and complications of enterovirus D68, both before and during the large outbreak of 2014. The magnitude and severity of the enterovirus D68 outbreak underscores a need for improved diagnostic work-up of paediatric respiratory illness, not only to prevent unnecessary use of antibiotics, but also to ensure better surveillance of diseases. Existing surveillance systems should be assessed in terms of capacity and ability to detect and report any upsurge of respiratory viruses such as enterovirus D68 in a timely manner, and focus should be paid to development of preventive measures against these emerging enteroviruses that have potential for severe disease.

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Severe respiratory illness associated with a nationwide outbreak of enterovirus D68 in the USA (2014): a descriptive epidemiological investigation

Claire Midgley, John T. Watson, W Allan Nix … (2015)

Summary 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 χ2 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.

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A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA.

Kevin Messacar, Teri L Schreiner, John A Maloney … (2015)

Clusters of acute flaccid paralysis or cranial nerve dysfunction in children are uncommon. We aimed to assess a cluster of children with acute flaccid paralysis and cranial nerve dysfunction geographically and temporally associated with an outbreak of enterovirus-D68 respiratory disease.

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Author and article information

Journal

Journal ID (nlm-ta): Asia Pac Allergy

Journal ID (iso-abbrev): Asia Pac Allergy

Journal ID (publisher-id): APA

Title: Asia Pacific Allergy

Publisher: Asia Pacific Association of Allergy, Asthma and Clinical Immunology

ISSN (Print): 2233-8276

ISSN (Electronic): 2233-8268

Publication date Collection: April 2018

Publication date (Electronic): 18 April 2018

Volume: 8

Issue: 2

Electronic Location Identifier: e16

Affiliations

[1 ]Department of Pediatrics, National Hospital Organization Ureshino Medical Center, Saga, Japan.

[2 ]Department of Pediatrics, Saga-Ken Medical Centre Koseikan, Saga, Japan.

[3 ]Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan.

[4 ]Department of Pediatrics, National Hospital Organization Saga Hospital, Saga, Japan.

[5 ]Shimada Kids Clinic, Saga, Japan.

[6 ]Baba Children Clinic, Saga, Japan.

Author notes

Correspondence to Masafumi Zaitsu. Department of Pediatrics, National Hospital Organization Ureshino Medical Center, 2436 Shimojukuhei, Ureshino, Ureshino City, Saga 843-0393, Japan. Tel: +81-954-43-1120, Fax: +81-954-42-2452, zaitsum@ 123456aol.com

Author information

Masafumi Zaitsu https://orcid.org/0000-0003-2326-954X

Article

DOI: 10.5415/apallergy.2018.8.e16

PMC ID: 5931923

SO-VID: 89b8e3d6-bb2a-4b97-b25d-91f81be41172

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.