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Hospital's resource burden reveals magnitude of 2014 enterovirus D68 outbreak
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Based on patient volumes, respiratory treatments and staffing needs, the magnitude of the 2014 enterovirus D68 outbreak was much greater than previously estimated at a Colorado pediatric hospital, according to a recent research letter.
“During the typically calm respiratory season from August to September [2014], vast increases in respiratory patient volumes leading to record volumes of asthma medication usage and respiratory therapist demands were experienced in association with an enterovirus D68 outbreak,” Kevin Messacar, MD, sections of hospital medicine and infectious diseases, Children’s Hospital Colorado, told Infectious Diseases in Children. “In this study we quantified the burden of the outbreak at our institution in the absence of a widely available clinical test for the virus.”
Kevin Messacar
During the enterovirus D68 outbreak in 2014, only 1,153 cases across 49 states were microbiologically confirmed, suggesting the true impact of the outbreak was difficult to estimate, Messacar and colleagues wrote. Measuring resource burden allowed the researchers to determine the relative impact of the outbreak indirectly, but more accurately.
In their observational retrospective study, Messacar and colleagues observed resource utilization at Children’s Hospital Colorado during the outbreak that occurred from Aug. 1 through Sept. 30. The researchers forecasted expected values of resource utilization by performing a seasonal autoregressive integrated moving average time series analysis on data from January 2011 through July 2014, adjusting for seasonal variation and hospital growth. To determine the resource burden, they compared their observed data with their forecast.
Messacar and colleagues wrote that both respiratory patient volumes and asthma medication use increased more than they anticipated. Respiratory ED visits increased by 36%, respiratory hospital admissions increased by 80%, respiratory pediatric ICU admissions grew by 79%, albuterol sulfate use increased by 86%, steroid use increased by 72%, and second-line asthma medications increased by 101% (all, P < .05). In addition, respiratory equipment use and respiratory therapist demands increased significantly. Days spent on the ventilator (27%) and intermittent positive airway pressure therapy (30%) also were more than expected, as did administered inhaled medication doses (54%) and respiratory therapist procedures for every hour worked (70%; all P < .05).
“It is important to understand the burden of an emerging respiratory virus like enterovirus D68, so that children’s hospitals can be prepared if, or when, it returns,” he said. “We are fortunate that enterovirus D68 did not return to cause widespread disease in 2015. But if it does return to cause this extent of disease in the future, development of vaccines or therapeutics against this virus will become scientific priorities.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Heikki Peltola, MD
Enterovirus D68 – just a (respiratory) virus among others?
In a recent JAMA Pediatrics study, colleagues from Aurora, Colorado, reported an enterovirus D68 epidemic in their Children’s Hospital in August-September 2014. When compared to expected values, a significant increase was observed in the emergency department visits (36% increase), respiratory hospital admissions (80%), respiratory intensive care unit admissions (79%), asthma medication albuterol use (86%), steroids (72%), days in ventilator (28%), intermittent positive airway pressure therapy administration (30%), and inhaled medications executed by respiratory therapists (54%).
Services of respiratory therapists reached an all-time level in that institute. Albeit not as dramatic as with some other agents, D68 made a great hullabaloo in Aurora, and resource burden was felt intensively.
Being an enterovirus that shares biological properties with rhinoviruses, D68 causes much the same problems as those respiratory pathogens. Since virtually no activity prevails in the attempts to develop a vaccine – “a too difficult task”, say many – we should prepare to recognize a pending epidemic swiftly and try to minimize the spread of D68. Rhinovirus research has taught that, opposite to previous understanding, these viruses may stay alive in humans up to weeks (not only days), while many of these individuals remain symptomless. This unpleasant property makes it impossible to avoid infection only by keeping distance from people with running noses or other respiratory symptoms and signs.
Fortunately, we have one means which is inexpensive and readily accomplishable: repeated hand-washing with water and soap. Interestingly, regular soap perform better than well-advertised and costly “disinfectants”. In a recent three-armed study (Lau MS et al. Proc Natl Acad Sci USA 2015; doi: 10.1073/pnas.1423339112), the hazard of influenza infection in the increased hand hygiene intervention group declined by 37%. Assuming this finding to hold true for D68, frequent cleaning of surfaces, handles, etc., may also make sense.
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