Available online 10 January 2023, 105379

Enterovirus/ rhinovirus positivity increased to 21.7% in September 2022, 32.1% of which were EV-D68.

The increase in enterovirus/ rhinovirus positivity was associated with an increase in influenza like illness encounters.

The majority of patients infected with EV-D68 were younger than 5 years and 41.3% of them required supplemental oxygen.

Genomes made a new cluster within the B3 subclade and 29% of the genomes showed novel amino acid substitutions or combinations of substitutions within the hypervariable epitopes of VP1; BC and DE.

Changes within the BC loop correlated with an increase in average viral load in upper respiratory samples and supplemental oxygen requirement.

An increase in influenza like illness in children and adolescents at the Johns Hopkins Health system during summer 2022 was associated with increased positivity for enterovirus/ rhinovirus. We sought to characterize the epidemiology and viral evolution of enterovirus D68 (EV-D68).

A cohort of remnant respiratory samples tested at the Johns Hopkins Microbiology Laboratory was screened for enterovirus D68 (EV-D68). EV-D68 positives were characterized by whole genome sequencing and viral loads were assessed by droplet digital PCR (ddPCR). Genomic changes and viral loads were analyzed along with patients’ clinical presentations.

Of 566 screened samples, 126 were EV-D68 (22.3%). The median age of EV-D68 infected patients was four, a total of 52 required supplemental oxygen (41.3%), and 35 (27.8%) were admitted. Lung disease was the most frequent comorbidity that was associated with hospitalization. A total of 75 complete and 32 partial genomes were characterized that made a new cluster within the B3 subclade that was closest to US genomes from 2018. Novel amino acid changes (newly reported or a new combination) within the BC and DE loops were identified from 31 genomes (29%) which correlated with an increase in average viral load in respiratory specimens and the need for supplemental oxygen.

EV-D68 outbreaks continue to cause influenza like illness that could be overwhelming for the health system due to a significant demand for high flow oxygen. Viral evolution and an increase in the susceptible population are likely driving the trends of the increased EV-D68 infections.

Enterovirus

EV-D68

Respiratory

ILI

© 2023 The Author(s). Published by Elsevier B.V.