Enterovirus infections linked to severe respiratory illness in children without asthma

 The Centers for Disease Control and Prevention (CDC) and seven US pediatric medical centers report a notable association between Enterovirus D68 (EV-D68) and severe respiratory illness in children without prior medical conditions. Children with nonasthma or reactive airway disease (RAD) comorbidities demonstrated an increased likelihood of severe outcomes when hospitalized.

Severe respiratory illness linked to Enterovirus D68 (EV-D68) in children has gained attention in recent years. While EV-D68 typically presents with asthma-like symptoms, severe cases have been associated with acute flaccid myelitis (AFM), a neurologic condition causing limb weakness with unpredictable recovery.

A nationwide outbreak of EV-D68 in 2014 raised concerns about its impact on pediatric respiratory health as AFM cases spiked concurrently. Expanded testing capacity, including EV-D68-specific reverse-transcriptase polymerase-chain-reaction (rRT-PCR) assays, was introduced in select clinical and public health settings. Yet, systematic surveillance remains limited, with data largely drawn from single sites or short-term outbreak investigations.

Significant knowledge gaps remain in understanding the epidemiology of EV-D68-associated respiratory illness across multiple years and geographic locations.

In the study, "Enterovirus D68–Associated Respiratory Illness in Children," published in JAMA Network Open, researchers conducted a cross-sectional study to assess the epidemiology and clinical severity of EV-D68-associated respiratory illness in US children from 2017 to 2022 using a systematic, multi-site surveillance network.

Data from 976 children with laboratory-confirmed EV-D68 was collected across seven academic medical centers within the New Vaccine Surveillance Network, including Cincinnati, Houston, Kansas City, Nashville, Pittsburgh, Rochester, and Seattle. Research staff collected respiratory specimens using nasal and throat swabs. EV-D68 testing occurred through real-time PCR assays conducted at each site.

Enterovirus D68 (EV-D68) Detections Among Rhinovirus (RV) and EV Positive Cases and All Acute Respiratory Infection (ARI) Cases by Care Setting, New Vaccine Surveillance Network (2017-2022). Credit: JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2025.9131

Researchers identified 976 cases of EV-D68-associated respiratory illness in children under 18 years, with more than half requiring hospitalization. Among the 536 hospitalized children, 339 received supplemental oxygen, and 87 were admitted to intensive care units.

Children with nonasthma underlying conditions had significantly higher odds of severe outcomes. Odds of receiving supplemental oxygen were more than twice as high in this group (adjusted odds ratio [aOR], 2.72; 95% CI, 1.43–5.18), and ICU admission was three times more likely (aOR, 3.09; 95% CI, 1.72–5.56). No significant association emerged between asthma history and increased severity outcomes.

Detection peaks in 2018 and 2022 accounted for 92% of confirmed cases. During the pandemic surveillance period (March 1, 2020, to December 31, 2022), increased oxygen use was observed in children with nonasthma conditions (adjusted odds ratio [aOR], 1.61; 95% CI, 1.09–2.38).

No significant association emerged between asthma history and severe outcomes, though asthma-related discharge diagnoses were common among hospitalized children without prior asthma history.

Clinical triage and public health preparedness during Enterovirus outbreaks may require broader focus to include children with nonasthma comorbidities as well as those without prior medical conditions. Asthma history did not significantly correlate with severe outcomes but remains a clinical concern given the asthma-like presentation of Enterovirus infections.

As the authors state in the study conclusion, "Clinical and public health practitioners need to be aware that EV-D68 (while still a concern for children with asthma) can cause severe respiratory illness in otherwise healthy children of all ages, and that hospitalized children with nonasthma underlying conditions may be at higher risk for severe outcomes."

Parents, clinicians, and public health officials face heightened risks during years of elevated EV-D68 circulation. Robust surveillance systems remain essential for identifying emerging respiratory viruses and directing clinical resources during outbreak periods.

More information: Benjamin R. Clopper et al, Enterovirus D68–Associated Respiratory Illness in Children, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2025.9131

https://medicalxpress.com/news/2025-05-enterovirus-infections-linked-severe-respiratory.html