January 21, 2016
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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

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.