{"doi":"10.1093/ofid/ofad500.950","title":"905. Epidemiology of Enterovirus D68 in the US: New Vaccine Surveillance Network, 2017–2022","abstract":"Abstract Background Provisional US data indicated that enterovirus D68 (EV-D68) circulated during summer 2022. However, in contrast to 2018 (a previous high circulation year), EV-D68 circulation in 2022 was associated with unusual increases in asthma-specific healthcare visits and a lack of concomitant increases in acute flaccid myelitis (AFM). To explore these distinctions by year, we characterized respiratory EV-D68 circulation in 2022 and compared patient characteristics in 2022 to 2018. Methods We enrolled children aged < 18 years with acute respiratory illness (ARI) seeking care in an emergency department (ED) or as an inpatient (IP) across 7 US medical centers in the New Vaccine Surveillance Network (NVSN). Data sources included parent interview, medical chart review, and collection of a respiratory swab for molecular virus testing. Swabs were tested for EV-D68 from Jul–Nov 2017–2020, and year-round from Jul 2021. A convenience sample of EV-D68-positive swabs was sequenced. We assessed monthly EV-D68 percent positivity among children with ARI. We examined demographics, underlying conditions, and severity markers among children with EV-D68 in 2018 and 2022, by care setting (ED vs IP) and used 0.05 as a threshold of statistical significance. Results Between 2017–2022, there were 994 ED and IP EV-D68 detections at NVSN sites, with distinct peaks during the Jul-Nov testing periods in 2018 and 2022 (Figure). All viruses sequenced in 2018 and 2022 were lineage B3. Compared to 2018, IPs with EV-D68 in 2022 less frequently reported any underlying medical condition or a history of asthma, yet more frequently required supplemental oxygen or intubation (Table). Supplemental oxygen use was also more common among ED patients in 2022 than 2018 (13% vs 6%; p=0.028). Asthma exacerbation was a common primary discharge diagnosis among IPs but was less common in 2022 than 2018 (43% vs 53%; p=0.030). Conclusion EV-D68 circulation was high in 2018, appeared to be disrupted in 2020, and returned with early and high circulation in 2022. Compared to 2018, EV-D68 may have caused more severe respiratory disease in 2022, including in otherwise healthy children. The lack of AFM observed in 2022 despite high EV-D68 circulation needs further investigation. Disclosures Mary A. Staat, MD, MPH, CDC: Grant/Research Support|Cepheid: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|Pfizer: Grant/Research Support|Up-To-Date: Honoraria Elizabeth P. Schlaudecker, MD, MPH, Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Honoraria|Altona Diagnostics: Grant/Research Support|Baebies Inc: Advisor/Consultant|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|Bio-Rad: Grant/Research Support|Cepheid: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Lab Simply: Advisor/Consultant|Luminex: Grant/Research Support Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support Marian G. Michaels, MD, MPH, Merck: Grant/Research Support|Viracor: Grant/Research Support Geoffrey A. Weinberg, MD, Merck & Co: Honoraria Janet A. Englund, MD, Ark Biopharma: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant","journal":"Open Forum Infectious Diseases","year":2023,"id":387109,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9498,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":625905,"name":"Heidi L. Moline","orcid":"0000-0003-2171-6609","position":1,"is_corresponding":false},{"id":857631,"name":"Claire M. Midgley","orcid":"0000-0001-5196-4713","position":2,"is_corresponding":false},{"id":474541,"name":"Adriana Lopez","orcid":"0000-0002-8804-6219","position":3,"is_corresponding":false},{"id":378052,"name":"Terry Fei Fan Ng","orcid":"0000-0002-4815-8697","position":4,"is_corresponding":false},{"id":1023454,"name":"Ariana Perez","orcid":null,"position":5,"is_corresponding":false},{"id":236964,"name":"Mary Allen Staat","orcid":"0000-0003-1788-8037","position":6,"is_corresponding":false},{"id":772716,"name":"Elizabeth P. Schlaudecker","orcid":"0000-0001-5280-4439","position":7,"is_corresponding":false},{"id":236969,"name":"Leila C. Sahni","orcid":"0000-0002-0833-5695","position":8,"is_corresponding":false},{"id":62587,"name":"Julie A. Boom","orcid":"0000-0002-5500-117X","position":9,"is_corresponding":false},{"id":236972,"name":"Jennifer E. Schuster","orcid":"0000-0001-6365-566X","position":10,"is_corresponding":false},{"id":236965,"name":"Rangaraj Selvarangan","orcid":"0000-0003-3275-6657","position":11,"is_corresponding":false},{"id":105913,"name":"Natasha Halasa","orcid":"0000-0002-6381-1826","position":12,"is_corresponding":false},{"id":236971,"name":"Laura S Stewart","orcid":"0000-0001-6867-2223","position":13,"is_corresponding":false},{"id":268708,"name":"Robert W. Hickey","orcid":"0000-0002-7708-9512","position":14,"is_corresponding":false},{"id":368373,"name":"Marian G. Michaels","orcid":"0000-0002-2556-0544","position":15,"is_corresponding":false},{"id":236963,"name":"Geoffrey A. Weinberg","orcid":"0000-0002-3900-379X","position":16,"is_corresponding":false},{"id":239044,"name":"Peter G. Szilagyi","orcid":null,"position":17,"is_corresponding":false},{"id":239043,"name":"Eileen J. Klein","orcid":null,"position":18,"is_corresponding":false},{"id":233069,"name":"Janet A. Englund","orcid":"0000-0003-1134-4178","position":19,"is_corresponding":false},{"id":1155927,"name":"Benjamin R Clopper","orcid":"0000-0002-4178-2702","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-19T01:18:04.706547Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}