Enterovirus D68 Detection Among Hospitalized Children with Acute Respiratory Illness in Amman, Jordan

Abstract

Enterovirus D68 (EV-D68) primarily causes respiratory illness in children but is also associated with serious neurological outcomes. Although EV-D68 circulation has historically demonstrated a biennial pattern, with peaks during summer and fall, infections can occur year-round, with unpredictable outbreaks. Notable outbreaks occurred in the U.S. in 2014, in Canada in 2022, and more recently in Senegal in late 2023, leading to increased hospitalizations in affected children. However, data are lacking in the Middle East. This study aims to describe EV-D68 circulation and clinical severity among hospitalized children in Amman, Jordan. Data were obtained from a prospective viral surveillance study conducted at Al-Bashir Hospital, the largest public hospital in Amman, from January 2023 to April 2024. The study population included children under 5 years hospitalized with fever or respiratory symptoms. Nasal and throat swabs were collected and tested for EV-D68 and other respiratory viruses using RT-qPCR. Demographic and clinical information were gathered through parental interviews and medical chart reviews. Of the 2,168 children enrolled, we identified 14 (0.6%) cases of EV-D68, with 13 occurring in January 2023 and one in February 2023. Table 1 compares EV-D68–positive children to EV-D68–negative children. The median age of EV-D68–positive children was 5.2 months (IQR, 1.3–15.4), and most were female (64.3%). The majority were previously healthy (78.6%) and born at term (85.7%). The most common presenting symptoms were cough (100.0%), congestion or runny nose (78.6%), and shortness of breath (78.6%). Fever, reported in two cases (14.3%), was significantly more common in children negative for EV-D68 (59.7%). Another virus was co-detected with EV-D68 in 6 cases (42.9%). Children with EV-D68 were more likely to receive supplemental oxygen during hospitalization (64.3% vs 37.2%, p=0.047). Intensive care was required for three EV-D68-positive cases (21.4%). Among them, one child with adenovirus co-detection was intubated and subsequently died. Figure 1 provides a detailed visual breakdown of the clinical characteristics, presenting symptoms, co-detections, and in-hospital outcomes of the 14 EV-D68–positive cases. Our findings underscore that EV-D68, while infrequent, can lead to significant clinical severity among young children. As global circulation patterns of EV-D68 remain insufficiently understood, ongoing surveillance is critical. With monoclonal antibodies in development, monitoring EV-D68 circulation and identifying children at higher risk could enable timely preventive interventions, potentially mitigating EV-D68-associated morbidity and improving clinical outcomes.