Peer-reviewed article
2799. Inability to Locally Differentiate Rhinovirus/Enterovirus Results Impacts Infection Control Practices
Donelan S, Spitzer S, Spitzer E ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines the diagnostic challenge of distinguishing between rhinovirus and enterovirus in hospital laboratory testing, using samples from a single hospital in New York. Researchers tested 44 positive samples to identify which were enterovirus D68 (EV-D68), a respiratory virus that requires different infection control measures. The findings informed hospital policies for patient isolation during winter months, but do not address child health outcomes.
Key points
- Standard diagnostic tests cannot differentiate rhinovirus from enterovirus, creating infection control complications
- During one week in October 2018, 10 hospitalized patients (5 adults, 5 children) tested positive for EV-D68
- Among 21 specimens sent for typing in winter, all were identified as rhinovirus, not EV-D68
- The study informed hospital cohorting decisions during periods of high respiratory virus activity
- EV-D68 prevalence was higher in fall than winter, consistent with the seasonal pattern advisory
Limitations
This is a laboratory diagnostic study from a single hospital that does not evaluate outcomes for children or any clinical intervention. It provides no data on the health effects of EV-D68 on infected children or the impact of infection control measures on patient outcomes.
Abstract
Abstract Background Rhinoviruses and Enteroviruses are closely related members of the family picornavirideae; however, they have distinct clinical manifestations. Rhinoviruses cause respiratory infections while Enteroviruses often present as nonspecific febrile illnesses. Enterovirus D68 (EV-D68) is unusual in that although it is classified as an enterovirus it causes respiratory illness. Most of the currently used nucleic acid amplification assays for respiratory viruses do not distinguish between Rhino and Enteroviruses because of their shared homology. Rhino/Enterovirus infections are common in the Summer and Fall. In October of 2018 the NYS DOH issued a health advisory describing increased numbers of EV-D68 infection. Although there is no specific treatment for EV-D68, the advisory recommended contact precautions in addition to the droplet precautions recommended for other respiratory viruses. This recommendation creates logistical difficulties since there are no commercial test-kits that can identify EV-D68. The aim of this study was to determine the incidence of EV-D68 among patients admitted to Stony Brook Hospital that tested positive for Rhino/Enterovirus. Methods Nasopharyngeal swabs were tested with the BioFire® FilmArray® Respiratory Panel (RP 2) test. 44 Rhino/Enterovirus positive specimens were sent for further identification to the NYS DOH Virology Lab. Enterovirus was differentiated from Rhinovirus by qRT–PCR. EV-D68 was identified by sequencing. Results During one week in October, 10 patients were admitted with positive EV-D68 (5 adults and 5 children). In contrast, all 21 admitted patients who had specimens sent for typing had Rhinovirus. Conclusion This study confirmed that there was significant EV-D68 activity among patients who required hospitalization consistent with the NYS DOH advisory in the Fall of 2018. In contrast, in the Winter a drop in the prevalence of Rhino/enterovirus was observed. EV-D68 was not found in any of the samples sent for typing. These data informed our internal decision to cohort all patients this past Winter with positive Rhino/enterovirus results, positively impacting patient cohorting capabilities during a time with increased local influenza activity. Disclosures All authors: No reported disclosures.