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Children's Hospital Colorado experts publish article on the 2014 enterovirus D68 outbreak

Lead author Kevin Messacar, M.D., and team from Children's Colorado outline hospital's impact and preparedness for future outbreaks

Children's Hospital Colorado


IMAGE: Kevin Messacar, M.D., is a hospital medicine and infectious diseases specialist at Children's Hospital Colorado. view more

Credit: Children's Hospital Colorado

Aurora, Colo. (March 1, 2016) - From August to September 2014, a typically slow time for respiratory viruses, a nationwide outbreak of enterovirus D68 (EV-D68) left resources constrained for Children's Hospital Colorado (Children's Colorado) and pediatric organizations throughout the nation.

Due to the lack of a widely available test for the virus at the time, only 1,153 EV-D68 infections in 49 states were confirmed, though experts felt the true magnitude and impact of EV-D68 was much larger.

Researchers and operational experts looked at the change in hospital resources utilized during the outbreak periods and compared the data to what would have been expected during a calm respiratory season, which allowed the team to indirectly estimate the impact of the virus. Their findings were published online on January 19, 2016 and will appear in the March issue of JAMA Pediatrics. The methods used and data collected have created a guide for other hospitals to measure and prepare for potential outbreaks.

During the EV-D68 outbreak of 2014, Children's Colorado saw significant increases across all sectors, including respiratory patient volumes, asthma medication use, respiratory equipment use and respiratory therapist demands. Without being able to test more accurately for the virus during the actual outbreak, a cross-hospital team, led by Kevin Messacar, MD, hospital medicine and infectious diseases specialist at Children's Colorado, developed a new, quantifiable way to measure the impact of outbreaks after they occur.

"The enterovirus D68 outbreak affected every aspect of our hospital," said Messacar. "We created an EV-D68 consortium to look at how this outbreak strained resources. Through this study, we demonstrated that the number of confirmed infections grossly underestimates the true burden of this outbreak on children's hospitals."

The study suggest that EV-D68 had a much larger impact on children's hospitals in the United States in 2014 than previously estimated from confirmatory testing on a limited number of samples. The study also illustrates the importance of resource utilization monitoring in future unexpected outbreaks of emerging pathogens.

"It is important to understand the burden of an emerging respiratory virus like enterovirus D68 so that children's hospitals can be prepared if, and when, it returns," said Messacar. "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."

"The heroic efforts of the medical, nursing, and other clinical staff at Children's Hospital Colorado to provide expert care to affected children during this outbreak should be commended," said Messacar.


The team who worked on the study represented infectious disease, epidemiology, pulmonary, respiratory therapy, hospital medicine, emergency medicine and critical care. Joining Messacar, hospital medicine and infectious disease, as authors of the study were Sarah Parker, MD, and Samuel R. Dominguez, MD, PhD, infectious disease, Stephen M.M. Hawkins, MD, pulmonary medicine, Joyce Baker, MBA, RRT-NPS,AE-C, director of respiratory therapy, Kelly Pearce, data analyst in epidemiology, and Suhong Tong, biostatistician in pediatric medicine. Additional support was provided by Suchitra Rao, MD, hospital medicine and infectious disease, Rakesh Mistry, MD, emergency medicine, Gina DeMasellis, MD, critical care and Jerrod Milton, vice president of operations.

About Children's Hospital Colorado

Children's Hospital Colorado (Children's Colorado) has defined and delivered pediatric health care excellence for more than 100 years. Founded in 1908, Children's Colorado is a leading pediatric network entirely devoted to the health and well-being of children. Continually acknowledged as one of the nation's outstanding pediatric hospitals by U.S. News & World Report and ranked 5th on its Best Children's Hospitals 2015-16 Honor Roll, Children's Colorado is known for both its nationally and internationally recognized medical, research, education and advocacy programs, as well as comprehensive everyday care for kids throughout Colorado and surrounding states. Children's Colorado is the winner of the 2015 American Hospital Association-McKesson Quest for Quality Prize, and is a 2015 Most Wired hospital according to Hospitals & Health Networks magazine. Children's Colorado also is recognized for excellence in nursing from the American Nurses Credentialing Centers and has been designated a Magnet® hospital since 2005. The hospital's family-centered, collaborative approach combines the nation's top pediatric doctors, nurses and researchers to pioneer new approaches to pediatric medicine. With urgent, emergency and specialty care locations throughout Metro Denver and Southern Colorado, including its campus on the Anschutz Medical Campus, Children's Colorado provides a full spectrum of pediatric specialties. For more information, visit and connect with Children's Colorado on Facebook, Twitter and Pinterest.

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