{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:45:19Z","timestamp":1789670719522,"version":"4.0.1"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi250332-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Enterovirus D68 (EV-D68) typically causes mild to severe acute respiratory illness (ARI). Testing and surveillance for EV-D68 in the US are limited, and important epidemiologic gaps remain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250332-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize the epidemiology and clinical severity of EV-D68 among US children seeking care for ARI from 2017 to 2022, using a multisite, active, systematic surveillance network.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250332-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cross-sectional study collected data from the New Vaccine Surveillance Network, an active, prospective, population-based surveillance system of emergency departments (EDs) and hospitals at 7 US academic medical centers. Children with ARI and EV-D68\u2013positive results were enrolled during platform-wide EV-D68 testing periods (July to October 2017, July to November 2018, July to November 2020, and July 2021 to December 2022). Included children were aged younger than 18 years, reported 1 or more qualifying ARI symptoms, with a symptom duration less than 14 days at enrollment. Data were analyzed from in October 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250332-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Laboratory-confirmed EV-D68 infection, including overall infections or those without viral codetection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250332-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Trends and characteristics of EV-D68, including demographics, underlying conditions, and clinical severity by health care setting, were explored. Among hospitalized children with EV-D68\u2013positive results without viral codetection, multivariable logistic regression was used to examine factors associated with receipt of (1) supplemental oxygen or (2) intensive care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250332-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 2017 to 2022, 976 children with EV-D68\u2013positive results were identified (median [IQR] age, 47 [18-63] months; 391 [40.1%] female); most were enrolled in 2018 (382 children) and 2022 (533 children). Among these, 856 had no viral codetection, of which 320 were discharged home from the ED (median [IQR] age, 33 [16-59] months; 180 male [56.3%]; 237 [74.1%] with no reported underlying conditions) and 536 were hospitalized (median [IQR] age, 40 [19-69] months; 330 male [61.6%]; 268 [50.0%] with no reported underlying conditions). Among those hospitalized, 199 (37.1%) reported a history of asthma or reactive airway disease (RAD) and 77 (14.4%) reported a condition other than asthma or RAD. Having an underlying condition other than asthma or RAD was associated with increased odds of receiving supplemental oxygen (adjusted odds ratio, 2.72; 95% CI, 1.43-5.18) or intensive care admission (adjusted odds ratio, 3.09; 95% CI, 1.72-5.56); neither age group nor history of asthma or RAD were associated with oxygen receipt or intensive care admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250332-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cross-sectional study of children with medically attended EV-D68 infections, EV-D68 was associated with severe disease in otherwise healthy children of all ages, and children with nonasthma or RAD comorbidities were at higher risk for severe outcomes when hospitalized.<\/jats:p>\n                  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