Enterovirus D68 in a community hospital: A test-negative case-control study
Bibliographic record
Abstract
Background: In August 2014, a large North American outbreak of enterovirus D68 (EV-D68) was observed in association with severe respiratory illnesses in children as well as a possible association with acute flaccid paralysis. The full spectrum of clinical illness associated with EV-D68 is not well known. Objective: To compare children positive and negative for EV-D68 presenting to a community hospital during the North American outbreak in the fall of 2014. Methods: Consecutive nasopharyngeal swabs obtained from children (<18 years old) presenting to a large community hospital with respiratory symptoms in the fall of 2014 were tested for EV-D68. We conducted a test-negative case-control study between EV-D68 positive and EV-D68 negative children to describe the clinical and outcome characteristics. Controls were limited to children who had a nasopharyngeal swab obtained. EV-D68 indeterminate cases were excluded from the primary analysis. All nasopharyngeal swabs were referred to a reference laboratory for polymerase chain reaction testing and identification of EV-D68 through targeting the 5'NTR region and confirmed by amplifying the VP1 gene for serotype determination. Results: Of the 48 children tested there were 9 positive, 36 negative, and 3 indeterminate for EV-D68. Six of the 9 identified cases of EV-D68 were identified in the first week of testing (September 11–18, 2014). There were 35 children (78%) admitted to hospital for ≥1 day. EV-D68 infected children were significantly older (5.2 versus 2.5 years, p = 0.03). They were more likely to be concurrently taking asthma medications (44% versus 11%, p = 0.04) and receiving treatment with salbutamol (100% versus 58%, p = 0.02). There were no cases of severe respiratory distress or acute flaccid paralysis. Three EV-D68 infected children (33%) had viral co-infections identified. Conclusion: This study of a community hospital experience during the fall of 2014 demonstrates a series of mild illnesses from both EV-D68 positive and negative children. EV-D68 isolation was associated with age and asthmatic treatment in children.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".