TOP 58 - Prevalence of Powassan virus infection in children with suspected Lyme disease

Publication Number: 1817.TOP 58

Stephanie Hadley, Boston Children's Hospital, Boston, MA, United States; Desiree Noel Wagner. Neville, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Laura Chapman, Brown Health, Providence, RI, United States; Rebecca S.. Green, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Amy D. Thompson, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, United States; Anupam B. Kharbanda, Children’s Minnesota, Minneapolis, MN, United States; Meagan Ladell, Medical College of Wisconsin, Milwaukee, WI, United States; Chris Woll, Albany Medical College, Albany, NY, United States; Lise E. Nigrovic, Boston Children's Hospital, Boston, MA, United States

Background: Ixodes species ticks carry Borrelia species, the causative agent of Lyme disease, as well as other pathogens that cause human disease, including Powassan virus which can be transmitted within minutes of tick attachment. Although Powassan infections have been increasing in the years since discovery, the prevalence in children has not been evaluated. Infected children can have a range of symptoms from a mild flu-like illness to severe encephalitis. Children with mild symptoms from Powassan virus infection may not be recognized clinically given the overlap with other conditions, creating clinical uncertainty about the optimal approach to diagnosis.

Objective: Our goal was to evaluate the prevalence of Powassan infection in children undergoing evaluation for suspected Lyme disease, comparing rates between children with confirmed Lyme disease to symptom matched controls.

Design/Methods: We performed a case-control study nested within a prospective cohort of children < 21 years who were evaluated for Lyme disease at one of eight participating emergency departments. Lyme disease was defined with an erythema migrans (EM) lesion or positive two-tier Lyme disease serology. We selected Lyme disease cases (n=305) with symptom-matched controls (n=295) and performed both Powassan serology and reverse transcriptase polymerase chain reaction (RT-PCR) tests on biobanked research samples. We defined a Powassan infection as a positive two-tier serology or RT-PCR test. The prevalence of Powassan virus in children with Lyme disease and symptomatic controls will be compared using Fisher's exact tests. This study was approved by the hospital's Institutional Review Board. The research samples are currently being processed by a state department of health facility with completed results anticipated by the end of November. We will complete data analysis in December and January.

Table 1
Patient demographics and clinical symptoms