Clinical severity of rhinovirus/enterovirus compared to other respiratory viruses in children

Authors

  • Sandra A. Asner,

    Corresponding author
    1. Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
    • Correspondence: Dr. Sandra A. Asner, The Hospital for Sick Children, 555 University avenue, Toronto, ON M5G1X8, Canada. E-mail: Sandra.asner@sickkids.ca and Dr. Marek Smieja, L424-St Joseph's Healthcare, 50 Charlton Ave. E, Hamilton, ON L8N 4A6, Canada. E-mail: smiejam@mcmaster.ca

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  • Astrid Petrich,

    1. Division of Microbiology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
    2. Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada
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  • Jemila S. Hamid,

    1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
    2. Department of Pathology and Molecular Medicine, St Joseph's Healthcare, Hamilton, ON, Canada
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  • Dominik Mertz,

    1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
    2. Department of Medicine, Juravinski Hospital and Cancer Center, Hamilton, ON, Canada
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  • Susan E. Richardson,

    1. Division of Microbiology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
    2. Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada
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  • Marek Smieja

    Corresponding author
    1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
    2. Department of Pathology and Molecular Medicine, St Joseph's Healthcare, Hamilton, ON, Canada
    • Correspondence: Dr. Sandra A. Asner, The Hospital for Sick Children, 555 University avenue, Toronto, ON M5G1X8, Canada. E-mail: Sandra.asner@sickkids.ca and Dr. Marek Smieja, L424-St Joseph's Healthcare, 50 Charlton Ave. E, Hamilton, ON L8N 4A6, Canada. E-mail: smiejam@mcmaster.ca

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Abstract

Background

Human rhinovirus/enterovirus (HRV/ENT) infections are commonly identified in children with acute respiratory infections (ARIs), but data on their clinical severity remain limited.

Objectives

We compared the clinical severity of HRV/ENT to respiratory syncytial virus (RSV), influenza A/B (FLU), and other common respiratory viruses in children.

Patients/Methods

Retrospective study of children with ARIs and confirmed single positive viral infections on mid-turbinate swabs by molecular assays. Outcome measures included hospital admission and, for inpatients, a composite endpoint consisting of intensive care admission, hospitalization >5 days, oxygen requirements or death.

Results

A total of 116 HRV/ENT, 102 RSV, 99 FLU, and 64 other common respiratory viruses were identified. Children with single HRV/ENT infections presented with significantly higher rates of underlying immunosuppressive conditions compared to those with RSV (37·9% versus 13·6%; < 0·001), FLU (37·9% versus 22%; = 0·018) or any other single viral infection (37·9% versus 22·5%; = 0·024). In multivariable analysis adjusted for underlying conditions and age, children with HRV/ENT infections had increased odds of hospitalization compared to children with RSV infections (OR 2·6; 95% CI 1·4, 4·8; < 0·003) or FLU infections (OR 3·0; 95% CI 1·6, 5·8; <0·001) and increased odds of severe clinical disease among inpatients (OR 3·0; 95% CI 1·6,5·6; = 0·001) when compared to those with FLU infections.

Conclusions

Children with HRV/ENT had a more severe clinical course than those with RSV and FLUA/B infections and often had significant comorbidities. These findings emphasize the importance of considering HRV/ENT infection in children presenting with severe acute respiratory tract infections.

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