Clinical impact of human coronaviruses 229E and OC43 infection in diverse adult populations

Abstract

Background: The incidence and clinical impact of coronavirus (CoV) infection in elderly persons and those with underlying cardiopulmonary disease over a long duration is not well described. We determined the incidence and clinical impact of 229E and OC43 CoV in this population during 4 consecutive winters, and compared illnesses to influenza A, respiratory syncytial virus, and human metapneumovirus.

Methods: CoV 229E and OC43 were detected by reverse transcription polymerase chain reaction and serology in 4 adult populations under surveillance for acute respiratory illness during the winters of 1999-2003. Cohorts included healthy young adults, healthy elderly adults, high-risk adults with underlying cardiopulmonary disease, and a hospitalized group.

Results: Three hundred ninety-eight CoV infections were identified, with annual infection rates ranging from 2.8% to 26% in prospective cohorts, and prevalence ranging from 3.3% to 11.1% in the hospitalized cohort. The incidence of infections with each strain was similar, although asymptomatic infection and viral coinfection was significantly more common with 229E than OC43 infection. Although the incidence and clinical manifestations were similar for each strain, OC43-infected subjects tended to seek more medical care, as OC43 was twice as common as 229E among the hospitalized cohort.

Conclusions: CoV infections in the elderly are frequent, likely causing substantial medical disease burden.

Keywords: adults; coronavirus; elderly.

Figure 1.

Incidence of symptomatic 229E (solid black line) and OC43 (dashed gray line) coronavirus infections in the combined prospective cohorts and the hospital cohort for each of the 4 winters.

Figure 2.

Comparative clinical impact of coronavirus (CoV) 229E and OC43 to influenza A (Flu A), respiratory syncytial virus (RSV), and human metapneumovirus (hMPV) in the healthy elderly and high-risk cohorts. A and B, Percentage of subjects infected with each virus who called or visited their physician (MD; A) or sought care in an emergency department (ED) or were admitted to the hospital (B). Data used include symptomatic fully evaluated infections, excluding viral coinfections. Healthy elderly cohort (gray bars), high-risk cohort (black bars). C, Ratio of infections in combined healthy elderly and high-risk cohorts to the number of infections in the hospital cohort. Data for this analysis include asymptomatic and viral coinfections in the prospective cohorts.