Human rhinovirus species C infection in young children with acute wheeze is associated with increased acute respiratory hospital admissions

Abstract

Rationale: Human rhinovirus species C (HRV-C) is the most common cause of acute wheezing exacerbations in young children presenting to hospital, but its impact on subsequent respiratory illnesses has not been defined.

Objectives: To determine whether acute wheezing exacerbations due to HRV-C are associated with increased hospital attendances due to acute respiratory illnesses (ARIs).

Methods: Clinical information and nasal samples were collected prospectively from 197 children less than 5 years of age, presenting to hospital with an acute wheezing episode. Information on hospital attendances with an ARI before and after recruitment was subsequently obtained.

Measurements and main results: HRV was the most common virus identified at recruitment (n = 135 [68.5%]). From the 120 (88.9%) samples that underwent typing, HRV-C was the most common HRV species identified, present in 81 (67.5%) samples. Children with an HRV-related wheezing illness had an increased risk of readmission with an ARI (relative risk, 3.44; 95% confidence interval, 1.17-10.17; P = 0.03) compared with those infected with any other virus. HRV-C, compared with any other virus, was associated with an increased risk of a respiratory hospital admission before (49.4% vs. 27.3%, respectively; P = 0.004) and within 12 months (34.6% vs. 17.0%; P = 0.01) of recruitment. Risk for subsequent ARI admissions was further increased in atopic subjects (relative risk, 6.82; 95% confidence interval, 2.16-21.55; P = 0.001). Admission risks were not increased for other HRV species.

Conclusions: HRV-C-related wheezing illnesses were associated with an increased risk of prior and subsequent hospital respiratory admissions. These associations are consistent with HRV-C causing recurrent severe wheezing illnesses in children who are more susceptible to ARIs.

Figure 1.

Frequency of the various viruses detected at recruitment. *Coinfection indicates two or more viruses detected.

Figure 2.

Frequency of the human rhinovirus (HRV) species detected at recruitment.

Figure 3.

Kaplan–Meier survival analysis comparing human rhinovirus (HRV) with any other virus with respect to the number of months from the time of recruitment to the next hospital admission (P = 0.02). Black line = HRV; gray line = other virus.

Figure 4.

Kaplan–Meier survival analysis comparing human rhinovirus (HRV)-C with any other virus with respect to the number of months from the time of recruitment to the next hospital admission (P = 0.02). Black line = HRV; gray line = other virus.