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Multicenter Study
. 2023 Feb 1;6(2):e2254909.
doi: 10.1001/jamanetworkopen.2022.54909.

Circulation of Rhinoviruses and/or Enteroviruses in Pediatric Patients With Acute Respiratory Illness Before and During the COVID-19 Pandemic in the US

Danielle A Rankin  1   2 , Andrew J Spieker  3 , Ariana Perez  4   5 , Anna L Stahl  1 , Herdi K Rahman  1 , Laura S Stewart  1 , Jennifer E Schuster  6 , Joana Y Lively  4 , Zaid Haddadin  1 , Varvara Probst  1 , Marian G Michaels  7 , John V Williams  7 , Julie A Boom  8   9 , Leila C Sahni  8   9 , Mary A Staat  10 , Elizabeth P Schlaudecker  10 , Monica M McNeal  10 , Christopher J Harrison  6 , Geoffrey A Weinberg  11 , Peter G Szilagyi  11   12 , Janet A Englund  13 , Eileen J Klein  13 , Susan I Gerber  4 , Meredith McMorrow  4 , Brian Rha  4 , James D Chappell  1 , Rangaraj Selvarangan  6   14 , Claire M Midgley  4 , Natasha B Halasa  1 ; NVSN Network Investigators
Collaborators, Affiliations
Multicenter Study

Circulation of Rhinoviruses and/or Enteroviruses in Pediatric Patients With Acute Respiratory Illness Before and During the COVID-19 Pandemic in the US

Danielle A Rankin et al. JAMA Netw Open. .

Abstract

Importance: Rhinoviruses and/or enteroviruses, which continued to circulate during the COVID-19 pandemic, are commonly detected in pediatric patients with acute respiratory illness (ARI). Yet detailed characterization of rhinovirus and/or enterovirus detection over time is limited, especially by age group and health care setting.

Objective: To quantify and characterize rhinovirus and/or enterovirus detection before and during the COVID-19 pandemic among children and adolescents seeking medical care for ARI at emergency departments (EDs) or hospitals.

Design, setting, and participants: This cross-sectional study used data from the New Vaccine Surveillance Network (NVSN), a multicenter, active, prospective surveillance platform, for pediatric patients who sought medical care for fever and/or respiratory symptoms at 7 EDs or hospitals within NVSN across the US between December 2016 and February 2021. Persons younger than 18 years were enrolled in NVSN, and respiratory specimens were collected and tested for multiple viruses.

Main outcomes and measures: Proportion of patients in whom rhinovirus and/or enterovirus, or another virus, was detected by calendar month and by prepandemic (December 1, 2016, to March 11, 2020) or pandemic (March 12, 2020, to February 28, 2021) periods. Month-specific adjusted odds ratios (aORs) for rhinovirus and/or enterovirus-positive test results (among all tested) by setting (ED or inpatient) and age group (<2, 2-4, or 5-17 years) were calculated, comparing each month during the pandemic to equivalent months of previous years.

Results: Of the 38 198 children and adolescents who were enrolled and tested, 11 303 (29.6%; mean [SD] age, 2.8 [3.7] years; 6733 boys [59.6%]) had rhinovirus and/or enterovirus-positive test results. In prepandemic and pandemic periods, rhinoviruses and/or enteroviruses were detected in 29.4% (9795 of 33 317) and 30.9% (1508 of 4881) of all patients who were enrolled and tested and in 42.2% (9795 of 23 236) and 73.0% (1508 of 2066) of those with test positivity for any virus, respectively. Rhinoviruses and/or enteroviruses were the most frequently detected viruses in both periods and all age groups in the ED and inpatient setting. From April to September 2020 (pandemic period), rhinoviruses and/or enteroviruses were detectable at similar or lower odds than in prepandemic years, with aORs ranging from 0.08 (95% CI, 0.04-0.19) to 0.76 (95% CI, 0.55-1.05) in the ED and 0.04 (95% CI, 0.01-0.11) to 0.71 (95% CI, 0.47-1.07) in the inpatient setting. However, unlike some other viruses, rhinoviruses and/or enteroviruses soon returned to prepandemic levels and from October 2020 to February 2021 were detected at similar or higher odds than in prepandemic months in both settings, with aORs ranging from 1.47 (95% CI, 1.12-1.93) to 3.01 (95% CI, 2.30-3.94) in the ED and 1.36 (95% CI, 1.03-1.79) to 2.44 (95% CI, 1.78-3.34) in the inpatient setting, and in all age groups. Compared with prepandemic years, during the pandemic, rhinoviruses and/or enteroviruses were detected in patients who were slightly older, although most (74.5% [1124 of 1508]) were younger than 5 years.

Conclusions and relevance: Results of this study show that rhinoviruses and/or enteroviruses persisted and were the most common respiratory virus group detected across all pediatric age groups and in both ED and inpatient settings. Rhinoviruses and/or enteroviruses remain a leading factor in ARI health care burden, and active ARI surveillance in children and adolescents remains critical for defining the health care burden of respiratory viruses.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Spieker reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Schuster reported receiving grants for her institution from Merck & Co, Inc outside the submitted work. Dr Williams reported receiving personal fees from Quidel and GlaxoSmithKline outside the submitted work. Dr Sahni reported receiving grants for her institution from the Centers for Disease Control and Prevention (CDC) outside the submitted work. Dr Staat reported receiving grants from the NIH outside the submitted work. Dr Schlaudecker reported receiving grants from Pfizer and personal fees from Sanofi Pasteur outside the submitted work. Dr Harrison reported receiving grants for his institution from Children's Mercy Hospital during the conduct of the study and grants from GlaxoSmithKline, Pfizer, Merck & Co, Inc, and COVID-19 Prevention Network outside the submitted work. Dr Weinberg reported receiving personal fees from Merck & Co, Inc outside the submitted work. Dr Szilagyi reported receiving grants from the University of California, Los Angeles David Geffen School of Medicine BROAD Program during the conduct of the study. Dr Englund reported receiving grants from GlaxoSmithKline and Pfizer as well as personal fees from Meissa Vaccines, Moderna, Pfizer, Sanofi Pasteur, AstraZeneca, and Novavax outside the submitted work. Dr Gerber reported being employed at the CDC during the conduct of the study and at GlaxoSmithKline outside the submitted work. Dr Chappell reported receiving grants from the NIH during the conduct of the study. Dr Selvarangan reported receiving grants from Merck & Co, Inc, BioFire, Luminex, Hologic, Abbott, Becton Dickinson, and Cepheid outside the submitted work. Dr Halasa reported receiving grants from Sanofi and Quidel as well as personal fees from Genentech outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Virus Circulation Among Children and Adolescents With Respiratory Virus Testing, From 2016 to 2021
Other respiratory viruses included influenza, parainfluenza types 1 to 4, respiratory syncytial virus, and human metapneumovirus.
Figure 2.
Figure 2.. Adjusted Odds Ratios (aORs) of Rhinovirus and/or Enterovirus Detection in the Inpatient and Emergency Department Settings and Across Age Groups, From March 2020 to February 2021 vs From December 2016 to February 2020
Models were adjusted for age (continuous), sex, and insurance type (public, private, or self-pay), with fixed effects for surveillance sites. March 2020 was a transition month, which included patients in both the prepandemic and pandemic periods. The error bars represent 95% CIs.
Figure 3.
Figure 3.. Rhinovirus and/or Enterovirus (RV/EV) Single Detection or Codetection With Other Respiratory Viruses in the Prepandemic vs Pandemic Periods by Age Groups
Other respiratory viruses included influenza, parainfluenza types 1 to 4, respiratory syncytial virus (RSV), and human metapneumovirus.
See this image and copyright information in PMC

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