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. 2023 Mar 7;23(1):136.
doi: 10.1186/s12879-023-08084-4.

Clinical characteristics and outcomes of children with single or co-detected rhinovirus-associated acute respiratory infection in Middle Tennessee

Justin Z Amarin #  1 , Molly Potter #  2 , Jyotsna Thota  2 , Danielle A Rankin  2   3 , Varvara Probst  2 , Zaid Haddadin  2 , Laura S Stewart  2 , Ahmad Yanis  2 , Rana Talj  2 , Herdi Rahman  2 , Tiffanie M Markus  4 , James Chappell  2 , Mary Lou Lindegren  2   4 , William Schaffner  4   5 , Andrew J Spieker #  6 , Natasha B Halasa #  2
Affiliations

Clinical characteristics and outcomes of children with single or co-detected rhinovirus-associated acute respiratory infection in Middle Tennessee

Justin Z Amarin et al. BMC Infect Dis. .

Abstract

Background: Rhinovirus (RV) is one of the most common etiologic agents of acute respiratory infection (ARI), which is a leading cause of morbidity and mortality in young children. The clinical significance of RV co-detection with other respiratory viruses, including respiratory syncytial virus (RSV), remains unclear. We aimed to compare the clinical characteristics and outcomes of children with ARI-associated RV-only detection and those with RV co-detection-with an emphasis on RV/RSV co-detection.

Methods: We conducted a prospective viral surveillance study (11/2015-7/2016) in Nashville, Tennessee. Children < 18 years old who presented to the emergency department (ED) or were hospitalized with fever and/or respiratory symptoms of < 14 days duration were eligible if they resided in one of nine counties in Middle Tennessee. Demographics and clinical characteristics were collected by parental interviews and medical chart abstractions. Nasal and/or throat specimens were collected and tested for RV, RSV, metapneumovirus, adenovirus, parainfluenza 1-4, and influenza A-C using reverse transcription quantitative polymerase chain reaction assays. We compared the clinical characteristics and outcomes of children with RV-only detection and those with RV co-detection using Pearson's χ2 test for categorical variables and the two-sample t-test with unequal variances for continuous variables.

Results: Of 1250 children, 904 (72.3%) were virus-positive. RV was the most common virus (n = 406; 44.9%), followed by RSV (n = 207; 19.3%). Of 406 children with RV, 289 (71.2%) had RV-only detection, and 117 (28.8%) had RV co-detection. The most common virus co-detected with RV was RSV (n = 43; 36.8%). Children with RV co-detection were less likely than those with RV-only detection to be diagnosed with asthma or reactive airway disease both in the ED and in-hospital. We did not identify differences in hospitalization, intensive care unit admission, supplemental oxygen use, or length of stay between children with RV-only detection and those with RV co-detection.

Conclusion: We found no evidence that RV co-detection was associated with poorer outcomes. However, the clinical significance of RV co-detection is heterogeneous and varies by virus pair and age group. Future studies of RV co-detection should incorporate analyses of RV/non-RV pairs and include age as a key covariate of RV contribution to clinical manifestations and infection outcomes.

Keywords: Coinfection; Common cold; Epidemiology; Rhinovirus; Tennessee.

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Conflict of interest statement

Natasha Halasa, MD, MPH, receives grant support from Sanofi Pasteur, Quidel, and speaker compensation from an education grant supported by Genentech. Sanofi Pasteur also donated vaccines and influenza antibody testing for an influenza vaccine trial. The remaining authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Respiratory viruses co-detected with RV in 117 children with acute respiratory infection in Middle Tennessee. RV rhinovirus, RSV respiratory syncytial virus, AdV adenovirus, MPV metapneumovirus, Flu influenza, PIV parainfluenza virus
Fig. 2
Fig. 2
a Signs and symptoms of acute respiratory infection in 406 children with rhinovirus (RV)-only detection or RV co-detection in Middle Tennessee. b Signs and symptoms specific to children ≥ 5 years old are presented separately. p values were calculated using Pearson’s χ2 test
Fig. 3
Fig. 3
Most common diagnoses in children with single or co-detected rhinovirus-associated acute respiratory infection in Middle Tennessee (a) discharged from the emergency department or (b) hospitalized. p values were calculated using Pearson’s χ2 test. RAD reactive airway disease, RV rhinovirus
Fig. 4
Fig. 4
a Seasonality of rhinovirus (RV), respiratory syncytial virus (RSV), metapneumovirus (MPV), adenovirus (AdV), parainfluenza virus (PIV), and influenza (Flu) detected in 904 virus-positive children with acute respiratory infection in Middle Tennessee between November 15, 2015, and July 15, 2016. b Area plot of RV-only detections and RV co-detections in the same population and period
See this image and copyright information in PMC

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