701. PIV4 Infections in a Daycare Setting
Session: Abstracts: Virology
Friday, October 22, 2010
Background: The role of parainfluenza virus 4 (PIV-4) in respiratory tract infections (RTIs) may be underestimated due to difficulties in culture isolation and the lack of its inclusion in most viral antigen panels. Likewise, characterization of PIV-4 clinical disease and shedding are not well known. 

Methods: We enrolled and prospectively followed children 0-30 M from 3 daycare centers (DC) over a 3 year period. We obtained nasal swabs with each respiratory tract infection (RTI). Swabs were repeated weekly until illness resolution. RT-PCR was performed to detect respiratory syncytial virus (RSV), human metapneumovirus, influenza viruses A and B, parainfluenza viruses 1,2 ,3,4 (PIV), adenovirus, human coronaviruses and rhinovirus. Symptom diaries were completed for each illness.


We followed 225 children for 165 child-yrs and detected 523 RTIs.

Characteristics of PIV-4 Infections compared to other viruses:








All PIV4-neg RTIs

Total (%) RTIs

9/ 523(1.7%)


59/523 (11%)

514/ 523(98.3%)

Mean Age (months)





N(% ) male

4 (44)

35 (45)

30 (51)

275 (54)

N(%) fever

5 (56)

40 (53)

39 (66)

254 (50)

N (%) wheezing

3 (33)

23 (30)

37 (63)

177 (34)

Mean days DC missed





N(%)  Healthcare provider (HCP) visits

8 (89)

42 (55)


41 (69)


230 (45)


Number (%) with coinfection

6 (67)

57 (74)

30 (51)

187 (48)

Eight/9 PIV-4 infections were detected in the first 2 years of the study with only 1 infection the 3rd year. PIV4 was detected up to 16 days after symptom onset (range 4-16d, median 12d). PIV4 was not detected on the first swab in 3/9 PIV4+ illnesses, but was found later at days 12-13d.  These three illnesses had other viruses detected at illness onset.


Using molecular techniques, PIV-4 was an uncommon cause of RTI in our population. Seasonal prevalence varied from year to year during our study suggesting that PIV-4 may have an epidemic pattern. We did not identify a clinical syndrome distinguishing PIV-4 from other PIV infections, but PIV-4 was significantly more likely to result in a visit to a health care provider compared with PIV1-3 or PIV-4 negative RTIs. This suggests that PIV-4 infections may be more clinically significant than other common respiratory viruses in young children.

Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Mary Fairchok, MD , Pediatrics, Madigan Army Medical Center, Puyallup, WA
Emily Martin, PhD , Wayne State University, Detroit, MI
Jane Kuypers, PhD , Laboratory Medicine, University of Washington, Seattle, WA
Janet A. Englund, MD, FIDSA , Seattle Children's Research Institute, Seattle, WA
Susan Chambers, RN , Pediatrics, Madigan Army Medical Center, Puyallup, WA


M. Fairchok, None

E. Martin, Yes
Vioguard: Received Research Support,

J. Kuypers, None

J. A. Englund, None

S. Chambers, None

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