Background: Rhinovirus (RV) is an important cause of respiratory disease in children. This analysis describes RV clinical presentation and factors associated with illness severity among children with severe acute respiratory illness (SARI).
Methods: Three hospitals in Minneapolis-St. Paul conducted surveillance for children aged <18 years with SARI, defined as acute onset of respiratory symptoms requiring hospitalization. Respiratory specimens were collected for all identified cases and tested at the Minnesota Department of Health using RT-PCR for 25 viral and bacterial respiratory pathogens. Demographic and clinical data were collected through medical record review. Intensive care unit (ICU) admission was used as a proxy for severity.
Results: From May 2013 through January 2015, RV was detected in 749 (26%) of 1735 children. Of the RV positive children, the median age was 1.1 years (IQR 0.4-2.3). Comorbid conditions were identified in 52% and increased with age, from 40% among children aged <1 year to 78% among those aged >5 years (p<0.01). At least one other respiratory pathogen was detected in 42% of children, most commonly RSV (18%), adenovirus (13%), and parainfluenza 1-4 (7%). Admission to ICU was required for 143 (19%), and 5 (0.7%) died. Severity did not vary by age; children with neurologic (OR=2.2; CI 1.4-3.5) or neuromuscular (OR=3.2; CI 1.3-8.1) disorders were more likely to be admitted to the ICU (Figure). Admission to ICU was positively associated with respiratory distress at admission, but negatively associated with cough and nasal congestion (p<0.01). Fever was present in 30% of children. There was no difference in ICU admission between children with only RV infection compared to children with co-detections.
Conclusion : RV was the sole pathogen detected among a substantial proportion of young children with SARI. Clinical presentation commonly included respiratory distress that frequently required admission to the ICU, particularly among children with neurologic or neuromuscular disorders. Most cases did not have fever. Characterization of the specific RV type would enable enhanced understanding of the epidemiology of RV and potential type-specific control measures.
H. Friedlander, None
K. Como-Sabetti, None
D. Boxrud, None
X. Lu, None
R. Lynfield, None
S. S. Chaves, None
S. Bistodeau, None
A. Strain, None