Respiratory Enterovirus Infections and Other Respiratory virus coinfections in Children

Background: Emerging or re-emerging respiratory enteroviruses (EV) have been highlighted in recent years. We investigated the epidemiology and characteristics of EV-related respiratory infection. In addition, the impact of EV/non-EV respiratory virus coinfection in pediatric patients with respiratory EV infection was evaluated.

Methods: A retrospective review was performed in pediatric patients (less than 18 years) with acute respiratory infection and documented EV from respiratory specimens at Hallym University Dongtan Sacred Heart Hospital from March 2013 to February 2016. Respiratory specimens were collected from patients with any respiratory symptoms. EV and 15 other respiratory viruses were detected by multiplex polymerase chain reaction (PCR), which distinguished rhinovirus from EV.

Results: During the study period, a total of 4262 children were tested for EV and the positive rate was 4.0% (171/4262). EV detection rate varied through the years, range 1.8% in 2015 to 6.2% in 2013, and peaked in July. The median age of patients with respiratory EV infection was 1.8 years (interquartile range, 1.1-3.3). Ninety patients (52.6%) had lower respiratory tract infections (LRTI). No patients were admitted to the intensive care unit. Of 171 patients, 60 (35.1%) had EV single infection: EV with another virus in 77 (45.0%), EV with 2 or more viruses in 34 (19.9%). In patients with EV single infection, 19 (37.1%) had LRTI and 12 cases were identified in autumn or winter season. Rhinovirus was the most frequently coinfecting virus, followed by adenovirus and bocavirus. The patients with EV single infection was younger than the patients with EV/non-EV respiratory virus coinfection (median age, 2.4 vs. 1.7 years; P=0.089). The patients with EV/non-EV respiratory coinfection was significantly more likely to present with LRTI compared to those with EV single infection (odds ratio: 3.83, 95% CI, 1.95-7.47; P<0.0001).

Conclusion: The proportion of respiratory EV infection was 4.0% and EV played a role in LRTI. EV with other respiratory virus coinfection may increase the severity of disease.