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

Abstract

ImportanceRhinoviruses 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.ObjectiveTo 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 ParticipantsThis 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 MeasuresProportion 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.ResultsOf 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 RelevanceResults 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.

Comparing the Clinical Courses of Children With Human Rhinovirus/Enterovirus to Children With Other Respiratory Viruses in the Outpatient Setting

“…As previously observed, HRV/ENT positivity on RM-PCR testing was common, with nearly half of all positive RM-PCR samples processed at our lab between 2016 and 2019 being positive for this pathogen. 3,4 Similar to previously published studies, we note that the mean number of days of symptoms before nasopharyngeal testing was approximately 5 days, and patients had on average nearly 2 outpatient visits related to viral symptoms following testing. These findings underscore the interruption to daily life that positivity with such a pathogen may confer, including missed days of childcare for children and work for their caregivers.…”

“…Also, the known seasonality of FLU versus the year-round activity of HRV/ENT may prompt caregivers to present more rapidly for evaluation and influence a clinician's desire to test a patient with typical symptoms during the FLU season. 3,25 Additionally, we observed that children with FLU had fewer outpatient follow-up visits after testing compared to those with HRV/ENT. This could be related to the use of antiviral agents which shorten the course and severity of this infection.…”

“…1,2 Rhinoviruses and respiratory enteroviruses are common viral pathogens that cause common cold symptoms in children. 3 Studies using respiratory multiplex polymerase chain reaction (RM-PCR) panels for detecting respiratory viruses, such as the BioFire FilmArray Respiratory Panel, Biofire Diagnostics, Salt Lake City, UT, show that rhinoviruses and enteroviruses are the most commonly recovered pathogens. 4,5 Given the genetic relationship between rhinoviruses and enteroviruses, many commercially available RM-PCR platforms utilized by hospitals and outpatient clinics cannot distinguish between viruses.…”

Assessment of the Clinical Course of Human Rhinovirus/Enterovirus Infections in Pediatric Intensive Care

“…Additionally, 29 of the 70 non-PARDS cases (41.4%) had at least one underlying chronic illness. In a study by Rankin et al, 13 evaluating HRV and/or EV (+) cases before and during the COVID-19 pandemic, at least one chronic illness was present in 56.1% and 57.4% of cases in both periods.…”

Severe Respiratory Disease Among Children With and Without Medical Complexity During the COVID-19 Pandemic

“…The findings of greater relative mitigation of respiratory hospitalizations in non-CMC compared with CMC in FY 2020 was surprising as we expected greater declines among CMC due to their elevated risk. Potential explanations for this observation include the ongoing circulation of other respiratory viruses during the pandemic for which CMC are at particular risk for hospitalization (eg, enterovirus), 34 unavoidable respiratory admissions unrelated to an infection (eg, noninfectious triggers for asthma or aspiration), and the use of nonpharmacologic infection-prevention strategies to reduce infection risk prepandemic among families of CMC. These explanations may also be relevant in understanding why older children who have a baseline lower risk of respiratory hospitalizations 35 were also observed to have greater relative decreases in respiratory admissions during the pandemic.…”