Host and viral factors associated with severity of human rhinovirus-associated infant respiratory tract illness.
BACKGROUND
Risk factors for severe human rhinovirus (HRV)-associated infant illness are unknown.


OBJECTIVE
We sought to examine the role of HRV infection in infant respiratory tract illness and assess viral and host risk factors for HRV-associated disease severity.


METHODS
We used a prospective cohort of term, previously healthy infants enrolled during an inpatient or outpatient visit for acute upper or lower respiratory tract illness during the fall-spring months of 2004-2008. Illness severity was determined by using an ordinal bronchiolitis severity score, with higher scores indicating more severe disease. HRV was identified by means of real-time RT-PCR. The VP4/VP2 region from HRV-positive specimens was sequenced to determine species.


RESULTS
Of 630 infants with bronchiolitis or upper respiratory tract illnesses (URIs), 162 (26%) had HRV infection; HRV infection was associated with 18% of cases of bronchiolitis and 47% of cases of URI. Among infants with HRV infection, 104 (64%) had HRV infection alone. Host factors associated with more severe HRV-associated illness included a maternal and family history of atopy (median score of 3.5 [interquartile range [IQR], 1.0-7.8] vs 2.0 [IQR, 1.0-5.2] and 3.5 [IQR, 1.0-7.5] vs 2.0 [IQR, 0-4.0]). In adjusted analyses maternal history of atopy conferred an increase in the risk for more severe HRV-associated bronchiolitis (odds ratio, 2.39; 95% CI, 1.14-4.99; P = .02). In a similar model maternal asthma was also associated with greater HRV-associated bronchiolitis severity (odds ratio, 2.49, 95% CI, 1.10-5.67; P = .03). Among patients with HRV infection, 35% had HRVA, 6% had HRVB, and 30% had HRVC.


CONCLUSIONS
HRV infection was a frequent cause of bronchiolitis and URIs among previously healthy term infants requiring hospitalization or unscheduled outpatient visits. Substantial viral genetic diversity was seen among the patients with HRV infection, and predominant groups varied by season and year. Host factors, including maternal atopy, were associated with more severe infant HRV-associated illness.
Department of Pediatrics, Vanderbilt University, Nashville, TN 37232-8300, USA.
E Kathryn
EK
Miller
John V
JV
Williams
Tebeb
T
Gebretsadik
Kecia N
KN
Carroll
William D
WD
Dupont
Yassir A
YA
Mohamed
Laura-Lee
LL
Morin
Luke
L
Heil
Patricia A
PA
Minton
Kimberly
K
Woodward
Zhouwen
Z
Liu
Tina V
TV
Hartert
D001988:Bronchiolitis / Q000503:physiopathology / Q000821:virology; D003139:Common Cold / Q000235:genetics / Q000503:physiopathology* / Q000821:virology*; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology; D007223:Infant; D008297:Male; D009035:Mothers; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012229:Rhinovirus; D012307:Risk Factors
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