title: Epidemiology of multiple respiratory viruses in childcare attendees.
abstract: BACKGROUND
  The identification of multiple viruses during respiratory illness is increasing with advances in rapid molecular testing; however, the epidemiology of respiratory viral coinfections is not well known.
  
  
  METHODS
  In total, 225 childcare attendees were prospectively followed for up to 2 years. Nasal swabs were collected at respiratory illness onset and every 7-10 days until illness resolution. Swabs were tested by polymerase chain reaction for 15 respiratory viruses and subtypes.
  
  
  RESULTS
  At least 1 virus was detected in 382 (84%) of 455 new-onset illnesses with multiple viruses identified in 212 (46%). The proportion of subject swabs with multiple viruses detected changed as respiratory illnesses progressed from week to week, as did the prevalence of individual viruses. Children with multiple viruses detected at the time of illness onset had less frequent fever (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.35, 0.90), however, these children more often had illness symptoms lasting over 7 days (OR, 1.94; 95% CI, 1.20, 3.14).
  
  
  CONCLUSIONS
  A high proportion of daycare attendees had multiple viruses detected during respiratory illnesses. Delay between onset of illness and viral detection varied by virus, indicating that some viruses may be underrepresented in studies of virus epidemiology that rely on only a single test at symptom onset.
authors.affiliation: Department of Pharmacy Practice, Wayne State University, Detroit, Michigan, USA. etmartin@wayne.edu
authors.forename: Emily T
authors.initials: ET
authors.lastname: Martin
authors.forename: Mary P
authors.initials: MP
authors.lastname: Fairchok
authors.forename: Zach J
authors.initials: ZJ
authors.lastname: Stednick
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
mesh_terms: D000258:Adenovirus Infections, Human / Q000453:epidemiology; D002656:Child Day Care Centers; D002675:Child, Preschool; D060085:Coinfection; D016001:Confidence Intervals; D018352:Coronavirus Infections / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology; D056661:Human bocavirus; D006801:Humans; D015994:Incidence; D007223:Infant; D007251:Influenza, Human / Q000453:epidemiology; D008297:Male; D029121:Metapneumovirus; D009297:Nasal Mucosa / Q000821:virology; D016017:Odds Ratio; D018184:Paramyxoviridae Infections / Q000453:epidemiology*; D010322:Parvoviridae Infections / Q000453:epidemiology; D010850:Picornaviridae Infections / Q000453:epidemiology; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology*; D012229:Rhinovirus; D013997:Time Factors; D014861:Washington