title: Human rhinovirus species C infection in young children with acute wheeze is associated with increased acute respiratory hospital admissions.
abstract: BACKGROUND
  Human rhinovirus species C (HRV-C) is the most common cause of acute wheezing exacerbations in young children presenting to hospital, but its impact on subsequent respiratory illnesses has not been defined.
  
  
  OBJECTIVE
  To determine whether acute wheezing exacerbations due to HRV-C are associated with increased hospital attendances due to acute respiratory illnesses (ARIs).
  
  
  METHODS
  Clinical information and nasal samples were collected prospectively from 197 children less than 5 years of age, presenting to hospital with an acute wheezing episode. Information on hospital attendances with an ARI before and after recruitment was subsequently obtained.
  
  
  RESULTS
  HRV was the most common virus identified at recruitment (n = 135 [68.5%]). From the 120 (88.9%) samples that underwent typing, HRV-C was the most common HRV species identified, present in 81 (67.5%) samples. Children with an HRV-related wheezing illness had an increased risk of readmission with an ARI (relative risk, 3.44; 95% confidence interval, 1.17-10.17; P = 0.03) compared with those infected with any other virus. HRV-C, compared with any other virus, was associated with an increased risk of a respiratory hospital admission before (49.4% vs. 27.3%, respectively; P = 0.004) and within 12 months (34.6% vs. 17.0%; P = 0.01) of recruitment. Risk for subsequent ARI admissions was further increased in atopic subjects (relative risk, 6.82; 95% confidence interval, 2.16-21.55; P = 0.001). Admission risks were not increased for other HRV species.
  
  
  CONCLUSIONS
  HRV-C-related wheezing illnesses were associated with an increased risk of prior and subsequent hospital respiratory admissions. These associations are consistent with HRV-C causing recurrent severe wheezing illnesses in children who are more susceptible to ARIs.
authors.affiliation: 1 Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
authors.forename: Desmond W
authors.initials: DW
authors.lastname: Cox
authors.forename: Joelene
authors.initials: J
authors.lastname: Bizzintino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ferrari
authors.forename: Siew Kim
authors.initials: SK
authors.lastname: Khoo
authors.forename: Guicheng
authors.initials: G
authors.lastname: Zhang
authors.forename: Siobhan
authors.initials: S
authors.lastname: Whelan
authors.forename: Wai Ming
authors.initials: WM
authors.lastname: Lee
authors.forename: Yury A
authors.initials: YA
authors.lastname: Bochkov
authors.forename: Gary C
authors.initials: GC
authors.lastname: Geelhoed
authors.forename: Jack
authors.initials: J
authors.lastname: Goldblatt
authors.forename: James E
authors.initials: JE
authors.lastname: Gern
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Laing
authors.forename: Peter N
authors.initials: PN
authors.lastname: Le Souëf
mesh_terms: D000208:Acute Disease; D001249:Asthma / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology; D001988:Bronchiolitis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology; D002675:Child, Preschool; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D009297:Nasal Mucosa / Q000382:microbiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D012130:Respiratory Hypersensitivity / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D012135:Respiratory Sounds / Q000209:etiology*; D012141:Respiratory Tract Infections / Q000150:complications* / Q000382:microbiology; D012229:Rhinovirus / Q000145:classification* / Q000302:isolation & purification; D018570:Risk Assessment; D014904:Western Australia