title: Clinical severity of rhinovirus/enterovirus compared to other respiratory viruses in children.
abstract: BACKGROUND
  Human rhinovirus/enterovirus (HRV/ENT) infections are commonly identified in children with acute respiratory infections (ARIs), but data on their clinical severity remain limited.
  
  
  OBJECTIVE
  We compared the clinical severity of HRV/ENT to respiratory syncytial virus (RSV), influenza A/B (FLU), and other common respiratory viruses in children.
  
  
  METHODS
  Retrospective study of children with ARIs and confirmed single positive viral infections on mid-turbinate swabs by molecular assays. Outcome measures included hospital admission and, for inpatients, a composite endpoint consisting of intensive care admission, hospitalization >5 days, oxygen requirements or death.
  
  
  RESULTS
  A total of 116 HRV/ENT, 102 RSV, 99 FLU, and 64 other common respiratory viruses were identified. Children with single HRV/ENT infections presented with significantly higher rates of underlying immunosuppressive conditions compared to those with RSV (37.9% versus 13.6%; P < 0.001), FLU (37.9% versus 22%; P = 0.018) or any other single viral infection (37.9% versus 22.5%; P = 0.024). In multivariable analysis adjusted for underlying conditions and age, children with HRV/ENT infections had increased odds of hospitalization compared to children with RSV infections (OR 2.6; 95% CI 1.4, 4.8; P < 0.003) or FLU infections (OR 3.0; 95% CI 1.6, 5.8; <0.001) and increased odds of severe clinical disease among inpatients (OR 3.0; 95% CI 1.6,5.6; P = 0.001) when compared to those with FLU infections.
  
  
  CONCLUSIONS
  Children with HRV/ENT had a more severe clinical course than those with RSV and FLUA/B infections and often had significant comorbidities. These findings emphasize the importance of considering HRV/ENT infection in children presenting with severe acute respiratory tract infections.
authors.affiliation: Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Asner
authors.forename: Astrid
authors.initials: A
authors.lastname: Petrich
authors.forename: Jemila S
authors.initials: JS
authors.lastname: Hamid
authors.forename: Dominik
authors.initials: D
authors.lastname: Mertz
authors.forename: Susan E
authors.initials: SE
authors.lastname: Richardson
authors.forename: Marek
authors.initials: M
authors.lastname: Smieja
mesh_terms: D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D012141:Respiratory Tract Infections / Q000473:pathology* / Q000821:virology; D012189:Retrospective Studies; D014777:Virus Diseases / Q000473:pathology* / Q000821:virology; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*
keywords: Clinical disease severity; human rhinovirus/enterovirus; influenza; respiratory syncytial virus; single viral infections