title: Molecular epidemiology of human rhinovirus infections in the pediatric emergency department.
abstract: BACKGROUND
  Human rhinovirus (HRV) infections are highly prevalent, genetically diverse, and associated with both mild upper respiratory tract and more severe lower tract illnesses (LRTI).
  
  
  OBJECTIVE
  To characterize the molecular epidemiology of HRV infections in young children seeking acute medical care.
  
  
  METHODS
  Nasal swabs collected from symptomatic children <3 years of age receiving care in the Emergency and Urgent Care Departments at Seattle Children's Hospital were analyzed by a rapid polymerase chain reaction (PCR) system (FilmArray(®)) for multiple viruses including HRV/enterovirus. HRV-positive results were confirmed by laboratory-developed real-time reverse transcription PCR (LD-PCR). Clinical data were collected by chart review. A subset of samples was selected for sequencing using the 5' noncoding region. Associations between LRTI and HRV species and genotypes were estimated using logistic regression analysis.
  
  
  RESULTS
  Of 595 samples with HRV/enterovirus detected by FilmArray, 474 (80%) were confirmed as HRV by LD-PCR. 211 (96%) of 218 selected samples were sequenced; HRV species A, B, and C were identified in 133 (63%), 6 (3%), and 72 (34%), respectively. LRTI was more common in HRV-C than HRV-A illness episodes (adjusted OR [95% CI] 2.35[1.03-5.35). Specific HRV-A and HRV-C genotypes detected in multiple patients were associated with a greater proportion of LRTI episodes. In 18 patients with >1 HRV-positive illness episodes, a distinct genotype was detected in each.
  
  
  CONCLUSIONS
  Diverse HRV genotypes circulated among symptomatic children during the study period. We found an association between HRV-C infections and LRTI in this patient population and evidence of association between specific HRV genotypes and LRTI.
authors.affiliation: Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Martin
authors.affiliation: Department of Laboratory Medicine, University of Washington, Box 357110, 1959 NE Pacific Street, NW120, Seattle, WA 98195, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.affiliation: Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA.
authors.forename: Helen Y
authors.initials: HY
authors.lastname: Chu
authors.affiliation: Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Lacombe
authors.affiliation: Department of Laboratory Medicine, University of Washington, Box 357110, 1959 NE Pacific Street, NW120, Seattle, WA 98195, USA; Department of Laboratory Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
authors.forename: Xuan
authors.initials: X
authors.lastname: Qin
authors.affiliation: Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Strelitz
authors.affiliation: Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA.
authors.forename: Miranda
authors.initials: M
authors.lastname: Bradford
authors.affiliation: Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA.
authors.forename: Charla
authors.initials: C
authors.lastname: Jones
authors.affiliation: Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA; Department of Pediatrics, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
authors.forename: Eileen J
authors.initials: EJ
authors.lastname: Klein
authors.affiliation: Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA; Department of Pediatrics, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA. Electronic address: janet.englund.@seattlechildrens.org.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
mesh_terms: D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D010802:Phylogeny; D010850:Picornaviridae Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D012367:RNA, Viral; D012229:Rhinovirus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D012621:Seasons
chemical_list: D012367:RNA, Viral
keywords: Emergency department; Genotyping; HRV-C; Human rhinovirus; Lower respiratory tract infection