title: Back-to-school upper respiratory infection in preschool and primary school-age children in Israel.
abstract: BACKGROUND
  Increased upper respiratory infection (URI) among children at the beginning of school year is well known to parents and pediatricians. However, this phenomenon is not well documented or characterized.
  
  
  METHODS
  Computerized datasets from a large health maintenance organization in Israel were used to calculate the weekly rates of URI among children 3-14 years old for the years 2007-2012. In addition, nasopharyngeal swabs were collected in 2010-2012 from children with URI symptoms and controls during school opening time. Swabs were tested by real-time polymerase chain reaction for the presence of respiratory viruses.
  
  
  RESULTS
  Time-series analysis demonstrated a peak of URI in September each year. The peaks reached their height 2 weeks after school opening and returned to baseline within 4-7 weeks. The main 3 viruses detected both in URI patients and in healthy controls during the first weeks of school opening were rhinovirus, adenovirus and enterovirus. The detection rate of any respiratory virus, and of rhinovirus in particular, was significantly higher among cases than among controls (54% vs. 16%, P < 0.001 for any virus, and 35% vs. 6.0%, P < 0.01 for rhinovirus). When adjusting for age and sex cases had 5.8 times more viral detection when compared with controls. Upper respiratory symptoms were significantly more prevalent among the virus-positive cases when compared with negative ones.
  
  
  CONCLUSIONS
  Back-to-school illness consisting of URI has a distinct epidemiological pattern demonstrating a rapid rise peaking within 2 weeks of school opening and is associated predominantly with rhinovirus.
authors: From the *Israel Center for Disease Control, Israel Ministry of Health, Tel-Hashomer, Israel; †Department of Pediatrics, and ‡Department of Family and Community Medicine, New York Medical College, Valhalla, New York; §Department of Pediatric Emergency Medicine, Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel; ¶Department of Pediatrics, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; ‖Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Israel; **Maccabi Healthcare Services, Israel; and ††Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors: Michal
authors: M
authors: Perry Markovich
authors: Aharona
authors: A
authors: Glatman-Freedman
authors: Michal
authors: M
authors: Bromberg
authors: Arie
authors: A
authors: Augarten
authors: Hanna
authors: H
authors: Sefty
authors: Zalman
authors: Z
authors: Kaufman
authors: Hilda
authors: H
authors: Sherbany
authors: Liora
authors: L
authors: Regev
authors: Gabriel
authors: G
authors: Chodick
authors: Ella
authors: E
authors: Mendelson
authors: Tamy
authors: T
authors: Shohat
authors: Michal
authors: M
authors: Mandelboim
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D062486:Public Health Surveillance; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology*; D012189:Retrospective Studies; D012621:Seasons; D013334:Students / Q000706:statistics & numerical data; D014777:Virus Diseases / Q000453:epidemiology / Q000821:virology