Circulation of Rhinoviruses and/or Enteroviruses in Pediatric Patients With Acute Respiratory Illness Before and During the COVID-19 Pandemic in the US

Author:

Rankin Danielle A.12,Spieker Andrew J.3,Perez Ariana45,Stahl Anna L.1,Rahman Herdi K.1,Stewart Laura S.1,Schuster Jennifer E.6,Lively Joana Y.4,Haddadin Zaid1,Probst Varvara1,Michaels Marian G.7,Williams John V.7,Boom Julie A.89,Sahni Leila C.89,Staat Mary A.10,Schlaudecker Elizabeth P.10,McNeal Monica M.10,Harrison Christopher J.6,Weinberg Geoffrey A.11,Szilagyi Peter G.1112,Englund Janet A.13,Klein Eileen J.13,Gerber Susan I.4,McMorrow Meredith4,Rha Brian4,Chappell James D.1,Selvarangan Rangaraj614,Midgley Claire M.4,Halasa Natasha B.1,Moffatt Mary15,Weddle Gina15,Strelitz Bonnie15,Lacombe Kristen15,Rohlfs Chelsea15,

Affiliation:

1. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee

2. Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee

3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee

4. Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

5. General Dynamics Information Technology Inc, Falls Church, Virginia

6. Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri

7. Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania

8. Department of Pediatrics, Baylor College of Medicine, Houston, Texas

9. Texas Children’s Hospital, Houston

10. Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

11. Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York

12. Department of Pediatrics, UCLA (University of California, Los Angeles) Mattel Children’s Hospital, UCLA, Los Angeles

13. Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle

14. Department of Pathology and Laboratory Medicine, Children’s Mercy Kansas City, Kansas City, Missouri

15. and the NVSN Network Investigators

Abstract

ImportanceRhinoviruses and/or enteroviruses, which continued to circulate during the COVID-19 pandemic, are commonly detected in pediatric patients with acute respiratory illness (ARI). Yet detailed characterization of rhinovirus and/or enterovirus detection over time is limited, especially by age group and health care setting.ObjectiveTo quantify and characterize rhinovirus and/or enterovirus detection before and during the COVID-19 pandemic among children and adolescents seeking medical care for ARI at emergency departments (EDs) or hospitals.Design, Setting, and ParticipantsThis cross-sectional study used data from the New Vaccine Surveillance Network (NVSN), a multicenter, active, prospective surveillance platform, for pediatric patients who sought medical care for fever and/or respiratory symptoms at 7 EDs or hospitals within NVSN across the US between December 2016 and February 2021. Persons younger than 18 years were enrolled in NVSN, and respiratory specimens were collected and tested for multiple viruses.Main Outcomes and MeasuresProportion of patients in whom rhinovirus and/or enterovirus, or another virus, was detected by calendar month and by prepandemic (December 1, 2016, to March 11, 2020) or pandemic (March 12, 2020, to February 28, 2021) periods. Month-specific adjusted odds ratios (aORs) for rhinovirus and/or enterovirus–positive test results (among all tested) by setting (ED or inpatient) and age group (<2, 2-4, or 5-17 years) were calculated, comparing each month during the pandemic to equivalent months of previous years.ResultsOf the 38 198 children and adolescents who were enrolled and tested, 11 303 (29.6%; mean [SD] age, 2.8 [3.7] years; 6733 boys [59.6%]) had rhinovirus and/or enterovirus–positive test results. In prepandemic and pandemic periods, rhinoviruses and/or enteroviruses were detected in 29.4% (9795 of 33 317) and 30.9% (1508 of 4881) of all patients who were enrolled and tested and in 42.2% (9795 of 23 236) and 73.0% (1508 of 2066) of those with test positivity for any virus, respectively. Rhinoviruses and/or enteroviruses were the most frequently detected viruses in both periods and all age groups in the ED and inpatient setting. From April to September 2020 (pandemic period), rhinoviruses and/or enteroviruses were detectable at similar or lower odds than in prepandemic years, with aORs ranging from 0.08 (95% CI, 0.04-0.19) to 0.76 (95% CI, 0.55-1.05) in the ED and 0.04 (95% CI, 0.01-0.11) to 0.71 (95% CI, 0.47-1.07) in the inpatient setting. However, unlike some other viruses, rhinoviruses and/or enteroviruses soon returned to prepandemic levels and from October 2020 to February 2021 were detected at similar or higher odds than in prepandemic months in both settings, with aORs ranging from 1.47 (95% CI, 1.12-1.93) to 3.01 (95% CI, 2.30-3.94) in the ED and 1.36 (95% CI, 1.03-1.79) to 2.44 (95% CI, 1.78-3.34) in the inpatient setting, and in all age groups. Compared with prepandemic years, during the pandemic, rhinoviruses and/or enteroviruses were detected in patients who were slightly older, although most (74.5% [1124 of 1508]) were younger than 5 years.Conclusions and RelevanceResults of this study show that rhinoviruses and/or enteroviruses persisted and were the most common respiratory virus group detected across all pediatric age groups and in both ED and inpatient settings. Rhinoviruses and/or enteroviruses remain a leading factor in ARI health care burden, and active ARI surveillance in children and adolescents remains critical for defining the health care burden of respiratory viruses.

Publisher

American Medical Association (AMA)

Subject

General Medicine

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