Human rhinovirus species C infection in young children with acute wheeze is associated with increased acute respiratory hospital admissions

Am J Respir Crit Care Med. 2013 Dec 1;188(11):1358-64. doi: 10.1164/rccm.201303-0498OC.


Rationale: 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.

Objectives: 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.

Measurements and main 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Asthma / diagnosis
  • Asthma / immunology
  • Asthma / microbiology
  • Bronchiolitis / complications
  • Bronchiolitis / diagnosis
  • Bronchiolitis / microbiology
  • Child, Preschool
  • Disease Progression
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Hospitalization / statistics & numerical data
  • Hospitals, Pediatric / statistics & numerical data
  • Humans
  • Infant
  • Male
  • Nasal Mucosa / microbiology
  • Patient Readmission / statistics & numerical data
  • Respiratory Hypersensitivity / complications
  • Respiratory Hypersensitivity / diagnosis*
  • Respiratory Hypersensitivity / microbiology
  • Respiratory Sounds / etiology*
  • Respiratory Tract Infections / complications*
  • Respiratory Tract Infections / microbiology
  • Rhinovirus / classification*
  • Rhinovirus / isolation & purification
  • Risk Assessment
  • Western Australia