Epidemiology and clinical characteristics of human coronaviruses OC43, 229E, NL63, and HKU1: a study of hospitalized children with acute respiratory tract infection in Guangzhou, China

Eur J Clin Microbiol Infect Dis. 2018 Feb;37(2):363-369. doi: 10.1007/s10096-017-3144-z. Epub 2017 Dec 6.


Human coronaviruses (HCoV) OC43, 229E, NL63, and HKU1 are common respiratory viruses which cause various respiratory diseases, including pneumonia. There is a paucity of evidence on the epidemiology and clinical manifestations of these four HCoV strains worldwide. We collected 11,399 throat swabs from hospitalized children with acute respiratory tract infection from July 2009 to June 2016 in Guangzhou, China. These were tested for four strains of HCoV infection using real-time polymerase chain reaction (PCR). HCoV-positive patients were then tested for 11 other respiratory pathogens. 4.3% (489/11399) of patients were positive for HCoV, of which 3.0% were positive for OC43 (346/11399), 0.6% for 229E (65/11399), 0.5% for NL63 (60/11399), and 0.3% for HKU1 (38/11399). Patients aged 7-12 months had the highest prevalence of HCoV and OC43 when compared with other age groups (p < 0.001). The peak seasons of infection varied depending on the HCoV strain. Patients infected with a single strain of HCoV infection were less likely to present fever (≥ 38 °C) (p = 0.014) and more likely to present pulmonary rales (p = 0.043) than those co-infected with more than one HCoV strain or other respiratory pathogens. There were also significant differences in the prevalence of certain symptoms, including coughing (p = 0.032), pneumonia (p = 0.026), and abnormal pulmonary rales (p = 0.002) according to the strain of HCoV detected. This retrospective study of the prevalence of four HCoV strains and clinical signs among a large population of pediatric patients in a subtropical region of China provides further insight into the epidemiology and clinical features of HCoV.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • China / epidemiology
  • Coronavirus 229E, Human / isolation & purification*
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / virology
  • Coronavirus NL63, Human / isolation & purification*
  • Coronavirus OC43, Human / isolation & purification*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Prevalence
  • Real-Time Polymerase Chain Reaction
  • Respiratory Tract Infections / diagnosis*
  • Respiratory Tract Infections / epidemiology*
  • Respiratory Tract Infections / virology
  • Retrospective Studies