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Multicenter Study of Viral Etiology and Relapse in Hospitalized Children With Bronchiolitis

Hasegawa, Kohei MD, MPH*; Mansbach, Jonathan M. MD, MPH; Teach, Stephen J. MD, MPH; Fisher, Erin S. MD§; Hershey, Daniel MD§; Koh, Joyce Y. MD; Clark, Sunday ScD, MPH; Piedra, Pedro A. MD**; Sullivan, Ashley F. MS, MPH*; Camargo, Carlos A. Jr. MD, DrPH*

The Pediatric Infectious Disease Journal: August 2014 - Volume 33 - Issue 8 - p 809–813
doi: 10.1097/INF.0000000000000293
Original Studies

Background: It is unclear whether the infectious etiology of severe bronchiolitis affects short-term outcomes, such as posthospitalization relapse. We tested the hypothesis that children hospitalized with rhinovirus (RV) bronchiolitis, either as a sole pathogen or in combination with respiratory syncytial virus (RSV), are at increased risk of relapse.

Methods: We performed a 16-center, prospective cohort study of hospitalized children age <2 years with bronchiolitis. During the winters of 2007–2010, researchers collected clinical data and nasopharyngeal aspirates from study participants; the aspirates were tested using real-time polymerase chain reaction. The primary outcome was bronchiolitis relapse (urgent bronchiolitis visit or scheduled visit at which additions to the bronchiolitis medications were made) during the 2 weeks after hospital discharge.

Results: Among 1836 enrolled children with 2-week, follow-up data, the median age was 4 months and 60% were male. Overall, 48% had sole RSV infection, 8% had sole RV infection, and 13% had RSV/RV coinfection. Compared with children with sole RSV infection, and adjusting for 10 demographic and clinical characteristics and clustering of patients within hospitals, children with sole RV infection did not differ in their likelihood of relapse (odds ratio: 0.99; 95% confidence interval: 0.52–1.90; P = 0.98), whereas those with RSV/RV coinfection were more likely to have relapse (odds ratio: 1.54; 95% confidence interval: 1.03–2.30; P = 0.03).

Conclusions: In this prospective, multicenter, multiyear study of children hospitalized with bronchiolitis, we found that RSV/RV coinfection was independently associated with a higher likelihood of bronchiolitis relapse. Present data support the concept that the infectious etiology of severe bronchiolitis affects short-term outcomes.

Supplemental Digital Content is available in the text.

From the *Department of Emergency Medicine, Massachusetts General Hospital; Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA; Division of Emergency Medicine, Children’s National Health System, Washington, DC; §Department of Pediatrics, Rady Children’s Hospital, University of California San Diego, San Diego; Division of Hospital Medicine, Children’s Hospital Los Angeles, Los Angeles, CA; Department of Emergency Medicine, Weill Cornell Medical College, New York, NY; and **Departments of Molecular Virology and Microbiology, and Pediatrics, Baylor College of Medicine, Houston, TX.

Accepted for publication January 24, 2014.

This study was supported by the grants U01 AI-67693 and K23 AI-77801 from the National Institutes of Health (Bethesda, MD). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases or the National Institutes of Health.

The authors have no other funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Kohei Hasegawa, MD, MPH, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.