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Rhinovirus Infections and Associated Respiratory Morbidity in Infants: A Prospective Cohort Study

Mack, Ines MD; Kieninger, Elisabeth MD, PhD; Cangiano, Giulia MD; Tapparel, Caroline PhD; Kuehni, Claudia MD, PhD; Spycher, Ben PhD; Kaiser, Laurent MD; Frey, Urs MD, PhD; Regamey, Nicolas MD; Latzin, Philipp MD, PhD

The Pediatric Infectious Disease Journal: October 2016 - Volume 35 - Issue 10 - p 1069–1074
doi: 10.1097/INF.0000000000001240
Original Studies

Background: Risk factors promoting rhinovirus (RV) infections are inadequately described in healthy populations, especially infants.

Objectives: To determine the frequency of symptomatic and asymptomatic RV infections and identify possible risk factors from host and environment among otherwise healthy infants.

Methods: In a prospective birth cohort, respiratory health was assessed in 41 term-born infants by weekly telephonic interviews during the first year of life, and weekly nasal swabs were collected to determine RV prevalence. In a multilevel logistic regression model, associations between prevalence and respiratory symptoms during RV infections and host/environmental factors were determined.

Results: Twenty-seven percent of nasal swabs in 41 infants tested positive for RVs. Risk factors for RV prevalence were autumn months [odds ratio (OR) = 1.71, P = 0.01, 95% confidence interval (CI): 1.13–2.61], outdoor temperatures between 5 and 10°C (OR = 2.33, P = 0.001, 95% CI: 1.41–3.86), older siblings (OR = 2.60, P = 0.001, 95% CI: 1.50–4.51) and childcare attendance (OR = 1.53, P = 0.07, 95% CI: 0.96–2.44). Fifty-one percent of RV-positive samples were asymptomatic. Respiratory symptoms during RV infections were less likely during the first 3 months of life (OR = 0.34, P = 0.003, 95% CI: 0.17–0.69) and in infants with atopic mothers (OR = 0.44, P = 0.008, 95% CI: 0.24–0.80). Increased tidal volume (OR = 1.67, P = 0.03, 95% CI: 1.04–2.68) and outdoor temperatures between 2 and 5°C (OR = 2.79, P = 0.02, 95% CI: 1.17–6.61) were associated with more symptoms.

Conclusions: RVs are highly prevalent during the first year of life, and most infections are asymptomatic. Frequency of RV infections is associated with environmental factors, while respiratory symptoms during RV infections are linked to host determinants like infant age, maternal atopy or premorbid lung function.

Supplemental Digital Content is available in the text.

From the *Pediatric Respiratory Medicine, Inselspital and University of Bern, Bern, Switzerland; University Children’s Hospital (UKBB), University of Basel, Basel, Switzerland; Department of Pediatrics, University of Rome “La Sapienza,” Rome, Italy; §Faculty of Medicine, Division of Infectious Diseases and Laboratory of Virology, University Hospitals of Geneva, Geneva, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Accepted for publication March 25, 2016.

N.R. and P.L. have contributed equally to this study.

Supported by the Swiss National Foundation (grant numbers 324730_144280/1 to U.F. and P.L., 32473B_146679 to N.R. and L.K. and 32003B_144068 to C.K.), the Swiss National Science Foundation fellowship (PZ00P3_147987/1 to B.S.) and Fondation Botnar to P.L. For the remaining authors no funding was declared.

The authors have no 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: Philipp Latzin, MD, PhD, University Children’s Hospital Basel UKBB, Spitalstrasse 33, Basel 4031, Switzerland. E-mail

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