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Burden of Recurrent Respiratory Tract Infections in Children: A Prospective Cohort Study

Toivonen, Laura MD; Karppinen, Sinikka MD; Schuez-Havupalo, Linnea MD; Teros-Jaakkola, Tamara MD; Vuononvirta, Juho PhD; Mertsola, Jussi MD, PhD; He, Qiushui MD, PhD; Waris, Matti PhD; Peltola, Ville MD, PhD

The Pediatric Infectious Disease Journal: December 2016 - Volume 35 - Issue 12 - p e362–e369
doi: 10.1097/INF.0000000000001304
Original Studies

Background: The burden of recurrent respiratory infections is unclear. We identified young children with recurrent respiratory infections in order to characterize the clinical manifestations, risk factors and short-term consequences.

Methods: In this prospective cohort study, 1089 children were followed from birth to 2 years of age for respiratory infections by a daily symptom diary. Nasal swabs taken during respiratory infections were analyzed for viruses from 714 children. Nasopharyngeal swabs collected at 2 months of age were cultured for bacteria. The 10% of children with the highest number of annual respiratory illness days were defined to have recurrent respiratory tract infections.

Results: The 90th percentile in the number of annual respiratory illness days was 98. Children above this limit (n = 109) had a median of 9.6 acute respiratory infections per year. Rhinovirus was detected in 58% of their infections. Of the children with recurrent infections, 60% were diagnosed with at least 3 episodes of acute otitis media, 73% received at least 3 antibiotic treatments and 21% were hospitalized for an acute respiratory infection. Tympanostomy was performed for 35% and adenoidectomy for 13% of the children. Asthma was diagnosed in 12% by 24 months of age. Older siblings increased the risk of recurrent respiratory infections. Early nasopharyngeal colonization with Streptococcus pneumoniae was common in children who later developed recurrent infections.

Conclusions: Children with recurrent respiratory infections frequently use health care services and antibiotics, undergo surgical procedures and are at risk for asthma in early life. Having older siblings increases the risk of recurrent infections.

Supplemental Digital Content is available in the text.

From the *Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Turku Institute for Child and Youth Research, Department of Medical Microbiology and Immunology, and §Department of Virology, University of Turku, Turku, Finland.

Accepted for publication May 22, 2016.

Supported by the University of Turku; the Abo Akademi University; the Turku University Hospital; the Academy of Finland (Grants no: 123571, 140251 and 277535); the Foundation for Pediatric Research; and Research Funds from Specified Government Transfers, Hospital District of Southwest Finland. L.T. was also supported by the Satakunta Hospital District; the National Graduate School of Clinical Investigation; the University of Turku Graduate School; and the Paulo Foundation.

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: Ville Peltola, MD, PhD, Department of Pediatrics and Adolescent Medicine, Turku University Hospital, 20521 Turku, Finland. E-mail:

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