Comparing the Clinical Courses of Children with Human Rhinovirus/Enterovirus to Children with Other Respiratory Viruses in the Outpatient Setting

Milissa U. Jones*, Agnes S. Montgomery, Jennifer D. Coskun, Raymundo Z. Marcelo, Alyssa B. Sutton, Sorana Raiciulescu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: While infections caused by rhinoviruses and enteroviruses are common among children, the entirety of their clinical impact remains elusive. We compared the clinical outcomes of children with rhinovirus/enterovirus infections to other common respiratory viruses in outpatient settings. Methods: We conducted a retrospective analysis of nasopharyngeal samples singly positive for human rhinovirus/enterovirus (HRV/ENT), influenza A/B (FLU) or respiratory syncytial virus (RSV) from patients ≤17 years submitted for clinical testing via multiplex polymerase chain reaction between 2016 and 2019. We evaluated the following outpatient outcomes: days of respiratory symptoms before testing; visits for respiratory symptoms; receipt of a breathing treatment; receipt of antibiotics and hospital admission. Statistical analyses were conducted controlling for age and comorbid conditions. Results: There were 1355 positive samples included in this analysis (HRV/ENT: n = 743, FLU: n = 303 and RSV: n = 309). Compared to HRV/ENT, children with FLU had 28% fewer days of respiratory symptoms (β: -0.32; 95% confidence interval: -0.46 to -0.18; P < 0.001), fewer visits for respiratory symptoms, and significantly decreased odds of receiving a breathing treatment or antibiotics, and admission to the hospital. Children with RSV had a similar number of days of respiratory symptoms, outpatient visits and odds of hospital admission, but significantly increased odds of receiving a breathing treatment and antibiotics compared to those with HRV/ENT. Conclusion: Clinicians should have a high level of vigilance when managing children with positive respiratory viral testing for HRV/ENT given the potential for clinical outcomes similar to and, in some instances, worse than known highly pathogenic viruses.

Original languageEnglish
Pages (from-to)E432-E439
JournalPediatric Infectious Disease Journal
Issue number12
StatePublished - 1 Dec 2023
Externally publishedYes


  • clinical course
  • human rhinovirus/enterovirus
  • outcomes
  • severity
  • viral infections


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