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Increasing rhinovirus prevalence in paediatric intensive care patients since the SARS-CoV2 pandemic
Eliza Gil1, Sunando Roy2, Tim Best3
1Department of Clinical Research, London School of Hygiene and Tropical Medicine; Department of Microbiology, Virology & Infection Control, Great Ormond Street Hospital for Children, UK; Infection, Immunity and Inflammation Department, GOS Institute of Child Health, University College London, London, UK.
Insights
Rhinovirus (HRV) incidence in paediatric intensive care units (PICUs) dropped during lockdown but surged afterward to unprecedented levels. This rise in HRV infections among vulnerable children warrants attention for clinical and infection control strategies.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Epidemiology
Background:
- Rhinovirus (HRV) is a common seasonal pathogen in children.
- The COVID-19 pandemic and associated public health measures significantly altered viral epidemiology.
- HRV virtually disappeared from Great Ormond Street Hospital's (GOSH) pediatric intensive care units (PICUs) during the initial lockdown.
Purpose of the Study:
- To investigate changes in HRV infection patterns in PICU patients at GOSH following the emergence of SARS-CoV-2.
- To analyze the incidence and genotypes of HRV in a vulnerable pediatric population post-lockdown.
Main Methods:
- Retrospective analysis of 10,950 nasopharyngeal aspirate viral PCR samples from GOSH PICU patients (2019-2023).
- Included 3,083 positive respiratory virus samples, with 1,530 positive for HRV.
- Sequencing of 66 HRV isolates from August 2020 to January 2021 and retrospective electronic health record data collection.
Main Results:
- Following an initial reduction, HRV incidence rapidly increased, surpassing pre-pandemic levels.
- Multiple HRV genotypes emerged and circulated year-round at an elevated incidence.
- The surge in HRV infection occurred specifically in PICU patients, unlike other respiratory viruses.
Conclusions:
- HRV infection incidence in GOSH PICU patients is significantly higher post-SARS-CoV-2 emergence compared to pre-pandemic.
- This increased HRV burden in immunocompromised children has critical clinical and infection control implications.
- The distinct pattern of HRV increase highlights a unique epidemiological shift impacting vulnerable pediatric populations.
Background:
Rhinovirus (HRV) is a significant seasonal pathogen in children. The emergence of SARS-CoV2, and the social restrictions introduced in, disrupted viral epidemiology. Here we describe the experience of Great Ormond Street Hospital (GOSH), where HRV almost entirely disappeared from the paediatric intensive care units (PICU) during the first national lockdown and then rapidly re-emerged with a fast-increasing incidence, leading to concerns about possible nosocomial transmission in a vulnerable population.
Objectives:
To describe alterations in HRV infection amongst PICU patients at GOSH since the emergence of SARS-COV2 STUDY DESIGN: 10,950 nasopharyngeal aspirate viral PCR samples from GOSH PICU patients from 2019 to 2023 were included. 3083 returned a positive result for a respiratory virus, with 1530 samples positive for HRV. 66 HRV isolates from August 2020 - Jan 2021, the period of rapidly increasing HRV incidence, were sequenced. Electronic health record data was retrospectively collected for the same period.
Results:
Following a reduction in the incidence of HRV infection during the first national lockdown, multiple genotypes of HRV emerged amongst GOSH PICU patients, with the incidence of HRV infection rapidly surging to levels higher than that seen prior to the emergence of SARS-CoV2 and continuing to circulate at increased incidence year-round.
Conclusions:
The incidence of HRV infection amongst GOSH PICU patients is markedly higher than prior to the emergence of SARS-CoV2, a pattern not seen in other respiratory viruses. The increased burden of HRV-infection in vulnerable PICU patients has both clinical and infection prevention and control Implications.
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