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Factors Associated With Prolonged Respiratory Virus Detection From Polymerase Chain Reaction of Nasal Specimens
Zheyi Teoh1, Shannon Conrey1,2, Monica McNeal1,3
1Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Prolonged virus detection occurred in nearly 1 in 4 infections in healthy children, most frequently with bocavirus and rhinovirus/enterovirus. First-time infections and viral co-detections were linked to longer detection periods.
Area of Science:
- Pediatric infectious diseases
- Virology
- Epidemiology
Background:
- Limited understanding of respiratory viral shedding in children.
- Need for longitudinal data from healthy/asymptomatic populations.
- Focus on community-based birth cohorts.
Purpose of the Study:
- Characterize factors associated with prolonged virus detection by PCR.
- Investigate viral shedding dynamics in young children.
- Identify pathogens with extended detection periods.
Main Methods:
- Longitudinal study of 101 children from birth to 2 years (PREVAIL cohort).
- Weekly nasal swabs analyzed by Luminex Respiratory Pathogen Panel.
- Mixed-effects multivariable logistic regression for factor assessment.
Main Results:
- Prolonged virus detection (≥4 weeks) in 23.4% of 1489 infections.
- Highest rates for bocavirus (39%) and rhinovirus/enterovirus (33%).
- First-lifetime infection and viral co-detection significantly associated with prolonged detection.
Conclusions:
- Prolonged virus detection is common in healthy children, varying by pathogen.
- Bocavirus and rhinovirus/enterovirus show the longest detection durations.
- Further research needed on immunological factors influencing viral shedding duration.
Background:
Respiratory viral shedding is incompletely characterized by existing studies due to the lack of longitudinal nasal sampling and limited inclusion of healthy/asymptomatic children. We describe characteristics associated with prolonged virus detection by polymerase chain reaction (PCR) in a community-based birth cohort.
Methods:
Children were followed from birth to 2 years of age in the PREVAIL cohort. Weekly nasal swabs were collected and tested using the Luminex Respiratory Pathogen Panel. Weekly text surveys were administered to ascertain the presence of acute respiratory illnesses defined as fever and/or cough. Maternal reports and medical chart abstractions identified healthcare utilization. Prolonged virus detection was defined as a persistently positive test lasting ≥4 weeks. Factors associated with prolonged virus detection were assessed using mixed effects multivariable logistic regression.
Results:
From a sub-cohort of 101 children with ≥70% weekly swabs collected, a total of 1489 viral infections were detected. Prolonged virus detection was found in 23.4% of viral infections overall, 39% of bocavirus infections, 33% of rhinovirus/enterovirus infections, 14% of respiratory syncytial virus (RSV) A infections, and 7% of RSV B infections. No prolonged detection was found for influenza virus A or B, coronavirus 229E or HKU1, and parainfluenza virus 2 or 4 infections. First-lifetime infection with each virus, and co-detection of another respiratory virus were significantly associated with prolonged detection, while symptom status, child sex, and child age were not.
Conclusions:
Prolonged virus detection was observed in 1 in 4 viral infections in this cohort of healthy children and varied by pathogen, occurring most often for bocavirus and rhinovirus/enterovirus. Evaluating the immunological basis of how viral co-detections and recurrent viral infections impact duration of virus detection by PCR is needed to better understand the dynamics of prolonged viral shedding.
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