Acute Respiratory Illness in Pediatric Patients Before and During COVID-19 Pandemic


The positivity rate of rhinoviruses and enteroviruses decreased briefly following the onset of the COVID-19 pandemic, but by fall of 2020 resumed almost to pre-pandemic levels.

Danielle Rankin, PhD, MPH

Danielle Rankin, PhD, MPH

A team of investigators led by Danielle Rankin, PhD, MPH, Department of Pediatrics, Vanderbilt University Medical Center, aimed to examine the presence of rhinovirus and/or enterovirus among pediatric patients before and during the COVID-19 pandemic. 1

Data published today showed that the rapid onset of the COVID-19 virus didn't inhibit the anticipated spread of common viruses that often present in children and adolescents with acute respiratory illness (ARI). These viruses persisted as the most detected respiratory viruses among pediatric patients in the emergency department (ED) and inpatient settings, investigators found.

More specifically, when assessing the rates across different pediatric age groups during this period, the rhinoviruses and/or enteroviruses maintained prominence. The team's motivation was to provide further detail on the characterization of rhinoviruses and enteroviruses, not only by age group but also based on the treatment setting.

Respiratory Illness Across Emergency Departments

Data from the New Vaccine Surveillance Network (NSDN), a multicenter, active, prospective surveillance platform was gathered so investigators could observe the rate that children and adolescents who presented with fever or respiratory symptoms at emergency departments and hospitals. The cross-sectional study took place in 7 centers.

For the main outcome, the proportion of patients with rhinovirus, enterovirus or another virus was measured based on detection of the virus, according to calendar month. Comparative analyses between December 2016-March 2020, and March 2020-February 2021 were performed to observe the pre- and post-pandemic time periods.

Respiratory specimens were acquired from NVSN-enrolled patients (younger than 18 years of age) and tested for viruses. According to the study, investigators employed month-specific adjusted odds ratios for rhinovirus, enterovirus–positive test results were calculated regarding setting and age group, which compared each time period month-by-month during the pandemic to equivalent months of previous years.

Prevalence of Acute Respiratory Illness Before and During the Pandemic

Rhinoviruses/enteroviruses remained prominent among acute respiratory illnesses detected in the study population of pediatric patients that sought care from an emergency room, including those who were hospitalized.

The targeted viruses were present year round, but peaks were observed in late summer to early fall and also in spring. The positivity rate of these viruses decreased briefly following the onset of the COVID-19 pandemic, but by fall of 2020 resumed almost to the pre-pandemic levels.

"Findings of this study suggest that rhinoviruses and/or enteroviruses remain a major factor in acute respiratory illness in pediatric patients, including those hospitalized," investigators wrote. "Active surveillance is critical for defining the health care burden of respiratory viruses in this patient population."


  1. Rankin DA, Spieker AJ, Perez A, et al. Circulation of Rhinoviruses and/or Enteroviruses in Pediatric Patients With Acute Respiratory Illness Before and During the COVID-19 Pandemic in the US. JAMA Netw Open. 2023;6(2):e2254909. doi:10.1001/jamanetworkopen.2022.54909
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