Q: I know a number of children sick with rhinovirus. What is this virus and why is it such a big player this year?
A: Yes, our clinics, pediatric emergency department and inpatient wards have been swamped with children aged 3 months to 4 years who are congested, coughing, breathing fast and requiring oxygen. A few have required ventilator support. For most of us, kids included, rhinovirus is the most common cause of the common cold.
Human rhinoviruses are ubiquitous. Infections occur year-round, but do increase during the usual winter months, when other respiratory viruses increase in kids as well.
In Albuquerque, those months are usually February through April. To see a spike in respiratory viral infections in August is unusual. Many parents have said it may be due to the social interactions we are now enjoying after months of social distancing. Which is to say, social distancing works in terms of keeping kids safe from viruses. But, life must go on at some point. And when it did, our old friend Mr. Rhinovirus wanted to come out and play too!
It is usually associated with the common cold, with runny nose, sore throat, cough and feeling unwell. It can also cause ear infections, croup, pneumonia and acute bronchiolitis.
Bronchiolitis is when the small airways in infants under the age of two become clogged with secretions and inflammatory cells. The secretions, inflammation and the mucus-y obstruction of the small airways makes it difficult to breathe and can affect oxygenation.
It is the most frequent lower respiratory tract infection in children, especially in preterm infants, and represents the leading cause of hospitalization in infants, accounting for almost 20% of all pediatric hospital admissions in the United States.
Other viruses such as adenovirus, influenza, parainfluenza, metapneumovirus and human coronavirus can also cause bronchiolitis and hospitalization. Up to 30% of infants hospitalized with bronchiolitis have multiple respiratory virus co-infections
Clinically, bronchiolitis is characterized by few days of runny nose, fever, and cough, followed by increased work of breathing, with wheeze and/or crackles heard during breathing, or through a stethoscope. Most children with bronchiolitis have an uneventful course. Hospitalization is thought to occur in less than 5% of cases, and admission to a Pediatric Intensive Care Unit occurs in 2—6% of those hospitalized cases, in typical years.
Indicators for hospital admission are respiratory rate over 60 breaths/minute, marked chest wall retractions, apnea, an oxygen saturation lower than 90% on room air, bluish tinge to lips and inability to eat or drink enough due to breathlessness.
Transmission of rhinovirus is mainly attributed to hand contact between persons or contact with items like clothing that have a lot of viral particles on them. In the hospital we put these patients on contact isolation to minimize the spread to providers and other patients. Contact isolation means the care team will be wearing gowns and gloves when caring for your child. Nasal secretions seem to contain much higher viral loads than saliva.
While in the hospital, your child may be tested with a deep nasal swab to see if the suspected virus can be identified. It typically takes between 2-6 hours for the test to be resulted. If a child is intubated, tracheal secretions aspirated from the endotracheal tube can also be tested for these same viruses.
There is no treatment for most viruses, including rhinovirus. All we can do is provide supportive care with oxygen, nasal suctioning and hydration, giving the body time to clear the virus on its own.
So why do we sometimes stick a swab deep into your child’s nose, for the purpose of viral testing?
One reason to test is so we can put patients with the same virus into shared rooms together. Another reason to test is to know if your child has a different virus which might have some treatment options that may shorten the duration of illness. These include influenza, for which we can give Tamiflu, and Covid, for which we give steroids.
One related question is whether rhinovirus bronchiolitis is more likely to cause wheezing which persists even after the illness, as compared to other viruses. There are plenty of studies, from plenty of countries, looking at this. And they have conflicting results.
The final word, for the time being, is that rhinovirus might cause slightly more wheezing during acute illness than other viruses, including RSV, and that wheezing might last a bit longer after the illness. Or it might not. Each case is different and the most important thing is to watch your child carefully and work closely with your pediatrician, during the acute illness and afterwards.
Anjali Subbaswamy is a Pediatric Intensive Care Physician at UNM. Please send your questions to email@example.com.