Symptomatic and asymptomatic respiratory viral infections in the first year of life: association with acute otitis media development

Tasnee Chonmaitree, Pedro Alvarez-Fernandez, Kristofer Jennings, Rocio Trujillo, Tal Marom, Michael J Loeffelholz, Aaron L Miller, David P McCormick, Janak A Patel, Richard B Pyles, Tasnee Chonmaitree, Pedro Alvarez-Fernandez, Kristofer Jennings, Rocio Trujillo, Tal Marom, Michael J Loeffelholz, Aaron L Miller, David P McCormick, Janak A Patel, Richard B Pyles

Abstract

Background: Sensitive diagnostic assays have increased the detection of viruses in asymptomatic individuals. The clinical significance of asymptomatic respiratory viral infection in infants is unknown.

Methods: High-throughput, quantitative polymerase chain reaction assays were used to detect 13 common respiratory viruses from nasopharyngeal specimens collected during 2028 visits from 362 infants followed from near birth up to 12 months of age. Specimens were collected at monthly interval (months 1-6 and month 9) and during upper respiratory tract infection (URTI) episodes. Subjects were followed closely for acute otitis media (AOM) development.

Results: Viruses were detected in 76% of 394 URTI specimens and 27% of asymptomatic monthly specimens. Rhinovirus was detected most often; multiple viruses were detected in 29% of the specimens. Generalized mixed-model analyses associated symptoms with increasing age and female sex; detection of respiratory syncytial virus (RSV), influenza, rhinovirus, metapneumovirus, and adenovirus was highly associated with symptoms. Increasing age was also associated with multiple virus detection. Overall, 403 asymptomatic viral infections in 237 infants were identified. Viral load was significantly higher in URTI specimens than asymptomatic specimens but did not differentiate cases of URTI with and without AOM complication. The rate of AOM complicating URTI was 27%; no AOM occurred following asymptomatic viral infections. AOM development was associated with increasing age and infection with RSV, rhinovirus, enterovirus, adenovirus, and bocavirus.

Conclusions: Compared to symptomatic infection, asymptomatic viral infection in infants is associated with young age, male sex, low viral load, specific viruses, and single virus detection. Asymptomatic viral infection did not result in AOM.

Keywords: acute otitis media; asymptomatic infection; common cold; respiratory viruses; rhinovirus.

© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Figures

Figure 1.
Figure 1.
Proportion of respiratory viruses in 795 respiratory samples (1079 viruses) detected singly or in combination with other viruses. Rhinovirus was the most common and accounted for 40% of all detected viruses. In 567 (71%) specimens, a single virus was detected; 2 viruses were detected in 181 (23%) specimens; ≥3 viruses were identified in 47 (6%) specimens. Abbreviation: RSV, respiratory syncytial virus.
Figure 2.
Figure 2.
Percentage of virus-positive samples (asymptomatic vs symptomatic infections) by month (combined data 2009–2013). Symptomatic infection includes upper respiratory tract infection episodes and monthly visits with symptom history.
Figure 3.
Figure 3.
Viral load by specimen type; the median is represented by the heavy horizontal line. The interquartile range is shown by the boxes. The number of specimens in each category is shown at the bottom of each column. Abbreviations: AOM, acute otitis media; URTI, upper respiratory tract infection.

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