Human rhinovirus C associated with wheezing in hospitalised children in the Middle East

BackgroundFew studies have investigated the disease burden and genetic diversity of human rhinoviruses (HRVs) in developing countries.ObjectivesTo assess the burden of HRV in Amman, Jordan, and to characterise clinical differences between HRV groups.Study designWe prospectively studied children <5 years, hospitalised with respiratory symptoms and/or fever in Amman, Jordan. Viruses were identified by real-time reverse transcriptase polymerase chain reaction (RT-PCR). VP4/VP2 gene sequencing was performed on HRV-positive specimens.ResultsOf the 728 enrolled children, 266 (37%) tested positive for picornaviruses, 240 of which were HRV. Of the HRV-positive samples, 62 (26%) were of the recently identified group HRVC, 131 (55%) were HRVA and seven (3%) were HRVB. The HRVC strains clustered into at least 19 distinct genotypes. Compared with HRVA-infected children, children with HRVC were more likely to require supplemental oxygen (63% vs. 42%, p = 0.007) and, when co-infections were excluded, were more likely to have wheezing (100% vs. 82%, p = 0.016).ConclusionsThere is a significant burden of HRV-associated hospitalisations in young children in Jordan. Infection with the recently identified group HRVC is associated with wheezing and more severe illness.