Acute Severity Versus Long-Term Morbidity: Uncoupling the Roles of RSV and HRV in Childhood Respiratory Disease

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ID: 314523
2026
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Abstract
Abstract Background The distinct roles of respiratory syncytial virus (RSV) and human rhinovirus (HRV) in acute illness and subsequent asthma remain debated. China’s strict non-pharmaceutical interventions (NPIs) in 2022 provided a unique epidemiological setting to compare their clinical/inflammatory profiles and associations with long-term asthma risk. Methods This observational retrospective cohort study included children hospitalized with RSV- or HRV-induced acute lower respiratory tract infections (ALRTIs). We collected clinical data, subtyped RSV samples and conducted long-term follow-up to assess physician-diagnosed asthma using Kaplan‒Meier and multivariable logistic regression. Results Among 722 children (425 RSV, 275 HRV, 22 coinfection), RSV predominated in infants with a sharp winter peak (RSV-A dominant, 96.8%), while HRV circulated year-round across a broader age range. RSV infection was associated with greater acute severity, including higher rates of pneumonia and longer hospitalization (P < 0.05). In contrast, HRV triggered a distinct inflammatory response with significant leukocytosis and an eosinophil count over fourfold greater than the RSV group (P < 0.001). Follow-up revealed HRV infection was independently associated with increased risk of subsequent asthma (log-rank P < 0.001). Multivariable regression identified prior wheezing (aOR 2.82, 95% CI: 1.76-4.53), elevated eosinophils (aOR 2.43, 95% CI: 1.07-5.49), and HRV infection (aOR 1.85, 95% CI: 1.15-2.99) as independent predictors for asthma. Conclusion During China’s late NPI phase, HRV infection showed a stronger independent association with childhood asthma than RSV. This association, together with an eosinophil-predominant inflammatory profile, remained significant after adjustment for prior wheezing history. These findings should be interpreted as associations rather than evidence of causality.
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Authors Lu Qin, Na Ling, Xin-Qin Feng, Wei Li, X H Wang, Lan-Fang Tang
Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag314
URL
https://doi.org/10.1093/ofid/ofag314
Keywords Keywords not found

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