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. 2009 Mar 15;199(6):847-57.
doi: 10.1086/597122.

Human coronavirus and acute respiratory illness in older adults with chronic obstructive pulmonary disease

Geoffrey J Gorse  1 , Theresa Z O'Connor, Susan L Hall, Joseph N Vitale, Kristin L Nichol
Affiliations

Human coronavirus and acute respiratory illness in older adults with chronic obstructive pulmonary disease

Geoffrey J Gorse et al. J Infect Dis. .

Abstract

Background: The clinical features and incidence of human coronavirus (HCoV) infections in chronically ill older adults need better definition.

Methods: HCoV infection was determined on the basis of a 4-fold increase in serum antibody and the detection of HCoV by reverse-transcription polymerase chain reaction. Laboratory-documented influenza (LDI) was detected by serologic assay and culture. HCoV illnesses were compared with other acute respiratory illnesses identified by active surveillance, during the 1998-99 winter respiratory-virus season, of 2215 patients with chronic obstructive pulmonary disease who were > or = 50 years old and who received influenza vaccines.

Results: HCoV-229E and HCoV-OC43 were associated with 90 (14%) of 665 illnesses (HCoV-229E in 22, HCoV-OC43 in 67, and both in 1), LDI with 107 (16%) of 678 illnesses. In multivariate logistic regression analysis, myalgia was less likely with HCoV infection than with LDI (OR, 0.27 [95% confidence limit, 0.13-0.58]). A majority of these HCoV and LDI illnesses exhibited each of 11 symptoms and signs of acute respiratory illness. Spirometric results worsened most often with LDI, and many acute respiratory illnesses, regardless of etiology, were associated with hospitalization. A total of 8 illnesses were associated with HCoV-NL63, 1 with HCoV-HKU1.

Conclusions: The frequencies of HCoV and LDI illnesses were similar. HCoV illness was less severe than LDI illness, was accompanied by multiple respiratory and systemic symptoms, and was associated with hospitalization.

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Figures

Table 1
Table 1
Illnesses positive for human coronavirus (HCoV)–229E and HCoV-OC43 of 665 fully assessable illnesses for which both nasal-and-oropharyngeal (NOP)–swab and/or paired serum specimens were tested
Table 2
Table 2
Fully assessable illnesses positive for human coronavirus (HCoV)–229E and HCoV-OC43, of 487 illnesses for which both nasal-and-oropharyngeal (NOP)–swab and paired serum specimens were tested
Figure 1
Figure 1
List of 93 acute respiratory illnesses associated with human coronavirus (HCoV)-229E and -OC43 virus infections. The illnesses are listed in chronological order (regardless of whether the illness is a first episode of acute respiratory illness), by calendar month, from the beginning of October 1998 to April 1999 (the end of follow-up). Included among these 93 illnesses are 3 (2 HCoV-229E and 1 HCoV-OC43) that were not among the 665 illnesses that were assessable. For the patients infected with HCoV-229E and HCoV-OC43, the other respiratory illnesses, occurring before or after the HCoV-associated illness, are also shown. Of the patients with an illness associated with either HCoV-229E or HCoV-OC43, 1 had laboratory-documented influenza (LDI) before the HCoV illness, 4 had an HCoV illness before LDI, 13 had LDI concurrent with the HCoV infection during the illness, 9 had a non-HCoV/non-LDI illness before the HCoV illness, and 12 had either an HCoV-229E or HCoV-OC43 illness before a non-HCoV/non-LDI illness. Each row represents 1 patient, and the reporting site is identified by the 2-letter code for US states and Puerto Rico (PR), to the left of the graph. Of 20 sites, 19 in 13 states and PR reported illnesses associated with HCoV (HCoV-229E in 11 states and HCoV-OC43 in 12 states and PR). HCoV-associated illnesses were reported by 2 sites in Florida, 2 in Southern and 1 in Northern California, 2 in Texas, and 2 in Virginia; study sites reporting the most HCoV-229E and -OC43-associated illnesses were in Virginia (15 illnesses), Alabama (13 illnesses), Minnesota (10 illnesses), Missouri (9 illnesses), and Texas (9 illnesses). The cumulative numbers of illnesses of HCoV-associated illnesses, regardless of whether it was a first episode of acute respiratory illness and including those associated with HCoV and those with both HCoV and LDI, are graphed by calendar month (the cumulative number is that which occurred up to the beginning of the corresponding month); 32 HCoV-associated illnesses (5 HCoV-229E and 27 HCoV-OC43) occurred by the end of 1998, and 61 occurred during 1999 (19 HCoV-229E, 41 HCoV-OC43, and 1 with both strains). The only period when HCoV-229E–associated illnesses predominated was after February 1999 (10 HCoV-229E and 7 HCoV-OC43)
Table 3
Table 3
Demographic and clinical characteristics and clinical outcomes for 585 veterans with acute respiratory illnesses, categorized by first episode
Table 4
Table 4
Univariate and multivariate associations between illness group and 11 symptoms/signs of acute respiratory illness and vaccine group
Table 5
Table 5
Spirometric and clinical measures of severity of acute respiratory illness, by illness group
Table 6
Table 6
Characteristics of patients and first episodes of acute respiratory illnesses associated with either human coronavirus (HCoV)–NL63 or HCoV–HKU1
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