Original article
Impact and seasonality of human rhinovirus infection in hospitalized patients for two consecutive years
Impacto e sazonalidade da infecção por rinovírus humano em pacientes internados por dois anos consecutivos
Jaqueline Leottea, Hygor Trombettaa, Heloisa Z. Faggiona, Bernardo M. Almeidab, Meri B. Nogueirac, Luine R. Vidalc, Sonia M. Rabonia,c,
Corresponding author
a Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Doenças Infecciosas, Curitiba, PR, Brazil
b Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Epidemiologia Hospitalar, Curitiba, PR, Brazil
c Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Laboratório de Virologia, Curitiba, PR, Brazil
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RVH A/B/C, rinovírus humano tipos A/B/C; VSR, vírus sincicial respiratório; EV, enterovírus; FLU, vírus da gripe A e B; PIV, vírus parainfluenza; ADV, adenovírus; MPV, metapneumovírus humano; CoV, coronavírus; BoV, bocavírus humano.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jaqueline Leotte, Hygor Trombetta, Heloisa Z. Faggion, Bernardo M. Almeida, Meri B. Nogueira, Luine R. Vidal, Sonia M. Raboni" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Jaqueline" "apellidos" => "Leotte" ] 1 => array:2 [ "nombre" => "Hygor" "apellidos" => "Trombetta" ] 2 => array:2 [ "nombre" => "Heloisa Z." "apellidos" => "Faggion" ] 3 => array:2 [ "nombre" => "Bernardo M." "apellidos" => "Almeida" ] 4 => array:2 [ "nombre" => "Meri B." "apellidos" => "Nogueira" ] 5 => array:2 [ "nombre" => "Luine R." "apellidos" => "Vidal" ] 6 => array:2 [ "nombre" => "Sonia M." 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Faggion, Bernardo M. Almeida, Meri B. Nogueira, Luine R. Vidal, Sonia M. Raboni" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Jaqueline" "apellidos" => "Leotte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Hygor" "apellidos" => "Trombetta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Heloisa Z." "apellidos" => "Faggion" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Bernardo M." "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Meri B." 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"apellidos" => "Raboni" "email" => array:1 [ 0 => "sraboni@ufpr.br" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Doenças Infecciosas, Curitiba, PR, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Epidemiologia Hospitalar, Curitiba, PR, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Laboratório de Virologia, Curitiba, PR, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Impacto e sazonalidade da infecção por rinovírus humano em pacientes internados por dois anos consecutivos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 913 "Ancho" => 2490 "Tamanyo" => 205871 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Human rhinovirus infections: seasonality, monthly median temperature, and rainfall data, 2012–2013, Curitiba, Brazil. HRV, human rhinovirus; RV, respiratory viruses.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Human rhinoviruses (HRVs) belong to <span class="elsevierStyleItalic">Picornaviridae</span> family, genus <span class="elsevierStyleItalic">Enterovirus</span>, and are divided in three species (HRV-A, HRV-B, and HRV-C) with about 100 serotypes within these species.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,2</span></a> The development of highly-sensitive molecular techniques for characterization of the HRV genome has recently allowed recognition of the HRV-C species.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> There is already evidence that this new species may be more virulent and more strongly associated with lower respiratory tract infections than HRV-A and HRV-B.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">HRV is the most common cause of upper respiratory tract infections, being responsible for at least 50% of cases of the common cold. This leads to considerable economic burden in terms of medical visits and both school and work absenteeism.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,4</span></a> HRVs have also been linked to lower airway effects that result in significant morbidity and mortality,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> such as exacerbations of chronic pulmonary disease, severe bronchiolitis in infants and children, as well as fatal pneumonia in elderly and immunocompromised adults.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4,5</span></a> In general, HRV infections occur during spring and autumn,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> and manifest differently depending on whether the lower or upper respiratory tract is infected. Infections of the upper respiratory tract ordinarily include symptoms of the common cold, but can present as acute otitis media or rhinosinusitis. On the other hand, infections of the lower respiratory tract can cause severe symptoms and result in bronchiolitis and pneumonia.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In Brazil, since the influenza A pandemic of 2009, referral hospitals have been conducting active surveillance to detect respiratory viruses. Such surveillance includes notification and laboratory investigation of cases meeting the diagnostic criteria of severe acute respiratory infection (SARI). This viral respiratory infection monitoring has resulted in important information about the circulation of other community-acquired respiratory viruses (CRV). The present study reports the epidemiological features, clinical characteristics, and outcomes of HRV infections in comparison with other CRV infections in patients hospitalized in a referral hospital in Southern Brazil, for two consecutive years.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient selection and data acquisition</span><p id="par0020" class="elsevierStylePara elsevierViewall">Patients hospitalized at an academic tertiary care center in Southern Brazil from whom respiratory samples were collected and sent for investigation, or who were diagnosed with SARI in 2012 or 2013, were included in the study. Respiratory samples (nasal swab or nasopharyngeal aspirate, or bronchoalveolar lavage) were collected in different periods of hospitalization according to medical recommendation. Individuals with more than one sample collected during the same symptomatic period were considered as a single case and only the first result was evaluated, so that the number of respiratory viral detections was not overestimated. The medical records and influenza notification forms of patients with detectable respiratory virus were reviewed, focusing on epidemiology, clinical manifestation, outcome, laboratory findings, and diagnosis of SARI. SARI was defined as a flu-like syndrome with signs of severity (dyspnea or oxygen saturation below 95%).</p><p id="par0025" class="elsevierStylePara elsevierViewall">During the study, a total of 1002 cases were identified in both databases. Of these, five cases were excluded because the researchers could not access the medical records and a further 242 were excluded as no samples had been sent for virus detection. Thus, 755 patients with respiratory samples investigated for respiratory virus detection were included. The Institutional Ethics Review Board approved the study (No. #18714013.4.0000.0096).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Respiratory virus (RV) detection</span><p id="par0030" class="elsevierStylePara elsevierViewall">RVs were detected using a multiplex reverse transcription polymerase chain reaction (RT-PCR) technique. The viral genome was extracted using a High Pure Viral RNA Kit (Roche Inc., Mannheim, Germany) in accordance with the manufacturer's instructions. First strand cDNA synthesis was achieved using random primers and an ImProm-II reverse transcription system (Promega Inc., WI, USA). The resulting cDNA was then subject to PCR by using a Seeplex<span class="elsevierStyleSup">®</span> RV15 ACE Detection Kit (Seegene Inc., Korea), in accordance with the manufacturer's protocol. This multiplex PCR technology enables a simultaneous detection of 15 respiratory viruses: human adenovirus (AdV), human metapneumovirus (MPV), parainfluenza virus type 1, 2, 3, and 4 (PIV-1, PIV-2, PIV-3, and PIV-4), influenza A (FLUA), influenza B (FLUB), respiratory syncytial virus type A and B (RSV-A, RSV-B), human rhinovirus types A/B/C (HRV), human enterovirus (EV), human bocavirus (BoV), and human coronavirus (CoV) types 229E/NL63 (alpha coronaviruses) and OC43/HKU1 (beta coronaviruses).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Data were compiled using JMP version 5.2.1 (SAS Institute Inc., Cary, NC, USA) and analyzed using GraphPad Prism version 5.03 (GraphPad Software Inc., CA, USA). Parametric and non-parametric tests were used as appropriate. The nonparametric Spearman correlation coefficient was used to analyze meteorological data. Variables with an associated <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 in the univariate analysis and those considered as confounding factors (age and length of hospitalization) were subjected to multivariate logistic regression to identify independent predictors for severe disease. All <span class="elsevierStyleItalic">p</span>-values were two-tailed and a value of <0.05 was considered significant.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Meteorological data</span><p id="par0040" class="elsevierStylePara elsevierViewall">Curitiba is located in Southern Brazil and has a temperate climate. Data on monthly measures of temperature and rainfall were supplied by the Meteorological System of Paraná (Sistema Meteorológico do Paraná [SIMEPAR]).</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 444 (444/755; 59%) samples were positive for CRV infection, including 201 (201/444; 45%) cases in 2012 and 243 (55%) in 2013. The most frequently detected viruses were HRV (37%) and RSV (36%; <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were 162 cases positive for HRV over the study period: 83 (51%) in 2012 and 79 (49%) in 2013, with 282 cases of other respiratory viruses infections during the same period.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">To evaluate the epidemiological profile and clinical impact HRV infections, data from HRV infected patients were compared with those with other CRV infections, groups 1 and 2, respectively) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). For this analysis, only cases with single infections were included, excluding nosocomial infections, since given that patients with nosocomial infections were already in the hospital, it would be expected that they would have some underlying illness, which could overestimate the severity of infections. Most HRV infected patients were younger than 2 years (57%), 53% were younger than 1 year, and 37% were younger than 6 months of age. The groups showed no statistically significant difference in median age. Gender was unequally distributed between the groups.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The main clinical manifestations observed in both groups included fever, cough, and dyspnea. However, the HRV positive group had a significantly lower proportion of cases with fever (62%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001), and more comorbidities than the other group (40% <span class="elsevierStyleItalic">vs.</span> 27%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.043). Although immunosuppression, chronic lung disease, and heart disease were the major medical conditions present in both groups, chronic lung disease was more frequent in the HRV group (17%), but without significant difference. Concerning the diagnosis of SARI, there were fewer patients diagnosed with this syndrome in the HRV group (60%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006) than in the other CRV group. In the multivariate analysis of the relationship between clinical characteristics significantly different between the HRV- and other CRV-groups, only the higher prevalence of previous comorbidities in the HRV group was significant. Patients with no comorbidities were 1.6 (95% CI: 1.04–2.34) times more likely to be infected CRVs other than HRV, in comparison to patients with comorbidities.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Despite the fact that most of chest X-rays of HRV infected cases were missed (53%), radiologic alterations were described in 83% of the performed exams. Most of the findings observed were interstitial infiltrate (33%) and pulmonary consolidation (28%), with no significant difference between both groups.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Severe disease was defined as that requiring mechanical ventilatory support, or intensive care unit (ICU) admission, or death during hospitalization; no significant difference was found between the groups. Two HRV infected patients died during hospitalization, both from respiratory infection complications.</p><p id="par0070" class="elsevierStylePara elsevierViewall">HRV had the highest rates of coinfection (69%) of the 128 samples with more than one CRV detected. The viruses most co-detected with HRV were EV (40/88; 45%) and RSV (29/88; 33%), as shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. In 52% of cases, the co-detection involved HRV plus another virus, and in 16% of cases, HRV was associated with two or more viruses. In 65 cases, HRV was the only virus detected.</p><p id="par0075" class="elsevierStylePara elsevierViewall">A comparison of the clinical characteristics of mono-infected HRV patients with co-infected HRV patients was performed, and no relation between viral co-detection and disease severity (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.717) was found. The clinical features significantly associated with HRV co-detection were as follows: age 6–48 months (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3.2; 95% CI: 1.3–8.1), length of hospitalization more than 30 days (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9.7; 95% CI: 2.5–36.8), and no SARI diagnosis (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.0; 95% CI: 1.7–9.3). As co-infection with HRV alone was not related with severe disease, a second analysis was performed comparing disease severity between HRV co-infected patients and patients infected with other CRVs. Neither the presence nor absence of HRV co-detection was associated with disease severity (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.196).</p><p id="par0080" class="elsevierStylePara elsevierViewall">Cases of HRV infection occurred throughout the study period (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The months of May to August demonstrated the highest number of HRV infections during 2012, peaking in August (17 cases; 10%). In 2013, the seasonality of HRV infection was from March to May, peaking in May (19 cases; 12%). Comparing the monthly distribution of HRV cases with average temperature (°C) and rainfall (mm), a negative correlation between the number of HRV cases and the average temperature (<span class="elsevierStyleItalic">r</span>s<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.636, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) was demonstrated, but there was no significant correlation with rainfall (<span class="elsevierStyleItalic">r</span>s<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.036, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.866).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Since the implementation of systematic investigation into respiratory viruses in hospitalized patients with SARI, HRV has been found with high frequency, either alone or co-detected with other respiratory viruses. Since some of these infections may have a poor prognosis, including death, it is critical to know and better characterize this infection to be prepared for its early diagnosis, appropriate clinical management, and prevention of nosocomial spread.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The high frequency of HRV found in clinical samples from patients with SARI was similar to that reported by Kim et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> in a tertiary hospital in Korea. He et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> analyzed a hospitalized pediatric population and found a prevalence of 48%, while Walker and Ison<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> found a prevalence of 14% in a hospitalized adult population. This difference between age groups was observed in this study, emphasizing the greater vulnerability of children to this infection, probably as consequence of a more intense inflammatory process triggered by primary infection or by favorable anatomical conditions of the respiratory tract in younger children.</p><p id="par0095" class="elsevierStylePara elsevierViewall">RSV was the first pathogen identified to be associated with the severe respiratory disease in children. However, since the development of molecular techniques to detect HRV, this virus has been the focus of the most recent studies in this field. Nowadays, HRV infections have been linked with exacerbations of chronic lung diseases and fatal pneumonia in patients at the extremes of age or with pre-existing comorbidities.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4,5</span></a> The importance of one study that evaluated the characteristics of HRV infections in a tertiary hospital is based on these new concerns. Marcone et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> reported a higher number of HRV infections in hospitalized children in Argentina when compared with pediatric outpatients with acute respiratory infection, demonstrating a scenario that contributed to the increased concern about HRV infection in the hospital setting.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Previous studies have reported that the HRV infection rate in hospitals varies from 21% to 41%.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8,11,12</span></a> However, this variation is probably accounted for by the differences in age and clinical characteristics of patients analyzed in each study. Although this study included all age groups, a predominance of pediatric patients infected with HRV was observed, mostly younger than 1 year old. In addition, the HRV-positive group had a greater proportion of patients with pre-existing comorbidities than the group with other identified CRVs.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6,7,11–14</span></a> Among the comorbidities observed in this study, chronic lung diseases were frequent in the HRV group, a correlation that has already been demonstrated in another similar study,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> which corroborates the close association of HRV infection and exacerbations of chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), asthma, and cystic fibrosis.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Of 444 samples positive for CRVs, 128 samples (29%) had at least two co-detected viruses, in keeping with the expected 10–31% encountered in hospitalized individuals.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">7,8,15</span></a> The viruses most frequently co-detected with HRV were EV (45%), RSV (33%), and AdV (18%); consistent with previously reported patterns.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">14,15</span></a> However, the high frequency of EV and HRV co-detection may be as a result of using the 5′NRT region of the viral genome to identify both pathogens, which may have lowered the specificity of the RT-PCR test.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> A more appropriate means to discern between these species would be to carry out the RT-PCR followed by nucleotide sequencing of amplicons.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> The high level of dual infection involving HRV and RSV is often explained both by the coexistence of these viruses throughout the year and their similar seasonal variation,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> but this hypothesis is not unanimous.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In contrast to findings reported by Goka et al.,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> this study did not show an association between disease severity and viral co-detections. Furthermore, HRV was not found to have a protective influence in cases where it was involved in co-detection, as there was no significant difference in disease severity when comparing the groups with or without HRV co-detection. Likewise, in contradiction to the present findings, Asner et al.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> observed an increased disease severity in children infected with HRV alone. Among the probable factors associated with these contrasting findings, the following may be cited: (i) analysis in different groups of patients (outpatient and hospitalized), (ii) assessing a small number of patients, and (iii) adoption of different severity criteria.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Fever was less frequent in patients infected with HRV compared to other CRVs.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">19,20</span></a> Chest X-ray findings were normal in 17%, showed interstitial infiltrate in 33%, and demonstrated pulmonary consolidation in 28% of cases, with no significant difference between the HRV and other CRV groups. These patterns are similar to those reported by Fica et al.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> in hospitalized adults in Chile. There were significantly fewer cases of SARI diagnosed in the patients infected with HRV than other CRVs. Overall, 14% (110/770) of patients with SARI were infected with HRV. This concurs with a previous study.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Reports about the seasonality of HRV infection, including a study from Argentina,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> which is in close geographical proximity of Southern Brazil, show that it circulates mainly in autumn and spring.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">7,8,19</span></a> Although HRV occurred in almost all months of the study period, different peaks were observed in 2012 and 2013, and neither peak included spring. In 2013, the highest prevalence of HRV infection was in autumn, followed by winter, and <span class="elsevierStyleItalic">vice versa</span> in 2012. The analysis of meteorological data found a negative correlation between the number of HRV cases and the average temperature, but no significant correlation with rainfall. However, in order to more accurately establish the seasonality of HRV infections, the analysis should include additional years.</p><p id="par0125" class="elsevierStylePara elsevierViewall">This research had some limitations: (i) it was a retrospective study and some medical records were incomplete; (ii) HRV species were not identified, which would have yielded important data since the genotypes reportedly have different virulence; (iii) this analysis was carried out only with hospitalized patients, which may have overestimated the impact of HRV infection; and (iv) it was not possible to evaluate the frequency of nosocomial HRV infection, data critical to guide preventive measures in the most affected settings. However, this is the first report about HRV infections in the region and a critical analysis of the data is important to obtain greater awareness of the dynamics of dispersion and impact of these respiratory viruses in the community.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion, HRV has a high prevalence in the hospitalized children and was present in cases of severe disease, including death. However, a dependent relationship between the presence of HRV in viral co-detections and severity of disease was not observed in this study. Conflicts in the literature demand a closer analysis of cases of co-detection involving HRV with review of the data to determine the impact of this, since the lack of standardization between studies probably contributes to the divergent data. HRV infection is closely associated with comorbidities, mainly chronic lung diseases, and is an important factor in exacerbations of these underlying lung diseases. The colder seasons were the period with higher frequency of HRV infections in Southern Brazil, and therefore must be a period to warn clinicians about young age children affected by respiratory infections, especially those with comorbidities such as chronic lung disease. Patients with this profile should have respiratory samples collected to identify possible viral infection, and if HRV is detected, the medical staff should be ready for adequate management, taking into consideration the possible poor outcomes.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0135" class="elsevierStylePara elsevierViewall">SMR is sponsored by a <span class="elsevierStyleGrantSponsor" id="gs1">CNPq</span> fellowship.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres838104" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec833838" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres838105" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec833837" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient selection and data acquisition" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Respiratory virus (RV) detection" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Meteorological data" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-06-27" "fechaAceptado" => "2016-07-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec833838" "palabras" => array:3 [ 0 => "Human rhinovirus" 1 => "Acute respiratory infections" 2 => "Respiratory virus" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec833837" "palabras" => array:3 [ 0 => "Rinovírus humano" 1 => "Infecções respiratórias agudas" 2 => "Vírus respiratório" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To report epidemiological features, clinical characteristics, and outcomes of human rhinovirus (HRV) infections in comparison with other community acquired respiratory virus (CRV) infections in patients hospitalized for two consecutive years.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a cross-sectional study. Clinical, epidemiological, and laboratory data of patients hospitalized with acute respiratory syndrome in a tertiary care hospital from 2012 to 2013 were reviewed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">HRV was the most common CRV observed (36%, 162/444) and was present in the majority of viral co-detections (69%, 88/128), mainly in association with human enterovirus (45%). Most HRV-infected patients were younger than 2 years (57%). Overall, patients infected with HRV had a lower frequency of severe acute respiratory infection than those infected with other CRVs (60% and 84%, respectively, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006), but had more comorbidities (40% and 27%, respectively; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.043). However, in the adjusted analysis this association was not significant. The mortality rate within the HRV group was 3%. Detection of HRV was more prevalent during autumn and winter, with a moderately negative correlation between viral infection frequency and temperature (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.636, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) but no correlation with rainfall (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.036, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.866).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">HRV is usually detected in hospitalized children with respiratory infections and is often present in viral co-detections. Comorbidities are closely associated with HRV infections. These infections show seasonal variation, with predominance during colder seasons.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Relatar as características epidemiológicas, as características clínicas e os resultados das infecções por rinovírus humano (RVH) em comparação a outras infecções por vírus respiratórios adquiridos na comunidade (VRCs) em pacientes internados por dois anos consecutivos.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este foi um estudo transversal. Foram revisados os dados clínicos, epidemiológicos e laboratoriais de pacientes internados com síndrome respiratória aguda em um hospital terciário de 2012 a 2013.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O RVH foi o VRC mais comum observado (36%, 162/444) e esteve presente na maior parte das codetecções virais (69%, 88/128), principalmente em associação ao enterovírus humano (45%). A maioria dos pacientes infectados por RVH possuía menos de 2 anos (57%). De modo geral, os pacientes com RVH apresentaram uma menor frequência de infecção respiratória aguda grave que os pacientes infectados por outros VRCs (60% e 84%, respectivamente, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,006), porém mais comorbidades (40% e 27%, respectivamente; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,043). Contudo, em uma análise ajustada, essa associação não foi significativa. A taxa de mortalidade no grupo RVH foi 3%. A detecção de RVH foi mais prevalente durante o outono e inverno, com uma correlação negativa moderada entre a frequência de infecção viral e a temperatura (r<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>-0,636, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), porém nenhuma correlação com a precipitação (r<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>-0,036, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,866).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusão</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O RVH é normalmente detectado em crianças internadas com infecções respiratórias e normalmente está presente em codetecções virais. As comorbidades estão estreitamente associadas a infecções por RVH. Essas infecções mostram variação sazonal, com predominância durante as estações mais frias.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Leotte J, Trombetta H, Faggion HZ, Almeida BM, Nogueira MB, Vidal LR, et al. Impact and seasonality of human rhinovirus infection in hospitalized patients for two consecutive years. J Pediatr (Rio J). 2017;93:294–300.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 939 "Ancho" => 2373 "Tamanyo" => 70296 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Respiratory virus detected in hospitalized patients with acute respiratory infection in a tertiary hospital, Southern Brazil, 2012–2013 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>755). HRV A/B/C, human rhinovirus types A/B/C; RSV, respiratory syncytial virus; EV, enterovirus; FLU, influenza A and B viruses; PIV, parainfluenza viruses; ADV, adenovirus; MPV, human metapneumovirus; CoV, human coronaviruses; BoV, human bocavirus.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 913 "Ancho" => 2490 "Tamanyo" => 205871 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Human rhinovirus infections: seasonality, monthly median temperature, and rainfall data, 2012–2013, Curitiba, Brazil. HRV, human rhinovirus; RV, respiratory viruses.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">HRV, human rhinovirus; CRV, community-acquired respiratory virus; IQR, interquartile range, ICU, intensive care unit; SARI, severe acute respiratory infections; NS, not significant, OR, odds ratio.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Bold values are in statistically significant.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">HRV (group 1) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">CRV (group 2) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Unadjusted analyses \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Adjusted analyses \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>60 (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>196 (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92 (47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">138 (70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2–5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5–14 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>14–50 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>>50 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>(IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(0.2–8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(0.2–2.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Length of hospitalization</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><5 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5–15 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">109 (55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>15–30 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>>30 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median, days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">0.0032</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>(IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(2–9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(4.2–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Symptoms</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 (62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">168 (85) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">0.001</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cough \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55 (92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">189 (96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyspnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56 (93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">183 (93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Radiological findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Missed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18(9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Interstitial infiltrate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pulmonary consolidation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mixed patterns \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other findings<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">0.043</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">0.033</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Immunosuppression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chronic lung disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chronic heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.067 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mechanical ventilation</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ICU</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Death</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SARI diagnosis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">165 (84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">0.006</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1414573.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Pleural effusion, atelectasis.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparison of the clinical and epidemiological profile of patients hospitalized with HRV- <span class="elsevierStyleItalic">vs.</span> other CRV-monoinfections, 2012–2013.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of the complete genome sequences of human rhinovirus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 1 | 7 |
| 2024 October | 25 | 38 | 63 |
| 2024 September | 39 | 33 | 72 |
| 2024 August | 56 | 38 | 94 |
| 2024 July | 49 | 40 | 89 |
| 2024 June | 19 | 13 | 32 |
| 2024 May | 20 | 18 | 38 |
| 2024 April | 21 | 21 | 42 |
| 2024 March | 21 | 15 | 36 |
| 2024 February | 13 | 18 | 31 |
| 2024 January | 18 | 19 | 37 |
| 2023 December | 15 | 20 | 35 |
| 2023 November | 24 | 27 | 51 |
| 2023 October | 25 | 36 | 61 |
| 2023 September | 31 | 34 | 65 |
| 2023 August | 33 | 18 | 51 |
| 2023 July | 27 | 16 | 43 |
| 2023 June | 17 | 9 | 26 |
| 2023 May | 24 | 14 | 38 |
| 2023 April | 16 | 11 | 27 |
| 2023 March | 23 | 15 | 38 |
| 2023 February | 14 | 13 | 27 |
| 2023 January | 17 | 17 | 34 |
| 2022 December | 24 | 25 | 49 |
| 2022 November | 26 | 24 | 50 |
| 2022 October | 25 | 31 | 56 |
| 2022 September | 15 | 33 | 48 |
| 2022 August | 22 | 26 | 48 |
| 2022 July | 20 | 27 | 47 |
| 2022 June | 19 | 30 | 49 |
| 2022 May | 30 | 26 | 56 |
| 2022 April | 37 | 35 | 72 |
| 2022 March | 32 | 40 | 72 |
| 2022 February | 13 | 23 | 36 |
| 2022 January | 13 | 16 | 29 |
| 2021 December | 11 | 25 | 36 |
| 2021 November | 14 | 17 | 31 |
| 2021 October | 13 | 19 | 32 |
| 2021 September | 7 | 10 | 17 |
| 2021 August | 10 | 8 | 18 |
| 2021 July | 9 | 7 | 16 |
| 2021 June | 9 | 4 | 13 |
| 2021 May | 9 | 12 | 21 |
| 2021 April | 10 | 14 | 24 |
| 2021 March | 16 | 12 | 28 |
| 2021 February | 8 | 6 | 14 |
| 2021 January | 14 | 12 | 26 |
| 2020 December | 10 | 10 | 20 |
| 2020 November | 18 | 10 | 28 |
| 2020 October | 16 | 10 | 26 |
| 2020 September | 24 | 13 | 37 |
| 2020 August | 10 | 7 | 17 |
| 2020 July | 4 | 5 | 9 |
| 2020 June | 12 | 5 | 17 |
| 2020 May | 4 | 13 | 17 |
| 2020 April | 8 | 9 | 17 |
| 2020 March | 7 | 7 | 14 |
| 2020 February | 13 | 17 | 30 |
| 2020 January | 15 | 17 | 32 |
| 2019 December | 8 | 6 | 14 |
| 2019 November | 2 | 3 | 5 |
| 2019 October | 13 | 22 | 35 |
| 2019 September | 12 | 19 | 31 |
| 2019 August | 8 | 11 | 19 |
| 2019 July | 10 | 14 | 24 |
| 2019 June | 9 | 17 | 26 |
| 2019 May | 8 | 5 | 13 |
| 2019 April | 15 | 12 | 27 |
| 2019 March | 12 | 17 | 29 |
| 2019 February | 6 | 5 | 11 |
| 2019 January | 10 | 9 | 19 |
| 2018 December | 18 | 5 | 23 |
| 2018 November | 25 | 9 | 34 |
| 2018 October | 109 | 14 | 123 |
| 2018 September | 73 | 16 | 89 |
| 2018 August | 30 | 4 | 34 |
| 2018 July | 32 | 5 | 37 |
| 2018 June | 37 | 5 | 42 |
| 2018 May | 70 | 11 | 81 |
| 2018 April | 14 | 2 | 16 |
| 2018 March | 11 | 2 | 13 |
| 2018 February | 8 | 2 | 10 |
| 2018 January | 12 | 3 | 15 |
| 2017 December | 13 | 3 | 16 |
| 2017 November | 23 | 3 | 26 |
| 2017 October | 17 | 2 | 19 |
| 2017 September | 10 | 4 | 14 |
| 2017 August | 14 | 3 | 17 |
| 2017 July | 24 | 8 | 32 |
| 2017 June | 24 | 11 | 35 |
| 2017 May | 24 | 9 | 33 |
| 2017 April | 1 | 3 | 4 |
| 2017 March | 0 | 4 | 4 |
| 2017 February | 1 | 5 | 6 |
| 2017 January | 2 | 12 | 14 |
| 2016 December | 0 | 8 | 8 |
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