Prevalence of respiratory viruses using polymerase chain reaction in children with wheezing, a systematic review and meta–analysis

INTRODUCTION: Wheezing is a major problem in children, and respiratory viruses are often believed to be the causative agent. While molecular detection tools enable identification of respiratory viruses in wheezing children, it remains unclear if and how these viruses are associated with wheezing. The objective of this systematic review is to clarify the prevalence of different respiratory viruses in children with wheezing. METHODS: We performed an electronic in Pubmed and Global Index Medicus on 01 July 2019 and manual search. We performed search of studies that have detected common respiratory viruses in children ≤18 years with wheezing. We included only studies using polymerase chain reaction (PCR) assays. Study data were extracted and the quality of articles assessed. We conducted sensitivity, subgroup, publication bias, and heterogeneity analyses using a random effects model. RESULTS: The systematic review included 33 studies. Rhinovirus, with a prevalence of 35.6% (95% CI 24.6–47.3, I(2) 98.4%), and respiratory syncytial virus, at 31.0% (95% CI 19.9–43.3, I(2) 96.4%), were the most common viruses detected. The prevalence of other respiratory viruses was as follows: human bocavirus 8.1% (95% CI 5.3–11.3, I(2) 84.6%), human adenovirus 7.7% (95% CI 2.6–15.0, I(2) 91.0%), influenza virus6.5% (95% CI 2.2–12.6, I(2) 92.4%), human metapneumovirus5.8% (95% CI 3.4–8.8, I(2) 89.0%), enterovirus 4.3% (95% CI 0.1–12.9, I(2) 96.2%), human parainfluenza virus 3.8% (95% CI 1.5–6.9, I(2) 79.1%), and human coronavirus 2.2% (95% CI 0.6–4.4, I(2) 79.4%). CONCLUSIONS: Our results suggest that rhinovirus and respiratory syncytial virus may contribute to the etiology of wheezing in children. While the clinical implications of molecular detection of respiratory viruses remains an interesting question, this study helps to illuminate the potential of role respiratory viruses in pediatric wheezing. REVIEW REGISTRATION: PROSPERO, CRD42018115128.