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Interviewer: A study shows that half the time, a positive test does not mean positively sick. Up next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs, the Science and Research Show is on The Scope.

Interviewer: I'm talking with Dr. Carrie Byington, Professor of Pediatrics at the University of Utah and Co-Director of the Utah Center for a Clinical and Translational Science. Dr. Byington, you've published a study in the journal, "Clinical Infectious Disease," and as a part of this study, you turned up some pretty surprising results about how often infections with respiratory virus actually cause illness. First of all, what do we mean by that?

Dr. Byington: The study that we performed used a very sensitive diagnostic test called PCR and PCR picks up nucleic acid, like DNA and RNA, from different viruses and bacteria. What we know is that it's very sensitive and can pick up these materials very frequently, but as clinicians, sometimes it's difficult for us to interpret a positive test result. We really didn't know how often would we see positive results in individuals who have no symptoms. Like, if I just tested you on a day that you were well, might I find a virus in your nose?

So we did a study over an entire year where we followed families every week and collected samples from them every week, whether or not they were sick. So some days they were sick and some days they were well when we collected the samples. And we also had them fill out symptoms diaries that would tell us had they been sick, did they have a fever, were they having cold symptoms during the time, the week of collection.

So when we were able to put all the data together and to analyze it, we found that about half of the time that we were able to detect a virus in the nose of an individual, they had no symptoms. And so that is really striking to us. It tells us that the virus, at least the viral products of DNA and RNA, their nucleic acid, can stay in our noses for some time. And as a clinician, that information is really important to me when I am faced with a sick patient. So when I'm faced with a sick patient and I have a positive test for a virus, how likely is it that I can attribute the illness to the virus that I found in the nose?

Interviewer: Well, that's interesting. I mean, it kind of calls into question how useful that sort of test is.

Dr. Byington: Well, first of all, I think that having the test is really beneficial and they've been demonstrated to help in the treatment of patients in multiple settings, not just in our study or in Utah, but really all over the world. One of the things that our study will help people to see is that it isn't just 50-50 across the board. It really depends on how old you are and younger children, especially infants and children younger than 5, are much more likely to have symptoms with their viral infection than older adults. So that, as a pediatrician, is useful information to me.
The other thing that was very helpful is, we followed people when they were sick and well and so we were able to see someone acquire a virus and have illness symptoms and then, follow them over the weeks to see how long was it till their symptoms went away and how long was it until their test became negative. And we often see that the symptoms go away before the test becomes negative. And we also saw that different kinds of viruses have different risks for producing symptoms.

So a virus, like influenza, very often produces symptoms, which I think was not terribly surprising. All of us know that influenza is a very serious infection and can lead people to be hospitalized. On the other hand, rhinovirus, which is an extremely common virus and the cause of the common cold, very rarely did adults have symptoms when they had rhinovirus. And even in children, young children, it was only about half the time that they had symptoms with rhinovirus.

So again, as a clinician, if I see a child who is ill, especially a child who is very ill, and I have a positive test for rhinovirus and that's all that I have, I'm going to be suspicious that that rhinovirus is not the cause of the illness that I see before me and that I'm going to need to look for other things to make sure that I'm not missing another potentially treatable infection.

Interviewer: And you had mentioned a really interesting point, which is that someone's symptoms might go away before the virus goes away. Does that mean at that trailing off period that they're still spreading the virus or we don't know?

Dr. Byington: We don't know for sure, but we suspect that they may be able to. So that is also really, really important for a number of reasons. It helps inform us about how we would isolate a patient if they came into the hospital because even if they don't have symptoms, they may be able to spread a virus to someone who is immunocompromised or someone who could become very ill if they were exposed to the virus. So that's really important.

It's also important to us as we think about our healthcare workers, how do we make sure our healthcare workers, who are exposed to so many things, number one, stay healthy, and number two, that we can protect the patients that they are caring for and making sure that our healthcare workers are not spreading the viruses in the hospital setting.

Interviewer: If healthcare providers can kind of understand these new answers between when symptoms arise for each type of virus that might help them to interpret the results that they get in a clinical setting.

Dr. Byington: Well, when you're faced as a clinician with a sick individual, you have to make decisions and you have to make decisions with the best data that you have. You don't always have all the data and you don't always have all the research studies to inform. And so that's one of the reasons this was an important problem that we were encountering every day in our practice and we really wanted to address it.

Announcer: Interesting, informative and all in the name of better health. This is The Scope Health Sciences Radio.

Interviewer: The bigger the family, the more likely they are to get sick. More about that next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on the Scope.

Interviewer: I'm talking to Dr. Carrie Byington, Professor of Pediatrics at the University of Utah and Co-Director of the Utah Center for Clinical and Translational Science. You and your team have published a study in the journal, "Clinical Infectious Disease" monitoring how often families or households are infected with virus. Some of your findings are really striking.

Dr. Byington: We're really excited to publish our findings on the study that we call the BIG LoVE Study, which stands for Better Identification of Germs-Longitudinal Viral Epidemiology Studies. And we've found that individuals who are living alone had a virus detected in their nose between three and four weeks out of the year. When we looked at families with six children living in the household, a virus was detected in the house 87% of the weeks. Almost the entire year

Interviewer: Oh, my gosh.

Dr. Byington:
someone had a virus in the household. So as a pediatrician, it helps me a lot to be able to talk with families who come in and say, "Someone's always sick in the household." And in fact, that's true.

Interviewer: There it is.

Dr. Byington: And it's probably fairly normal. And so that helps us in our practice to be able to reassure families, are they seeing something normal or is their child having more infections than they should be having? And that's a common question I get as a pediatrician.

Interviewer: With each additional child in the family does the amount that that family's infected with virus increase?

Dr. Byington: Having one child changes your risks quite a bit as a household. And you go from having virus in the household from about 7% of the time to about a third of the time, you'll have virus in the household. But, for those families that have two, three, or four children, the risk of virus was fairly constant within the household, about 50% of the weeks. After you passed the threshold of four children, so families with five and six children, we saw another sharp increase in the number of viruses.

Interviewer: And so is it the kids that are bringing the virus into the household?

Dr. Byington: In many cases, yes, it looks like it is the child that's bringing the virus. And especially the very young child. I think it would not be a surprise to parents who have children younger than five that they are commonly infected with a virus. And we've found that in our group that children younger than five had a virus in their nose 50% of the week. One out of every two weeks, they had a virus in their nose.

That, for me, again, as a pediatrician and an investigator is very, very interesting. On the one hand, I'd like to find ways to prevent people from getting sick and to interrupt the transmission, like giving them the flu vaccine to protect them. But on the other hand, I'm very interested in finding out whether there is a benefit to getting certain viruses at certain times during our lives. And I think that that's something

Interviewer: Oh, interesting.

Dr. Byington:
that we can really begin to explore with the data that we've collected. We're learning more and more in the field of infectious diseases about the microbiome and bacteria that we have in our system that may be beneficial to us. And I think we're also going to be learning about the virome, about the virus that we have and carry. How do those viruses interact with the bacteria in our microbiome? How do they interact with our own immune system?

Interviewer: So being infected with virus as a child might be a good thing?

Dr. Byington: Yes, in many cases, I think it can be a good thing. And it can often serve as almost an immunization, if you will, to protect you down the line. But I don't think that we yet know which viruses and which order is important. That's what some of these studies are going to begin to help us do.

Interviewer: And it also might be hard to convince parents of that when it becomes inconvenient to keep kids home from school and things like that.

Dr. Byington: Absolutely. And we need to try to understand how often that's going to happen. And I would say for parents of young children, they can be assured that they're going to have six to seven viral respiratory illnesses each year, their children will have those, and that's quite normal. And they as parents will also get to share in some of those viral illnesses.

Interviewer: So parents of children, are they sick more often than other adults that do not have children?

Dr. Byington: Yes. We did find that in our study. And we found an interesting age breakdown. So parents of younger children, so those in the ages of 18 to 39, were nearly twice as likely to have viruses as older parents who were over the age of 40. So again, the younger parents may have had more exposure through their young children, but maybe the also developed better immunity during that period of time that protected them when they were older than the age of 40. So it's interesting.

Interviewer: Yeah, very interesting. What can we do with this information? What can families do with this information and what can healthcare providers do?

Dr. Byington: Well, I think what this information really does for both families and for healthcare providers is say what's normal, what is the baseline for normal. When should I relax and say this is just what I have to go through in the first two to three years of my child's life and when do I have to be more concerned? It also helps us to know which viruses are really associated with mild illness and which viruses may often result in needing medical care. And so, as a clinician, as a pediatrician, it helps me say which viruses would be really important to focus on for vaccines to try to prevent more serious consequences.

Announcer: Interesting, informative and all in the name of better health. This is The Scope Health Sciences Radio.

Pediatrics is generally a very happy specialty. When it's sad it's a very sad specialty. I think pediatricians bond together for that reason. You know, I've heard people say they can't even walk into the children's hospital. It's too hard, it's too depressing. To me it's a wonderful place filled with hope.

Working with children is difficult because devices, medications, vaccines are all tested on adults. You're always going to be relying on adult studies and children are not just small adults.

About 10% of all infants in the first 90 days will have a fever. It's a really vexing problem especially for young infants. Because any fever could represent a very serious infection you have one chance in the emergency room to get it right. Do you admit them or do you send them home? And you want to make the right choice.

The current recommendation is all of those infants have medical care and that the majority of them would be hospitalized. But that's hundreds of thousands of admissions each year. It's incredibly costly, in the billions of dollars.

For the last 15 years or so, all of my time here at the University of Utah, I have focused on the development and implementation of something we call the Evidence Based Care Process Model. Using input from laboratory staff, nursing staff, administrators and parents we built a care process model that we could all say, "This represents the best possible care that we could give in our system".

We started small with one virus and now we have technology where we can diagnose 15 viruses, we can diagnose bacteria in under an hour. It's now routine in hundreds of hospitals around the country including many children's hospitals. And so being able to go to a parent and say, "I know why your baby has a fever," that is such a relief. And that's where the joy of it is and that's where the benefit of it is. You know that kids are better off not just here but in other places because you did the research.