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RV/EV, Seasonal Coronaviruses Most Frequent Respiratory Viruses in Students and Staff


Researchers conducted a voluntary surveillance program in a Kansas City, Missouri, school district to detect the prevalence of respiratory viruses among students and staff members.

Rhinovirus/enterovirus (RV/EV) and seasonal coronaviruses were the respiratory viruses detected most frequently among students and staff members of a Kansas City, Missouri, school district, according to the CDC’s latest Morbidity and Mortality Weekly Report.

The researchers implemented a voluntary surveillance program in a school district that consisted of 33 pre-K to grade 12 schools to gain a better understanding of respiratory viruses. Other than COVID-19, there has not been a wide surveillance for respiratory viruses in primary and secondary schools, they explained. This program occurred between November and April of the 2022–2023 school year.

All district students and staff members were eligible to voluntarily enroll in respiratory virus testing and symptom surveys, which researchers notified them about through existing communication channels. Participants self-collected anterior nasal swabs each month, which the researchers tested using multiplex viral polymerase chain reaction. Additionally, enrolled participants, or their parents or guardians, filled out an electronic survey 36 hours before each monthly test about respiratory virus infection symptoms experienced during the previous 7 days.

In total, the program had 894 total participants. The study population included 639 (71.5%) students, representing 3.0% of the 21,419 total district enrollments, and 255 (28.5%) full-time staff members, equating to 7.1% of the 3577 total employees. The researchers tested 3232 surveillance specimens, 2360 (73.0%) from students and 872 (27.0%) from staff members. Of the 3232 symptom surveys sent, participants completed 2393 (74.0%); researchers collected a median of 4 specimens per participant (IQR = 3­-5).

A total of 805 (24.9%) specimens tested positive for any virus (95% CI; 23.4%-26.4%), and more than one virus was detected in 81 (2.5%) specimens. Overall, researchers detected RV/EV most frequently (392; 12.1%), followed by all seasonal coronaviruses (NL63, HKU1, OC43, and 229E) (181; 5.6%). Researchers noted that they infrequently detected influenza and respiratory syncytial virus, which they explained could be because the testing occurred after seasonal peaks.

Among pre-K and elementary school specimens, researchers frequently detected RV/EV (14.4%; 17.1%), adenovirus (12.2%; 3.3%), and human metapneumovirus (4.4%; 3.7%). The number of student specimens included 1413 (43.7%) from elementary school students, 479 (14.8%) from middle school students, 378 (11.7%) from high school students, and 90 (2.8%) from pre-K students. The median age of students was 10.1 years (IQR = 7.5-12.5 years), and 289 (45.2%) were male. Also, researchers found that pre-K students had the highest prevalence of reporting 1 or more symptoms (41.1%) compared with high school students, who reported symptoms least often (14.0%) (P < .0001).

On the other hand, staff members frequently tested positive for RV/EV (4.8%), seasonal coronaviruses (3.8%), and COVID-19 (3.3%).

The researchers identified 3 limitations to their study, one being that the population consisted only of volunteers, so the results may not represent all students and staff members. Also, participants collected all nasal swabs, but a lack of survey response resulted in approximately 25% of specimens without known symptomatology. Lastly, this report indicated positive laboratory results, not the likelihood of a student or staff member receiving a positive test result during the school year.

Despite these limitations, the researchers noted that these study results displayed the importance of understanding the epidemiology of respiratory viruses in a school setting. Additionally, they expressed their hopes for these results to help make students and staff more aware of the prevalent respiratory viruses in their schools, guiding them in implementing prevention practices.

“To support healthy learning environments for all, it is important to implement strategies to prevent and reduce the spread of infectious diseases, including staying up to date with recommended vaccinations, including COVID-19 and influenza vaccines, practicing good hand hygiene and respiratory etiquette, staying home when sick, and improving indoor ventilation,” the authors wrote.


Goldman JL, Lee BR, Porter J, et al. Notes from the field: multipathogen respiratory virus testing among primary and secondary school students and staff members in a large metropolitan school district — Missouri, November 2, 2022-April 19, 2023. MMWR Morb Mortal Wkly Rep. Published online July 14, 2023. doi:10.15585/mmwr.mm7228a4

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