Background. The incidence and clinical impact of Coronavirus (CoV) infection in elderly persons and those with underlying cardiopulmonary disease over a long duration is not well described. We determined the incidence and clinical impact of 229E and OC43 CoV in this population during four consecutive winters, and compared illnesses to influenza A, respiratory syncytial virus (RSV) and human metapneumovirus (hMPV).Methods. CoV229E and OC43 were detected by RT-PCR and serology in four adult populations under surveillance for acute respiratory illness during the winters of 1999-2003. Cohorts included young healthy adults, healthy elderly, high-risk adults with underlying cardiopulmonary disease, and a hospitalized group.Results. 398 CoV infections were identified, with annual infection rates ranging from 2.8-26% in prospective cohorts, and prevalence ranging from 3.3-11.1% in the hospitalized cohort. The incidence of infections with each strain was similar, although asymptomatic infection and viral co-infection was significantly more common with 229E than OC43 infection. Although the incidence and clinical manifestations were similar for each strain, OC43 infected subjects tended to seek more medical care as OC43 was twice as common as 229E among the hospitalized cohort.Conclusions. CoV infections in the elderly are frequent, likely causing substantial medical disease burden.

Background. Increased pneumococcal loads are associated with severe outcomes. We determined the prevalence of pneumococcal DNA in blood specimens from patients hospitalized with acute lower respiratory tract infection and identified factors associated with invasive pneumococcal pneumonia, bacterial loads, and death.Methods. A total of 8523 patients were enrolled as part of prospective hospital-based surveillance. Blood was collected for quantitative pneumococcal (lytA) detection, and nasopharyngeal specimens were collected for detection of influenza virus and other respiratory viruses by real-time polymerase chain reaction.Results. Of 6396 cases (75%) with lytA results, 422 (7%) were positive for pneumococcal DNA. The prevalences of human immunodeficiency virus (HIV) and influenza virus were 51% (2965/5855) and 8% (485/6358), respectively. On multivariable analysis, HIV infection (adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.6-3.6), influenza virus coinfection (aOR, 1.4; 95% CI, 1.2-2.1), oxygen therapy during admission (aOR, 1.6; 95% CI, 1.1-2.3) and in-hospital death (aOR, 2.1; 95% CI, 1.1-4.0) were significantly associated with increased pneumococcal load. Among lytA-positive patients, after adjustment for length of hospitalization, duration of symptoms, and oxygen therapy during admission, pneumococcal loads ≥10,000 DNA copies/mL (aOR, 3.6; 95% CI, 1.8-7.2) were associated with increased risk of death.Conclusions. HIV and influenza virus infections were associated with elevated pneumococcal loads, which, in turn, were associated with increased risk of death.

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