Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 21, Number 2—February 2015

Acquisition of Human Polyomaviruses in the First 18 Months of Life

Article Metrics
citations of this article
EID Journal Metrics on Scopus
Rebecca RockettComments to Author , Seweryn Bialasiewicz, Lebogang Mhango, Jane Gaydon, Rebecca Holding, David Whiley, Stephen B. Lambert, Robert S. Ware, Michael D. Nissen, Keith Grimwood, and Theo P. Sloots
Author affiliations: Queensland Children’s Medical Research Institute, Brisbane, Queensland, Australia (R.J. Rockett, S. Bialasiewicz, L. Mhango, J. Gaydon, R. Holding, D.M. Whiley, S. B. Lambert, R.S.Ware, M.D. Nissen, K. Grimwood, T. P. Sloots); The University of Queensland, Brisbane (R.S. Ware); Queensland Health, Brisbane (S.B. Lambert); Pathology Queensland Central Laboratory, Herston, Queensland, Australia (M.D. Nissen); Griffith University, Gold Coast, Queensland, Australia (K. Grimwood); Gold Coast University Hospital, Gold Coast (K. Grimwood)

Cite This Article


We investigated the presence of 4 human polyomaviruses (PyVs) (WU, KI, Merkel cell, and Malawi) in respiratory specimens from a community-based birth cohort. These viruses typically were acquired when children were ≈1 year of age. We provide evidence that WU, KI, and Malawi, but not Merkel cell PyVs, might have a role in respiratory infections.

Human polyomaviruses (PyVs) JC and BK were discovered in 1971 and are believed to be acquired by a respiratory or fecal–oral route (1). They predominantly cause disease in immunocompromised persons (2). In the past 7 years, 11 new human PyVs have been described. These include WU (WUPyV), KI (KIPyV), Merkel cell (MCPyV), and Malawi (MWPyV) PyVs, all of which have been detected in respiratory secretions, particularly from children (3). Whether these viruses are pathogenic or simply passengers in the respiratory tract is not known. WUPyV and KIPyV were the first respiratory tract–associated PyVs and were discovered in children with acute respiratory infections (4,5).

MCPyV was identified in Merkel cell carcinoma tissue, and evidence suggested that genome integration of MCPyV initiates cell transformation (6). MCPyV has also been reported in respiratory samples, but potential skin or environmental contamination of respiratory samples must be considered (79). In 2013, MWPyV was detected in the fecal sample of a healthy child, and it has also been detected in samples from patients with gastrointestinal symptoms and in anal warts (10,11). We recently reported that MWPyV was frequently present in respiratory secretions, particularly in children <5 years of age (12). However, most of these studies were performed on convenience samples from acutely ill patients and included no samples or limited numbers of samples from healthy controls.

We investigated the presence of the respiratory-associated human PyVs (WUPyV, KIPyV, MCPyV, and MWPyV) in samples collected weekly, regardless of symptoms, from healthy children in Australia during their first 18 months of life. These children were participating in a community-based longitudinal birth cohort study (Observational Research in Childhood Infectious Disease [ORChID]).

The Study

The ORChID study is an ongoing dynamic birth cohort study in Brisbane (Queensland, Australia) that has been described (13). The study was approved by the Human Research Ethics Committees of the Children’s Health Queensland Hospital and Health Service, the Royal Brisbane and Women’s Hospital, and The University of Queensland. In brief, anterior nasal swab specimens were collected at birth and weekly until the child’s second birthday (Technical Appendix).

The present study reports on the first 56 children to complete 18 months (censored for swab specimens collected after 530 study days) of the ORChID study. A total of 3,851 nasal swab specimens (mean 69 swab specimens/child, range 41–77 swab specimens/child) during 29,678 person-days of observation (mean 530 person-days of observation/participant, range 384−560 person-days of observation/participant). These samples were tested for WUPyV, KIPyV, MCPyV, and MWPyV by using reported real-time PCRs (12,13). Samples were screened for 13 common respiratory viruses according to the ORChID study protocol (Technical Appendix).

A sole detection episode was defined as ≥1 consecutive swab specimens in which an individual PyV was the only virus detected, and no other viruses were reported 7 days before or after detection of the PyV. Detection of a different PyV or the same PyV after 30 days and ≥2 intervening negative samples was considered a new infection episode. During the period of the sole detection episode, clinical symptoms were broadly categorized as upper respiratory, lower respiratory, nonspecific, and gastrointestinal (Technical Appendix). Nonspecific symptoms were only separately categorized when unaccompanied by upper or lower respiratory symptoms. Gastrointestinal symptoms were recorded in the presence or absence of respiratory symptoms.

All 4 novel PyV viruses were detected in respiratory samples from children ≤18 months of age; MWPyV was the predominant virus (157 positive detections) (Table 1). A total of 23% (13/56 for MCPyV) and 56% (31/56 for MWPyV) of children had ≥1 positive result for 1 of the PyVs. WUPyV, KIPyV, and MWPyV were initially detected when the child was ≈1 year of age, and each virus was detected for a mean of 2 consecutive weeks after primary detection. MCPyV was detected less frequently; primary detections occurred in children ≈7 months of age, which was earlier than detection of WUPyV, KIPyV, and MWPyV (p<0.001, by Mann-Whitney 2-tailed test with pairwise comparisons of ages). MCPyV was not seen in any consecutive swab specimen collections.

WUPyV (50%, 18/36) and KIPyV (49%, 31/63) were commonly detected with other respiratory viruses. MWPyV (33%, 52/157) and MCPyV (21%, 3/13) had lower semiquantitative viral loads (p<0.001, by Mann-Whitney 2-tailed test with pairwise comparisons of cycle thresholds), and were less frequently detected with other respiratory viruses (Table 1; Technical Appendix).

Symptoms were reported during sole detection episodes for WUPyV, KIPyV, and MWPyV, but not for MCPyV (Table 2). During symptomatic episodes, numerous overlapping respiratory virus detections were commonly observed, which made sole detection episodes of PyV too rare to be considered in a formal statistical analysis. However, sole detection episodes corresponded to parental reporting of clinical symptoms for 57% (4/7) of WUPyV and 36% of KIPyV (5/14) and MWPyV (13/36) infection episodes (Table 2). Most symptoms reported during the sole detection episodes were upper respiratory (Table 2).


Primary acquisition of WUPyV, KIPyV, and MWPyV occurred most commonly when children were ≈12 months of age, which is consistent with previous serologic data showing PyV primary infection in children at an early age (3). MCPyV was also detected within this cohort, but age, frequency of detection, and lower levels of viral shedding contrasted with the findings for WUPyV, KIPyV, and MWPyV. This finding is supported by other retrospective studies that showed that MCPyV is more frequently detected in the respiratory tract of adults (7). Previously reported high co-detection rates of WUPyV and KIPyV with other respiratory viruses (>70%) have hampered efforts to associate these viruses with clinical symptoms (3,14). However, we observed a lower rate of PyV co-detection, which enables us to examine the association of PyV sole detection episodes with symptoms. This examination showed that most symptoms were upper respiratory, although gastrointestinal symptoms were also reported during WUPyV, KIPyV, and MWPyV sole detection episodes.

A higher viral load was observed for WUPyV and KIPyV than for MWPyV and MCPyV. Although use of cycle thresholds as a semiquantitative marker has some limitations, thresholds suggest that WUPyV and KIPyV actively replicate in the respiratory tract and may account for the higher rate of reported symptoms with sole detection of WUPyV. A previous study in the Netherlands also reported a higher symptom association of WUPyV than KIPyV, but MWPyV was not investigated in that study (15). MWPyV was first detected in fecal specimens from healthy children, but we found that MWPyV was the most prevalent PyV detected in respiratory specimens and that it was associated with upper respiratory infection symptoms in >33% of sole detection episodes. We found that 1/36 participants had gastrointestinal symptoms during an episode of MWPyV sole detection, which is an observation that warrants further investigation.

MCPyV is shed from healthy skin, and MWPyV has been detected in anal warts. Thus, a limitation of this study is potential cutaneous contamination of swab specimens by the parent or child during sample collection. Although the complex nature of virus acquisition and overlapping intervals of virus detection confound the association of PyV sole detection episodes with particular symptoms, our data show that WUPyV, KIPyV, and MWPyV, but not MCPyV, are frequently detected within the respiratory tract of healthy children <18 months of age and are associated with mild upper respiratory symptoms.

Dr. Rockett is a senior research scientist at Queensland Children’s Medical Research Institute, Brisbane, Queensland, Australia. Her research interests are the biology and pathogenesis of emerging human PyVs, and molecular diagnostic techniques and their application to virus detection.



We thank Anne Cook, Francis Maguire, and Minda Sarna for providing assistance during collection of clinical data.

This study was supported by the National Health and Medical Research Council, Australia (grant 615700), a Queensland Children’s Hospital Research Institute PhD scholarship (grant 5001), and the Children’s Health Foundation (Brisbane, Australia) (program grant 50006).



  1. Bofill-Mas  S, Formiga-Cruz  M, Clemente-Casares  P, Calafell  F, Girones  R. Potential transmission of human polyomaviruses through the gastrointestinal tract after exposure to virions or viral DNA. J Virol. 2001;75:102909. DOIPubMedGoogle Scholar
  2. Monaco  MC, Jensen  PN, Hou  J, Durham  LC, Major  EO. Detection of JC virus DNA in human tonsil tissue: evidence for site of initial viral infection. J Virol. 1998;72:991823 .PubMedGoogle Scholar
  3. Feltkamp  MC, Kazem  S, van der Meijden  E, Lauber  C, Gorbalenya  AE. From Stockholm to Malawi: recent developments in studying human polyomaviruses. J Gen Virol. 2013;94:48296. DOIPubMedGoogle Scholar
  4. Gaynor  AM, Nissen  MD, Whiley  DM, Mackay  IM, Lambert  SB, Wu  G, Identification of a novel polyomavirus from patients with acute respiratory tract infections. PLoS Pathog. 2007;3:e64. DOIPubMedGoogle Scholar
  5. Allander  T, Andreasson  K, Gupta  S, Bjerkner  A, Bogdanovic  G, Persson  MA, Identification of a third human polyomavirus. J Virol. 2007;81:41306. DOIPubMedGoogle Scholar
  6. Feng  H, Shuda  M, Chang  Y, Moore  PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science. 2008;319:1096100. DOIPubMedGoogle Scholar
  7. Goh  S, Lindau  C, Tiveljung-Lindell  A, Allander  T. Merkel cell polyomavirus in respiratory tract secretions. Emerg Infect Dis. 2009;15:48991. DOIPubMedGoogle Scholar
  8. Bialasiewicz  S. Merkel cell polyomavirus DNA in respiratory specimens from children and adults. Emerg Infect Dis. 2009;15:4924. DOIPubMedGoogle Scholar
  9. Foulongne  V, Courgnaudy  V, Champeau  W, Segondy  M. Detection of Merkel polyomavirus on environmental surfaces. J Med Virol. 2011;83:14359. DOIPubMedGoogle Scholar
  10. Siebrasse  EA, Reyes  A, Lim  ES, Zhao  G, Mkakosya  RS, Manary  MJ, Identification of MW polyomavirus, a novel polyomavirus in human stool. J Virol. 2012;86:103216 PubMed. DOIPubMedGoogle Scholar
  11. Buck  CB, Phan  GQ, Raiji  MT, Murphy  PM, McDermott  DH, McBride  AA. Complete genome sequence of a tenth human polyomavirus. J Virol. 2012;86:10887. DOIPubMedGoogle Scholar
  12. Rockett  RJ, Sloots  TP, Bowes  S, O’Neill  N, Ye  S, Robson  J, Detection of novel polyomaviruses, TSPyV, HPyV6, HPyV7, HPyV9 and MWPyV in feces, urine, blood, respiratory swabs and cerebrospinal fluid. PLoS ONE. 2013;8:e62764. DOIPubMedGoogle Scholar
  13. Lambert  SB, Ware  RS, Cook  AL, Maguire  FA, Whiley  DM, Bialasiewicz  S, Observational Research in Childhood Infectious Disease s (ORChID): a dynamic birth cohort study. BMJ Open. 2012;2:pii: e002134.
  14. Babakir-Mina  M, Ciccozzi  M, Perno  CF, Ciotti  M. The novel KI, WU, MC polyomaviruses: possible human pathogens? New Microbiol. 2011;34:18.PubMedGoogle Scholar
  15. van der Zalm  MM. Prevalence and pathogenicity of WU and KI polyomaviruses in children, the Netherlands. Emerg Infect Dis. 2008;14:17879. DOIPubMedGoogle Scholar




Cite This Article

DOI: 10.3201/eid2102.141429

Table of Contents – Volume 21, Number 2—February 2015

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.



Please use the form below to submit correspondence to the authors or contact them at the following address:

Rebecca J. Rockett, Queensland Paediatric Infectious Diseases Laboratory, Queensland Children’s Medical Research Institute, Bldg c28, Back Rd, Herston, Brisbane, QLD 4029, Australia

Send To

10000 character(s) remaining.


Page created: January 21, 2015
Page updated: January 21, 2015
Page reviewed: January 21, 2015
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.