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Nothing to Sneeze At: Rhinovirus

School nurses are no strangers to the common cold - all those sniffles, sneezes, and coughs come with the territory. And it’s no wonder those symptoms are so familiar. According to Boston Children’s Hospital, people in the United States suffer 1 billion colds yearly, and schools can be breeding grounds for the more than 200 viruses that cause them. There is one virus family, however, that is the most common etiologic agent of the “common cold,” and that is the rhinovirus. The CDC estimates that “children have an average of two rhinovirus infections each year,” resulting in more than 22 million missed school days. That’s a lot of colds and a good reason to take a closer look at rhinoviruses, their impact on students, and how school nurses can help reduce transmission and keep kids healthy and in the classroom. 


Rhinovirus infections are primarily restricted to the upper respiratory tract; however, they can potentially cause other health complications such as otitis media, sinusitis, and pneumonia. These infections can also worsen pre-existing conditions like asthma and chronic bronchitis. Colds caused by rhinovirus infections are prevalent all year round. However, they are responsible for most colds in the fall, contributing to an initial surge in incidence (up to 80%) during this season, with a second “rhino” resurgence typically appearing in late spring. Transmission occurs with exposure to infected respiratory secretions. This can be through touching hands or surfaces, inoculating your own eyes or nose, or even inhaling droplets in the air. 


Generally, rhinoviruses cause mild symptoms that are self-limiting. School-aged children often complain of nasal congestion, cough, and runny nose, but students may also experience sore throat, headaches, body aches, fatigue, and fever. On assessment, students may present with:

  • A red nose with excessive dripping/nasal drainage
  • Nasal drainage is either clear/watery or mucopurulent (yellow or green)
  • Red, watery eyes
  • Throat exam typically within normal limits (no redness or exudate)
  • Slightly swollen but non-tender cervical lymph nodes
  • Chest auscultation may potentially detect rhonchi


According to the AAP, about 5-10% of children with colds develop a secondary bacterial infection or other health problem that may result in symptoms including ear pain, difficulty breathing, persistent fever, severe sinus pressure, or a sore throat lasting longer than five days. 


A typical rhinovirus in children lasts about 10-14 days, although a cough can persist for up to 2-3 weeks. School exclusion policies may differ, but generally, students with a fever, who cannot control secretions or cough, or who are not feeling well enough to participate in all school activities should stay home. Interventions for students experiencing mild rhinovirus symptoms in the school setting may include:

  • Petroleum jelly under the nose to protect from redness
  • Nasal saline spray to relieve nasal congestion
  • Fluids and rest for increased immune response
  • Saltwater gargles for throat irritation
  • OTC medications only as prescribed by an HCP and administered appropriately within state or school regulations



The AAP clearly states, “For practical purposes, the spread of colds cannot be prevented.” So, what can school nurses do to protect the health of their students? The key is to focus on evidence-based interventions that have been shown to be effective in reducing the transmission of this virus. Here are a few strategies you may want to consider:


Incorporating preventative strategies and timely identification and treatment of symptoms will limit rhinovirus-related complications and help manage overall health and wellness in school communities.

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