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Meta-Analysis
. 2020 Jun;10(1):010426.
doi: 10.7189/jogh.10.010426.

The role of viral co-infections in the severity of acute respiratory infections among children infected with respiratory syncytial virus (RSV): A systematic review and meta-analysis

You Li  1 , Pallavi Pillai  1 , Fuyu Miyake  1 , Harish Nair  1
Affiliations
Meta-Analysis

The role of viral co-infections in the severity of acute respiratory infections among children infected with respiratory syncytial virus (RSV): A systematic review and meta-analysis

You Li et al. J Glob Health. 2020 Jun.

Abstract

Background: Respiratory syncytial virus (RSV) is the predominant viral cause of childhood pneumonia. Little is known about the role of viral-coinfections in the clinical severity in children infected with RSV.

Methods: We conducted a systematic literature review of publications comparing the clinical severity between RSV mono-infection and RSV co-infection with other viruses in children under five years (<5y). Clinical severity was measured using the following six clinical outcomes: hospitalisation, length of hospital stay, use of supplemental oxygen, intensive care unit (ICU) admission, mechanical ventilation and deaths. We summarised the findings by clinical outcome and conducted random-effect meta-analyses, where applicable, to quantitatively synthesize the association between RSV mono-infection/RSV co-infection and the clinical severity.

Results: Overall, no differences in the clinical severity were found between RSV mono-infection and RSV co-infection with any viruses, except for the RSV-human metapneumovirus (hMPV) co-infection. RSV-hMPV coinfection was found to be associated with a higher risk of ICU admission (odds ratio (OR) = 7.2, 95% confidence interval (CI) = 2.1-25.1; OR after removal of the most influential study was 3.7, 95% CI = 1.1-12.3). We also observed a trend from three studies that RSV-hMPV coinfections were likely to be associated with longer hospital stay.

Conclusion: Our findings suggest that RSV-hMPV coinfections might be associated with increased risk for ICU admission in children <5y compared with RSV mono-infection but such association does not imply causation. Our findings do not support the association between RSV coinfections with other viruses and clinical severity but further large-scale investigations are needed to confirm the findings.

Protocol registration: PROSPERO CRD42019154761.

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Conflict of interest statement

Competing interests: YL, PP and FM have no competing interests to declare. HN reports grants and personal fees from Innovative Medicines Initiative, grants from World Health Organization, personal fees from Bill and Melinda Gates Foundation, grants and personal fees from Sanofi, personal fees from Janssen, personal fees from AbbVie, grants from National Institute of Health Research, outside the submitted work. The authors have completed the ICMJE conflict of interest form (available upon request from the corresponding author), and declare no further conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA diagram for selection of studies.
Figure 2
Figure 2
Comparison of risk for use of supplement oxygen between RSV mono-infection and A) RSV coinfections with any viruses, B) RSV coinfections with rhinovirus, C) RSV coinfections with human metapneumovirus. Mono – mono-infection, Co – co-infection, O2 – use of supplement oxygen.
Figure 3
Figure 3
Comparison of risk for ICU admission between RSV mono-infection and A) RSV coinfections with any viruses, B) RSV coinfections with rhinovirus, C) RSV coinfections with human metapneumovirus. Mono – mono-infection, Co – co-infection, ICU – intensive care unit.
Figure 4
Figure 4
Comparison of risk for mechanical ventilation between RSV mono-infection and A) RSV coinfections with any viruses, B) RSV coinfections with rhinovirus. Mono – mono-infection; Co – co-infection; MV – mechanical ventilation.
See this image and copyright information in PMC

References

    1. Bénet T, Sánchez Picot V, Messaoudi M, Chou M, Eap T, Wang J, et al. Microorganisms Associated With Pneumonia in Children &lt;5 Years of Age in Developing and Emerging Countries: The GABRIEL Pneumonia Multicenter, Prospective, Case-Control Study. Clin Infect Dis. 2017;65:604-12. - PMC - PubMed
    1. Pneumonia Etiology Research for Child Health (PERCH) Study Group Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Lancet. 2019;394:757-79. 10.1016/S0140-6736(19)30721-4 - DOI - PMC - PubMed
    1. Wang X, Li Y, Nair H.The Role of Attributable Fraction in the Exposed in Assessing the Association of Microorganisms With Pneumonia. Clin Infect Dis. 2019;68:1067-8. 10.1093/cid/ciy815 - DOI - PubMed
    1. Shi T, McAllister DA, O’Brien KL, Simoes EAF, Madhi SA, Gessner BD, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017;390:946-58. 10.1016/S0140-6736(17)30938-8 - DOI - PMC - PubMed
    1. Li Y, Reeves RM, Wang X, Bassat Q, Brooks WA, Cohen C, et al. Global patterns in monthly activity of influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus: a systematic analysis. Lancet Global Health. 2019;7:e1031-e1045. 10.1016/S2214-109X(19)30264-5 - DOI - PubMed