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. 2022 Oct 10;9(11):ofac531.
doi: 10.1093/ofid/ofac531. eCollection 2022 Nov.

Viral Coinfections in Hospitalized Coronavirus Disease 2019 Patients Recruited to the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK Study

Elen Vink  1 , Chris Davis  1 , Alasdair MacLean  2 , David Pascall  3   4 , Sarah E McDonald  1 , Rory Gunson  2 , Hayley E Hardwick  5 , Wilna Oosthuyzen  6 , Peter J M Openshaw  7 , J Kenneth Baillie  6 , Malcolm G Semple  5   8 , Antonia Ho  1 ; ISARIC4C Investigators
Collaborators, Affiliations

Viral Coinfections in Hospitalized Coronavirus Disease 2019 Patients Recruited to the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK Study

Elen Vink et al. Open Forum Infect Dis. .

Abstract

Background: We conducted this study to assess the prevalence of viral coinfection in a well characterized cohort of hospitalized coronavirus disease 2019 (COVID-19) patients and to investigate the impact of coinfection on disease severity.

Methods: Multiplex real-time polymerase chain reaction testing for endemic respiratory viruses was performed on upper respiratory tract samples from 1002 patients with COVID-19, aged <1 year to 102 years old, recruited to the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK study. Comprehensive demographic, clinical, and outcome data were collected prospectively up to 28 days post discharge.

Results: A coinfecting virus was detected in 20 (2.0%) participants. Multivariable analysis revealed no significant risk factors for coinfection, although this may be due to rarity of coinfection. Likewise, ordinal logistic regression analysis did not demonstrate a significant association between coinfection and increased disease severity.

Conclusions: Viral coinfection was rare among hospitalized COVID-19 patients in the United Kingdom during the first 18 months of the pandemic. With unbiased prospective sampling, we found no evidence of an association between viral coinfection and disease severity. Public health interventions disrupted normal seasonal transmission of respiratory viruses; relaxation of these measures mean it will be important to monitor the prevalence and impact of respiratory viral coinfections going forward.

Keywords: PCR; SARS-CoV-2; disease severity; respiratory virus; rhinovirus; surveillance.

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Conflict of interest statement

Potential conflicts of interest. S. E. M. reports funding from the Medical Research Council (MRC). D. P. reports funding from UK Research and Innovation and payment from the University of Cambridge—Sir Isaac Newton Institute for conference organization. E. V. reports funding from the MRC (MC_ST_CVR_2019) and lecture fees from Janssen. A. H. reports grants from the MRC and Public Health Scotland and was a member of the National Institute for Health Research (NIHR) Urgent Public Health Group. M. G. S. reports grants from NIHR UK, MRC, and the Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, University of Liverpool, during the conduct of the study. M. G. S. is chair of the scientific advisory board and a minority shareholder at Integrum Scientific, and director and majority shareholder of MedEx Solutions Ltd, both unrelated to this submission. M. G. S. is a nonremunerated member of Pfizer's External Data Monitoring Committee for their mRNA vaccine program(s), HMG UK Scientific Advisory Group for Emergencies (SAGE), COVID-19 Response, and HMG UK New Emerging Respiratory Virus Threats Advisory Group. J. K. B. reports grants from the UK Department of Health and Social Care, the Wellcome Trust, and MRC. P. J. M. O. reports personal fees from consultancies (ie, GlaxoSmithKline, Janssen, Bavarian Nordic, Pfizer, and Cepheid) and for the European Respiratory Society; grants from the MRC, MRC Global Challenge Research Fund, EU, NIHR Biomedical Research Centre, MRC–GlaxoSmithKline, Wellcome Trust, and NIHR (HPRU in Respiratory Infection); and is an NIHR senior investigator, unrelated to this submission. P. J. M. O.'s role as president of the British Society for Immunology was unpaid, but travel and accommodation at some meetings were paid for by the society.

Figures

Figure 1.
Figure 1.
Study Design. (A) Study flow chart. (B) Location of study sites. COVID-19, coronavirus disease 2019; PCR, polymerase chain reaction; UK, United Kingdom; URT, upper respiratory tract.
Figure 2.
Figure 2.
(A) Etiology of coinfection; coinfecting viruses detected by multiplex polymerase chain reaction in cohort of 1002 hospitalized COVID-19 patients. (B) Coinfection status of samples collected, by month. (C) Coinfecting viruses by month of detection. Flu B, influenza B virus; hMPV, human metapneumovirus; hRV, human rhinovirus; PIV-1–4, para-influenza viruses 1–4; RSV, respiratory syncytial virus.
Figure 3.
Figure 3.
Risk groups for coinfection. Multivariable logistic regression analysis adjusted odds plot. CI, confidence interval; OR, odds ratio.
Figure 4.
Figure 4.
Multivariable logistic regression analysis adjusted odds ratio plots. (A) Risk factors for critical care admission. (B) Risk factors for mortality.
See this image and copyright information in PMC

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