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. 2023 Sep 1;42(9):774-780.
doi: 10.1097/INF.0000000000003981. Epub 2023 May 30.

Respiratory Coinfections in Children With SARS-CoV-2

Adrianna Westbrook  1 , Tingyu Wang  1 , Kushmita Bhakta  2   3 , Julie Sullivan  2   3 , Mark D Gonzalez  4 , Wilbur Lam  2   3 , Christina A Rostad  2   3
Affiliations

Respiratory Coinfections in Children With SARS-CoV-2

Adrianna Westbrook et al. Pediatr Infect Dis J. .

Abstract

Background: As the transmission of endemic respiratory pathogens returns to prepandemic levels, understanding the epidemiology of respiratory coinfections in children with SARS-CoV-2 is of increasing importance.

Methods: We performed a retrospective analysis of all pediatric patients 0-21 years of age who had a multiplexed BioFire Respiratory Panel 2.1 test performed at Children's Healthcare of Atlanta, Georgia, from January 1 to December 31, 2021. We determined the proportion of patients with and without SARS-CoV-2 who had respiratory coinfections and performed Poisson regression to determine the likelihood of coinfection and its association with patient age.

Results: Of 19,199 respiratory panel tests performed, 1466 (7.64%) were positive for SARS-CoV-2, of which 348 (23.74%) also had coinfection with another pathogen. The most common coinfection was rhino/enterovirus (n = 230, 15.69%), followed by adenovirus (n = 62, 4.23%), and RSV (n = 45, 3.507%). Coinfections with SARS-CoV-2 were most commonly observed in the era of Delta (B.1.617.2) predominance (190, 54.60%), which coincided with periods of peak rhino/enterovirus and RSV transmission. Although coinfections were common among all respiratory pathogens, they were significantly less common with SARS-CoV-2 than other pathogens, with exception of influenza A and B. Children <2 years of age had the highest frequency of coinfection and of detection of any pathogen, including SARS-CoV-2. Among children with SARS-CoV-2, for every 1-year increase in age, the rate of coinfections decreased by 8% (95% CI, 6-9).

Conclusions: Respiratory coinfections were common in children with SARS-CoV-2. Factors associated with the specific pathogen, host, and time period influenced the likelihood of coinfection.

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Conflict of interest statement

C.A.R.’s institution has received funds to conduct clinical research unrelated to this manuscript from the National Institutes of Health, BioFire Inc, GSK, MedImmune, Micron, Janssen, Merck, Moderna, Novavax, PaxVax, Pfizer, Regeneron, Sanofi-Pasteur. She is co-inventor of patented respiratory syncytial virus vaccine technology unrelated to this manuscript, which has been licensed to Meissa Vaccines, Inc. The remaining authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Pathogen detection by multiplexed respiratory PCR panel (BioFire) at Children’s Healthcare of Atlanta, 2021. A: Pathogen detection by month. B: Pathogen detection by age. C: Respiratory coinfections with SARS-CoV-2 by month. D: Respiratory coinfections with SARS-CoV-2 by age.
FIGURE 2.
FIGURE 2.
Chord diagram showing respiratory coinfections within the study cohort for all pathogens detected >50 times.
See this image and copyright information in PMC

References

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Supplementary concepts