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Meta-Analysis
. 2024 Jun 19;16(6):982.
doi: 10.3390/v16060982.

Does Prior Respiratory Viral Infection Provide Cross-Protection Against Subsequent Respiratory Viral Infections? A Systematic Review and Meta-Analysis

Vennila Gopal  1   2 , Matthew Chung Yi Koh  3 , Jinghao Nicholas Ngiam  3 , Ong Hang-Cheng  4 , Jyoti Somani  1   3 , Paul Anatharajah Tambyah  1   3 , Jeremy Tey  1   5
Affiliations
Meta-Analysis

Does Prior Respiratory Viral Infection Provide Cross-Protection Against Subsequent Respiratory Viral Infections? A Systematic Review and Meta-Analysis

Vennila Gopal et al. Viruses. .

Abstract

The epidemiology of different respiratory viral infections is believed to be affected by prior viral infections in addition to seasonal effects. This PROSPERO-registered systematic review identified 7388 studies, of which six met our criteria to answer the question specifically. The purpose of this review was to compare the prevalence of sequential viral infections in those with previously documented positive versus negative swabs. The pooled prevalence of sequential viral infections over varying periods from 30-1000 days of follow-up was higher following a negative respiratory viral swab at 0.15 than following a positive swab at 0.08, indicating the potential protective effects of prior respiratory viral infections. However, significant heterogeneity and publication biases were noted. There is some evidence, albeit of low quality, of a possible protective effect of an initial viral infection against subsequent infections by a different virus, which is possibly due to broad, nonspecific innate immunity. Future prospective studies are needed to validate our findings.

Keywords: meta-analysis; respiratory virus infection; sequential infection; systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest directly related to this study. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for systematic reviews [18].
Figure 2
Figure 2
(A) Forest plot showing pooled prevalence of a positive viral swab (any virus) following an initial viral infection (any virus) (B) Forest plot showing pooled prevalence of a positive viral swab (any virus) following an initial negative swab.
Figure 3
Figure 3
Forest plot showing pooled prevalence of enterovirus/rhinovirus infection, following an initial positive viral swab.
Figure 4
Figure 4
Forest plot showing pooled prevalence of seasonal coronavirus infection following an initial positive viral swab.
Figure 5
Figure 5
Forest plot showing pooled prevalence of a positive viral swab following an initial seasonal coronavirus infection.
Figure 6
Figure 6
Forest plot showing pooled prevalence of a positive viral swab following an initial enterovirus/rhinovirus infection.
Figure 7
Figure 7
Forest plot showing pooled prevalence of a positive viral swab following an initial influenza infection.
Figure 8
Figure 8
Forest plot showing pooled estimate of relative risk of SARS-CoV-2 following an initial positive viral swab.
Figure 9
Figure 9
Subgroup analysis of studies excluding SARS-CoV-2, showing pooled prevalence of a secondary viral infection following an initial positive viral swab.
See this image and copyright information in PMC

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