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. 2025 May 1;16(5):e00840.
doi: 10.14309/ctg.0000000000000840.

Patients With Inflammatory Bowel Disease Are at Increased Risk of Respiratory Syncytial Virus Infections After Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Propensity-Matched Cohort Analysis

Saqr Alsakarneh  1 , Oscar Ramirez Ramirez  2 , Mary S Hayney  3 , Jana G Hashash  4 , Francis A Farraye  4 , Freddy Caldera  5
Affiliations

Patients With Inflammatory Bowel Disease Are at Increased Risk of Respiratory Syncytial Virus Infections After Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Propensity-Matched Cohort Analysis

Saqr Alsakarneh et al. Clin Transl Gastroenterol. .

Abstract

Introduction: Patients with inflammatory bowel disease (IBD) are at an increased risk of infections. Before the COVID-19 pandemic, respiratory syncytial virus (RSV) followed predictable seasonal patterns, which have been recently disrupted. This study aimed to investigate whether severe acute respiratory syndrome (SARS) coronavirus 2 (CoV-2) infection is associated with an increased risk of RSV infection in patients with IBD compared with those without a history of SARS-CoV-2 infection.

Methods: This retrospective cohort study used the TriNetX database to identify patients aged 18 years and older with IBD and SARS-CoV-2 infection (IBD-SARS-CoV-2 cohort) during the 2022 and 2023 RSV seasons. A 1:1 propensity score matching was used to compare patients with IBD but no history of SARS-CoV-2 infection (IBD non-SARS-CoV-2 cohort).

Results: In the 2022 IBD-SARS-CoV-2 cohort (mean age: 53.7 ± 17.6 years; 59% female; 77% White), the RSV infection risk was 0.47%, higher than 0.19% in the matched IBD non-SARS-CoV-2 cohort (adjusted odds ratio [aOR]: 2.4; 95% CI: 1.5-3.6). The risk was highest 30-60 days after SARS-CoV-2 infection (aOR: 2.9; 95% CI: 1.7-4.9), particularly in those aged 60 years and older (aOR: 2.5; 95% CI: 1.3-4.5). The use of systemic corticosteroids (aOR: 2.3; 95% CI: 1.1-4.6) or immune-modifying therapies (aOR: 3.9; 95% CI: 2-7.1) was associated with higher RSV infection risk. Similar trends were observed during the 2023 RSV season, with no significant differences in RSV-related hospitalizations.

Discussion: Adults with IBD have a higher risk of RSV infection after SARS-CoV-2 infection, particularly those receiving steroids or immune therapies. SARS-CoV-2 infection may have contributed to the recent RSV infection surge in this population, warranting further research.

Keywords: COVID-19; immunosuppression; inflammatory bowel disease; respiratory infection.

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Conflict of interest statement

Guarantor of the article: Freddy Caldera, DO, MS, PhD, FACG.

Specific author contributions: S.A.: study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript and critical revision of manuscript. O.R.R.: analysis and interpretation of data, drafting of manuscript and critical revision of manuscript. M.S.H.: critical revision of manuscript. J.G.H.: critical review of the manuscript. F.A.F.: critical revision of manuscript. F.C.: study concept and design, analysis and interpretation of data, drafting of manuscript, and critical revision of manuscript.

Financial support: None to report.

Potential competing interests: Dr. Freddy Caldera has received research support from Takeda Pharmaceuticals, Janssen and Novavax. He has been a consultant for Takeda, Arena Pharmaceuticals, GSK, and Celgene. Dr. Hashash served on an Advisory Board for Bristol Myers Squibb. Dr. Farraye is a consultant for Avalo Therapeutics, BMS, Braintree Labs, Fresenius Kabi, GI Reviewers, GSK, Iterative Health, Janssen, Pfizer, Sandoz Immunology, Sebela and Viatris. He sits on a DSMB for Lilly Pharmaceuticals Dr. Hayney is a consultant for GSK Vaccines and has received research support from Takeda Pharmaceuticals, Novavax, and Dynavax.

IRB statement: This study was exempted from the IRB as it involved publicly available deidentified data based on the recommendations of the National Human Research Protection Advisory Committee policy.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Cohort selection flowchart for assessing RSV infection risk among IBD patients with and without prior SARS-CoV-2 infection across 2022 and 2023 seasons. aOR, adjusted odds ratio; CD, Crohn's disease; CI, confidence interval; IBD, inflammatory bowel disease; RSV, respiratory syncytial virus; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; UC, ulcerative colitis.
Figure 2.
Figure 2.
Risk of RSV infection in the IBD-severe acute respiratory syndrome coronavirus 2 cohort compared with the IBD control cohort stratified by age group during 2022 RSV season. aOR, adjusted odds ratio; CI, confidence interval; IBD, inflammatory bowel disease; RSV, respiratory syncytial virus.
Figure 3.
Figure 3.
Risk of RSV infection in the IBD-severe acute respiratory syndrome coronavirus 2 cohort compared with the IBD control cohort in 2022 and 2023 RSV seasons. aOR, adjusted odds ratio; CD, Crohn's disease; CI, confidence interval; IBD, inflammatory bowel disease; RSV, respiratory syncytial virus; UC, ulcerative colitis.
See this image and copyright information in PMC

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