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. 2025 May 9:ciaf194.
doi: 10.1093/cid/ciaf194. Online ahead of print.

Respiratory Syncytial Virus Co-Detection With Other Respiratory Viruses Is Not Significantly Associated With Worse Clinical Outcomes Among Children Aged <2 Years: New Vaccine Surveillance Network, 2016-2020

Justin Z Amarin  1   2 , Ariana P Toepfer  3 , Andrew J Spieker  4 , Haya Hayek  1 , Tess Stopczynski  4 , Yasmeen Z Qwaider  1 , Laura S Stewart  1 , James D Chappell  1 , Mary Allen Staat  5 , Elizabeth P Schlaudecker  5 , Geoffrey A Weinberg  6 , Peter G Szilagyi  6   7 , Janet A Englund  8 , Eileen J Klein  8 , Marian G Michaels  9 , John V Williams  9 , Rangaraj Selvarangan  10 , Christopher J Harrison  11 , Leila C Sahni  12 , Vasanthi Avadhanula  13 , Meredith L McMorrow  3 , Heidi L Moline  3 , Natasha B Halasa  1
Affiliations

Respiratory Syncytial Virus Co-Detection With Other Respiratory Viruses Is Not Significantly Associated With Worse Clinical Outcomes Among Children Aged <2 Years: New Vaccine Surveillance Network, 2016-2020

Justin Z Amarin et al. Clin Infect Dis. .

Abstract

Background: Risk factors for severe respiratory syncytial virus (RSV) illness include early infancy, premature birth, and underlying medical conditions. However, the clinical significance of respiratory viral co-detection is unclear. We compared the clinical outcomes of young children with RSV-only detection and those with RSV viral co-detection.

Methods: We conducted active, population-based surveillance of children with medically attended fever or respiratory symptoms at 7 US medical centers (1 December 2016-31 March 2020). Demographic and clinical data were collected through parental interviews and chart abstractions. Nasal swabs, with or without throat swabs, were systematically tested for RSV and 6 other common respiratory virus groups. We compared clinical outcomes, including hospitalization, and among those hospitalized, length of stay, intensive care unit admission, supplemental oxygen use, and intubation, between children aged <2 years with RSV-only detection and those with RSV co-detection.

Results: We enrolled 18 008 children aged <2 years. Of 17 841 (99.1%) tested for RSV, 5099 (28.6%) were positive. RSV was singly detected in 3927 children (77.0%) and co-detected in 1172 (23.0%). RSV co-detection with parainfluenza virus or adenovirus was associated with significantly lower odds of hospitalization (adjusted odds ratio, 0.56; 95% confidence interval [CI]: .33-.95; P = .031) and supplemental oxygen use (adjusted odds ratio, 0.66; 95% CI: .46-.95; P = .026), respectively, than RSV-only detection. For all other comparisons, we did not identify a significant association between RSV co-detection and worse clinical outcomes.

Conclusions: Co-detection of RSV with another respiratory virus was not significantly associated with worse clinical outcomes compared with RSV-only detection.

Keywords: co-infection; hospitalization; infant; respiratory syncytial virus infections; respiratory tract infections.

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Conflict of interest statement

Potential conflicts of interest. J. D. C. reports grant support from Merck and the National Institutes of Health (NIH). M. A. S. reports grant support from the NIH, Cepheid, and Merck, support for contributions to UpToDate chapters, and consulting fees from Merck. E. P. S. reports grant support from Pfizer, an honorarium from Sanofi Pasteur, travel funds from the Pediatric Infectious Diseases Society, participation on a Division of Microbiology and Infectious Diseases Data and Safety Monitoring Board, and roles as a board member for the World Society of Pediatric Infectious Diseases and committee chair for the Pediatric Infectious Diseases Society. G. A. W. reports grant support from the AIDS Institute of the New York State Department of Health, consulting fees from the New York State Department of Health and Inhalon Biopharma, an honorarium from Merck, and board participation at Emory University. J. A. E. reports grant support from AstraZeneca, Pfizer, Merck, GlaxoSmithKline, and Moderna; consulting fees from Pfizer, Meissa Vaccine, Moderna Vaccines, AstraZeneca, GlaxoSmithKline, Merck, and Shionogi; and travel payments from AstraZeneca and Pfizer for lectures. M. G. M. reports grant support from the NIH and a waiver of admission fees for speaking at the American Transplant Congress 2024. J. V. W. reports grant support from the NIH and compensation for participation on the Independent Data Monitoring Committee (GlaxoSmithKline) and Data and Safety Monitoring Board (National Institute of Allergy and Infectious Diseases International Maternal Pediatric Adolescent AIDS Clinical Trials study). R. S. reports grant support from Hologic, BioFire, Becton Dickinson, Luminex, and Cepheid and payment for serving on an advisory board from GlaxoSmithKline. C. J. H. reports grant support from GlaxoSmithKline, Merck, and Pfizer and an honorarium from Pediatric News. L. C. S. reports travel support from the Gates Foundation to attend a meeting. N. B. H. reports grant support from Sanofi, Quidel, and Merck and an honorarium from Genentech. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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