Assessing respiratory viral exclusion and affinity interactions through co-infection incidence in a pediatric population during the 2022 resurgence of influenza and RSV

Abstract

IntroductionIn the Northeast US, respiratory viruses such as influenza and respiratory syncytial virus (RSV), which were largely suppressed by COVID-19-related social distancing, made an unprecedented resurgence during 2022, leading to a substantial rise in viral co-infections. However, the relative rates of co-infection with seasonal respiratory viruses over this period have not been assessed.MethodsHere we reviewed multiplex respiratory viral PCR data (BioFire FilmArray™ Respiratory Panel v2.1 [RPP]) from patients with respiratory symptoms presenting to our medical center in New York City to assess co-infection rates of respiratory viruses, which were baselined to total rates of infection for each virus. We examined trends in monthly RPP data from adults and children during November 2021 through December 2022 to capture the full seasonal dynamics of respiratory viruses across periods of low and high prevalence.ResultsOf 50,022 RPPs performed for 34,610 patients, 44% were positive for at least one target, and 67% of these were from children. The overwhelming majority of co-infections (93%) were seen among children, for whom 21% of positive RPPs had two or more viruses detected, as compared to just 4% in adults. Relative to children for whom RPPs were ordered, children with co-infections were younger (3.0 vs 4.5 years) and more likely to be seen in the ED or outpatient settings than inpatient and ICU settings. In children, most viral co-infections were found at significantly reduced rates relative to that expected from the incidence of each virus, especially those involving SARS-CoV-2 and influenza. SARS-CoV-2 positive children had an 85%, 65% and 58% reduced rate of co-infection with influenza, RSV, and Rhino/enteroviruses, respectively, after compensating for the incidence of infection with each virus (p< 0.001).DiscussionOur results demonstrate that most respiratory viruses peaked in different months and present in co-infections less than would be expected based on overall rates of infection, suggesting a viral exclusionary effect between most seasonal respiratory viruses, including SARS-CoV-2, influenza and RSV. We also demonstrate the significant burden of respiratory viral co-infections among children. Further work is necessary to understand what predisposes certain patients for viral co-infection despite this exclusionary effect.

The Seasonality of Respiratory Viruses in a Hong Kong Hospital, 2014–2023

“…A rebound of respiratory virus activity was observed in March and April 2023. Overall, our observation was similar to the change in seasonality in other geographical regions [ 9 , 10 , 11 , 12 ].…”

“…The timeline of a few of these countermeasures is given in Figure 1 . There were reports from a number of regions on the seasonality of respiratory viruses before and during the COVID-19 pandemic, revealing suppression of non-SARS-CoV-2, clinically important respiratory viruses during the period of unusual, global-scale pandemic intervention and their resurgence after ‘returning to normal life’ [ 9 , 10 , 11 , 12 ]. This knowledge provides valuable insights for better preparedness against future outbreaks and pandemics, which is especially important to healthcare providers for situation assessment and wise allocation of manpower and resources to cope with surges of clinical needs.…”

Clinical Evaluation of the BIOFIRE SPOTFIRE Respiratory Panel

“…From the late COVID-19 pandemic, a rebound in the activities of non-SARS-CoV-2 respiratory pathogens has been observed worldwide [ 19 , 20 , 21 , 22 , 23 , 24 ]. In clinical laboratories, the attention and resources have been shifting from SARS-CoV-2 detection to multiplex detection of SARS-CoV-2 plus other respiratory pathogens.…”

Respiratory pathogenic microbial infections: a narrative review

“…Sato et al 48 estimated the clinical and virological impact of influenza and other respiratory virus co-infections in children, and suggested that it was necessary to assess clinical symptoms as well as the levels of detected viruses to determine which virus contributed to the development of illness when multiple respiratory viruses were detected in the same patient. Conversely, Weidmann et al 49 reviewed the co-infection rates of respiratory viruses in patients presenting respiratory symptoms who visited their medical centre in New York City, and suggested a viral exclusionary effect between most seasonal respiratory viruses, including SARS-CoV-2, influenza virus, and RSV. They also demonstrated a significant burden of respiratory viral co-infections among children.…”