Infectious Disease

Children with COVID-19, second infection much more likely to have worse symptoms

January 18, 2023

2 min read

Source/Disclosures

Disclosures:
Agathis reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Children hospitalized with COVID-19 who had a secondary viral infection like respiratory syncytial virus or rhinovirus were around twice as likely to have severe respiratory illness, a study found.

According to Nickolas T Agathis, MD, MPHa medical officer at the CDC, “the association between respiratory virus coinfections and severe disease is not well understood.”

Data derived from Agathis N, et al. pediatrics. 2023;doi:10.1542/peds.2022-059037.

Nickolas Agathis

“In general, coinfections appear to occur more frequently in children than adults, and past data indicate that coinfections can result in more severe illness,” Agathis told Healio. “The purpose of this study was to assess the frequency and characteristics of respiratory virus codetections — or testing positive for more than one virus — among children hospitalized with COVID-19 and evaluate the association between having codetections and having severe illness.”

Agathis and colleagues analyzed data collected from the US COVID-19 Associated Hospitalization Surveillance Network (COVID-NET) between March 2020 and February 2022 on 4,372 children infected with SARS-CoV-2 who were admitted primarily for fever, a respiratory illness or presumed COVID -19

The researchers narrowed the group to 2,659 children who had complete additional viral testing, such as for respiratory syncytial virus, influenza, rhinovirus/enterovirus, adenovirus, human metapneumovirus, human coronaviruses other than SARS-CoV-2 and parainfluenza.

Of this group, 21% were coinfected — 15% with rhinovirus or enterovirus, 7% with RSV, 1% with influenza and 10% with other assorted viruses. These children were more likely to be older than age 5 years and were around twice as likely to be severely ill.

The adjusted ORs for severe illness among children with any coinfection were 2.1 for patients aged younger than 2 years (95% CI, 1.5-3) and 1.9 for children ages 2 to 4 years (95% CI, 1.2-3.1). Adjusted ORs for children coinfected with rhinovirus or enterovirus were 2.4 for patients younger than age 2 years (95% CI, 1.6-3.7) and 2.4 for patients aged 2 to 4 years (95% CI, 1.2-4.6). RSV coinfection in kids younger than age 2 years was also associated with severe illness (OR = 1.9; 95% CI, 1.3-2.9). The researchers found no significant associations among children aged 5 years or older.

“We found that testing positive for another respiratory virus, most frequently respiratory syncytial virus and rhinovirus/enterovirus, may increase illness severity among children under 5 years old hospitalized with SARS-CoV-2 infection,” Agathis said. “Specifically, children in this age group with rhinovirus/enterovirus codetection, as well as those under 2 years of age with RSV codetection, were more likely to have severe illness. Influenza codetections were uncommon during the study period, but this is likely due to the low flow circulation seen at this time.”

Agathis said that in accordance with CDC guidance and with multiple respiratory viruses circulating throughout the country, “there’s no time like the present” for eligible children to get up to date on COVID-19 and influenza vaccinations to prevent severe respiratory illness.

“They should also take everyday precautions like staying home when sick, covering their mouth and nose when they cough or sneeze, and regularly washing their hands,” Agathis said. “In addition, clinicians should consider testing young children hospitalized with COVID-19 for other respiratory viruses, especially when virus circulation is high, because it may help target treatment and management of these children and improve surveillance of these viruses.”

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