Systematic review and meta‐analysis of respiratory viral coinfections in children

Abstract

Respiratory infections are a common cause of paediatric morbidity. Clinical outcomes in children hospitalized with single respiratory virus infection are compared with those with two or more viral-viral coinfection. Studies were restricted to those reporting on children aged less than 5 years (PROSPERO CRD#42014009133). Published data to calculate risk ratios (RR) comparing children with single viral infections to coinfection using a random effects model were used. Similar analyses by pathogen pairs and by excluding children with comorbidities were performed. Of 4443 articles reviewed, 19 were included. Overall, no differences in the risk of fever, admission to an intensive care unit (ICU), oxygen use, mechanical ventilation and abnormal radiographs between children with single infection and those with coinfection were found. When analysing only children without comorbidities, the risk of fever (RR = 1.16 to RR = 1.24, 95% confidence intervals (CI) = 1.00-1.55) and ICU admission (RR = 1.08 to RR = 1.31, 95% CI = 0.93-1.83) increased but remained non-significant. Point estimates suggested an increased risk of ICU admission in those coinfected with either respiratory syncytial virus or human metapneumovirus compared with those with single infection but was nonsignificant. Our findings suggest that coinfection is not associated with increased clinical severity, but further investigations by pathogen pairs are warranted.

Viral respiratory infections diagnosed by multiplex polymerase chain reaction in pediatric patients

“…The most common viruses detected in coinfections were RV/EV and RSV. Clinical importance of the viral coinfections is not clear as several studies detected no effect on the severity of the disease …”

Parallel pathogens in the upper and lower respiratory tracts in children with a respiratory tract infection, as revealed by the Filmarray assay

“…3,10,32 The study of co-infection and the clinical features in children with RTIs were limited by the number of participants in this study. A previous study also demonstrated that neither viral load nor viral co-infections were significantly associated with disease severity.…”

Year in review 2016: Interstitial lung disease, pulmonary vascular disease, pulmonary function, paediatric lung disease, cystic fibrosis and sleep

“…The most common cause of ALRI is viral infection and there remains doubt as to whether co-infections with more than one virus increase the severity of infection. Lim et al 83 performed a systematic review and meta-analysis of respiratory co-infections in children and found no evidence of increased clinical severity of co-infections, although point estimates did suggest the possibility of increased risk of admission to intensive care and further careful studies will be needed to better understand these risks. In addition to clinical factors and variable pathogen factors, we also recognize that healthcare practices and behaviours vary considerably and may influence admission to hospital, use of intensive care, length of stay etc.…”