Viral Coinfection of Children Hospitalized with Severe Acute Respiratory Infections During COVID-19 Pandemic

Methods: This study was conducted between March 2020 and December 2021. All children admitted to the ICU with a diagnosis of SARI and who were tested by polymerase chain reaction on nasopharyngeal swabs for SARS-CoV-2 and other common respiratory viral pathogens were included in the study.

Results: The result of the viral panel identified 446 children, with one infected with a single virus and 160 co-infected with two or more viruses. This study employed descriptive analyses, where a total of twenty-two coinfections among SARI-causing viruses were identified. Thus, the five most frequent coinfections that were selected for the study are: hRV/SARS-CoV-2 (17.91%), hRV/RSV (14.18%), RSV/SARS-CoV-2 (12.69%), hRV/BoV (10.45%), and hRV/AdV (8.21%). The most significant age group was 38.1%, representing patients aged between 24 and 59 months (61 individuals). Patients older than 59 months represented a total of 27.5%, comprising forty-four patients. The use of oxygen therapy was statistically significant in coinfections with Bocavirus, other CoVs, Metapneumovirus, and RSV. Coinfections with SARS-CoV-2 and the other different coinfections presented a similar time of use of oxygen therapy with a value of ( > 0.05). In the year 2020, hRV/BoV was more frequent in relation to other types of coinfections, representing a total of 35.1%. The year 2021 presented a divergent profile, with hRV/SARS-CoV-2 coinfection being the most frequent (30.8%), followed by hRV/RSV (28.2%). Additionally, 25.6% and 15.4% represented coinfections between RSV/SARS-CoV-2 and hRV/AdV, respectively. We saw that two of the patients coinfected with hRV/SARS-CoV-2 died, representing 9.52% of all deaths in the study. In addition, both hRV/hBoV and hRV/RSV had death records for each case, representing 8.33% and 6.67% of all deaths, respectively.

Conclusion: Coinfections with respiratory viruses, such as RSV and hBoV, can increase the severity of the disease in children with SARI who are admitted to the ICU, and children infected with SARS-CoV-2 have their clinical condition worsened when they have comorbidities.

Citing Articles

Etiological Spectrum of Acute Respiratory Infections in Bulgaria During the 2023-2024 Season and Genetic Diversity of Circulating Influenza Viruses.

Korsun N, Trifonova I, Pavlova D, Uzunova Y, Ivanov I, Ivanov D Viruses. 2025; 17(2).

PMID: 40007025 PMC: 11860199. DOI: 10.3390/v17020270.

Prevalence of post-pandemic SARS-CoV-2 in patients with respiratory syndrome in Brazzaville, Republic of the Congo.

Demboux Lyelet J, Issamou Mayengue P, Koukouikila-Koussounda F, Doniama Essialaba A, Vembe Mahounga C, Mandiangou A BMC Infect Dis. 2025; 25(1):217.

PMID: 39953406 PMC: 11827307. DOI: 10.1186/s12879-025-10541-1.

Hospital-based cross-sectional study on the clinical characteristics of children with severe acute respiratory infections in Hungary.

Orosz N, Gomori G, Battamir U, Nagy A BMC Infect Dis. 2024; 24(1):1268.

PMID: 39521980 PMC: 11549780. DOI: 10.1186/s12879-024-10186-6.

Risk of COVID-19 in Children throughout the Pandemic and the Role of Vaccination: A Narrative Review.

Weber D, Zimmerman K, Tartof S, McLaughlin J, Pather S Vaccines (Basel). 2024; 12(9).

PMID: 39340021 PMC: 11435672. DOI: 10.3390/vaccines12090989.

Prevalence and Clinical Impact of Viral and Bacterial Coinfections in Hospitalized Children and Adolescents Aged under 18 Years with COVID-19 during the Omicron Wave in Russia.

Yakovlev A, Afanasev V, Alekseenko S, Belyaletdinova I, Isankina L, Gryaznova I Viruses. 2024; 16(8).

PMID: 39205154 PMC: 11360790. DOI: 10.3390/v16081180.

References

Yoshida L, Suzuki M, Nguyen H, Le M, Vu T, Yoshino H . Respiratory syncytial virus: co-infection and paediatric lower respiratory tract infections. Eur Respir J. 2013; 42(2):461-9. DOI: 10.1183/09031936.00101812. View

Martinez-Roig A, Salvado M, Caballero-Rabasco M, Sanchez-Buenavida A, Lopez-Segura N, Bonet-Alcaina M . Viral coinfection in childhood respiratory tract infections. Arch Bronconeumol. 2014; 51(1):5-9. PMC: 7105245. DOI: 10.1016/j.arbres.2014.01.018. View

Zandi M, Soltani S, Fani M, Abbasi S, Ebrahimi S, Ramezani A . Severe acute respiratory syndrome coronavirus 2 and respiratory syncytial virus coinfection in children. Osong Public Health Res Perspect. 2021; 12(5):286-292. PMC: 8561020. DOI: 10.24171/j.phrp.2021.0140. View

Ji K, Sun J, Yan Y, Han L, Guo J, Ma A . Epidemiologic and clinical characteristics of human bocavirus infection in infants and young children suffering with community acquired pneumonia in Ningxia, China. Virol J. 2021; 18(1):212. PMC: 8554736. DOI: 10.1186/s12985-021-01682-1. View

Le Glass E, Hoang V, Boschi C, Ninove L, Zandotti C, Boutin A . Incidence and Outcome of Coinfections with SARS-CoV-2 and Rhinovirus. Viruses. 2021; 13(12). PMC: 8709236. DOI: 10.3390/v13122528. View

Silva P, Regina Malveste Ito C, Moreira A, Santos M, Candido Goncalves Barbosa L, Wastowski I . Influenza and other respiratory viruses in children: prevalence and clinical features. Eur J Clin Microbiol Infect Dis. 2022; 41(12):1445-1449. PMC: 9607802. DOI: 10.1007/s10096-022-04515-3. View

Abo Y, Clifford V, Lee L, Costa A, Crawford N, Wurzel D . COVID-19 public health measures and respiratory viruses in children in Melbourne. J Paediatr Child Health. 2021; 57(12):1886-1892. PMC: 8242487. DOI: 10.1111/jpc.15601. View

Malekifar P, Pakzad R, Shahbahrami R, Zandi M, Jafarpour A, Rezayat S . Viral Coinfection among COVID-19 Patient Groups: An Update Systematic Review and Meta-Analysis. Biomed Res Int. 2021; 2021:5313832. PMC: 8416381. DOI: 10.1155/2021/5313832. View

Candido D, Claro I, de Jesus J, Souza W, Moreira F, Dellicour S . Evolution and epidemic spread of SARS-CoV-2 in Brazil. Science. 2020; 369(6508):1255-1260. PMC: 7402630. DOI: 10.1126/science.abd2161. View

10.

Kim H, Lee E, Lee N, Woo S, Kim J, Rhee J . Impact of coronavirus disease 2019 on respiratory surveillance and explanation of high detection rate of human rhinovirus during the pandemic in the Republic of Korea. Influenza Other Respir Viruses. 2021; 15(6):721-731. PMC: 8446939. DOI: 10.1111/irv.12894. View

11.

McGavern D, Kang S . Illuminating viral infections in the nervous system. Nat Rev Immunol. 2011; 11(5):318-29. PMC: 5001841. DOI: 10.1038/nri2971. View

12.

Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S . Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review. JAMA Pediatr. 2020; 174(9):882-889. DOI: 10.1001/jamapediatrics.2020.1467. View

13.

Sly P, Jones C . Viral co-detection in infants hospitalized with respiratory disease: is it important to detect?. J Pediatr (Rio J). 2011; 87(4):277-80. DOI: 10.2223/JPED.2117. View

14.

Kouni S, Karakitsos P, Chranioti A, Theodoridou M, Chrousos G, Michos A . Evaluation of viral co-infections in hospitalized and non-hospitalized children with respiratory infections using microarrays. Clin Microbiol Infect. 2012; 19(8):772-7. PMC: 7129253. DOI: 10.1111/1469-0691.12015. View

15.

Zachariah P, Johnson C, Halabi K, Ahn D, Sen A, Fischer A . Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children's Hospital in New York City, New York. JAMA Pediatr. 2020; 174(10):e202430. PMC: 7270880. DOI: 10.1001/jamapediatrics.2020.2430. View

16.

Vink E, Davis C, MacLean A, Pascall D, McDonald S, Gunson R . Viral Coinfections in Hospitalized Coronavirus Disease 2019 Patients Recruited to the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK Study. Open Forum Infect Dis. 2022; 9(11):ofac531. PMC: 9619746. DOI: 10.1093/ofid/ofac531. View

17.

Varela F, Sartor I, Polese-Bonatto M, Azevedo T, Kern L, Fazolo T . Rhinovirus as the main co-circulating virus during the COVID-19 pandemic in children. J Pediatr (Rio J). 2022; 98(6):579-586. PMC: 9015957. DOI: 10.1016/j.jped.2022.03.003. View

18.

Lee B, Harrison C, Myers A, Jackson M, Selvarangan R . Differences in pediatric SARS-CoV-2 symptomology and Co-infection rates among COVID-19 Pandemic waves. J Clin Virol. 2022; 154:105220. PMC: 9222346. DOI: 10.1016/j.jcv.2022.105220. View

19.

Hanchi A, Guennouni M, Ben Houmich T, Echchakery M, Draiss G, Rada N . Changes in the Epidemiology of Respiratory Pathogens in Children during the COVID-19 Pandemic. Pathogens. 2022; 11(12). PMC: 9781834. DOI: 10.3390/pathogens11121542. View

20.

De Paulis M, Gilio A, Ferraro A, Ferronato A, do Sacramento P, Botosso V . Severity of viral coinfection in hospitalized infants with respiratory syncytial virus infection. J Pediatr (Rio J). 2011; 87(4):307-13. DOI: 10.2223/JPED.2100. View