Abstract
BackgroundAcute respiratory illnesses are a leading cause of global morbidity and mortality in children. Coinfection with multiple respiratory viruses is common. Although the effects of each virus have been studied individually, the impacts of coinfection on disease severity are less understood.MethodsA secondary analysis was performed of a maternal influenza vaccine trial conducted between 2011 and 2014 in Nepal. Prospective weekly household‐based active surveillance of infants was conducted from birth to 180 days of age. Mid‐nasal swabs were collected and tested for respiratory syncytial virus (RSV), rhinovirus, influenza, human metapneumovirus (HMPV), coronavirus, parainfluenza (HPIV), and bocavirus by RT‐PCR. Coinfection was defined as the presence of two or more respiratory viruses detected as part of the same illness episode.ResultsOf 1730 infants with a respiratory illness, 327 (19%) had at least two respiratory viruses detected in their primary illness episode. Of 113 infants with influenza, 23 (20%) had coinfection. Of 214 infants with RSV, 87 (41%) had coinfection. The cohort of infants with coinfection had increased occurrence of fever lasting ≥ 4 days (OR 1.4, 95% CI: 1.1, 2.0), and so did the subset of coinfected infants with influenza (OR 5.8, 95% CI: 1.8, 18.7). Coinfection was not associated with seeking further care (OR 1.1, 95% CI: 0.8, 1.5) or pneumonia (OR 1.2, 95% CI: 0.96, 1.6).ConclusionA high proportion of infants had multiple viruses detected. Coinfection was associated with greater odds of fever lasting for four or more days, but not with increased illness severity by other measures.
Highlights
Acute lower respiratory tract infections (ALRI), including pneumonia and bronchiolitis, were responsible for an estimated 650,000 deaths of children under five years old in 2016, and continue to be a major cause of infant morbidity and mortality worldwide.[1]
A seasonal influenza vaccine is widely available, and developing an respiratory syncytial virus (RSV) vaccine is among the primary 2020-2025 goals for GAVI (Global Alliance for Vaccines and Immunization) and the WHO, despite several recent failed candidates. 5,6 Understanding the role of coinfections will help inform the relative burden of disease of each respiratory virus, and add context to future vaccination intervention and development efforts
Subjects had a mean age of 11 weeks, 54% were male (n=936), 13% were premature (n=225), and 20% were born low birth weight (n=349)
Summary
Acute lower respiratory tract infections (ALRI), including pneumonia and bronchiolitis, were responsible for an estimated 650,000 deaths of children under five years old in 2016, and continue to be a major cause of infant morbidity and mortality worldwide.[1] Several viruses cause respiratory illness in children, including influenza, respiratory syncytial virus (RSV), rhinovirus, enterovirus, and adenovirus. 2 Influenza is among the most common etiologies of ALRI episodes, and is responsible for an estimated 39 million cases each year among both children and adults. An estimated 30,000-100,000 children under 5 years old die from influenza each year, with 99% of these occurring in developing countries.[3] RSV is responsible for over 33 million new cases of childhood ALRI each year, and an estimated 55,000 to 190,000 deaths of children under 5 years old can be attributed to ALRI from RSV alone. A seasonal influenza vaccine is widely available, and developing an RSV vaccine is among the primary 2020-2025 goals for GAVI (Global Alliance for Vaccines and Immunization) and the WHO, despite several recent failed candidates. 5,6 Understanding the role of coinfections will help inform the relative burden of disease of each respiratory virus, and add context to future vaccination intervention and development efforts
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