Respiratory coinfections less common in older children with COVID-19

Respiratory coinfections are proving to be not only common in children, but are more common the younger the child is.Indeed, for every one-year increase in age, the rate of coinfections among children with SARS-CoV-2 decreased by 8%, a study in The Pediatric Infectious Diseases Journal found. And children under the age of two years have the greatest risk of having other respiratory infections along with COVID-19.It is already recognized that children with COVID-19 are more likely to present with multiple respiratory infections and, along with that, have more severe outcomes. But this study was conducted to determine what the patterns are like now that other endemic pathogens are returning to pre-pandemic levels. The researchers did not respond to interview requests.Respiratory coinfections are commonly seen in young children presenting to the ED, said the authors. And there are notable differences between different ages.Read: A clearer link between RSV and childhood asthmaA retrospective analysis was conducted of all patients aged zero to 21 years of age who had a multiplexed respiratory panel (RP) test performed at any of three childrens’ hospitals in Atlanta, Georgia. The study was conducted from January 1, 2021, to December 31, 2021 and data were gathered from departments throughout the hospitals.Using nasal swabs, the RP can detect multiple pathogens. It included adenovirus, coronaviruses 229E, HKU1, NL63, OC43, SARS-CoV-2, human metapneumovirus, human rhinovirus-enterovirus, influenza A (including subtypes), influenza B, parainfluenza viruses 1 through 4, RSV, and bacterial infections including Bordetella pertussis, Bordetella parapertussis, Chlamydophila pneumoniae, and Mycoplasma pneumoniae.During the study period, 19,199 patients were tested. Of these, 1,466 (7.64%) were positive for SARS-CoV-2 and 17,733 (92.36%) were negative. Of the patients who were positive for SARS-CoV-2, 348 (23.74%) were found to have a coinfection by another pathogen.The most common coinfection pathogens were rhino-enterovirus in 230 (15.69%) patients, followed by adenovirus in 62 (4.23%) patients, and RSV in 45 (3.07%). Of the patients who did not have SARS-CoV-2, 10,361 (58.43%) tested positive for another pathogen, with more than half having rhino-enterovirus in 6,055 (58.44%) patients, followed by RSV and adenovirus.The researchers noted that the RSV coinfections coincided with a summer surge. The SARS-CoV-2 cases were mostly Delta and Omicron.However, it was found that regardless of SARS-CoV-2 status, patients with multiple pathogens were significantly younger than those who did not have another pathogen.The findings also revealed differences in terms of where testing was done, with the emergency department (ED) standing out. Most of the tests, 12,200 of them, were performed in the ED, while 3,604 were from inpatient floors, 2,717 in the ICU, 547 among outpatients. The remainder were in procedure and operating rooms.The ED had the highest percentage of SARS-CoV-2 infections, numbering 1,078 (8.84%). The ED also had the highest percentage of other respiratory infections, coinfections, and coinfections plus COVID-91.This isn’t necessarily a surprise since children with COVID-19 and additional pathogens are more likely to be sicker. Generally, most tests from the ICU and inpatient floors were completely negative for any of the pathogens tested for. When it came to the age of the patients, children under two years had the highest frequency of detection of any pathogen—whether it was a single infection or coinfection. And those under 12 months of age had a higher frequency than older children.Of note, several pathogens were found to be more common in children who did not have SARS-CoV-2.“Rhino/enterovirus, RSV, influenza A, parainfluenza 3, parainfluenza 4, coronavirus NL63, coronavirus OC43, HMPV, and adenovirus were each significantly more likely to be seen in those without SARS-CoV-2 versus those with SARS-CoV-2,” the study said.Also, coinfections were less likely among children with influenza A, and B but the study offered no explanation for this.“Although coinfections were common among all respiratory pathogens, they were significantly less common with SARS-CoV-2 than other pathogens, with exception of influenza A and influenza B, which were detected infrequently,” the study said.Coinfections are more common in kids because they have less exposure or immunity than adults who have been exposed to more viruses, said Dr. Anna Banerji, an associate professor of pediatrics at the University of Toronto’s Dalla Lana School of Public Health. She was not part of this study but has studied the patterns of lower respiratory tract infections in infants in the Canadian Arctic.The more infections a child has, the sicker they can get. “One infection can make them mildly sick, but when they get RSV on top of it, it tends to make them more sick,” she told the Medical Post. And children with underlying conditions are at greater risk. “Anyone who is immunocompromised, preterm infants infants with underlying health issues such as severe cardiac or respiratory illness, are all at risk of more severe illness, as well as children living in remote, overcrowded conditions.”Generally, the best defense is “prevention with the COVID vaccine, influenza vaccine. And the remote Indigenous babies should get the new RSV antibody, nirsevimab, which unfortunately hasn't (yet) been distributed for this season. That means that many Indigenous babies will be hospitalized when they might not have if they had the RSV antibody. A research letter published last year as a letter in Pediatric Pulmonary found low rates of coinfection with RSV and SARS-CoV-2. The authors, from Nationwide Children's Hospital in Columbus, Ohio, reported that of more than 2,000 pediatric patients with RSV and 6,000 with SARS‐ COV‐2, “the proportion of children with RSV/SARS‐ CoV‐2 codetections was low,” at only 3%. But many of those with coinfections had more severe disease.

Respiratory coinfections less common in older children with COVID-19

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