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Does Viral Co-Infection Influence the Severity of Acute Respiratory Infection in Children?
Miriam Cebey-López1,2, Jethro Herberg3, Jacobo Pardo-Seco1,2,4
1Grupo de Investigación en Genética, Vacunas, Infecciones y Pediatría, Hospital Clínico Universitario and Universidade de Santiago de Compostela (USC), Galicia, Spain.
Insights
Viral co-infections are common in children with respiratory infections but do not increase severity. Bacterial superinfections significantly worsen outcomes, while pneumococcal vaccination offers protection against severe respiratory illness.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Clinical Virology
Background:
- Viral co-infections are frequently detected in children experiencing respiratory infections.
- The clinical significance of these viral co-infections on disease pathogenesis, severity, and outcomes remains unclear.
Purpose of the Study:
- To investigate the correlation between viral co-infection and clinical presentation in pediatric patients hospitalized with acute respiratory infections (ARI).
Main Methods:
- A prospective, multicenter study (GENDRES network) in Spain (2011-2013) collected clinical data on ARI severity.
- Respiratory secretions were analyzed for viral pathogens using a nested polymerase chain reaction (PCR) assay.
- Findings were validated against an independent UK cohort.
Main Results:
- The number of detected viruses did not correlate with disease severity markers.
- Bacterial superinfection was significantly associated with increased severity, PICU admission, higher clinical scores, need for respiratory support, and longer hospital stays.
- Pneumococcal vaccination demonstrated a protective effect, reducing respiratory distress, PICU admission, clinical score, need for respiratory support, and oxygen dependency.
Conclusions:
- While viral co-infections are common in hospitalized children with ARI, they do not appear to significantly impact disease severity.
- Bacterial superinfections are a critical factor in escalating disease severity.
- Pneumococcal vaccination plays a protective role in mitigating the severity of respiratory illness in children.
Background:
Multiple viruses are often detected in children with respiratory infection but the significance of co-infection in pathogenesis, severity and outcome is unclear.
Objectives:
To correlate the presence of viral co-infection with clinical phenotype in children admitted with acute respiratory infections (ARI).
Methods:
We collected detailed clinical information on severity for children admitted with ARI as part of a Spanish prospective multicenter study (GENDRES network) between 2011-2013. A nested polymerase chain reaction (PCR) approach was used to detect respiratory viruses in respiratory secretions. Findings were compared to an independent cohort collected in the UK.
Results:
204 children were recruited in the main cohort and 97 in the replication cohort. The number of detected viruses did not correlate with any markers of severity. However, bacterial superinfection was associated with increased severity (OR: 4.356; P-value = 0.005), PICU admission (OR: 3.342; P-value = 0.006), higher clinical score (1.988; P-value = 0.002) respiratory support requirement (OR: 7.484; P-value < 0.001) and longer hospital length of stay (OR: 1.468; P-value < 0.001). In addition, pneumococcal vaccination was found to be a protective factor in terms of degree of respiratory distress (OR: 2.917; P-value = 0.035), PICU admission (OR: 0.301; P-value = 0.011), lower clinical score (-1.499; P-value = 0.021) respiratory support requirement (OR: 0.324; P-value = 0.016) and oxygen necessity (OR: 0.328; P-value = 0.001). All these findings were replicated in the UK cohort.
Conclusion:
The presence of more than one virus in hospitalized children with ARI is very frequent but it does not seem to have a major clinical impact in terms of severity. However bacterial superinfection increases the severity of the disease course. On the contrary, pneumococcal vaccination plays a protective role.
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