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Updated: Sep 12, 2025

Author Spotlight: Advancements in Multiplex Detection of Respiratory Viruses
Published on: November 10, 2023
Respiratory and Other Infections Following COVID
Andrea J Allen1, Nhat Nguyen1, Vitaly Lorman1
1Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Children who had SARS-CoV-2 infection did not have a higher risk of subsequent respiratory syncytial virus (RSV) or other infections. This study compared infection risks in children with SARS-CoV-2 versus influenza and other respiratory illnesses.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Epidemiology
Background:
- The 2022 surge in respiratory syncytial virus (RSV) cases prompted investigation into potential contributing factors, including immune suppression following SARS-CoV-2 infection.
- Understanding the impact of SARS-CoV-2 on subsequent infection risks in children is crucial for public health strategies.
Purpose of the Study:
- To compare the risk of subsequent respiratory syncytial virus (RSV) and other infections in children with and without prior SARS-CoV-2 infection.
- To evaluate the association between SARS-CoV-2 infection and the incidence of other respiratory illnesses in pediatric populations.
Main Methods:
- A retrospective cohort study utilized electronic health records from 27 US health systems.
- Children under 5 years with SARS-CoV-2 infection were compared to those with influenza or other respiratory tract infections.
- Inverse probability of treatment weighting and weighted logistic regression were applied to analyze outcomes over 15 to 180 days.
Main Results:
- Children with SARS-CoV-2 infection showed lower odds of subsequent RSV compared to those with influenza (aOR 0.73) or other respiratory infections (aOR 0.78).
- The odds of any respiratory tract infection and any infection were also lower in the SARS-CoV-2 group compared to the influenza group.
- No increased risk of RSV or other infections was observed within 6 months following SARS-CoV-2 infection.
Conclusions:
- SARS-CoV-2 infection in children was not associated with an increased risk of subsequent RSV, respiratory, or any type of infection within 6 months.
- Findings suggest that SARS-CoV-2 infection does not heighten susceptibility to other common childhood infections in the short term.
- The hypothesis of SARS-CoV-2-induced immune suppression leading to increased RSV risk was not supported by this study.
Background:
One hypothesis for the respiratory syncytial virus (RSV) surge in 2022 was suppression of immune responses following SARS-CoV-2 infection. Our objective was to compare the risk of subsequent RSV and other infections among children with and without SARS-CoV-2 infection.
Methods:
We conducted a retrospective cohort study using electronic health record data from 27 US health systems analyzing children aged under 5 years with SARS-CoV-2 infection (test/coded) between March and July 2022. The comparison groups were children with (a) influenza infection and (b) respiratory tract infection with no evidence of SARS-CoV-2/influenza infection. The primary and secondary outcomes were RSV infection and respiratory or any infection in the subsequent 15 to 180 days, respectively. We applied inverse probability of treatment weighting and performed weighted logistic regression modeling.
Results:
Our primary and secondary cohorts consisted of 18 767 and 114 414 children with SARS-CoV-2 infection, and 6697 and 30 424 with influenza infection, respectively, and 46 697 with another acute respiratory tract infection. The odds of subsequent RSV were lower in the SARS-CoV-2 group compared with the influenza group (adjusted odds ratio [aOR] 0.73, 95% CI 0.61-0.86) and compared with the group with any respiratory tract infection (aOR 0.78, 95% CI 0.7-0.87). The odds of a respiratory tract infection and any infection were lower in the SARS-CoV-2 group than the influenza group (aOR 0.62, 95% CI 0.59-0.64 and aOR 0.67, 95% CI 0.65-0.7, respectively).
Conclusions:
We did not find an increased risk of RSV or a respiratory or any type of infection within 6 months of SARS-CoV-2 infection, compared with influenza and other respiratory illnesses.
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