Codetections of Other Respiratory Viruses Among Children Hospitalized With COVID-19
Nickolas T. Agathis, Kadam Patel, Jennifer Milucky, Christopher A. Taylor, Michael Whitaker, Huong Pham, Onika Anglin, Shua J. Chai, Nisha B. Alden, James Meek, Evan J. Anderson, Andy Weigel, Sue Kim, Ruth Lynfield, Chad Smelser, Alison Muse, Kevin Popham, Laurie M. Billing, Melissa Sutton, H. Keipp Talbot, Andrea George, Meredith McMorrow, Fiona P. Havers, CDC COVID-NET Surveillance Team, Pam Daily Kirley, Breanna Kawasaki, Kimberly Yousey‐Hindes, Kyle P. Openo, Val Tellez Nunez, Kayla Bilski, Susan L. Ropp, Grant Barney, Nancy M. Bennett, Eli Shiltz, Nasreen Abdullah, William Schaffner, Mary Hill
Abstract
OBJECTIVES: To assess the clinical impact of respiratory virus codetections among children hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: During March 2020 to February 2022, the US coronavirus disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) identified 4372 children hospitalized with SARS-CoV-2 infection admitted primarily for fever, respiratory illness, or presumed COVID-19. We compared demographics, clinical features, and outcomes between those with and without codetections who had any non-SARS-CoV-2 virus testing. Among a subgroup of 1670 children with complete additional viral testing, we described the association between presence of codetections and severe respiratory illness using age-stratified multivariable logistic regression models. RESULTS: Among 4372 children hospitalized, 62% had non-SARS-CoV-2 respiratory virus testing, of which 21% had a codetection. Children with codetections were more likely to be <5 years old (yo), receive increased oxygen support, or be admitted to the ICU (P < .001). Among children <5 yo, having any viral codetection (<2 yo: adjusted odds ratio [aOR] 2.1 [95% confidence interval [CI] 1.5-3.0]; 2-4 yo: aOR 1.9 [95% CI 1.2-3.1]) or rhinovirus/enterovirus codetection (<2 yo: aOR 2.4 [95% CI 1.6-3.7]; 2-4: aOR 2.4 [95% CI 1.2-4.6]) was significantly associated with severe illness. Among children <2 yo, respiratory syncytial virus (RSV) codetections were also significantly associated with severe illness (aOR 1.9 [95% CI 1.3-2.9]). No significant associations were seen among children ≥5 yo. CONCLUSIONS: Respiratory virus codetections, including RSV and rhinovirus/enterovirus, may increase illness severity among children <5 yo hospitalized with SARS-CoV-2 infection.