Impact of co-infection with SARS-CoV-2 and other respiratory viruses on illness: Pooled analyses of 11 COVID-19 cohorts
de Hoog, Marieke LA; Hauser-van Westrhenen, Emma SEM; Winkel, Angelique MAM; de Jong, Menno D; van Houten, Marlies A; van Lelyveld, Steven FL; Eggink, Dirk; Euser, Sjoerd; Duijts, Liesbeth; Wildenbeest, Joanne G; Schuurman, Rob; van de Wijgert, Janneke HHM; Ieven, Margareta; Loens, Katherine; van der Velden, Alike W; Bonten, Marc JM; Goossens, Herman; Bruijning-Verhagen, Patricia CJL
Series / Report no.
Open Access
Type
Journal Article
Meta-Analysis
Article
Meta-Analysis
Article
Language
en
Date
2025-05-09
Research Projects
Organizational Units
Journal Issue
Title
Impact of co-infection with SARS-CoV-2 and other respiratory viruses on illness: Pooled analyses of 11 COVID-19 cohorts
Translated Title
Published in
J Infect 2025; 90(6):106501
Abstract
This individual patient data meta-analysis investigates the impact of SARS-CoV-2 infection with or without other respiratory viruses on Acute Respiratory Illness (ARI) occurrence and severity.
We pooled individual participant data from 11 prospective COVID-19 community and healthcare cohorts (2020-2024). A subject's first respiratory sample was tested for SARS-CoV-2 and a panel of respiratory viruses. The association of SARS-CoV-2 single versus viral co-infection with ARI occurrence and severity was analyzed using mixed effects regression. The analysis was repeated for Human Rhinovirus (HRV).
Of 1606 SARS-CoV-2 positive episodes (1597 subjects), 124 (7.7%) were co-infected with another respiratory virus, the majority with HRV (66.1%). SARS-CoV-2 Co-infection was associated with a lower odds of ARI than SARS-CoV-2 single infection in community cohorts (adjusted (a) OR: 0.39; 95%CI: 0.21-0.71). This association was not observed for ARI severity in healthcare cohorts (aOR: 1.76; 95%CI: 0.67-4.61). Co-infection versus single infection with HRV was associated with higher ARI occurrence and severity in both settings (community: aOR: 1.72 and healthcare: aOR: 6.04).
In community settings, SARS-CoV-2 co-infection with another virus, particularly HRV, attenuates ARI compared to SARS-CoV-2 single infection. The low number of detected co-infections with other viruses, such as influenza or RSV, limits generalizability to other combinations of co-infecting viruses.
We pooled individual participant data from 11 prospective COVID-19 community and healthcare cohorts (2020-2024). A subject's first respiratory sample was tested for SARS-CoV-2 and a panel of respiratory viruses. The association of SARS-CoV-2 single versus viral co-infection with ARI occurrence and severity was analyzed using mixed effects regression. The analysis was repeated for Human Rhinovirus (HRV).
Of 1606 SARS-CoV-2 positive episodes (1597 subjects), 124 (7.7%) were co-infected with another respiratory virus, the majority with HRV (66.1%). SARS-CoV-2 Co-infection was associated with a lower odds of ARI than SARS-CoV-2 single infection in community cohorts (adjusted (a) OR: 0.39; 95%CI: 0.21-0.71). This association was not observed for ARI severity in healthcare cohorts (aOR: 1.76; 95%CI: 0.67-4.61). Co-infection versus single infection with HRV was associated with higher ARI occurrence and severity in both settings (community: aOR: 1.72 and healthcare: aOR: 6.04).
In community settings, SARS-CoV-2 co-infection with another virus, particularly HRV, attenuates ARI compared to SARS-CoV-2 single infection. The low number of detected co-infections with other viruses, such as influenza or RSV, limits generalizability to other combinations of co-infecting viruses.