Comparison of clinical characteristics and severity of COVID-19 with or without viral co-infection in hospitalized children

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
• Main Authors: Shoji, Kensuke, Asai, Yusuke, Tsuzuki, Shinya, Matsunaga, Nobuaki, Suzuki, Setsuko, Iwamoto, Noriko, Funaki, Takanori, Miyairi, Isao, Ohmagari, Norio
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 11.09.2024
• Subjects: Children; Co-infection; Coronavirus disease 2019; Severe acute respiratory syndrome coronavirus 2; Severe acute respiratory syndrome coronavirus 2; COVID-19; COVIREGI-JP; ECMO; mPCR; SARS-CoV-2; Co-infection; Coronavirus disease 2019; ICU; Children; IQR; VOC; co-infection; children; severe acute respiratory syndrome coronavirus 2; coronavirus disease 2019
• ISSN: 1341-321X; 1437-7780; 1437-7780
• DOI: 10.1016/j.jiac.2024.09.009

Co-infection with other pathogens can alter the severity and clinical outcomes of viral infections. However, the information regarding viral co-infections in pediatric coronavirus disease 2019 (COVID-19) cases is still limited. This is a nationwide, retrospective cohort study using the data from the COVID-19 Registry Japan. The pediatric (<18 years), laboratory confirmed, hospitalized COVID-19 patients in the Omicron variant of concern predominant period (January 2022 to January 2024) were included. Co-infection was investigated by multiplex PCR. We compared clinical characteristics, symptoms, severity, and outcomes between children with and without co-infection. Among 245 hospitalized pediatric COVID-19 patients, 78 (31.8 %) had co-infections. The patient backgrounds of the “co-infection” and “SARS-CoV-2 alone” groups were similar, although age distribution was different, with a lower number of patients over 12 years in the co-infection group (n = 2, 2.6 % vs. n = 29, 17.4 %; P < 0.001). Among the patients with co-infection, the most common pathogen was enterovirus/rhinovirus (51.3 %), followed by parainfluenza virus (23.1 %) and adenovirus (12.8 %). Patients with co-infection more commonly had respiratory symptoms, including SpO2 < 96 %, shortness of breath, runny nose, and wheezing. Requirement of non-invasive oxygen support was higher in the co-infection group (n = 27, 34.6 % vs. n = 28, 16.8 %, P = 0.006). By multivariable logistic regression analysis, co-infection and presence of any comorbidity were identified as significant risk factors for necessity of oxygen therapy (odds ratio [95 % confidence interval] 2.44 [1.29–4.63] and 3.99 [2.07–7.82], respectively). Viral co-infection may increase the risk of respiratory distress in pediatric COVID-19 patients.