The role of viral co-infections in the severity of acute respiratory infections among children infected with respiratory syncytial virus (RSV): a systematic review and meta-analysis

You Li, Pallavi Pillai, Fuyu Miyake, Harish Nair

Research output: Contribution to journalArticlepeer-review

Abstract

Background Respiratory syncytial virus (RSV) is the predominant viral cause of childhood pneumonia. Little is known about the role of viral-coinfections in the clinical severity in children infected with RSV. Methods We conducted a systematic literature review of publications comparing the clinical severity between RSV mono-infection and RSV co-infection with other viruses in children under five years (<5y). Clinical severity was measured using the following six clinical outcomes: hospitalisation, length of hospital stay, use of supplemental oxygen, intensive care unit (ICU) admission, mechanical ventilation and deaths. We summarised the findings by clinical outcome and conducted random-effect meta-analyses, where applicable, to quantitatively synthesize the association between RSV mono-infection/RSV co-infection and the clinical severity. Results Overall, no differences in the clinical severity were found between RSV mono-infection and RSV co-infection with any viruses, except for the RSV-human metapneumovirus (hMPV) co-infection. RSV-hMPV coinfection was found to be associated with a higher risk of ICU admission (odds ratio [OR]: 7.2, 95% confidence interval [CI]: 2.1–25.1; OR after removal of the most influential study: 3.7, 95% CI: 1.1–12.3). We also observed a trend from three studies that RSV-hMPV coinfections were likely to be associated with longer hospital stay. Conclusion Our findings suggest that RSV-hMPV coinfections might be associated with increased risk for ICU admission in children <5y compared with RSV mono-infection but such association does not imply causation. Our findings do not support the association between RSV coinfections with other viruses and clinical severity but further large-scale investigations are needed to confirm the findings.
Original languageEnglish
Pages (from-to)010426
JournalJournal of Global Health
Volume10
Issue number1
Early online date11 Jun 2020
DOIs
Publication statusE-pub ahead of print - 11 Jun 2020

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