SARS-CoV-2 Coinfections and Severity in Hospitalized Children With Systematic Testing.

Authors

Costanza Di Chiara, Daniel S Farrar, Julie A Bettinger, Aaron Campigotto, Olivier Drouin, Joanne Embree, Scott A Halperin, Taj Jadavji, Kescha Kazmi, Jesse Papenburg, Rupeena Purewal, Manish Sadarangani, Laura Sauvé, Karina A Top, Fatima Kakkar, Shaun K Morris, for Members of the Canadian Immunization Monitoring Program, Active (IMPACT) COVID-19 Study

Published in

The Pediatric infectious disease journal. Sep 10, 2026. Epub Sep 10, 2026.

Abstract

Co-circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with other respiratory viruses raised concerns that coinfections may increase pediatric coronavirus disease 2019 (COVID-19) severity, but evidence is limited by variable testing practices. We assessed the epidemiology and outcomes of SARS-CoV-2 respiratory viral coinfections in hospitalized children.
We analyzed national surveillance data from the Canadian Immunization Monitoring Program, ACTive (IMPACT) COVID-19 study. Children aged <17 years hospitalized with confirmed COVID-19 during Delta and Omicron periods were included. Coinfection was defined as SARS-CoV-2 plus ≥1 additional respiratory virus. Primary analyses were restricted to centres with systematic multiplex polymerase chain reaction (PCR) testing of all admissions with acute respiratory illness (n = 5), while secondary analyses included all centres (n = 13). Associations with outcomes (respiratory support, ventilation, intensive care and severe COVID-19) were estimated using multivariable mixed-effects logistic regression and adjusted odds ratios (aORs).
Among 2831 hospitalized children, 938 were admitted at centers with systematic multiplex PCR testing, among whom 18.6% had ≥1 respiratory viral coinfection. Respiratory syncytial virus (39.7%) and enterovirus/rhinovirus (38.5%) coinfections were the most common. Coinfections were not associated with increased odds of severe COVID-19 in centers with systematic multiplex PCR testing (aOR 0.94; 95% confidence interval, 0.76-1.15). In secondary analyses including all centers irrespective of testing strategy, coinfections were associated with increased odds of severe COVID-19 (aOR 1.42; 95% confidence interval, 1.05-1.91).
In centers that systematically conducted multiplex PCR testing, SARS-CoV-2 respiratory viral coinfections were not associated with increased COVID-19 severity. Differences observed when including centers without systematic testing underscore the importance of considering testing strategies when evaluating the clinical impact of coinfections.

PMID:
42717388
Bibliographic data and abstract were imported from PubMed on 10 Sep 2026.

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