de Hoog Marieke L A, Hauser-van Westrhenen Emma S E M, Winkel Angelique M A M, de Jong Menno D, van Houten Marlies A, van Lelyveld Steven F L, Eggink Dirk, Euser Sjoerd, Duijts Liesbeth, Wildenbeest Joanne G, Schuurman Rob, van de Wijgert Janneke H H M, Ieven Margareta, Loens Katherine, van der Velden Alike W, Bonten Marc J M, Goossens Herman, Bruijning-Verhagen Patricia C J L
Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
Spaarne Gasthuis Academy, Spaarne Gasthuis, Hoofddorp, The Netherlands; Department of Medical Microbiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
J Infect. 2025 Jun;90(6):106501. doi: 10.1016/j.jinf.2025.106501. Epub 2025 May 9.
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.
本个体患者数据荟萃分析研究了感染或未感染其他呼吸道病毒的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）对急性呼吸道疾病（ARI）发生和严重程度的影响。
我们汇总了来自11个前瞻性2019冠状病毒病（COVID-19）社区和医疗队列（2020 - 2024年）的个体参与者数据。对受试者的第一份呼吸道样本进行SARS-CoV-2和一组呼吸道病毒检测。使用混合效应回归分析SARS-CoV-2单一感染与病毒合并感染与ARI发生和严重程度的关联。对人鼻病毒（HRV）重复进行该分析。
在1606例SARS-CoV-2阳性发作（1597名受试者）中，124例（7.7%）合并感染了另一种呼吸道病毒，大多数为HRV（66.1%）。在社区队列中，SARS-CoV-2合并感染与ARI发生几率低于SARS-CoV-2单一感染相关（校正（a）比值比（OR）：0.39；95%置信区间（CI）：0.21 - 0.71）。在医疗队列中，未观察到这种关联与ARI严重程度相关（aOR：1.76；95%CI：0.67 - 4.61）。在两种环境中，HRV合并感染与单一感染相比，均与更高的ARI发生率和严重程度相关（社区：aOR：1.72，医疗：aOR：6.04）。
在社区环境中，与SARS-CoV-2单一感染相比，SARS-CoV-2与另一种病毒（特别是HRV）合并感染会减轻ARI。检测到的与其他病毒（如流感或呼吸道合胞病毒（RSV））合并感染的数量较少，限制了对其他合并感染病毒组合的普遍性。
