title: Systematic review and meta-analysis of respiratory viral coinfections in children.
abstract: Respiratory infections are a common cause of paediatric morbidity. Clinical outcomes in children hospitalized with single respiratory virus infection are compared with those with two or more viral-viral coinfection. Studies were restricted to those reporting on children aged less than 5 years (PROSPERO CRD#42014009133). Published data to calculate risk ratios (RR) comparing children with single viral infections to coinfection using a random effects model were used. Similar analyses by pathogen pairs and by excluding children with comorbidities were performed. Of 4443 articles reviewed, 19 were included. Overall, no differences in the risk of fever, admission to an intensive care unit (ICU), oxygen use, mechanical ventilation and abnormal radiographs between children with single infection and those with coinfection were found. When analysing only children without comorbidities, the risk of fever (RR = 1.16 to RR = 1.24, 95% confidence intervals (CI) = 1.00-1.55) and ICU admission (RR = 1.08 to RR = 1.31, 95% CI = 0.93-1.83) increased but remained non-significant. Point estimates suggested an increased risk of ICU admission in those coinfected with either respiratory syncytial virus or human metapneumovirus compared with those with single infection but was non-significant. Our findings suggest that coinfection is not associated with increased clinical severity, but further investigations by pathogen pairs are warranted.
authors.affiliation: Wesfarmers Centre of Vaccine and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Faye Janice
authors.identifier: http://orcid.org/0000-0002-6037-2741
authors.initials: FJ
authors.lastname: Lim
authors.affiliation: Wesfarmers Centre of Vaccine and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: de Klerk
authors.affiliation: Wesfarmers Centre of Vaccine and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.|School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia.|Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.|PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Blyth
authors.affiliation: Wesfarmers Centre of Vaccine and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Parveen
authors.initials: P
authors.lastname: Fathima
authors.affiliation: Wesfarmers Centre of Vaccine and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Hannah C
authors.initials: HC
authors.lastname: Moore
mesh_terms: D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology*; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D016017:Odds Ratio; D012121:Respiration, Artificial; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology*; D012720:Severity of Illness Index
keywords: child; coinfection; respiratory tract infection; severity of illness