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Coinfection with respiratory viruses did not worsen COVID-19 in hospitalised children

Among 938 children admitted at Canadian centres that tested every respiratory admission, 18.6% had a viral coinfection, which carried no higher odds of severe COVID-19.

Canadian national surveillance of 2831 hospitalised children included 938 at centres testing every respiratory admission by multiplex PCR, of whom 18.6% had a coinfection. In those centres, coinfection carried no higher odds of severe COVID-19 (adjusted odds ratio 0.94). Across all centres irrespective of testing practice, the odds appeared raised (adjusted odds ratio 1.42).

Why it is interesting: The raised odds appear only when centres without systematic testing are included in the analysis.

Source
Pediatric Infectious Disease Journal, 10 September 2026
Paper
SARS-CoV-2 Coinfections and Severity in Hospitalized Children With Systematic Testing
Authors
Di Chiara C, Farrar DS, Bettinger JA, Campigotto A, Drouin O, Embree J et al.
DOI
10.1097/inf.0000000000005396
Type
Peer-reviewed article
Design
Prospective surveillance, 2831 hospitalized children aged <17 years, Delta and Omicron periods
Verdict
Refines prior evidence
Driver
Infection and pandemics
Free full text
Free to read at the publisher
Abstract — the authors' own words, CC BY

Background

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. Methods

We analyzed national surveillance data from the Canadian Immunization Monitoring Program, ACTive (IMPACT) COVID-19 study. Children aged Results

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). Conclusions

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.

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