Double Trouble, Examining Risk Factors Associated with Multiple Viral Infections in Children
Owen Simwale, Oliver Kunda, Sydney ShampileAbstract
Background
Poly viral acute respiratory tract infection (ARI) in the pediatric population is not uncommon during intense respiratory virus seasons. Risk factors associated with multi-virus infections are not fully understood. We undertook this small study to understand why some children come down with so many viruses at the same time. We investigated demographic and social risk factors associated with multiple viruses in children.
Methods
We examined positive RT-PCR test results for children under 10 years of age who were tested at a large University Hospital over three respiratory virus seasons (2015/16 to 2017/18). Our RT-PCR can detect 19 different respiratory viruses. During the three respiratory seasons, 1567 RT-PCR positive tests resulted involving 1027 individual children. Of these 501 (32%) had two or more viral detections and were included in the study. Demographic and social data on enrolled children were collected from consenting parents.
Results
Of the 502 children with multiple virus detections, a majority 449 (89.6%) had 1 to 4 viruses detected while 51 (10.4%) had 5 or more (range 5 to 9) viruses detected at the same time. Some statistically significant predictors of poly viral infections were age < 5 years, day care attendance, having 2 or more school going siblings. In a multivariate analysis, vaccination status, sex, race, immune suppression or disability did not show significant risk.
Conclusions
Understanding why and how children get infected with so many viruses is important for disease prevention. We highlight some of the ways parents, schools and public health care protect children from an onslaught of viral infections. We understand the research is inconclusive as to whether multiple viral infections cause severe illness, but anytime viruses co-exits there is also concern for genetic reassortment and recombination, altering virus evolution dynamics and generating novel variants with increased cross-species transmission risk.