Comparison of Rates of Hospitalization Between Single and Dual Virus Detection in a Mexican Cohort of Children and Adults With Influenza-Like Illness

Daniel E Noyola; Sally Hunsberger; Raydel Valdés Salgado; John H Powers 3rd; Arturo Galindo-Fraga; Ana A Ortiz-Hernández; Alejandra Ramirez-Venegas; Sarbelio Moreno-Espinosa; Beatriz Llamosas-Gallardo; M Lourdes Guerrero; John H Beigel; Guillermo Ruiz-Palacios; Santiago Perez-Patrigeon; Mexico Emerging Infectious Diseases Clinical Research Network ILI-002 Study Group

doi:10.1093/ofid/ofz424

Comparison of Rates of Hospitalization Between Single and Dual Virus Detection in a Mexican Cohort of Children and Adults With Influenza-Like Illness

Open Forum Infect Dis. 2019 Oct 3;6(11):ofz424. doi: 10.1093/ofid/ofz424. eCollection 2019 Nov.

Authors

Daniel E Noyola¹, Sally Hunsberger², Raydel Valdés Salgado³, John H Powers 3rd⁴, Arturo Galindo-Fraga⁵, Ana A Ortiz-Hernández⁶, Alejandra Ramirez-Venegas⁷, Sarbelio Moreno-Espinosa⁸, Beatriz Llamosas-Gallardo⁶, M Lourdes Guerrero⁵, John H Beigel², Guillermo Ruiz-Palacios⁵, Santiago Perez-Patrigeon⁵; Mexico Emerging Infectious Diseases Clinical Research Network ILI-002 Study Group

Affiliations

¹ Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México.
² National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
³ Westat, Rockville, Maryland, USA.
⁴ Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA.
⁵ Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico city, Mexico.
⁶ Instituto Nacional de Pediatría, Mexico city, Mexico.
⁷ Instituto Nacional de Enfermedades Respiratorias Ismaél Cosío Villegas, Mexico city, Mexico.
⁸ Hospital Infantil "Dr. Federico Gomez," Mexico city, Mexico.

Abstract

Background: Molecular detection methods allow for the simultaneous detection of several infectious agents. This study assesses whether co-infection with 2 viruses as compared with 1 is associated with increased hospitalization in those with acute respiratory infections.

Methods: We prospectively enrolled a cohort of pediatric and adult participants with influenza-like illness during 2010-2014 in Mexico. Clinical information and respiratory samples were collected at enrollment. Respiratory viruses were detected with multiplex polymerase chain reaction (PCR) and influenza-specific reverse transcription PCR assays. Participants were followed for 14 and 28 days after inclusion. Severity of disease, as measured by hospitalization with acute respiratory infections, was compared between single and dual viral infections.

Results: Among 5662 participants in the study, either 1 (n = 3285) or 2 (n = 641) viruses were detected in 3926 participants. Rhinovirus (n = 1433), influenza (n = 888), and coronaviruses (n = 703) were the most frequently detected viruses (either alone or in co-infection). Bocavirus, respiratory syncytial virus (RSV), metapneumovirus, and rhinovirus cases were hospitalized more often than other viruses. Bocavirus+rhinovirus cases were hospitalized more often than those with rhinovirus alone (but not bocavirus alone). RSV cases were more likely to be hospitalized than cases with co-infections of RSV and parainfluenza virus or coronavirus. Metapneumovirus cases were hospitalized more often than those co-infected with metapneumovirus+coronavirus.

Conclusions: In this study, detection of 2 viruses did not significantly increase hospitalizations compared with single virus infections. Larger studies will allow for distinguishing between sequential and simultaneous infection and for a better understanding of the role of each virus during the evolution of acute respiratory episodes.

Keywords: acute respiratory infections; coinfection; hospitalization; influenza; severity.

Abstract

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