Jayra Juliana Paiva Alves, Iago de Souza Gomes, Themis Rocha de Souza, Isabelle Cristina Clemente Santos, Pedro Henrique Ferreira Cavalcanti, Janaína Sonale Cavalcante Nogueira de Oliveira, Sônia Carmem Morais Leite, Ana Paula Ferreira Costa, Magaly Cristina Bezerra Câmara, Derley Galvão de Oliveira, Ana Helena Silva Moura, Wallace Pitanga Bezerra, Senei da Rocha Henrique, Karoline Ferreira Nascimento de Oliveira, Laiane Graziela Paulino da Costa, Paola Cristina Resende, Marcelo Ribeiro-Alves, Marilda Mendonça Siqueira, Josélio Maria Galvão de Araújo, Cristiana Couto Garcia
Among 545 cases, 13.2% showed viral co-detection. Co-detection was associated with dyspnoea, respiratory distress, low oxygen saturation, and diarrhoea, and inversely associated with cough. An increasing number of co-detected viruses was linked to more severe manifestations. Distinct viral combinations were associated with different clinical profiles. SARS-CoV-2 viral load and variants were not associated with co-detection.
BACKGROUND: Respiratory viral infections in children are characterised by the co-circulation of multiple viral pathogens, but the relevance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-detection with other respiratory viruses remains unclear.
OBJECTIVES: To evaluate the clinical and epidemiological implications of respiratory viral co-detection and the impact of viral diversity in paediatric SARS-CoV-2 infection.
METHODS: We conducted a retrospective-prospective molecular epidemiology study including children (0-11 years) with reverse transcription-polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection in Natal, northeast Brazil, between 2021 and 2024. Samples were analysed by multiplex RT-PCR for ten respiratory viruses. Associations between co-detection, the number of co-detected viruses, and clinical manifestations were assessed using multivariable logistic regression.
FINDINGS: Among 545 cases, 13.2% showed viral co-detection. Co-detection was associated with dyspnoea, respiratory distress, low oxygen saturation, and diarrhoea, and inversely associated with cough. An increasing number of co-detected viruses was linked to more severe manifestations. Distinct viral combinations were associated with different clinical profiles. SARS-CoV-2 viral load and variants were not associated with co-detection.
MAIN CONCLUSIONS: Respiratory viral co-detection is associated with distinct clinical and epidemiological profiles influenced by the number of co-detected viruses and viral combinations. These findings highlight the role of viral co-circulation and suggest interactions among respiratory viruses in the clinical expression of disease in children.