Respiratory viral coinfection in a birth cohort of infants in rural Nepal

Anne Emanuels, Stephen E. Hawes, Kira L. Newman, Emily T. Martin, Janet A. Englund, James M. Tielsch, Jane Kuypers, Subarna K. Khatry, Steven C. LeClerq, Joanne Katz, Helen Y. Chu

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Acute respiratory illnesses are a leading cause of global morbidity and mortality in children. Coinfection with multiple respiratory viruses is common. Although the effects of each virus have been studied individually, the impacts of coinfection on disease severity are less understood. Methods: A secondary analysis was performed of a maternal influenza vaccine trial conducted between 2011 and 2014 in Nepal. Prospective weekly household-based active surveillance of infants was conducted from birth to 180 days of age. Mid-nasal swabs were collected and tested for respiratory syncytial virus (RSV), rhinovirus, influenza, human metapneumovirus (HMPV), coronavirus, parainfluenza (HPIV), and bocavirus by RT-PCR. Coinfection was defined as the presence of two or more respiratory viruses detected as part of the same illness episode. Results: Of 1730 infants with a respiratory illness, 327 (19%) had at least two respiratory viruses detected in their primary illness episode. Of 113 infants with influenza, 23 (20%) had coinfection. Of 214 infants with RSV, 87 (41%) had coinfection. The cohort of infants with coinfection had increased occurrence of fever lasting ≥ 4 days (OR 1.4, 95% CI: 1.1, 2.0), and so did the subset of coinfected infants with influenza (OR 5.8, 95% CI: 1.8, 18.7). Coinfection was not associated with seeking further care (OR 1.1, 95% CI: 0.8, 1.5) or pneumonia (OR 1.2, 95% CI: 0.96, 1.6). Conclusion: A high proportion of infants had multiple viruses detected. Coinfection was associated with greater odds of fever lasting for four or more days, but not with increased illness severity by other measures.

Original languageEnglish (US)
Pages (from-to)739-746
Number of pages8
JournalInfluenza and other Respiratory Viruses
Issue number6
StatePublished - Nov 1 2020


  • coinfection
  • epidemiology
  • global health
  • human influenza
  • human respiratory syncytial virus
  • respiratory infections

ASJC Scopus subject areas

  • Epidemiology
  • Pulmonary and Respiratory Medicine
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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