Viral Coinfections in Hospitalized Coronavirus Disease 2019 Patients Recruited to the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK Study
Authors: Vink Elen , Davis Chris , MacLean Alasdair , Pascall David , McDonald Sarah E , Gunson Rory , Hardwick Hayley E , Oosthuyzen Wilna , Openshaw Peter J M , Baillie J Kenneth , Semple Malcolm G , Ho Antonia ,   ISARIC4C Investigators, Baillie J Kenneth , Openshaw Peter J M , Semple Malcolm G , Barclay Wendy S , Bogaert Debby , Chand Meera , Chechi Kanta , Cooke Graham S , Filipe Ana da Silva , Silva Thushan de , Docherty Annemarie B , Correia Gonçalo dos Santos , Dumas Marc-Emmanuel , Dunning Jake , Fletcher Tom , Green Christoper A , Greenhalf William , Griffin Julian L , Gupta Rishi K , Harrison Ewen M , Hiscox Julian A , Ho Antonia Ying Wai , Holden Karl , Horby Peter W , Ijaz Samreen , Khoo Saye , Klenerman Paul , Law Andrew , Lewis Matthew R , Liggi Sonia , Lim Wei Shen , Maslen Lynn , Mentzer Alexander J , Merson Laura , Meynert Alison M , Moore Shona C , Noursadeghi Mahdad , Olanipekun Michael , Osagie Anthonia , Palmarini Massimo , Palmieri Carlo , Paxton William A , Pollakis Georgios , Price Nicholas , Rambaut Andrew , Robertson David L , Russell Clark D , Sancho-Shimizu Vanessa , Sands Caroline J , Scott Janet T , Sigfrid Louise , Solomon Tom , Sriskandan Shiranee , Stuart David , Summers Charlotte , Swann Olivia V , Takats Zoltan , Takis Panteleimon , Tedder Richard S , Thompson A A Roger , Thomson Emma C , Thwaites Ryan S , Turtle Lance CW , Zambon Maria , Drake Thomas M , Fairfield Cameron J , Knight Stephen R , Mclean Kenneth A , Murphy Derek , Norman Lisa , Pius Riinu , Shaw Catherine A , Connor Marie , Dalton Jo , Gamble Carrol , Girvan Michelle , Halpin Sophie , Harrison Janet , Jackson Clare , Lee James , Marsh Laura , Plotkin Daniel , Roberts Stephanie , Saviciute Egle , Clohisey Sara , Hendry Ross , Knight Susan , Lahnsteiner Eva , Law Andrew , Leeming Gary , Norris Lucy , Scott-Brown James , Tait Sarah , Wham Murray , Clark Richard , Coutts Audrey , Donnelly Lorna , Fawkes Angie , Gilchrist Tammy , Hafezi Katarzyna , MacGillivray Louise , Maclean Alan , McCafferty Sarah , Morrice Kirstie , Murphy Lee , Wrobel Nicola , Adeniji Kayode , Agranoff Daniel , Agwuh Ken , Ail Dhiraj , Aldera Erin L , Alegria Ana , Allen Sam , Angus Brian , Ashish Abdul , Atkinson Dougal , Bari Shahedal , Barlow Gavin , Barnass Stella , Barrett Nicholas , Bassford Christopher , Basude Sneha , Baxter David , Beadsworth Michael , Bernatoniene Jolanta , Berridge John , Berry Colin , Best Nicola , Bothma Pieter , Brittain-Long Robin , Bulteel Naomi , Burden Tom , Burtenshaw Andrew , Caruth Vikki , Chadwick David , Chadwick David , Chambler Duncan , Chee Nigel , Child Jenny , Chukkambotla Srikanth , Clark Tom , Collini Paul , Cosgrove Catherine , Cupitt Jason , Cutino-Moguel Maria-Teresa , Dark Paul , Dawson Chris , Dervisevic Samir , Donnison Phil , Douthwaite Sam , Drummond Andrew , DuRand Ingrid , Dushianthan Ahilanadan , Dyer Tristan , Evans Cariad , Eziefula Chi , Fegan Chrisopher , Finn Adam , Fullerton Duncan , Garg Sanjeev , Garg Sanjeev , Garg Atul , Gkrania-Klotsas Effrossyni , Godden Jo , Goldsmith Arthur , Graham Clive , Grammatikopoulos Tassos , Hardy Elaine , Hartshorn Stuart , Harvey Daniel , Havalda Peter , Hawcutt Daniel B , Hobrok Maria , Hodgson Luke , Hormis Anil , Howard Joanne , Jacobs Michael , Jain Susan , Jennings Paul , Kaliappan Agilan , Kasipandian Vidya , Kegg Stephen , Kelsey Michael , Kendall Jason , Kerrison Caroline , Kerslake Ian , Koch Oliver , Koduri Gouri , Koshy George , Laha Shondipon , Laird Steven , Larkin Susan , Leiner Tamas , Lillie Patrick , Limb James , Linnett Vanessa , Little Jeff , Lyttle Mark , MacMahon Michael , MacNaughton Emily , Mankregod Ravish , Masson Huw , Matovu Elijah , McCullough Katherine , McEwen Ruth , Meda Manjula , Mills Gary , Minton Jane , Mirfenderesky Mariyam , Mohandas Kavya , Mok Quen , Moon James , Moore Elinoor , Morgan Patrick , Morris Craig , Mortimore Katherine , Moses Samuel , Mpenge Mbiye , Mulla Rohinton , Murphy Michael , Nagarajan Thapas , Nagel Megan , Nelson Mark , Norris Lillian , O'Shea Matthew K , Ostermann Marlies , Otahal Igor , Pais Mark , Palmieri Carlo , Panchatsharam Selva , Papakonstantinou Danai , Papineni Padmasayee , Paraiso Hassan , Patel Brij , Pattison Natalie , Pepperell Justin , Peters Mark , Phull Mandeep , Pintus Stefania , Planche Tim , Post Frank , Price David , Prout Rachel , Rae Nikolas , Reschreiter Henrik , Reynolds Tim , Richardson Neil , Roberts Mark , Roberts Devender , Rose Alistair , Rousseau Guy , Ruge Bobby , Ryan Brendan , Saluja Taranprit , Cole Sarah , Schmid Matthias L , Shah Aarti , Shankar-Hari Manu , Shanmuga Prad , Sharma Anil , Shawcross Anna , Pooni Jagtur Singh , Sizer Jeremy , Smith Richard , Snelson Catherine , Spittle Nick , Staines Nikki , Stambach Tom , Stewart Richard , Subudhi Pradeep , Szakmany Tamas , Tatham Kate , Thomas Jo , Thompson Chris , Thompson Robert , Tridente Ascanio , Tupper-Carey Darell , Twagira Mary , Vallotton Nick , Vancheeswaran Rama , Vincent-Smith Lisa , Visuvanathan Shico , Vuylsteke Alan , Waddy Sam , Wake Rachel , Walden Andrew , Welters Ingeborg , Whitehouse Tony , Whittaker Paul , Whittington Ashley , Wijesinghe Meme , Williams Martin , Wilson Lawrence , Winchester Stephen , Wiselka Martin , Wolverson Adam , Wootton Daniel G , Workman Andrew , Yates Bryan , Young Peter , McDonald Sarah E , Shaw Victoria , Ahmed Katie A , Armstrong Jane A , Ashworth Milton , Asiimwe Innocent G , Bakshi Siddharth , Barlow Samantha L , Booth Laura , Brennan Benjamin , Bullock Katie , Carlucci Nicola , Cass Emily , Catterall Benjamin W A , Clark Jordan J , Clarke Emily A , Cole Sarah , Cooper Louise , Cox Helen , Davis Christopher , Dincarslan Oslem , Carracedo Alejandra Doce , Dunn Chris , Dyer Philip , Elliott Angela , Evans Anthony , Finch Lorna , Fisher Lewis W S , Flaherty Lisa , Foster Terry , Garcia-Dorival Isabel , Gunning Philip , Hartley Catherine , Holmes Anthony , Jensen Rebecca L , Jones Christopher B , Jones Trevor R , Khandaker Shadia , King Katharine , Kiy Robyn T , Koukorava Chrysa , Lake Annette , Lant Suzannah , Latawiec Diane , Lavelle-Langham Lara , Lefteri Daniella , Lett Lauren , Livoti Lucia A , Mancini Maria , Massey Hannah , Maziere Nicole , McDonald Sarah , McEvoy Laurence , McLauchlan John , Metelmann Soeren , Miah Nahida S , Middleton Joanna , Mitchell Joyce , Moore Shona C , Murphy Ellen G , Penrice-Randal Rebekah , Pilgrim Jack , Prince Tessa , Reynolds Will , Ridley P Matthew , Sales Debby , Shaw Victoria E , Shears Rebecca K , Small Benjamin , Subramaniam Krishanthi S , Szemiel Agnieska , Taggart Aislynn , Tanianis-Hughes Jolanta , Thomas Jordan , Trochu Erwan , Tonder Libby van , Wilcock Eve , Zhang J Eunice , Keating Seán , Donegan Cara , Spencer Rebecca G , Donohue Chloe , Griffiths Fiona , Hardwick Hayley , Oosthuyzen Wilna 
Published: October 2022

Abstract

Background
We conducted this study to assess the prevalence of viral coinfection in a well characterized cohort of hospitalized coronavirus disease 2019 (COVID-19) patients and to investigate the impact of coinfection on disease severity.

Methods
Multiplex real-time polymerase chain reaction testing for endemic respiratory viruses was performed on upper respiratory tract samples from 1002 patients with COVID-19, aged &lt;1 year to 102 years old, recruited to the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK study. Comprehensive demographic, clinical, and outcome data were collected prospectively up to 28 days post discharge.

Results
A coinfecting virus was detected in 20 (2.0%) participants. Multivariable analysis revealed no significant risk factors for coinfection, although this may be due to rarity of coinfection. Likewise, ordinal logistic regression analysis did not demonstrate a significant association between coinfection and increased disease severity.

Conclusions
Viral coinfection was rare among hospitalized COVID-19 patients in the United Kingdom during the first 18 months of the pandemic. With unbiased prospective sampling, we found no evidence of an association between viral coinfection and disease severity. Public health interventions disrupted normal seasonal transmission of respiratory viruses; relaxation of these measures mean it will be important to monitor the prevalence and impact of respiratory viral coinfections going forward.