Skip to main navigation menu Skip to main content Skip to site footer

Assessing the Effect of Viral Coinfection on Pneumonia Diagnosis Odds in Children and Adolescents with Influenza

Evaluación del efecto de la coinfección viral sobre las posibilidades de diagnóstico de neumonía en niños y adolescentes con influenza



Open | Download


Section
Research Article

How to Cite
1.
Mendoza-Cano O, Ortega-Ramírez AD, Murillo-Zamora E. Assessing the Effect of Viral Coinfection on Pneumonia Diagnosis Odds in Children and Adolescents with Influenza. Rev. Investig. Innov. Cienc. Salud [Internet]. 2025 May 26 [cited 2025 Jun. 5];7(2):1-12. Available from: https://riics.info/index.php/RCMC/article/view/395

Dimensions
PlumX

Oliver Mendoza-Cano,

Facultad de Ingeniería Civil; Universidad de Colima; Colima; México.


Ana Daniela Ortega-Ramírez,

Facultad de Medicina; Universidad de Colima; Colima; México.


Efrén Murillo-Zamora,

Unidad de Investigación en Epidemiología Clínica; Instituto Mexicano del Seguro Social; Villa de Álvarez; México.


Introduction. Influenza infections pose a major public health concern, especially in children and adolescents at high risk for severe pneumonia. Coinfections with multiple pathogens exacerbate respiratory infections. This study assessed the effect of coinfections on pneumonia diagnosis in this population.

Methods. A cross-sectional analysis was conducted using data from a nationwide epidemiological surveillance system in Mexico. Data from 2,057 RT-PCR-confirmed influenza cases in patients aged 15 years and younger, recorded between January and October 26, 2024, were analyzed. The primary outcome was pneumonia diagnosis, with associations to coinfection and other risk factors assessed using odds ratios (OR) and 95% confidence intervals (CI).

Results. Pneumonia was diagnosed in 36.0% of the cases, with coinfection more common among those diagnosed with pneumonia (7.4% vs. 3.1%,  < 0.001). In the multiple regression model, coinfection was associated with a 95% increase in pneumonia odds (OR = 1.95, 95% CI 1.27 – 3.00). Younger age, obesity, and immunosuppression were also associated with higher odds of pneumonia.

Conclusions. Our findings suggest that viral coinfections increase the odds of pneumonia in pediatric influenza cases. Widespread influenza vaccination remains critical for reducing influenza-related disease burden, while systematic coinfection screening would enable timely clinical interventions.


Article visits 40 | PDF visits 20


  1. Machado CM, Souza ACMF, Romano CM, Freire WS, Costa AA, Figueiredo WM, et al. Influenza A and B in a cohort of outpatient children and adolescent with influenza like-illness during two consecutive influenza seasons. Braz J Infect Dis [Internet]. 2020;24(1):73-80. doi: https://doi.org/10.1016/j.bjid.2019.12.005
  2. Nolan VG, Arnold SR, Bramley AM, Ampofo K, Williams DJ, Grijalva CG, et al. Etiology and Impact of Coinfections in Children Hospitalized With Community-Acquired Pneumonia. J Infect Dis [Internet]. 2018;218(2):179-88. doi: https://doi.org/10.1093/infdis/jix641
  3. Chertow DS, Memoli MJ. Bacterial coinfection in influenza: a grand rounds review. JAMA [Internet]. 2013;309(3):275-82. doi: https://doi.org/10.1001/jama.2012.194139
  4. Sharma-Chawla N, Sender V, Kershaw O, Gruber AD, Volckmar J, Henriques-Normark B, et al. Influenza A Virus Infection Predisposes Hosts to Secondary Infection with Different Streptococcus pneumoniae Serotypes with Similar Outcome but Serotype-Specific Manifestation. Infect Immun [Internet]. 2016;84(12):3445-57. doi: https://doi.org/10.1128/IAI.00422-16
  5. Choo S, Lee YY, Lee E. Clinical significance of respiratory virus coinfection in children with Mycoplasma pneumoniae pneumonia. BMC Pulm Med [Internet]. 2022;22(1):212. doi: https://doi.org/10.1186/s12890-022-02005-y
  6. Jiang W, Wu M, Zhou J, Wang Y, Hao C, Ji W, et al. Etiologic spectrum and occurrence of coinfections in children hospitalized with community-acquired pneumonia. BMC Infect Dis [Internet]. 2017;17(1):787. doi: https://doi.org/10.1186/s12879-017-2891-x
  7. Ozaras R, Cirpin R, Duran A, Duman H, Arslan O, Bakcan Y, et al. Influenza and COVID-19 coinfection: Report of six cases and review of the literature. J Med Virol [Internet]. 2020;92(11):2657-65. doi: https://doi.org/10.1002/jmv.26125
  8. General Directorate of Epidemiology, Government of Mexico. [Standardized Guidelines for Epidemiological and Laboratory Surveillance of Viral Respiratory Disease] [Internet]. Mexico City: Health Department, Government of Mexico; 2023 Sep [cited 2024 Nov 21]. 124 p. Available from: https://www.gob.mx/salud/documentos/lineamiento-estandarizado-para-la-vigilancia-epidemiologica-y-por-laboratorio-de-la-enfermedad-respiratoria-viral
  9. El Guerche-Seblain C, Etcheto A, Parmentier F, Afshar M, Macias AE, Puentes E, et al. Hospital admissions with influenza and impact of age and comorbidities on severe clinical outcomes in Brazil and Mexico. PLoS One [Internet]. 2022;17(11):e0273837. doi: https://doi.org/10.1371/journal.pone.0273837
  10. Fernandes-Matano L, Monroy-Muñoz IE, Bermudez de Leon M, Leal-Herrera YA, Palomec-Navia ID, Ruiz-Pacheco JA, et al. Analysis of influenza data generated by four epidemiological surveillance laboratories in Mexico, 2010-2016. Epidemiol Infect [Internet]. 2019;147:e183. doi: https://doi.org/10.1017/S0950268819000694
  11. Torres A, Cilloniz C, Niederman MS, Menendez R, Chalmers JD, Wunderink RG, et al. Pneumonia. Nat Rev Dis Primers [Internet]. 2021;7(1):25. doi: https://doi.org/10.1038/s41572-021-00259-0
  12. Ferreira HLS, Costa KLP, Cariolano MS, Oliveira GS, Felipe KKP, Silva ESA, et al. High incidence of rhinovirus infection in children with community-acquired pneumonia from a city in the Brazilian pre-Amazon region. J Med Virol [Internet]. 2019;91(10):1751-8. doi: https://doi.org/10.1002/jmv.25524
  13. Yan Y, Sun J, Ji K, Guo J, Han L, Li F, et al. High incidence of the virus among respiratory pathogens in children with lower respiratory tract infection in northwestern China. J Med Virol [Internet]. 2023;95(1):e28367. doi: https://doi.org/10.1002/jmv.28367
  14. Reina J, Dueñas Morales J. Respiratory co-infections between influenza viruses and respiratory syncytial virus (2014-2017). An Pediatr [Internet]. 2019;90(2):118-9. doi: https://doi.org/10.1016/j.anpede.2018.02.011
  15. Sanz I, Perez D, Rojo S, Domínguez-Gil M, Ortiz de Lejarazu R, Eiros JM. [Coinfections of influenza and other respiratory viruses are associated to children]. An Pediatr [Internet]. 2022;96(4):334-41. doi: https://doi.org/10.1016/j.anpedi.2020.12.024
  16. Le-Corre N, Pérez R, Vizcaya C, Martínez-Valdebenito C, López T, Monge M, et al. Relevance of codetection of respiratory viruses in the severity of acute respiratory infection in hospitalized children. Andes pediatr [Internet]. 2021;92(3):349-58. doi: https://doi.org/10.32641/andespediatr.v92i3.1756
  17. Del Riccio M, Caini S, Bonaccorsi G, Lorini C, Paget J, Velden K, et al. Global analysis of respiratory viral circulation and timing of epidemics in the pre–COVID-19 and COVID-19 pandemic eras, based on data from the Global Influenza Surveillance and Response System (GISRS). Int J Infect Dis [Internet]. 2024;144:107052. doi: https://doi.org/10.1016/j.ijid.2024.107052
  18. Oweidat, KA, Toubasi AA, Alghrabli A, Khater Y, Saleh N, Albtoosh AS, et al. Alterations in Patients’ Clinical Outcomes and Respiratory Viral Pathogen Activity following the COVID-19 Pandemic. Viruses [Internet]. 2023;15(10):1975. doi: https://doi.org/10.3390/v15101975
  19. Chen SJ, Walker PJB, Mulholland K, Graham HR, ARI Review group. Childhood pneumonia in humanitarian emergencies in low- and middle-income countries: A systematic scoping review. J Glob Health [Internet]. 2022;12:10001. doi: https://doi.org/10.7189/jogh.12.10001
  20. Wishaupt JO, Ploeg T, Groot R, Versteegh FGA, Hartwig NG. Single- and multiple viral respiratory infections in children: disease and management cannot be related to a specific pathogen. BMC Infect Dis [Internet]. 2017;17(1):62. doi: https://doi.org/10.1186/s12879-016-2118-6
  21. Costa LF, Silveira HL, Queiroz DAO, Mantese OC, Yokosawa J. Respiratory virus infections in hospitalized and non-hospitalized children: determinants of severe course of the disease. J Infect Dev Ctries [Internet]. 2022;16(1):196-205. doi: https://doi.org/10.3855/jidc.15117
  22. Qiao M, Moyes G, Zhu F, Li Y, Wang X. The prevalence of influenza bacterial co-infection and its role in disease severity: A systematic review and meta-analysis. J Glob Health [Internet]. 2023;13:04063. doi: https://doi.org/10.7189/jogh.13.04063
  23. Hernandez-Garduno E. Comorbidities that predict acute respiratory syndrome coronavirus 2 test positivity in Mexican Children: A case-control study. Pediatr Obes [Internet]. 2021;16(5):e12740. doi: https://doi.org/10.1111/ijpo.12740
  24. Moreno-Noguez M, Rivas-Ruiz R, Roy-Garcia I, Pacheco-Rosas DO, Moreno-Espinosa S, Flores-Pulido AA. Risk factors associated with SARS-CoV-2 pneumonia in the pediatric population. Bol Med Hosp Infant Mex [Internet]. 2021;78(4):251-8. doi: https://doi.org/10.24875/BMHIM.20000263
  25. Honce R, Schultz-Cherry S. Impact of Obesity on Influenza A Virus Pathogenesis, Immune Response, and Evolution. Front Immunol [Internet]. 2019;10:1071. doi: https://doi.org/10.3389/fimmu.2019.01071
  26. Shamah-Levy T, Cuevas-Nasu L, Gaona-Pineda EB, Valenzuela-Bravo DG, Gomez-Humaran IM, Avila-Arcos MA. Childhood obesity in Mexico: Influencing factors and prevention strategies. Front Public Health [Internet]. 2022;10:949893. doi: https://doi.org/10.3389/fpubh.2022.949893
  27. Ministry of Health of the Government of Mexico. [Epidemiological Situation of COVID-19, Influenza, and Other Respiratory Viruses in Mexico. Epidemiological Week 51, 2024]. Mexico City: Health Department, Government of Mexico; 2024 [cited 2025 Apr 13]. 19 p. Available from: https://www.gob.mx/cms/uploads/attachment/file/963830/ERV_SE51_2024.pdf
  28. World Health Organization. Recommended composition of influenza virus vaccines for use in the 2023-2024 northern hemisphere influenza season. Geneva: World Health Organization (WHO); 2024 Feb 24 [cited 2025 Apr 13]. 11 p. Available from: https://www.who.int/publications/m/item/recommended-composition-of-influenza-virus-vaccines-for-use-in-the-2023-2024-northern-hemisphere-influenza-season
  29. Paradowska-Stankiewicz I, Pancer K, Poznańska A, Hordowicz M, Skibicka M, Słowiński, et al. Tick-borne encephalitis epidemiology and surveillance in Poland, and comparison with selected European countries before and during the COVID-19 pandemic, 2008 to 2020. Euro Surveill [Internet]. 2023;28(18):2200452. doi: https://doi.org/10.2807/1560-7917.ES.2023.28.18.2200452
  30. Aakjaer M, Bruin ML, Kulahci M, Andersen M. Surveillance of Antidepressant Safety (SADS): Active Signal Detection of Serious Medical Events Following SSRI and SNRI Initiation Using Big Healthcare Data. Drug Saf [Internet]. 2021;44(11):1215-30. doi: https://doi.org/10.1007/s40264-021-01110-x
Sistema OJS 3.4.0.7 - Metabiblioteca |