J Infect Dis

. 2023 Aug 2;jiad305.
doi: 10.1093/infdis/jiad305. Online ahead of print. Risk of Subsequent Respiratory Virus Detection After Primary Virus Detection in a Community Household Study - King County, Washington 2019-2021

Jessica Heimonen 1 , Eric J Chow 1 2 3 , Yongzhe Wang 1 , James P Hughes 4 5 , Julia Rogers 1 , Anne Emanuels 1 , Jessica O'Hanlon 1 , Peter D Han 6 , Caitlin R Wolf 1 , Jennifer K Logue 1 , Constance E Ogokeh 7 8 , Melissa A Rolfes 7 , Timothy M Uyeki 7 , Lea Starita 6 9 , Janet A Englund 10 11 , Helen Y Chu 1


Background: The epidemiology of respiratory viral infections is complex. How infection with one respiratory virus affects risk of subsequent infection with the same or another respiratory virus is not well described.
Methods: We retrospectively analyzed data from a longitudinal household cohort study from October 2019-June 2021. Enrolled households completed active surveillance for acute respiratory illness (ARI), and participants with ARI self-collected nasal swabs; after April 2020, participants with ARI or laboratory-confirmed SARS-CoV-2 and their household members self-collected nasal swabs. Specimens were tested via multiplex RT-PCR for respiratory viruses. A Cox regression model with a time-dependent covariate examined risk of subsequent detections following a specific primary viral detection.
Results: Rhinovirus was the most frequently detected pathogen in study specimens (n=406, 9.5%). Among 51 participants with multiple viral detections, rhinovirus to seasonal coronavirus (8, 14.8%) was the most common viral detection pairing. Relative to no primary detection, there was a 1.03-2.06-fold increase in risk of subsequent virus detection in the 90 days following primary detection; risk varied by primary virus: parainfluenza, rhinovirus, and respiratory syncytial virus were statistically significant.
Conclusions: Primary virus detection was associated with higher risk of subsequent virus detection within the first 90 days after primary detection.

Keywords: Respiratory viral infection; co-infection; household transmission; seasonal epidemic; viral interference.