512 - Immunity Interrupted: Links Between SARS-CoV-2 And the Tripledemic Of 2022.

Publication Number: 3493.512

Karyssa Bobosky, Beaumont Children's Hospital, Rochester Hills, MI, United States; Ruba Barbar, Corewell health east, Royal Oak, MI, United States; Anuoluwa Fasanmi, Beaumont Children's Hospital, Royal Oak, MI, United States; Sophie Condron, Oakland University William Beaumont School of Medicine, Auburn Hills, MI, United States; Julie George, Corewell Health, Royal Oak, MI, United States

Background: One hypothesis for the tripledemic and RSV surge of 2022 is possible viral-viral interaction and immune suppression following SARS-CoV-2 infection.

Objective: Our objective was to compare the risk of viral re-infection and concurrent infections in children with and without SARS-CoV-2 infection.

Design/Methods: This was a retrospective cohort study using electronic health record data from pediatric emergency rooms in a health care system with numerous locations throughout the state. We included children under the age of 18 yrs. diagnosed with a viral upper respiratory infection between January 1st, 2021, and December 31st, 2023. The comparison groups were children with (a) SARS-CoV-2 alone, (b) SARS-CoV-2 and another respiratory virus, and (c) with viral infections excluding SARS-CoV-2. The primary outcome was viral re-infection in the subsequent 15 to 120 days. The secondary outcomes were the frequency of concurrent viral infections as well as clinical outcomes (i.e., oxygen use, length of stay, etc.).

Results: We included data from 37,116 patients. The cohorts consisted of 4,004 with SARS-CoV-2 alone, 1,678 with SARS-CoV-2 + another virus, and 31,434 with non-SARS-CoV-2 viruses. When comparing the SARS-CoV-2 only group (a) by ICD 10 code to the other two groups the odds of having a re-infection were higher in the other groups. The odds ratio (OR) in Group C was 1.42 and the OR was 1.38 in Group B with a reinfection rate of 4.4%, 6.0%, and 6.1% respectively in Groups A, B, and C. For the lab confirmed infection rates, the OR of having a recurrent infection in the other 2 groups compared to the SARS-CoV-2 only group was 1.44 with a re-infection rate of 2% compared to 2.8% in the other groups. Indicating viral re-infection was less common in those with SARS-CoV-2. The most common viruses seen in re-infection in all three groups were RSV, SARS-CoV-2, and Influenza. In group A these made up 37.7% (n=26), 33.3%(n=23), and 23.2% (n=16) respectively. In group B they made up 29.3% (n=12), 39.0% (n=16), 29.3%(n=12) and in C 32.4% (n=231), 29.2% (n=208), and 26.6% (n=190) respectively. Among those with lab confirmed re-infection, rates of having multiple viral infection at once on re-infection were low at 0.4% (n=13), 0.3% (n=4), and 0.3% (n=69) in groups a,b, and c.

Conclusion(s): There was no increased risk of viral re-infection or concurrent infection in children with SARS-CoV-2 infection within 4 months. Re-infection with multiple viruses at once in any group was rare. Finally, the most frequently seen infections during the study period were SARS-CoV-2, RSV, and Influenza with RSV being the most prevalent overall.