Severe outcomes of individual or multiple respiratory viral infections in a large national healthcare system, 2022-2023.

IF 3.4 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Frontiers in Public Health Pub Date : 2026-04-22 eCollection Date: 2026-01-01 DOI:10.3389/fpubh.2026.1808528

Janet M Grubber, Ikwo K Oboho, Kaitlin N Swinnerton, Theodore C Feldman, Nhan V Do, Nathanael R Fillmore, Westyn Branch-Elliman, Paul A Monach

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Abstract

Background: Routine testing for SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) was deployed in a large US healthcare system in 2022-2023. This policy allowed identification of a large cohort of co-infected patients and comparison of outcomes without confounding by testing indication.

Methods: Patients "triple-tested" in the US Veterans Health Administration were classified by infection status in the first week of a positive test. Multivariable logistic regression was used to estimate associations of different infections with hypoxemia (SpO₂ < 90% or supplementary oxygen >2 L/min) or death, separately, expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Findings: Among 835,987 triple-tested patients, 170,592 (20.4%) tested positive for SARS-CoV-2 alone, 30,454 (3.6%) influenza alone, 13,207 (1.6%) RSV alone, and 1,300 (0.2%) multiple viruses. Frequencies of hypoxemia and death were 8.0 and 1.9% with SARS-CoV-2, 7.7 and 0.8% with influenza, 9.3 and 1.1% with RSV, 8.7 and 1.5% with multiple viruses, and 8.9 and 2.0% with all-negative tests. After adjustment for age and immune-suppressive drugs, odds of hypoxemia were slightly higher with influenza (aOR = 1.12, CI 1.06-1.17), lower with RSV (aOR = 0.91, CI 0.85-0.97), and not significantly different with multiple viruses (aOR = 1.09, CI 0.89-1.34), relative to SARS-CoV-2 alone. Odds of death were lower with influenza (aOR = 0.52, CI 0.46-0.60) or RSV (aOR = 0.51, CI 0.43-0.60) and no different with multiple infections (aOR = 0.86, CI 0.54-1.36), relative to SARS-CoV-2 alone.

Interpretation: Co-infection was rare (0.2% of tested cases), with incidences of hypoxemia and death similar to SARS-CoV-2 alone. Death was less frequent with influenza or RSV than SARS-CoV-2.

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2022-2023年大型国家医疗保健系统中个体或多重呼吸道病毒感染的严重后果

背景：2022-2023年在美国大型医疗保健系统中部署了SARS-CoV-2、流感和呼吸道合胞病毒（RSV）的常规检测。这一政策允许识别一大群合并感染的患者，并在没有检测指征混淆的情况下对结果进行比较。方法：在美国退伍军人健康管理局进行“三重检测”的患者在检测阳性的第一周内按感染状况进行分类。使用多变量logistic回归分别估计不同感染与低氧血症（SpO2 2 L/min）或死亡的关联，以校正优势比（aOR）表示，95%置信区间（CI）。结果：在835,987例三联检测患者中，170,592例（20.4%）单独检测为SARS-CoV-2阳性，30,454例（3.6%）单独检测为流感阳性，13,207例（1.6%）单独检测为RSV阳性，1,300例（0.2%）多种病毒阳性。低氧血症和死亡的发生率分别为：SARS-CoV-2组8.0和1.9%，流感组7.7和0.8%，RSV组9.3和1.1%，多种病毒组8.7和1.5%，全阴性组8.9和2.0%。在调整年龄和免疫抑制药物后，流感患者低氧血症的发生率略高（aOR = 1.12,CI 1.06-1.17）， RSV患者低（aOR = 0.91,CI 0.85-0.97），而与多种病毒（aOR = 1.09,CI 0.89-1.34）相比，单独感染SARS-CoV-2患者无显著差异（aOR = 1.09,CI 0.89-1.34）。流感（aOR = 0.52,CI 0.46-0.60）或RSV （aOR = 0.51,CI 0.43-0.60）的死亡几率较低，与单独感染SARS-CoV-2相比，多重感染（aOR = 0.86,CI 0.54-1.36）的死亡几率无差异。解释：合并感染罕见（占检测病例的0.2%），低氧血症和死亡发生率与单独感染SARS-CoV-2相似。与SARS-CoV-2相比，流感或RSV的死亡率较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Public Health Medicine-Public Health, Environmental and Occupational Health

CiteScore

4.80

自引率

7.70%

发文量

4469

审稿时长

14 weeks

期刊介绍： Frontiers in Public Health is a multidisciplinary open-access journal which publishes rigorously peer-reviewed research and is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians, policy makers and the public worldwide. The journal aims at overcoming current fragmentation in research and publication, promoting consistency in pursuing relevant scientific themes, and supporting finding dissemination and translation into practice. Frontiers in Public Health is organized into Specialty Sections that cover different areas of research in the field. Please refer to the author guidelines for details on article types and the submission process.