新型冠狀病毒共同感染在2022至2023年Omicron時期對台灣兒童流感病毒或呼吸道融合病毒感染之影響

Abstract

背景：2022年各國放寬新冠疫情管制措施後，爆發新冠病毒Omicron變異株、流感病毒、與呼吸道融合病毒的三重大流行（Tripledemic）。然而，三重大流行對兒童健康的影響目前仍缺乏實證研究。本研究的目的為探討新冠病毒Omicron變異株感染是否會增加兒童流感或呼吸道融合病毒感染的重症風險。 方法：本研究為回溯性世代研究，比較2022年1月1日至2023年12月31日期間在台灣兩家醫學中心就診兒童新冠病毒共同感染與單一流感或呼吸道融合病毒感染在年齡、過去病史、疫苗接種、症狀、氧氣或呼吸器使用、住院與加護病房照護比例上的差異。重症的定義為使用呼吸器、入住加護病房或於住院中死亡。使用多變項羅吉斯迴歸評估共同感染與發生重症的相關性。 結果：相較於僅有流感的兒童（n = 784），新冠病毒與流感病毒共同感染的兒童（n = 78）年齡較小、呼吸喘及需氧氣治療或使用呼吸器比例較高、住院及加護病房照護的比例也較高。相較於僅感染呼吸道融合病毒的兒童（n = 303），新冠病毒與呼吸道融合病毒共同感染的兒童（n = 45）使用呼吸器及加護病房照護的比例較高。新冠病毒感染顯著增加流感重症風險（adjusted odds ratio [aOR]: 4.60, 95% confidence interval [CI]: 1.35-15.68），且此影響在新冠病毒感染後持續至90天。新冠病毒感染亦顯著增加呼吸道融合病毒感染重症風險，但影響僅在新冠病毒感染後8至30天內（aOR: 8.31, 95% CI: 1.69-40.74）。 結論：在Omicron變異株時期，兒童新冠病毒與流感病毒的共同感染顯著增加重症風險，影響長達90天。在新冠病毒感染後8至30天內，感染呼吸道融合病毒發生重症風險顯著增加。

Background: After the relaxation of Coronavirus Disease 2019 (COVID-19) control measures in various countries since 2022, the tripledemic of SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) has emerged. However, there is a lack of clinical evidence on the impact of the tripledemic on children's health. This study aims to investigate whether the SARS-CoV-2 Omicron variant infection increases the risk of severe illness from influenza or RSV infection in children. Methods: This retrospective cohort study analyzed the clinical data of pediatric patients at two medical centers in Taiwan from January 1, 2022, to December 31, 2023, comparing differences in age, underlying conditions, vaccination status, symptoms, oxygen or ventilator support, hospitalization, and ICU care between children with SARS-CoV-2 co-infection and those with influenza or RSV mono-infection. Severe respiratory illness was defined as requiring mechanical ventilation, ICU care, or resulting in in-hospital mortality. Multivariable logistic regression models were used to assess the association between co-infections and severe respiratory illness. Results: Compared to those with influenza mono-infection (n = 784), children with SARS-CoV-2 and influenza co-infection (n = 78) were younger, presented with more dyspnea, required more oxygen or ventilator support, and had higher proportions of hospitalization and ICU care. Children with SARS-CoV-2 and RSV co-infection (n = 45) required more mechanical ventilation and ICU care compared to those with RSV mono-infection (n = 303). COVID-19 significantly increased the risk of severe illness in children with influenza (aOR: 4.60, 95% CI: 1.35-15.68), and this impact persisted for up to 90 days after the initial SARS-CoV-2 infection. COVID-19 also significantly increased the risk of severe illness in children with RSV infection, but only within 8 to 30 days after the initial SARS-CoV-2 infection (aOR: 8.31, 95% CI: 1.69-40.74). Conclusions: During the Omicron era, SARS-CoV-2 and influenza co-infections significantly increased the risk of severe illness in children, and this impact persisted for up to 90 days. Children with RSV infection occurring within 8 to 30 days after a SARS-CoV-2 infection also had a significantly increased risk of severe illness.