Risk of Subsequent Respiratory Virus Detection After Primary Virus Detection in a Community Household Study-King County, Washington, 2019-2021

J Infect Dis. 2024 Feb 14;229(2):422-431. doi: 10.1093/infdis/jiad305.


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: From October 2019 to June 2021, enrolled households completed active surveillance for acute respiratory illness (ARI), and participants with ARI self-collected nasal swab specimens; after April 2020, participants with ARI or laboratory-confirmed severe acute respiratory syndrome coronavirus 2 and their household members self-collected nasal swab specimens. Specimens were tested using multiplex reverse-transcription polymerase chain reaction 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 (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 after primary detection; risk varied by primary virus: human parainfluenza virus, 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: coinfection; household transmission; respiratory viral infection; seasonal epidemic; viral interference.

MeSH terms

  • Enterovirus Infections*
  • Humans
  • Infant
  • Respiratory Syncytial Virus, Human*
  • Respiratory Tract Infections* / diagnosis
  • Respiratory Tract Infections* / epidemiology
  • Rhinovirus / genetics
  • Virus Diseases*
  • Viruses* / genetics
  • Washington / epidemiology