SynthesisPloS one2014
Clinical disease severity of respiratory viral co-infection versus single viral infection: a systematic review and meta-analysis.
Synthesis in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 108 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
108 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- The prevalence of influenza bacterial co-infection and its role in disease severity: A systematic review and meta-analysis.Journal of global health · 2023Pooled it
- The role of viral co-infections in the severity of acute respiratory infections among children infected with respiratory syncytial virus (RSV): A systematic review and meta-analysis.Journal of global health · 2020Pooled it
- Respiratory viral coinfection and disease severity in children: A systematic review and meta-analysis.Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2016Pooled it
- Viral etiology of acute respiratory infections in hospitalized children in Novosibirsk City, Russia (2013 - 2017).PloS one · 2018Trial
- Observed Clinical and Operational Factors Are Associated with Biomarker Test Utilization in Respiratory Virus RT-PCR Testing: A Real-World Analysis of Inflammatory, Cardiac, and Thrombotic Biomarkers.Diagnostics (Basel, Switzerland) · 2026Article
- Seasonal Distribution, Virus-Specific Hematologic Profiles, and Predictors of Hospitalization in Children with Respiratory Viral Infections.Children (Basel, Switzerland) · 2026Article
- Epidemiology and clinical outcomes of common respiratory viruses detected by multiplex RT-PCR in patients at a national infectious disease reference center in Romania, 2022-2025.Virology journal · 2026Article
- Association of respiratory viral detection with complex febrile seizures and hospitalisation in children after the COVID-19 pandemic: a retrospective observational study.BMJ paediatrics open · 2026Observational
- Acute Respiratory Tract Infections and Severe Disease Among Hospitalized Children.JAMA network open · 2026Article
- Respiratory pathogen epidemiology in the post-pandemic era: a multicenter retrospective study from Saudi Arabia.BMC infectious diseases · 2026Article
- Epidemiological dynamics of respiratory tract infections in a major northern coastal city (Dalian), China, following the COVID-19 pandemic.BMC infectious diseases · 2026Article
- Shifting patterns of pediatric respiratory viruses during the SARS-CoV-2 pandemic: a retrospective observational study.BMC infectious diseases · 2026Observational
- Epidemiology of acute respiratory infections in children in Pudong, Shanghai: analysis of seven respiratory test results from 2018 to 2023.Virology journal · 2026Article
- Parental self-efficacy, health locus of control, and preventive behaviors against respiratory infections in young children: a cross-sectional survey study.Frontiers in public health · 2026Article
- Analysis of influenza A, influenza B andFrontiers in public health · 2026Article
- Epidemiology and co-infection networks of pediatric respiratory pathogens in eastern China after COVID-19 restriction relaxation: a retrospective study.Frontiers in cellular and infection microbiology · 2026Article
- Respiratory virus genomic epidemiology during post-pandemic re-emergence of influenza in Australia.Virus evolution · 2026Article
- Viral pathogens in the etiology of acute respiratory infections in Bulgaria during the 2024-2025 season and genetic diversity of circulating influenza viruses.Frontiers in microbiology · 2026Article
- Adenovirus Types in US Children Hospitalized or Seen in the Emergency Department With Acute Respiratory Illness, 2016-2019.Open forum infectious diseases · 2025Article
- Co-infections with Multiple Viruses: A Frequent cause of Community-Acquired Pneumonia in Sarawak Malaysia.IJID regions · 2025Article
48 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
backgroundResults from cohort studies evaluating the severity of respiratory viral co-infections are conflicting. We conducted a systematic review and meta-analysis to assess the clinical severity of viral co-infections as compared to single viral respiratory infections.
methodsWe searched electronic databases and other sources for studies published up to January 28, 2013. We included observational studies on inpatients with respiratory illnesses comparing the clinical severity of viral co-infections to single viral infections as detected by molecular assays. The primary outcome reflecting clinical disease severity was length of hospital stay (LOS). A random-effects model was used to conduct the meta-analyses.
resultsTwenty-one studies involving 4,280 patients were included. The overall quality of evidence applying the GRADE approach ranged from moderate for oxygen requirements to low for all other outcomes. No significant differences in length of hospital stay (LOS) (mean difference (MD) -0.20 days, 95% CI -0.94, 0.53, p = 0.59), or mortality (RR 2.44, 95% CI 0.86, 6.91, p = 0.09) were documented in subjects with viral co-infections compared to those with a single viral infection. There was no evidence for differences in effects across age subgroups in post hoc analyses with the exception of the higher mortality in preschool children (RR 9.82, 95% CI 3.09, 31.20, p<0.001) with viral co-infection as compared to other age groups (I2 for subgroup analysis 64%, p = 0.04).
conclusionsNo differences in clinical disease severity between viral co-infections and single respiratory infections were documented. The suggested increased risk of mortality observed amongst children with viral co-infections requires further investigation.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.