Respiratory and other infections following COVID
Allen, AJ; Nguyen, N; Lorman, V; et al., Pediatrics
Published
August 2025
Journal
Pediatrics
Abstract
Background: One hypothesis for the respiratory syncytial virus (RSV) surge in 2022 was suppression of immune responses following SARS-CoV-2 infection. Our objective was to compare the risk of subsequent RSV and other infections among children with and without SARS-CoV-2 infection.
Methods: We conducted a retrospective cohort study using electronic health record data from 27 US health systems analyzing children aged under 5 years with SARS-CoV-2 infection (test/coded) between March and July 2022. The comparison groups were children with (a) influenza infection and (b) respiratory tract infection with no evidence of SARS-CoV-2/influenza infection. The primary and secondary outcomes were RSV infection and respiratory or any infection in the subsequent 15 to 180 days, respectively. We applied inverse probability of treatment weighting and performed weighted logistic regression modeling.
Results: Our primary and secondary cohorts consisted of 18,767 and 114,414 children with SARS-CoV-2 infection, and 6,697 and 30,424 with influenza infection, respectively, and 46,697 with another acute respiratory tract infection. The odds of subsequent RSV were lower in the SARS-CoV-2 group compared with the influenza group (adjusted odds ratio [aOR] 0.73, 95% CI 0.61-0.86) and compared with the group with any respiratory tract infection (aOR 0.78, 95% CI 0.7-0.87). The odds of a respiratory tract infection and any infection were lower in the SARS-CoV-2 group than the influenza group (aOR 0.62, 95% CI 0.59-0.64 and aOR 0.67, 95% CI 0.65-0.7, respectively).
Conclusions: We did not find an increased risk of RSV or a respiratory or any type of infection within 6 months of SARS-CoV-2 infection, compared with influenza and other respiratory illnesses.
Authors
Andrea J Allen, Nhat Nguyen, Vitaly Lorman, Mitchell Maltenfort, Abu Saleh Mohammad Mosa, Anisha Sekar, Asuncion Mejias, Emily Taylor, Eneida A Mendonca, Aleisha M Nabower, Asa Oxner, Catharine Paules, David A Williams, Dimitri A Christakis, Marion R Sills, Ravi Jhaveri, Sandy Gonzalez, Saul Blecker, Srinivasan Suresh, W Schuyler Jones, L Charles Bailey, Mollie R Cummins, Elizabeth A Chrischilles, Christopher B Forrest, Suchitra Rao, RECOVER consortium
Keywords
Not available
Short Summary
In this RECOVER study, researchers wanted to find out if getting COVID-19 made young children more likely to get sick later. Some researchers believe that the immune system (the body’s defense system) won’t be able to fight off germs well after someone has had COVID-19. They also thought that children might be more likely to catch the cold-like virus that spread widely in 2022, called respiratory syncytial virus (RSV), or other lung infections after having COVID-19. To learn more, RECOVER researchers looked at the electronic health records (EHRs) of thousands of young children (those less than 5 years old) across 27 US health systems. They compared more than 133,000 young children who had COVID-19 to more than 37,000 young children who had the flu and more than 46,000 young children who had other respiratory infections. Researchers checked for RSV and other respiratory infections for 6 months in each group. They found the opposite of what was believed about the body’s immune system: young children who had COVID-19 were less likely to get RSV or other respiratory infections than young children in the other groups. This study is important because it suggests that getting COVID-19 may not make young children more likely to get RSV or other respiratory illnesses afterward.