294 - COVID-19 and viral co-infections in infants during the first three COVID-19 waves in New York City

Poster Number: 294
Publication Number: 294.215

Christopher G. Xanthos, Weill Cornell Medicine, Brooklyn, NY, United States; Will Simmons, Weill Cornell Medicine, New York, NY, United States; Jin-Young Han, Weill Cornell Medicine, New York, NY, United States; Erika Abramson, Weill Cornell Medicine, New York, NY, United States; Zachary M. Grinspan, Weill Cornell Medicine, New York, NY, United States; Karen P. Acker, Weill Cornell Medicine, New York, NY, United States

Background: Infants with SARS-CoV-2 infections generally have mild illness yet are at risk for hospitalization and respiratory disease. We hypothesized that co-infections with other respiratory viruses would result in more severe COVID-19 disease compared to SARS-CoV-2 infection alone. We also hypothesized outcomes would vary by waves, due to variations in circulation of other respiratory viruses.

Objective: To describe the clinical presentation of infants with SARS-CoV-2 infection during the first 3 waves of the COVID-19 pandemic in NYC and determine the impact of known viral co-infections on hospitalization and clinical outcome.

Design/Methods: A retrospective chart review was performed on infants identified by the Weill Cornell Institutional Data Repository who tested positive for SARS-CoV-2 by PCR between 3/1/2020 and 8/31/2021. Descriptive statistics were calculated for patient demographics in each of the three pandemic waves in NYC, and unadjusted, two-tailed, two-sample tests were used to compare clinical outcomes in infants with and without known viral co-infections.

Results: We identified 205 infants who tested positive for SARS-CoV-2: 25 during the first wave (3/1/2020-7/31/20), 164 during the second wave (8/1/20-6/30/21), and 16 during the third wave (7/1/21-8/31/21). The most common indications for testing were for current symptoms (150, 73.2%), COVID-19 exposure (99, 48.3%), and pre-procedural or pre-admission testing (19, 9.3%). There were 44 (21.5%) infants admitted. The most common indications were ruling out serious bacterial infection (20/44, 45%) and symptom-monitoring for COVID-19 infection (20/44, 45%). A total of 13 infants had known viral co-infections (13, 6.3%), most commonly rhinovirus/enterovirus (7/13, 54%) and RSV (3/13, 23%). Rates of viral co-infections varied by wave: 3/25 (12%) in the first, 7/164 (4.2%) in the second, and 3/16 (19%) in the third. Infants with viral co-infections were more likely to be hospitalized (7/13, 53.8% vs 37/192, 19.3%, P = 0.003) and require respiratory support (3/13, 23% vs 5/192, 2.6%, P < 0.001) compared to infants without known viral co-infections.Conclusion(s): Infants with COVID-19 and viral co-infections were more likely to require hospitalization and respiratory support compared to those without known co-infections, suggesting that severe COVID-19 disease may be driven by other respiratory viruses. Co-infections occurred in each wave, though the prevalence varied. Our study is limited by small sample size, potential sample bias, and that not all infants were tested for other viral infections, with further analyses focusing only on those that were.