{"doi":"10.1016/j.jinf.2025.106616","title":"Independent and interactive effects of viral species on early-life lower respiratory tract illness","abstract":"OBJECTIVES: To determine the association between viral species and odds of severe lower respiratory tract illnesses (sLRI) versus upper respiratory illness (URI) among children under 2 years of age. METHODS: Infants (n=2061) enrolled in the Puerto Rican Infant Metagenomic and Epidemiologic Study of Respiratory Outcomes were surveilled for respiratory illnesses until age 2 years (March 2020 to April 2024). Nasal swabs from 1363 illnesses (774 participants) were screened for 21 pathogens. RESULTS: RSV infections occurred in 23% of sLRIs and increased odds of sLRI vs URI (OR=9.28; 95% CI, 5.43-15.85). Metapneumovirus, parainfluenza, and non-SARS-CoV-2 coronavirus also increased odds of sLRIs, while SARS-CoV-2 was associated with lower risk of sLRIs. Rhinovirus (43%) and bocavirus (16.1%) were commonly detected, but were not associated with sLRI risk. Co-infection with multiple viral species was associated with 2.92-fold greater odds of sLRI (95% CI, 2.05-4.16) compared to single viral species infections. Rhinovirus-bocavirus was the most common co-infection, and interaction between these viruses was associated with increased odds of sLRI. CONCLUSIONS: Diverse viral pathogens drive early-life sLRIs. Some (e.g. RSV and metapneumovirus) have an intrinsic propensity to cause sLRIs, while other viruses' lower airway pathogenicity depends on other factors, including co-infection.","journal":"Journal of Infection","year":2025,"id":576215,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8402,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1177586,"name":"E.A. 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