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Peer-reviewedCC BY 4.0Epidemiology and Infection

Viral interference with SARS-CoV-2 during the COVID-19 pandemic: An individual participant data meta-analysis

  • Emma S. E. M. Hauser-van Westrhenen1
  • Marieke L. A. De Hoog1
  • Angelique M. A. M. Winkel2,3
  • Laia Junquera Guinovart1
  • A. H. Ayesha Lavell4,5
  • Menno D. de Jong3
  • Marlies A. van Houten6
  • Steven F. L. van Lelyveld7
  • Dirk Eggink8
  • Sjoerd Euser9
  • Liesbeth Duijts10
  • Joanne G. Wildenbeest11
8 more authors
  • Rob Schuurman12
  • Janneke H. H. M. van de Wijgert1
  • Margareta Ieven13
  • Katherine Loens13
  • Alike W. van der Velden14
  • Marc J. M. Bonten1
  • Herman Goossens13
  • Patricia C. J. L. Bruijning-Verhagen1
14 affiliations
  1. 1Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
  2. 2Spaarne Gasthuis Academy, Spaarne Gasthuis Hoofddorp, The Netherlands
  3. 3Department of Medical Microbiology, Amsterdam UMC Locatie AMC, The Netherlands
  4. 4Department of Internal Medicine, Amsterdam UMC Locatie VUmc, The Netherlands
  5. 5Amsterdam Institute for Infection and Immunity, The Netherlands
  6. 6Department of Pediatrics, Spaarne Gasthuis, The Netherlands
  7. 7Department of Internal Medicine, Spaarne Gasthuis, The Netherlands
  8. 8National Institute for Public Health and the Environment, The Netherlands
  9. 9Regional Public Health Laboratory Kennemerland, The Netherlands
  10. 10Department of Pediatrics and Department of Neonatal and Pediatric Intensive Care, Erasmus University Medical Center Rotterdam, The Netherlands
  11. 11Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, The Netherlands
  12. 12Department of Medical Microbiology, University Medical Centre Utrecht, The Netherlands
  13. 13Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
  14. 14Department of Primary Care, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
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Abstract

Viral interference between SARS-CoV-2 and other respiratory virus infections has been implicated, but symptom-based testing in observational studies may bias estimations. We used individual participant data from ten cohort studies conducted during pandemic years 2020–2024 to study virus interference. Respiratory samples were PCR-tested for viruses including SARS-CoV-2. The primary analysis was based on samples collected from cohort participants regardless of respiratory symptoms. A secondary analysis included only symptom-based testing data. We estimated odds ratios for co-occurrence of SARS-CoV-2 with other respiratory viruses. The primary analysis included data from six cohorts (n = 1 023). In total 205 of 2 465 samples were SARS-CoV-2 positive (8.3%). Co-detections with SARS-CoV-2 occurred less frequently than expected under the assumption of zero interference (OR: 0.72; 95% CI: 0.40–1.25) for samples positive for another virus. The secondary analysis (five cohorts, n = 1 715) included 2 088 samples from symptomatic subjects, with 506 SARS-CoV-2 infections (24.2%). The OR of SARS-CoV-2 detection was 0.16 (95% CI: 0.10–0.25) for samples positive for another virus. Minimizing selection bias, our results still point towards negative viral interference with SARS-CoV-2, but effect-estimates are weaker and non-significant. Apart from selection bias, the stronger effects found in symptomatic individuals could also indicate that symptomatic infection enhances virus interference.

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Cite

BibTeXRIS
BibTeX
@article{westrhenen2026viral,
  title = {{Viral interference with SARS-CoV-2 during the COVID-19 pandemic: An individual participant data meta-analysis}},
  author = {Emma S. E. M. Hauser-van Westrhenen and Marieke L. A. De Hoog and Angelique M. A. M. Winkel and Laia Junquera Guinovart and A. H. Ayesha Lavell and Menno D. de Jong and Marlies A. van Houten and Steven F. L. van Lelyveld and Dirk Eggink and Sjoerd Euser and Liesbeth Duijts and Joanne G. Wildenbeest and Rob Schuurman and Janneke H. H. M. van de Wijgert and Margareta Ieven and Katherine Loens and Alike W. van der Velden and Marc J. M. Bonten and Herman Goossens and Patricia C. J. L. Bruijning-Verhagen},
  journal = {Epidemiology and Infection},
  year = {2026},
  month = oct,
  doi = {10.1017/s0950268826102088},
  url = {https://doi.org/10.1017/s0950268826102088},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Viral interference with SARS-CoV-2 during the COVID-19 pandemic: An individual participant data meta-analysis
AU  - Emma S. E. M. Hauser-van Westrhenen
AU  - Marieke L. A. De Hoog
AU  - Angelique M. A. M. Winkel
AU  - Laia Junquera Guinovart
AU  - A. H. Ayesha Lavell
AU  - Menno D. de Jong
AU  - Marlies A. van Houten
AU  - Steven F. L. van Lelyveld
AU  - Dirk Eggink
AU  - Sjoerd Euser
AU  - Liesbeth Duijts
AU  - Joanne G. Wildenbeest
AU  - Rob Schuurman
AU  - Janneke H. H. M. van de Wijgert
AU  - Margareta Ieven
AU  - Katherine Loens
AU  - Alike W. van der Velden
AU  - Marc J. M. Bonten
AU  - Herman Goossens
AU  - Patricia C. J. L. Bruijning-Verhagen
PY  - 2026
DA  - 2026/10/14
JO  - Epidemiology and Infection
DO  - 10.1017/s0950268826102088
UR  - https://doi.org/10.1017/s0950268826102088
AB  - Viral interference between SARS-CoV-2 and other respiratory virus infections has been implicated, but symptom-based testing in observational studies may bias estimations. We used individual participant data from ten cohort studies conducted during pandemic years 2020–2024 to study virus interference. Respiratory samples were PCR-tested for viruses including SARS-CoV-2. The primary analysis was based on samples collected from cohort participants regardless of respiratory symptoms. A secondary analysis included only symptom-based testing data. We estimated odds ratios for co-occurrence of SARS-CoV-2 with other respiratory viruses. The primary analysis included data from six cohorts (n = 1 023). In total 205 of 2 465 samples were SARS-CoV-2 positive (8.3%). Co-detections with SARS-CoV-2 occurred less frequently than expected under the assumption of zero interference (OR: 0.72; 95% CI: 0.40–1.25) for samples positive for another virus. The secondary analysis (five cohorts, n = 1 715) included 2 088 samples from symptomatic subjects, with 506 SARS-CoV-2 infections (24.2%). The OR of SARS-CoV-2 detection was 0.16 (95% CI: 0.10–0.25) for samples positive for another virus. Minimizing selection bias, our results still point towards negative viral interference with SARS-CoV-2, but effect-estimates are weaker and non-significant. Apart from selection bias, the stronger effects found in symptomatic individuals could also indicate that symptomatic infection enhances virus interference.
SN  - 0950-2688
SN  - 1469-4409
ER  -