Virus–virus interactions of febrile respiratory syndrome among patients in China based on surveillance data from February 2011 to December 2020

The burden of acute respiratory infections is still considerable, and virus-virus interactions may affect their epidemics, but previous evidence is inconclusive. To quantitatively investigate the interactions among respiratory viruses at both the population and individual levels, we use data from the pathogen surveillance for febrile respiratory syndrome (FRS) in China from February 2011 to December 2020. Cases tested for influenza virus (IV), respiratory syncytial virus (RSV), human parainfluenza virus (PIV), human Adenovirus (AdV), human coronavirus (CoV), human bocavirus (BoV), and rhinovirus (RV) were collected. We used spearman's rank correlation coefficients and binary logistic regression models to analyze the interactions between any two of the viruses at the population and individual levels, respectively. Among 120 237 cases, 4.5% were coinfected with two or more viruses. Correlation coefficients showed seven virus pairs were positively correlated, namely: IV and RSV, PIV and AdV, PIV and CoV, PIV and BoV, PIV and RV, AdV and BoV, and CoV and RV. Regression models showed positive interactions for all virus pairs, except for the negative interaction between IV and RV (odds ratio = 0.70, 95% confidence interval: 0.61-0.81). Most of the respiratory viruses interact positively, while IV and RV interact negatively.