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The interactions of SARS-CoV-2 with cocirculating pathogens: Epidemiological implications and current knowledge gaps
Despite the availability of effective vaccines, the persistence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suggests that cocirculation with other pathogens and resulting multiepidemics (of, for example, COVID-19 and influenza) may become increasingly frequent. To better forecast...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9994710/ https://www.ncbi.nlm.nih.gov/pubmed/36888684 http://dx.doi.org/10.1371/journal.ppat.1011167 |
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author | Wong, Anabelle Barrero Guevara, Laura Andrea Goult, Elizabeth Briga, Michael Kramer, Sarah C. Kovacevic, Aleksandra Opatowski, Lulla Domenech de Cellès, Matthieu |
author_facet | Wong, Anabelle Barrero Guevara, Laura Andrea Goult, Elizabeth Briga, Michael Kramer, Sarah C. Kovacevic, Aleksandra Opatowski, Lulla Domenech de Cellès, Matthieu |
author_sort | Wong, Anabelle |
collection | PubMed |
description | Despite the availability of effective vaccines, the persistence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suggests that cocirculation with other pathogens and resulting multiepidemics (of, for example, COVID-19 and influenza) may become increasingly frequent. To better forecast and control the risk of such multiepidemics, it is essential to elucidate the potential interactions of SARS-CoV-2 with other pathogens; these interactions, however, remain poorly defined. Here, we aimed to review the current body of evidence about SARS-CoV-2 interactions. Our review is structured in four parts. To study pathogen interactions in a systematic and comprehensive way, we first developed a general framework to capture their major components: sign (either negative for antagonistic interactions or positive for synergistic interactions), strength (i.e., magnitude of the interaction), symmetry (describing whether the interaction depends on the order of infection of interacting pathogens), duration (describing whether the interaction is short-lived or long-lived), and mechanism (e.g., whether interaction modifies susceptibility to infection, transmissibility of infection, or severity of disease). Second, we reviewed the experimental evidence from animal models about SARS-CoV-2 interactions. Of the 14 studies identified, 11 focused on the outcomes of coinfection with nonattenuated influenza A viruses (IAVs), and 3 with other pathogens. The 11 studies on IAV used different designs and animal models (ferrets, hamsters, and mice) but generally demonstrated that coinfection increased disease severity compared with either monoinfection. By contrast, the effect of coinfection on the viral load of either virus was variable and inconsistent across studies. Third, we reviewed the epidemiological evidence about SARS-CoV-2 interactions in human populations. Although numerous studies were identified, only a few were specifically designed to infer interaction, and many were prone to multiple biases, including confounding. Nevertheless, their results suggested that influenza and pneumococcal conjugate vaccinations were associated with a reduced risk of SARS-CoV-2 infection. Finally, fourth, we formulated simple transmission models of SARS-CoV-2 cocirculation with an epidemic viral pathogen or an endemic bacterial pathogen, showing how they can naturally incorporate the proposed framework. More generally, we argue that such models, when designed with an integrative and multidisciplinary perspective, will be invaluable tools to resolve the substantial uncertainties that remain about SARS-CoV-2 interactions. |
format | Online Article Text |
id | pubmed-9994710 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-99947102023-03-09 The interactions of SARS-CoV-2 with cocirculating pathogens: Epidemiological implications and current knowledge gaps Wong, Anabelle Barrero Guevara, Laura Andrea Goult, Elizabeth Briga, Michael Kramer, Sarah C. Kovacevic, Aleksandra Opatowski, Lulla Domenech de Cellès, Matthieu PLoS Pathog Review Despite the availability of effective vaccines, the persistence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suggests that cocirculation with other pathogens and resulting multiepidemics (of, for example, COVID-19 and influenza) may become increasingly frequent. To better forecast and control the risk of such multiepidemics, it is essential to elucidate the potential interactions of SARS-CoV-2 with other pathogens; these interactions, however, remain poorly defined. Here, we aimed to review the current body of evidence about SARS-CoV-2 interactions. Our review is structured in four parts. To study pathogen interactions in a systematic and comprehensive way, we first developed a general framework to capture their major components: sign (either negative for antagonistic interactions or positive for synergistic interactions), strength (i.e., magnitude of the interaction), symmetry (describing whether the interaction depends on the order of infection of interacting pathogens), duration (describing whether the interaction is short-lived or long-lived), and mechanism (e.g., whether interaction modifies susceptibility to infection, transmissibility of infection, or severity of disease). Second, we reviewed the experimental evidence from animal models about SARS-CoV-2 interactions. Of the 14 studies identified, 11 focused on the outcomes of coinfection with nonattenuated influenza A viruses (IAVs), and 3 with other pathogens. The 11 studies on IAV used different designs and animal models (ferrets, hamsters, and mice) but generally demonstrated that coinfection increased disease severity compared with either monoinfection. By contrast, the effect of coinfection on the viral load of either virus was variable and inconsistent across studies. Third, we reviewed the epidemiological evidence about SARS-CoV-2 interactions in human populations. Although numerous studies were identified, only a few were specifically designed to infer interaction, and many were prone to multiple biases, including confounding. Nevertheless, their results suggested that influenza and pneumococcal conjugate vaccinations were associated with a reduced risk of SARS-CoV-2 infection. Finally, fourth, we formulated simple transmission models of SARS-CoV-2 cocirculation with an epidemic viral pathogen or an endemic bacterial pathogen, showing how they can naturally incorporate the proposed framework. More generally, we argue that such models, when designed with an integrative and multidisciplinary perspective, will be invaluable tools to resolve the substantial uncertainties that remain about SARS-CoV-2 interactions. Public Library of Science 2023-03-08 /pmc/articles/PMC9994710/ /pubmed/36888684 http://dx.doi.org/10.1371/journal.ppat.1011167 Text en © 2023 Wong et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Review Wong, Anabelle Barrero Guevara, Laura Andrea Goult, Elizabeth Briga, Michael Kramer, Sarah C. Kovacevic, Aleksandra Opatowski, Lulla Domenech de Cellès, Matthieu The interactions of SARS-CoV-2 with cocirculating pathogens: Epidemiological implications and current knowledge gaps |
title | The interactions of SARS-CoV-2 with cocirculating pathogens: Epidemiological implications and current knowledge gaps |
title_full | The interactions of SARS-CoV-2 with cocirculating pathogens: Epidemiological implications and current knowledge gaps |
title_fullStr | The interactions of SARS-CoV-2 with cocirculating pathogens: Epidemiological implications and current knowledge gaps |
title_full_unstemmed | The interactions of SARS-CoV-2 with cocirculating pathogens: Epidemiological implications and current knowledge gaps |
title_short | The interactions of SARS-CoV-2 with cocirculating pathogens: Epidemiological implications and current knowledge gaps |
title_sort | interactions of sars-cov-2 with cocirculating pathogens: epidemiological implications and current knowledge gaps |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9994710/ https://www.ncbi.nlm.nih.gov/pubmed/36888684 http://dx.doi.org/10.1371/journal.ppat.1011167 |
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