The epidemiology and clinical characteristics of co‐infection of SARS‐CoV‐2 and influenza viruses in patients during COVID‐19 outbreak

Yue, Huihui; Zhang, Ming; Liu, Xing; Wang, Ke; Rao, Xiaoling; Hong, Lei; Tian, Jianbo; Zhou, Peng; Deng, Yan; Shang, Jin

doi:10.1002/jmv.26163

Cited by 165 publications

(186 citation statements)

References 9 publications

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“…In our study, coinfections were not associated with adverse mortality rates when compared to simple SARS-CoV-2 infections alone, which is consistent with previous studies. 3,19 However, the detection rate of other pathogens was 15.6% in our study, while other studies 20,21,23 had a higher detection rate, suggesting that coinfection may be a common feature during the COVID-19 pandemic. When managing COVID-19 patients, being aware of the presence of another respiratory pathogen causing coinfection plays an important role in assisting health-care workers in their use of targeted medications and therapies, aimed at treating these potential pathogens.…”

Section: Dovepresscontrasting

confidence: 82%

<p>Coinfection of SARS-CoV-2 and Other Respiratory Pathogens</p>

Ma¹,

Wang²,

Grange³

et al. 2020

IDR

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To differentiate between respiratory infections caused by SARS-CoV-2 and other respiratory pathogens during the COVID-19 outbreak in Wuhan, we simultaneously tested for SARS-CoV-2 and pathogens associated with CAP to determine the incidence and impact of respiratory coinfections in COVID-19 patients. Patients and Methods: We included 250 patients who were diagnosed with COVID-19. RT-PCR was used to detect influenza A, influenza B and respiratory syncytial viruses. Chemiluminescence immunoassays were used to detect IgM antibodies for adenovirus, Chlamydia pneumoniae and Mycoplasma pneumoniae in the serum of patients. Based on these results, we divided the patients into two groups, the simple SARS-CoV-2-infected group and the coinfected SARS-COV-2 group. Coinfected patients were then further categorized as having a coinfection of viral pathogen (CoIV) or coinfection of atypical bacterial pathogen (CoIaB). Results: No statistically significant differences were found in age, gender, the time taken to return negative SARS-CoV-2 nucleic acid test results, length of hospital stays, and mortality between the simple SARS-CoV-2 infection group and the coinfection group. Of the 250 hospitalized COVID-19 patients, 39 (15.6%) tested positive for at least one respiratory pathogen in addition to SARS-CoV-2. A third of these pathogens were detected as early as the 1st week after symptom onset and another third were identified after more than three weeks. The most detected CAP pathogen was C. pneumoniae (5.2%), followed by the respiratory syncytial virus (4.8%), M. pneumoniae (4.4%) and adenovirus (2.8%). Patients coinfected with viral pathogens (CoIV) (n=18) had longer hospital stays when compared to patients coinfected with atypical bacterial pathogens (CoIaB) (n=21). Except for one fatality, the remaining 38 coinfected patients all recovered with favourable outcomes. Conclusion: Coinfections in COVID-19 patients are common. The coinfecting pathogens can be detected at variable intervals during COVID-19 disease course and remain an important consideration in targeted treatment strategies for COVID-19 patients.

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Section: Dovepresscontrasting

confidence: 82%

<p>Coinfection of SARS-CoV-2 and Other Respiratory Pathogens</p>

Ma¹,

Wang²,

Grange³

et al. 2020

IDR

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“…If individuals are coinfected with both SARS-CoV-2 and influenza, this could lead to more severe disease outcomes. Since the beginning of the SARS-CoV-2 pandemic, a number of case reports of SARS-CoV-2 and influenza coinfection with severe outcomes have been published 1,[9][10][11][12][13] . However, there is a propensity for case reports to highlight more severe cases and there has been no systematic analysis of disease outcomes in coinfected patients compared to non-coinfected controls.…”

Section: Introductionmentioning

confidence: 99%

Interactions between SARS-CoV-2 and Influenza and the impact of coinfection on disease severity: A test negative design

Stowe

Tessier

Zhao

et al. 2020

Preprint

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Background: The potential impact of COVID-19 alongside influenza on morbidity, mortality and health service capacity is a major concern as the Northern Hemisphere winter approaches. This study investigates the interaction between influenza and COVID-19 during the latter part of the 2019-20 influenza season in England. Methods: Individuals tested for influenza and SARS-CoV-2 were extracted from national surveillance systems between 20/01/2020 and 25/04/2020. To estimate influenza infection on the risk of SARS-CoV-2 infection, univariable and multivariable analyses on the odds of SARS-CoV-2 in those who tested positive for influenza compared to those who tested negative for influenza. To assess whether a coinfection was associated with severe SARS-CoV-2 outcome, univariable and multivariable analyses on the odds of death adjusted for age, sex, ethnicity, comorbidity and coinfection status. Findings: The risk of testing positive for SARS-CoV-2 was 68% lower among influenza positive cases, suggesting possible pathogenic competition between the two viruses. Patients with a coinfection had a risk of death of 5.92 (95% CI, 3.21-10.91) times greater than among those with neither influenza nor SARS-CoV-2 suggesting possible synergistic effects in coinfected individuals. The odds of ventilator use or death and ICU admission or death was greatest among coinfection patients showing strong evidence of an interaction effect compared to SARS-CoV-2/influenza acting independently. Interpretation: Cocirculation of these viruses could have a significant impact on morbidity, mortality and health service demand. Testing for influenza alongside SARS-CoV-2 and maximising influenza vaccine uptake should be prioritised to mitigate these risks.

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“…Effective strategies for the prevention of influenza are of critical importance as we enter the 2020-2021 influenza season. The confluence of the upcoming influenza season and the ongoing coronavirus disease 2019 (COVID-19) pandemic is expected to place additional stress on our health care system, fueled in part by similarities in presenting complaints for these two illnesses, as well as by the potential for increased risk of poor outcomes in patients co-infected with COVID-19 and influenza [ 2 - 4 ].…”

Section: Introductionmentioning

confidence: 99%

Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial

Wijesundara¹,

Fukunaga²,

Ogarek³

et al. 2020

J Med Internet Res

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Background Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. Objective The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. Methods Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record–documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were excluded from main analyses. Results Among portal users, 28.4% (5549/19,506) of those randomized to receive messages and 27.1% (5294/19,505) of the usual care group had influenza vaccinations documented by November 2015 (P=.004). In multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, 95% CI 1.02-1.12). Among portal nonusers, 8.4% (1262/15,000) of those randomized to receive calls and 8.2% (3586/43,596) of usual care had documented vaccinations (P=.47), and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9%), and over half of interactive voice response calls placed (7599/14,984; 50.7%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5% of those reached (5513/7599) responded to a similar question. Conclusions Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination (OR 1.07, 95% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. Trial Registration ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277

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The epidemiology and clinical characteristics of co‐infection of SARS‐CoV‐2 and influenza viruses in patients during COVID‐19 outbreak

Cited by 165 publications

References 9 publications

<p>Coinfection of SARS-CoV-2 and Other Respiratory Pathogens</p>

<p>Coinfection of SARS-CoV-2 and Other Respiratory Pathogens</p>

Interactions between SARS-CoV-2 and Influenza and the impact of coinfection on disease severity: A test negative design

Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial

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