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Liang J, Wang Y, Lin Z, He W, Sun J, Li Q, Zhang M, Chang Z, Guo Y, Zeng W, Liu T, Zeng Z, Yang Z, Hon C. Influenza and COVID-19 co-infection and vaccine effectiveness against severe cases: a mathematical modeling study. Front Cell Infect Microbiol 2024; 14:1347710. [PMID: 38500506 PMCID: PMC10945002 DOI: 10.3389/fcimb.2024.1347710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/01/2024] [Indexed: 03/20/2024] Open
Abstract
Background Influenza A virus have a distinctive ability to exacerbate SARS-CoV-2 infection proven by in vitro studies. Furthermore, clinical evidence suggests that co-infection with COVID-19 and influenza not only increases mortality but also prolongs the hospitalization of patients. COVID-19 is in a small-scale recurrent epidemic, increasing the likelihood of co-epidemic with seasonal influenza. The impact of co-infection with influenza virus and SARS-CoV-2 on the population remains unstudied. Method Here, we developed an age-specific compartmental model to simulate the co-circulation of COVID-19 and influenza and estimate the number of co-infected patients under different scenarios of prevalent virus type and vaccine coverage. To decrease the risk of the population developing severity, we investigated the minimum coverage required for the COVID-19 vaccine in conjunction with the influenza vaccine, particularly during co-epidemic seasons. Result Compared to the single epidemic, the transmission of the SARS-CoV-2 exhibits a lower trend and a delayed peak when co-epidemic with influenza. Number of co-infection cases is higher when SARS-CoV-2 co-epidemic with Influenza A virus than that with Influenza B virus. The number of co-infected cases increases as SARS-CoV-2 becomes more transmissible. As the proportion of individuals vaccinated with the COVID-19 vaccine and influenza vaccines increases, the peak number of co-infected severe illnesses and the number of severe illness cases decreases and the peak time is delayed, especially for those >60 years old. Conclusion To minimize the number of severe illnesses arising from co-infection of influenza and COVID-19, in conjunction vaccinations in the population are important, especially priority for the elderly.
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Affiliation(s)
- Jingyi Liang
- Department of Engineering Science, Faculty of Innovation Engineering, Macau University of Science and Technology, Taipa, Macao SAR, China
- Respiratory Disease AI Laboratory on Epidemic and Medical Big Data Instrument Applications, Faculty of Innovation Engineering, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Yangqianxi Wang
- Department of Engineering Science, Faculty of Innovation Engineering, Macau University of Science and Technology, Taipa, Macao SAR, China
- Respiratory Disease AI Laboratory on Epidemic and Medical Big Data Instrument Applications, Faculty of Innovation Engineering, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Zhijie Lin
- Department of Engineering Science, Faculty of Innovation Engineering, Macau University of Science and Technology, Taipa, Macao SAR, China
- Respiratory Disease AI Laboratory on Epidemic and Medical Big Data Instrument Applications, Faculty of Innovation Engineering, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Wei He
- Department of Engineering Science, Faculty of Innovation Engineering, Macau University of Science and Technology, Taipa, Macao SAR, China
- Respiratory Disease AI Laboratory on Epidemic and Medical Big Data Instrument Applications, Faculty of Innovation Engineering, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Jiaxi Sun
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, China
| | - Qianyin Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingyi Zhang
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, China
| | - Zichen Chang
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, China
| | - Yinqiu Guo
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, China
| | - Wenting Zeng
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, China
| | - Tie Liu
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, China
| | - Zhiqi Zeng
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, China
- Guangzhou Laboratory, Guangzhou, Guangdong, China
| | - Zifeng Yang
- Respiratory Disease AI Laboratory on Epidemic and Medical Big Data Instrument Applications, Faculty of Innovation Engineering, Macau University of Science and Technology, Macao, Macao SAR, China
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangzhou Laboratory, Guangzhou, Guangdong, China
| | - Chitin Hon
- Department of Engineering Science, Faculty of Innovation Engineering, Macau University of Science and Technology, Taipa, Macao SAR, China
- Respiratory Disease AI Laboratory on Epidemic and Medical Big Data Instrument Applications, Faculty of Innovation Engineering, Macau University of Science and Technology, Macao, Macao SAR, China
- Guangzhou Laboratory, Guangzhou, Guangdong, China
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Kandeel A, Fahim M, Deghedy O, H Roshdy W, K Khalifa M, El Shesheny R, Kandeil A, Wagdy S, Naguib A, Afifi S, Abdelghaffar K. Multicenter study to describe viral etiologies, clinical profiles, and outcomes of hospitalized children with severe acute respiratory infections, Egypt 2022. Sci Rep 2023; 13:21860. [PMID: 38071208 PMCID: PMC10710477 DOI: 10.1038/s41598-023-48814-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
In late 2022, severe acute respiratory infections (SARI) surveillance reported an abrupt increase in non-COVID-19 infections among children after three years of drastic reductions. Signals of increased absenteeism due to respiratory symptoms among primary and preparatory school children were detected by Event-Based Surveillance. We conducted a hospital-based survey of children who were admitted with SARI to identify the causative pathogen(s) and estimate the burden of infection. A survey was conducted among children < 16 years in 21 referral hospitals in the three governorates with the highest SARI rates. Patients' demographics, clinical symptoms, and severity were collected from medical records using a line list. Patients were swabbed and tested for a panel of 33 respiratory pathogens by RT-PCR at the Central Laboratory in Cairo. Descriptive data analysis was performed for demographic data. Patients' characteristics were compared by causative agents' clinical picture and severity using Chi2 with a p < 0.05 significance. Overall, 317 patients were enrolled, 58.3% were ≤ 1 year of age, 61.5% were males. Of 229 (72.7%) of positively tested patients, viruses caused 92.1% including RSV 63.8%, Rhinovirus 10.0%, Influenza 9.2%, Adenovirus 5.2%, and 1.3% co-infected with two viruses. Bacteria caused 3.5% of cases and 4.4% had mixed viral-bacterial infections. Rhinovirus was the most common cause of death among children with SARI, followed by RSV (8.7% and 1.4%), whereas influenza and Adenovirus did not result in any deaths. Patients with viral-bacterial infections are more likely to be admitted to ICU and die at the hospital than bacterial or viral infections (60% and 20% vs. 31.8% and 1.9% vs. 12.5% and 12.5%, p < 0.001). Viruses particularly RSV are the leading cause of SARI causing significant health problem among children < 16 years in Egypt. Bacterial on top of viral infection can worsen disease courses and outcomes. Studies are required to estimate the SARI burden accurately among Egyptian children and a comprehensive approach tailored to Egypt is necessary to reduce its burden.
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Affiliation(s)
- Amr Kandeel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Manal Fahim
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Ola Deghedy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt.
| | - Wael H Roshdy
- Central Public Health Laboratories, Ministry of Health and Population, Cairo, Egypt
| | - Mohamed K Khalifa
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, 12622, Egypt
| | - Rabeh El Shesheny
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, 12622, Egypt
| | - Ahmed Kandeil
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, 12622, Egypt
| | - Saly Wagdy
- Central Public Health Laboratories, Ministry of Health and Population, Cairo, Egypt
| | - Amel Naguib
- Central Public Health Laboratories, Ministry of Health and Population, Cairo, Egypt
| | - Salma Afifi
- Consultant Ministry of Health and Population, Cairo, Egypt
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Varshney K, Pillay P, Mustafa AD, Shen D, Adalbert JR, Mahmood MQ. A systematic review of the clinical characteristics of influenza-COVID-19 co-infection. Clin Exp Med 2023; 23:3265-3275. [PMID: 37326928 PMCID: PMC10618381 DOI: 10.1007/s10238-023-01116-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
COVID-19 has impacted populations across the globe and has been a major cause of morbidity and mortality. Influenza is another potentially deadly respiratory infection that affects people worldwide. While both of these infections pose major health threats, little is currently understood regarding the clinical aspects of influenza and COVID-19 co-infection. Our objective was to therefore provide a systematic review of the clinical characteristics, treatments, and outcomes for patients who are co-infected with influenza and COVID-19. Our review, which was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, involved searching for literature in seven different databases. Studies were eligible for inclusion if they included at least one co-infected patient, were available in English, and described clinical characteristics for the patients. Data were pooled after extraction. Study quality was assessed using the Joanna Brigg's Institute Checklists. Searches produced a total of 5096 studies, and of those, 64 were eligible for inclusion. A total of 6086 co-infected patients were included, 54.1% of whom were male; the mean age of patients was 55.9 years (SD = 12.3). 73.6% of cases were of influenza A and 25.1% were influenza B. 15.7% of co-infected patients had a poor outcome (death/deterioration). The most common symptoms were fever, cough, and dyspnea, with the most frequent complications being pneumonia, linear atelectasis, and acute respiratory distress syndrome. Oseltamivir, supplemental oxygen, arbidol, and vasopressors were the most common treatments provided to patients. Having comorbidities, and being unvaccinated for influenza, were shown to be important risk factors. Co-infected patients show symptoms that are similar to those who are infected with COVID-19 or influenza only. However, co-infected patients have been shown to be at an elevated risk for poor outcomes compared to mono-infected COVID-19 patients. Screening for influenza in high-risk COVID-19 patients is recommended. There is also a clear need to improve patient outcomes with more effective treatment regimens, better testing, and higher rates of vaccination.
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Affiliation(s)
- Karan Varshney
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC, 3216, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Preshon Pillay
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC, 3216, Australia
| | - Ashmit Daiyan Mustafa
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC, 3216, Australia
| | - Dennis Shen
- School of Medicine, University of New England, Armidale, NSW, Australia
| | | | - Malik Quasir Mahmood
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC, 3216, Australia
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Potdar V, Vijay N, Mukhopadhyay L, Aggarwal N, Bhardwaj SD, Choudhary ML, Gupta N, Kaur H, Narayan J, Kumar P, Singh H, Abdulkader RS, Murhekar M, Mishra M, Thangavel S, Nagamani K, Dhodapkar R, Fomda BA, Varshney U, Majumdar A, Dutta S, Vijayachari P, Turuk J, Majumdar T, Sahoo GC, Pandey K, Bhargava A, Negi SS, Khatri PK, Kalawat U, Biswas D, Khandelwal N, Borkakoty B, Manjushree S, Singh MP, Iravane J, Kaveri K, Shantala GB, Brijwal M, Choudhary A, Dar L, Malhotra B, Jain A. Pan-India influenza-like illness (ILI) and Severe acute respiratory infection (SARI) surveillance: epidemiological, clinical and genomic analysis. Front Public Health 2023; 11:1218292. [PMID: 37927860 PMCID: PMC10624221 DOI: 10.3389/fpubh.2023.1218292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023] Open
Abstract
Background Over time, COVID-19 testing has significantly declined across the world. However, it is critical to monitor the virus through surveillance. In late 2020, WHO released interim guidance advising the use of the existing Global Influenza Surveillance and Response System (GISRS) for the integrated surveillance of influenza and SARS-CoV-2. Methods In July 2021, we initiated a pan-India integrated surveillance for influenza and SARS-CoV-2 through the geographically representative network of Virus Research and Diagnostic Laboratories (VRDLs) across 26 hospital and laboratory sites and 70 community sites. A total of 34,260 cases of influenza-like illness (ILI) and Severe acute respiratory infection (SARI) were enrolled from 4 July 2021 to 31 October 2022. Findings Influenza A(H3) and B/Victoria dominated during 2021 monsoon season while A(H1N1)pdm09 dominated during 2022 monsoon season. The SARS-CoV-2 "variants of concern" (VoC) Delta and Omicron predominated in 2021 and 2022, respectively. Increased proportion of SARI was seen in extremes of age: 90% cases in < 1 year; 68% in 1 to 5 years and 61% in ≥ 8 years age group. Approximately 40.7% of enrolled cases only partially fulfilled WHO ILI and SARI case definitions. Influenza- and SARS-CoV-2-infected comorbid patients had higher risks of hospitalization, ICU admission, and oxygen requirement. Interpretation The results depicted the varying strains and transmission dynamics of influenza and SARS-CoV-2 viruses over time, thus emphasizing the need to continue and expand surveillance across countries for improved decision making. The study also describes important information related to clinical outcomes of ILI and SARI patients and highlights the need to review existing WHO ILI and SARI case definitions.
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Affiliation(s)
| | - Neetu Vijay
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Labanya Mukhopadhyay
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Neeraj Aggarwal
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | | | | | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Harmanmeet Kaur
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Jitendra Narayan
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Prabhat Kumar
- Biomedical Informatics (BMI) Division, Indian Council of Medical Research, New Delhi, India
| | - Harpreet Singh
- Biomedical Informatics (BMI) Division, Indian Council of Medical Research, New Delhi, India
| | | | | | - Meena Mishra
- VRDL, All India Institute of Medical Sciences, Nagpur, India
| | | | - K. Nagamani
- VRDL, Gandhi Medical College, Secunderabad, India
| | - Rahul Dhodapkar
- VRDL, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | - Agniva Majumdar
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - P. Vijayachari
- ICMR-Regional Medical Research Centre, Port Blair, India
| | | | | | | | - Krishna Pandey
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | | | | | | | - Usha Kalawat
- VRDL, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Debasis Biswas
- VRDL, All India Institute of Medical Sciences, Bhopal, India
| | | | | | | | - Mini P. Singh
- VRDL, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - K. Kaveri
- VRDL, King Institute of Preventive Medicine and Research, Chennai, India
| | - G. B. Shantala
- VRDL, Bangalore Medical College and Research Institute, Bangalore, India
| | - Megha Brijwal
- VRDL, All India Institute of Medical Sciences, New Delhi, India
| | | | - Lalit Dar
- VRDL, All India Institute of Medical Sciences, New Delhi, India
| | | | - Amita Jain
- VRDL, King George’s Medical University, Lucknow, India
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Kandeel A, Fahim M, Deghedy O, Roshdy WH, Khalifa MK, Shesheny RE, Kandeil A, Naguib A, Afifi S, Mohsen A, Abdelghaffar K. Resurgence of influenza and respiratory syncytial virus in Egypt following two years of decline during the COVID-19 pandemic: outpatient clinic survey of infants and children, October 2022. BMC Public Health 2023; 23:1067. [PMID: 37277781 DOI: 10.1186/s12889-023-15880-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Two years after unprecedented low rates of circulation of most common respiratory viruses (SARS-CoV-2), the Egyptian ARI surveillance system detected an increase in acute respiratory infections (ARIs) with a reduced circulation of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), especially among school children. A national survey was conducted to estimate the burden and identify the viral causes of ARIs among children < 16 years of age. METHODS A one-day survey was carried out in 98 governmental outpatient clinics distributed all over Egypt 26 governorates. The four largest referral hospitals in each governorate where most influenza-like illness (ILI) patients seek care were selected. Using the WHO case definition, the first five patients < 16 years of age with ILI symptoms visiting the selected outpatient clinics on the survey day were enrolled. Basic demographic and clinical data of patients were collected using a linelist. Patients were swabbed and tested for SARS-CoV-2, influenza, and Respiratory Syncytial virus (RSV) by RT-PCR at the Central Laboratory in Cairo. RESULTS Overall, 530 patients enrolled, their mean age was 5.8 ± 4.2, 57.1% were males, and 70.2% reside in rural or semi-rural areas. Of all patients, 134 (25.3%) had influenza, 111 (20.9%) RSV, and 14 (2.8%) coinfections. Influenza-positive children were older compared to RSV, (7.2 ± 4.1, 4.3 ± 4.1, p < 0.001), with more than half of them (53.0%) being school students. Dyspnea was reported in RSV more than in influenza (62.2% vs. 49.3%, p < 0.05). Among RSV patients, children < 2 years had a higher rate of dyspnea than others (86.7% vs. 53.1%, < 0.001). CONCLUSIONS A resurgence of influenza and RSV was detected in Egypt in the 2022-2023 winter season. Influenza caused a higher rate of infection than RSV, while RSV caused more severe symptoms than influenza. Monitoring a broader range of respiratory pathogens is recommended to estimate the ARI burden and risky groups for severe disease in Egypt.
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Affiliation(s)
- Amr Kandeel
- Ministry of Health and Population, Cairo, Egypt
| | - Manal Fahim
- Ministry of Health and Population, Cairo, Egypt
| | - Ola Deghedy
- Ministry of Health and Population, Cairo, Egypt
| | - Wael H Roshdy
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Mohamed K Khalifa
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, 12622, Dokki, Giza, Egypt
| | - Rabeh El Shesheny
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, 12622, Dokki, Giza, Egypt
| | - Ahmed Kandeil
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, 12622, Dokki, Giza, Egypt
| | - Amel Naguib
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Salma Afifi
- Consultant Ministry of Health and Population, Cairo, Egypt
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