A comparative analysis of the outcomes of patients with influenza or COVID-19 in a tertiary hospital in Belgium

Wallemacq, Silvio; Danwang, Célestin; Scohy, Anaïs; Belkhir, Leïla; Greef, Julien De; Kabamba, Benoît; Yombi, Jean Cyr

doi:10.1016/j.jiac.2022.07.012

Cited by 9 publications

(10 citation statements)

References 22 publications

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“…Conversely, SARS-CoV-2 stood out as the sole cause of 49% of hospital-admitted SARI deaths during this time. This aligns with other LMIC, middle-income and developed countries as India, the USA, Belgium, France, and Austria, revealing a heightened risk of in-hospital mortality (up to five times) among COVID-19 patients compared to influenza cases [ 19 , 26 – 30 ]. Consequently, global influenza cases and deaths saw a notable decline during the pandemic, with minimal influenza activity and associated hospitalizations during the 2020–2021 flu seasons [ 31 – 33 ].…”

Section: Discussionsupporting

confidence: 84%

Characterizing deaths among adult patients with severe acute respiratory infection: during the pre- and COVID-19 pandemic periods in Bangladesh, 2018–2022

Hassan,

Islam,

Shoshi

et al. 2023

Trop Med Health

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Background Severe acute respiratory infection (SARI) is a leading cause of mortality globally, peaking during the COVID-19 pandemic. We analyzed SARI-associated deaths during the pre-and-pandemic periods in Bangladesh to identify the contributing factors. Methods We analyzed data from hospital-based influenza surveillance at nine tertiary-level hospitals in Bangladesh. We considered March 2018–February 2020 as the pre-pandemic period and March 2020–February 2022 as the pandemic period and included adult (≥ 18 years) participants in our study. Surveillance physicians identified WHO-SARI case definition meeting inpatients and collected demographics, clinical characteristics, and outcomes at hospital discharge and 30 days post-discharge. We performed rRT-PCR for influenza and SARS-CoV-2 viruses on collected nasopharyngeal and oropharyngeal swabs. We used multivariable Cox's regression models to calculate the hazard ratio (HR) for factors associated with SARI deaths in these adult patients. Results We enrolled 4392 SARI patients during the pre-pandemic and 3824 SARI patients during the pandemic period. Case fatality ratio was higher during the pandemic: 13.62% (521) [in-hospital: 6.45% (247); post-discharge: 7.17% (274)] compared to pre-pandemic, 6.01% (264) [in-hospital: 2.01% (89), post-discharge: 4% (175)] (p < 0.001). Pre-pandemic, influenza was detected in 14% (37/264) of SARI deaths. Influenza was detected during the pandemic in 2.3% (12/521), SARS-CoV-2 in 41.8% (218/521), and both viruses in only one SARI death. History of smoking and the presence of 1 or more co-morbid conditions independently attributed to SARI deaths in adults in the pre-pandemic period. SARI deaths in such patients were also associated with respiratory difficulties on admission in both pre-pandemic (aHR 2.36; 95% CI:1.65–3.36) and pandemic period (aHR 2.30; 95% CI: 1.57–3.35) after accounting for age, sex, smoking status, presence of 1 or more co-morbid conditions, and detection of influenza and SARS-CoV-2 viruses. Conclusions During the pandemic, SARI mortality increased; influenza-associated mortality declined, and SARS-CoV-2 caused over a third of SARI deaths. Post-discharge mortality was higher than in-hospital mortality during both periods. Limiting premature discharge and strengthening post-discharge monitoring and nursing services could reduce unexpected deaths. Formative research to better understand post-discharge mortality is essential to reduce SARI deaths.

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Section: Discussionsupporting

confidence: 84%

Characterizing deaths among adult patients with severe acute respiratory infection: during the pre- and COVID-19 pandemic periods in Bangladesh, 2018–2022

Hassan,

Islam,

Shoshi

et al. 2023

Trop Med Health

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“…An attempt to investigate the role of severe SARS-CoV2 infection on the susceptibility to superinfections has been done by other authors using as control group patients hospitalized for other respiratory viral infections, in particular influenza [ 7 , 11 , 12 , 13 ]. DeVoe et al [ 6 ] compared the rates of hospital-onset secondary bacterial infections in patients with COVID-19 (n=314), influenza (n=82) and controls (patients without detection of SARS-CoV2 or influenza, n=14.332) admitted at a large hospital in US, from October 2019 to October 2020.…”

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confidence: 99%

“…A study conducted in 7 ICUs in Wales comparing the rate of early (within 48 hours) and late (>48 hours from hospital admission) bacterial infections in patients admitted for COVID-19 (n=299), influenza (n=48) and non-viral pneumonia (n=177) showed that the rate of patients with early positive significant culture was 8.7%, 25% and 14.4% in COVID-19, influenza and non-viral pneumonia patients, while the percentage of patients with late positive significant culture was 41%, 33% and 27%, respectively [ 11 ]. In a propensity matched cohort of patients with COVID-19 and influenza hospitalized at a teaching hospital in Belgium, pulmonary bacterial superinfections occurred more frequently among patients with influenza (46.2% vs 7.4%) [ 12 ]. Finally, a nationwide cohort study comparing the incidence of superinfections in patients with severe COVID-19 admitted to the ICU compared with ICU patients with influenza A/B in Denmark is ongoing [ 13 ].…”

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confidence: 99%

The controversial bond between COVID-19 and bacterial superinfections

Bonazzetti

Giannella

2023

Clinical Microbiology and Infection

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“…Our estimated incidence of hospitalization and mortality are also somewhat underestimated as 8.4% of patients/substitute decision makers declined study participation. Similarly, although in previous case series of influenza <10% of cases were readmitted—and in our population area most would be readmitted to the same hospital—we may have missed an additional small number of deaths [ 37 , 38 ]. Our identification of underlying illness by chart review may not accurately capture all underlying illnesses.…”

Section: Discussionmentioning

confidence: 78%

Burden of Severe Illness Associated With Laboratory-Confirmed Influenza in Adults Aged 50–64 Years, 2010–2011 to 2016–2017

Kim

Coleman

Kwong

et al. 2022

Open Forum Infectious Diseases

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Background Understanding the burden of influenza is necessary to optimize recommendations for influenza vaccination. We describe the epidemiology of severe influenza in 50-64-year-old residents of metropolitan Toronto and Peel region, Canada, over seven influenza seasons. Methods Prospective population-based surveillance for hospitalization associated with laboratory-confirmed influenza was conducted from 9/2010-8/2017. Conditions increasing risk of influenza complications were as defined by Canada’s National Advisory Committee on Immunization. Age-specific prevalence of medical conditions was estimated using Ontario health administrative data. Population rates were estimated using Statistics Canada data. Results Over 7 seasons, 1,228 hospitalizations occurred in patients aged 50-64 years: 40% due to A(H3N2), 30% A(H1N1), and 22% influenza B. The average annual hospitalization rate was 15.6, 20.9 and 33.2/100,000 in 50-54, 55-59, and 60-64-year-olds; average annual mortality was 0.9/100,000. Overall, 33% of patients had received current season influenza vaccine; 963 (86%) had ≥1 underlying condition increasing influenza complication risk. The most common underlying medical conditions were chronic lung disease (38%) and diabetes mellitus (31%); 25% of patients were immunocompromised. The average annual hospitalization rate was 6.1/100,000 in those without and 41/100,000 in those with any underlying condition, and highest in those with renal disease or immunocompromise (138 and 281/100,000 respectively). The case fatality rate in hospitalized patients was 4.4%; median length of stay was 4 days (IQR 2-8). Conclusions The burden of severe influenza in 50-64-year-olds remains significant despite our universal publicly funded vaccination program. These data may assist in improving estimates of the cost-effectiveness of new strategies to reduce this burden.

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A comparative analysis of the outcomes of patients with influenza or COVID-19 in a tertiary hospital in Belgium

Cited by 9 publications

References 22 publications

Characterizing deaths among adult patients with severe acute respiratory infection: during the pre- and COVID-19 pandemic periods in Bangladesh, 2018–2022

Characterizing deaths among adult patients with severe acute respiratory infection: during the pre- and COVID-19 pandemic periods in Bangladesh, 2018–2022

The controversial bond between COVID-19 and bacterial superinfections

Burden of Severe Illness Associated With Laboratory-Confirmed Influenza in Adults Aged 50–64 Years, 2010–2011 to 2016–2017

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