Considering Interim Interventions to Control COVID-19 Associated Morbidity and Mortality—Perspectives

Abstract

Aims and objectives: The pandemic of COVID-19 is evolving worldwide, and it is associated with high mortality and morbidity. There is a growing need to discuss the elements of a coordinated strategy to control the spread and mitigate the severity of COVID-19. H1N1 and Streptococcus pneumonia vaccines are available. The current analysis was performed to analyze the severity of COVID-19 and influenza (H1N1) vaccination in adults ≥ 65. Also, to correlate the lower respiratory tract infections (LRIs), and influenza attributable to the lower respiratory tract infections' incidence with Covid-19 mortality. Evolutionarily influenza is close in resemblance to SARS-CoV-2 viruses and shares some common epitopes and mechanisms. Methods: Recent influenza vaccination data of 34 countries from OECD and other publications were correlated with COVID-19 mortality from worldometer data. LRIs attributable to influenza and streptococcus pneumonia were correlated with COVID-19 mortality. Specifically, influenza-attributable LRI incidence data of various countries (n = 182) was correlated with COVID-19 death by linear regression and receiver operating characteristic (ROC) curve analyzes. In a logistic regression model, population density and influenza LRI incidence were correlated with COVID-19 mortality. Results: There is a correlation between COVID-19-related mortality, morbidity, and case incidence and the status of influenza vaccination, which appears protective. The tendency of correlation is increasingly highlighted as the pandemic is evolving. In countries where influenza immunization is less common, there is a correlation between LRIs and influenza attributable to LRI incidence and COVID-19 severity, which is beneficial. ROC curve showed an area under the curve of 0.86 (CI 0.78 to 0.944, P < 0.0001) to predict COVID-19 mortality >150/million and a decreasing trend of influenza LRI episodes. To predict COVID-19 mortality of >200/million population, the odds ratio for influenza incidence/100,000 was −1.86 (CI −2.75 to −0.96, P < 0.0001). To predict the parameter Covid-19 mortality/influenza LRI episodes * 1000>1000, the influenza parameter had an odd's ratio of −3.83 (CI −5.98 to −1.67), and an AUC of 0.94. Arokiaraj Influenza Reduces COVID-19 Severity Conclusion: Influenza (H1N1) vaccination can be used as an interim measure to mitigate the severity of COVID-19 in the general population. In appropriate highrisk circumstances, Streptococcus pneumonia vaccination would also be an adjunct strategy, especially in countries with a lower incidence of LRIs.

Pneumococcal and Influenza Vaccination Rates and Pneumococcal Invasive Disease Rates Set Geographical and Ethnic Population Susceptibility to Serious COVID-19 Cases and Deaths

“…This study shows that influenza vaccination may have some protective effect against COVID-19 acquisition, though this result was found only as a synergistic effect for the international dataset and for Italy, but not for the United States, and results of other studies have also been contradictory [ 46 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 61 , 62 , 63 , 64 ]. Notably, however, a protective effect of influenza vaccination against coronaviruses and respiratory viruses has previously been reported: Wolff [ 175 ] found that influenza vaccination in the 2017–2018 influenza season protected against resulted in “virus interference”’ with other respiratory infections, “significantly associated with coronavirus and human metapneumovirus; however, significant protection with vaccination was associated not only with most influenza viruses, but also parainfluenza, RSV, and non-influenza virus coinfections.” [ 175 ] Additionally, pneumococcal and influenza vaccinations have been found to synergize in preventing community-acquired pneumonias [ 139 ].…”

“…However, as they note [ 45 ], some of the vaccinations occurred within similar time frames for the patient, so confounding effects were difficult to tease apart. Nonetheless, other population-level studies have also identified COVID-19 protective effects of influenza vaccination [ 49 , 50 , 51 , 52 , 53 , 54 , 55 ] and MMR vaccination [ 56 , 57 , 58 ], or more specifically, rubella vaccination [ 48 ]. Again, except for the Sambul et al [ 48 ] study, data were not controlled for possible confounding effects of receiving multiple vaccines within a similar timeframe, but in several controlled studies, neither MMR (or measles-containing and rubella-containing vaccines) nor influenza vaccine was associated with protection against COVID-19 case or death rates in population-wide studies [ 5 , 59 , 60 ].…”

Association between influenza vaccination and hospitalisation or all-cause mortality in people with COVID-19: a retrospective cohort study

“…22 Another study examined influenza vaccination data from 34 countries (using Organisation for Economic Cooperation and Development data) with COVID-19 mortality from worldometer data and reported a negative correlation between influenza vaccination status and COVID-19 mortality (R 2 0.338). 17 These studies were limited by the use of aggregated data, however. Two retrospective studies using patient-level data include a large Italian cohort study in which receipt of influenza vaccination was associated with 11% lower odds of COVID-19 diagnosis, and among a subgroup of those aged ≥65 years vaccinated in the first half of the vaccination programme, a 44% and 30% lower odds of hospitalisation and mortality, respectively.…”

The Association between Influenza Vaccination and COVID-19 and Its Outcomes: A Systematic Review and Meta-Analysis of Observational Studies

“…Based on the assumptions, Del Riccio et al [11] conducted a systematic review and found that there was overall no evidence to suggest a negative impact of influenza vaccination on SARS-CoV-2 related infections, illness, or deaths, while some of the included studies even reported significantly inverse associations. Though some of the recent studies have found that influenza vaccine uptake was negatively associated with COVID-19 incidence [12,13], severity [13,14], and mortality [13,15], others showed no evidence of such associations [16][17][18]. Therefore, a systematic review and meta-analysis of the association between influenza vaccination and SARS-CoV-2 infection and its outcomes is needed to provide conclusive evidence.…”