Decline of Influenza and Respiratory Viruses With COVID-19 Public Health Measures

Doroshenko, Alexander; Lee, Nelson; MacDonald, Clayton; Zelyas, Nathan; Asadi, Leyla; Kanji, Jamil N.

doi:10.1016/j.mayocp.2021.09.004

Cited by 21 publications

(20 citation statements)

References 36 publications

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“…Since pathogen interference is not a widely appreciated phenomenon, it has been claimed that the imposition of lockdowns during the COVID-19 pandemic were responsible for the early decline in influenza activity during the winter of 2019/20 [ 63 , 64 ]. However, close inspection of weekly influenza activity figures in the UK show very clearly that influenza activity had dropped to baseline levels by week 3 of 2020 and had declined to zero during week 12 [ 65 ].…”

Section: Discussionmentioning

confidence: 99%

“…In Canada during the 20-week period after week 11 of 2020 compared to the pervious 148 weeks a 70% decline in influenza prevalence was observed. However, respiratory syncytial virus (RSV) only declined by 54%, parainfluenza virus (PIV) declined by 60%, but coronaviruses (hCoVs) (excluding COVID-19s) increased by 80%, metapneumoviruses (HMPV) increased by +45%, and entero/rhino viruses (hERV) by +40% [ 64 ]. These results indicate that while protective measures may have played a limited role, additional virus-specific factors were specifically involved.…”

Section: Discussionmentioning

confidence: 99%

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System Complexity in Influenza Infection and Vaccination: Effects upon Excess Winter Mortality

Jones¹,

Ponomarenko

2022

Infectious Disease Reports

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Unexpected outcomes are usually associated with interventions in complex systems. Excess winter mortality (EWM) is a measure of the net effect of all competing forces operating each winter, including influenza(s) and non-influenza pathogens. In this study over 2400 data points from 97 countries are used to look at the net effect of influenza vaccination rates in the elderly aged 65+ against excess winter mortality (EWM) each year from the winter of 1980/81 through to 2019/20. The observed international net effect of influenza vaccination ranges from a 7.8% reduction in EWM estimated at 100% elderly vaccination for the winter of 1989/90 down to a 9.3% increase in EWM for the winter of 2018/19. The average was only a 0.3% reduction in EWM for a 100% vaccinated elderly population. Such outcomes do not contradict the known protective effect of influenza vaccination against influenza mortality per se—they merely indicate that multiple complex interactions lie behind the observed net effect against all-causes (including all pathogen causes) of winter mortality. This range from net benefit to net disbenefit is proposed to arise from system complexity which includes environmental conditions (weather, solar cycles), the antigenic distance between constantly emerging circulating influenza clades and the influenza vaccine makeup, vaccination timing, pathogen interference, and human immune diversity (including individual history of host-virus, host-antigen interactions and immunosenescence) all interacting to give the observed outcomes each year. We propose that a narrow focus on influenza vaccine effectiveness misses the far wider complexity of winter mortality. Influenza vaccines may need to be formulated in different ways, and perhaps administered over a shorter timeframe to avoid the unanticipated adverse net outcomes seen in around 40% of years.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

System Complexity in Influenza Infection and Vaccination: Effects upon Excess Winter Mortality

Jones¹,

Ponomarenko

2022

Infectious Disease Reports

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“…There was an estimated reduction in influenza incidence by 70.8% and 67.4%, for influenza A(H1N1) and B respectively, in the first 10weeks following implementation of widespread nonpharmaceutical interventions [2 ▪ ]. Compared to previous years, the 2020–2021 influenza season was shorter, had fewer cases, and lower positivity rates in both Southern and Northern hemispheres [1 ▪ ,3 ▪ ,4–7]. Similarly, data reported to the World Health Organization's FluNet Global Influenza Surveillance and Response System for the 2021 influenza season indicate very few influenza cases [8].…”

Section: Clinical Aspects Of Influenzamentioning

confidence: 99%

Influenza: clinical aspects, diagnosis, and treatment

Sukhdeo

Lee

2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewTo review the clinico-epidemiological aspects of influenza in the context of the Coronavirus Disease 2019 (COVID-19) pandemic; the recent advances in point-of-care molecular diagnostics and co-detection of influenza and coronaviruses, and the development of new influenza therapeutics. Recent findingsRates of influenza have declined globally since the 2020--2021 season; waning population immunity and uncertainty in vaccine strains could pose a risk in its significant resurgence, especially where pandemic public health interventions start being lifted. As symptoms are similar for influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, accurate, rapid diagnostics are needed to guide management. In addition to neuraminidase inhibitors, newer class of antivirals including polymerase inhibitors show promise in treating influenza infections in adults, children, and high-risk individuals.

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“…9 As the months International Journal of Stroke, 18 (4) went on during the COVID-19 pandemic, these public health interventions did not completely disappear and subsequently assisted in the regional decrease of other communicable diseases such as influenza and other upper respiratory infections. [10][11][12] To date, little is known about the effect that a decreased incidence of respiratory infection has on other, possibly patho-physiologically associated diseases. Although its pathogenesis remains poorly understood, spontaneous cervical artery dissections (sCeAD) has been linked to seasonal variability and upper respiratory infections.…”

Section: Introductionmentioning

confidence: 99%

Decline in spontaneous cervical artery dissection incidence during COVID-19 public health measures: Evidence for a role of upper respiratory infections in pathogenesis

Mayer

Heidbreder

Kiechl

et al. 2023

International Journal of Stroke

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Background Upper respiratory infections have been suggested as a risk factor for spontaneous cervical artery dissection (sCeAD). If this is the case, public health measures implemented to contain the spread of SARS-CoV-2, which also reduced other communicable diseases such as influenza, might be associated with a reduction in cervical artery dissection incidence. Aim: We determined the incidence of sCeAD before, during and after the COVID-19 pandemic, and the associated public health measures. Methods All patients suffering a sCeAD and seen in Innsbruck Austria, between January of 2002 to December of 2016 (pre-COVID comparators) and between January of 2020 to August of 2022 were recorded through two individual prospective cohort studies. We compared admission rates, demographic and clinical characteristics of sCeAD patients in pre-COVID-19 and COVID-19 times. Results In total, 249 sCeAD patients were admitted prior to the COVID-19 pandemic compared to 20 during its course. Baseline characteristics of sCeAD subjects did not differ in subjects admitted during and prior to the pandemic. Following the introduction of public health measures for the pandemic there was a marked decrease of sCeAD admissions from 16.5 per year to 6.3 per year (p=0.012). Since the measures were ended the number of sCeAD admissions increased again. In contrast, the number of all ischemic stroke patients treated at the Medical University of Innsbruck did not alter during the pandemic. (N per year: 633 in 2015 – 687 in 2017 – 684 in 2019 – 731 in 2020 – 717 in 2021). Conclusions The incidence of sCeAD fell markedly during the pandemic and this may have resulted from the public health measures introduced and a subsequent reduction in upper respiratory infections. Our study provides indirect evidence for a role of infection in the pathogenesis of sCeAD. Data access: Anonymized data not published within this article will be made available by request from any qualified investigator.

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Decline of Influenza and Respiratory Viruses With COVID-19 Public Health Measures

Cited by 21 publications

References 36 publications

System Complexity in Influenza Infection and Vaccination: Effects upon Excess Winter Mortality

System Complexity in Influenza Infection and Vaccination: Effects upon Excess Winter Mortality

Influenza: clinical aspects, diagnosis, and treatment

Decline in spontaneous cervical artery dissection incidence during COVID-19 public health measures: Evidence for a role of upper respiratory infections in pathogenesis

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