Epidemiology, Disease Severity and Outcome of Severe Acute Respiratory Syndrome Coronavirus 2 and Influenza Viruses Coinfection Seen at Egypt Integrated Acute Respiratory Infections Surveillance, 2020–2022

Abstract

Background. Cocirculation of influenza (Flu) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (SARS-CoV-2/Flu) represent a public health concern as it may worsen the severity and increase fatality from coronavirus disease 2019. An increase in the number of patients with coinfection was recently reported. We studied epidemiology, severity, and outcome of patients with SARS-CoV-2/Flu coinfection seen at Egypt’s integrated acute respiratory infections surveillance to better describe disease impact and guide effective preventive measures. Methods. The first two outpatients were seen daily, and every fifth patient admitted to 19 sentinel hospitals with respiratory symptoms was enrolled. Patients were interviewed using a standardized questionnaire and provided nasopharyngeal swabs to be tested for SARS-CoV-2 and influenza by real-time polymerase chain reaction at the central laboratory. Data from all patients with coinfection were obtained, and descriptive data analysis was performed for patients’ demographics, clinical course, and outcome. Results. The total number of patients enrolled between January 2020 and April 2022 was 18,160 and 6,453 (35.5%) tested positive for viruses, including 52 (0.8%) coinfection. Of them, 36 (69.2%) were coinfected with Flu A/H3, 9 (17.3%) Flu-B, and 7 (13.5%) Flu A/H1. Patients’ mean age was 33.2 ± 21, 55.8% were males, and 20 (38.5%) were hospitalized, with mean hospital days 6.7 ± 6. At the hospital, 14 (70.0%) developed pneumonia, 6 (30.0%) ICU admitted, and 4 (20.0%) died. The hospitalization rate among patients coinfected with Flu-B and Flu A/H3 was 55.6 and 41.7%, with mean hospital days (8.0 ± 6 and 6.4 ± 6), pneumonia infection (40.0 and 80.0%), ICU admission (40.0 and 26.7%), and death (20.0% for both), while no patients hospitalized with A/H1. Conclusions. The recent increase in the number of SARS-CoV-2/Flu coinfections was identified in Egypt. The disease could have a severe course and high fatality, especially in those coinfected with Flu-B and Flu A/H3. Monitoring disease severity and impact is required to guide preventive strategy.

Multicenter study to describe viral etiologies, clinical profiles, and outcomes of hospitalized children with severe acute respiratory infections, Egypt 2022

“…Coinfection with influenza and SARS-CoV-2 was reported in Egypt before and led to more severe course and outcomes compared to a single viral infection 9 , 34 . Similarly, this study reported coinfection with more than one viral cause.…”

“…Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality among children under five, particularly in developing countries, and pose a major threat to healthcare systems 8 . In Egypt, ARIs are monitored through integrated surveillance for ARI, National Disease Surveillance System for communicable diseases (NEDSS), ARI syndromic surveillance, ARI mortality surveillance, and event-based surveillance systems (EBS) 9 . ARI's integrated surveillance system monitors the activity of influenza and SARS-CoV-2 at 12 influenza like illness (ILI) and 17 severe acute respiratory infections (SARI) sentinel sites located in 19 governmental hospitals, plus the Central Public Health Laboratory (CPHL) and a network of five regional laboratories.…”

Influenza and COVID-19 co-infection and vaccine effectiveness against severe cases: a mathematical modeling study

“…Currently, there is a large amount of clinical evidence indicating that co-infection with COVID-19 and influenza increases the risk of patient mortality and prolongs hospitalization ( Dadashi et al., 2021 ; Garg et al., 2022 ; Cong et al., 2022 ; Fahim et al., 2022 ; Musuuza et al., 2021 ). In patients with co-infections, the risk of death is around twice as high as in those with COVID-19 infection alone ( Stowe et al., 2021 ).…”