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. 2013 Nov;7(6):1079-87.
doi: 10.1111/irv.12020. Epub 2012 Oct 19.

Influenza A viruses dual and multiple infections with other respiratory viruses and risk of hospitalisation and mortality

Edward Goka  1 , Pamela Vallely, Kenneth Mutton, Paul Klapper
Affiliations

Influenza A viruses dual and multiple infections with other respiratory viruses and risk of hospitalisation and mortality

Edward Goka et al. Influenza Other Respir Viruses. 2013 Nov.

Abstract

Introduction: Recent literature suggests that dual or multiple virus infections may affect disease severity. However, few studies have investigated the effect of co-infection with influenza A viruses.

Objectives: To identify the association between influenza A and respiratory viruses co-infections with disease outcome.

Methodology: Data for samples from North West England tested between January 2007 and June 2011 was analysed for patterns of co-infection between influenza A viruses and eight respiratory viruses. Risk of hospitalisation to ICU or general ward in single versus co-infections was assessed using logistic regression.

Results: Of the 25,596 samples analysed for respiratory viruses 40·7% (10,501) were positive for any virus. Co-infections were detected in 4·7% (137/2879) of all patients with influenza A(H1N1)pdm09, and 7·3% (57/779) of those with other influenza A virus infections. Co-infection between seasonal influenza A viruses and influenza B virus was associated with a significant increase in the risk of admission to ICU/death (OR: 22·0, 95% CI: 2·21-219·8, P=0·008). Respiratory syncytial virus/influenza A (RSV/Flu A) co-infection also increased this risk but was not statistically significant. For influenza A(H1N1)pdm09, RSV and AdV co-infection increased risk of hospitalisation to general ward whereas Flu B increased risk of admission to ICU, but none of these were statistically significant.

Conclusion: Co-infection is a significant predictor of disease outcome; combined treatment, introduction of an integrated vaccine for all respiratory viruses and development of multi-target rapid diagnostic tests is recommended. Integration of respiratory viruses' co-infections into public health reports could also contribute to the accumulation of evidence.

Keywords: Co-infection; Influenza B virus; dual or multiple infections; influenza A viruses; respiratory virus infections.

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Figures

Figure 1
Figure 1
Schematic diagram of patient inclusion and exclusion.
Figure 2
Figure 2
Respiratory virus’ positivity rates by age group.
Figure 3
Figure 3
Seasonal distribution of respiratory viral infections January 2007–June 2011.
See this image and copyright information in PMC

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