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. 2015 Jun 11;10(6):e0128580.
doi: 10.1371/journal.pone.0128580. eCollection 2015.

Potential Impact of Co-Infections and Co-Morbidities Prevalent in Africa on Influenza Severity and Frequency: A Systematic Review

Adam L Cohen  1 , Meredith McMorrow  2 , Sibongile Walaza  3 , Cheryl Cohen  3 , Stefano Tempia  4 , Marissa Alexander-Scott  5 , Marc-Alain Widdowson  6
Affiliations

Potential Impact of Co-Infections and Co-Morbidities Prevalent in Africa on Influenza Severity and Frequency: A Systematic Review

Adam L Cohen et al. PLoS One. .

Abstract

Infectious diseases and underlying medical conditions common to Africa may affect influenza frequency and severity. We conducted a systematic review of published studies on influenza and the following co-infections or co-morbidities that are prevalent in Africa: dengue, malaria, measles, meningococcus, Pneumocystis jirovecii pneumonia (PCP), hemoglobinopathies, and malnutrition. Articles were identified except for influenza and PCP. Very few studies were from Africa. Sickle cell disease, dengue, and measles co-infection were found to increase the severity of influenza disease, though this is based on few studies of dengue and measles and the measles study was of low quality. The frequency of influenza was increased among patients with sickle cell disease. Influenza infection increased the frequency of meningococcal disease. Studies on malaria and malnutrition found mixed results. Age-adjusted morbidity and mortality from influenza may be more common in Africa because infections and diseases common in the region lead to more severe outcomes and increase the influenza burden. However, gaps exist in our knowledge about these interactions.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram for systematic reviews of influenza and dengue (D), malaria (MR), measles (MS), meningococcus (MN), Pneumocystis jirovecii pneumonia (PCP), hemoglobinopathies (H), and malnutrition (MT).
See this image and copyright information in PMC

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