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Meta-Analysis
. 2023 Mar 1;15(3):665.
doi: 10.3390/v15030665.

Burden of Influenza and Respiratory Syncytial Viruses in Suspected COVID-19 Patients: A Cross-Sectional and Meta-Analysis Study

Vivaldo Gomes da Costa  1 , Ana Júlia Chaves Gomes  1 , Cíntia Bittar  1 , Dayla Bott Geraldini  1 , Pâmela Jóyce Previdelli da Conceição  1 , Ágata Silva Cabral  1 , Tamara Carvalho  1 , Joice Matos Biselli  1 , Paola Jocelan Scarin Provazzi  1 , Guilherme Rodrigues Fernandes Campos  2 , Paulo Ricardo da Silva Sanches  3 , Paulo Inácio Costa  4 , Maurício Lacerda Nogueira  2 , João Pessoa Araujo Jr  5 , Fernando Rosado Spilki  6 , Marília Freitas Calmon  1 , Paula Rahal  1
Affiliations
Meta-Analysis

Burden of Influenza and Respiratory Syncytial Viruses in Suspected COVID-19 Patients: A Cross-Sectional and Meta-Analysis Study

Vivaldo Gomes da Costa et al. Viruses. .

Abstract

Non-SARS-CoV-2 respiratory viral infections, such as influenza virus (FluV) and human respiratory syncytial virus (RSV), have contributed considerably to the burden of infectious diseases in the non-COVID-19 era. While the rates of co-infection in SARS-CoV-2-positive group (SCPG) patients have been determined, the burden of other respiratory viruses in the SARS-CoV-2-negative group (SCNG) remains unclear. Here, we conducted a cross-sectional study (São José do Rio Preto county, Brazil), and we collected our data using a meta-analysis to evaluate the pooled prevalence of FluV and RSV among SCNG patients. Out of the 901 patients suspected of COVID-19, our molecular results showed positivity of FluV and RSV in the SCNG was 2% (15/733) and 0.27% (2/733), respectively. Co-infection with SARS-CoV-2 and FluV, or RSV, was identified in 1.7% of the patients (3/168). Following our meta-analysis, 28 studies were selected (n = 114,318 suspected COVID-19 patients), with a pooled prevalence of 4% (95% CI: 3-6) for FluV and 2% (95% CI: 1-3) for RSV among SCNG patients were observed. Interestingly, FluV positivity in the SCNG was four times higher (OR = 4, 95% CI: 3.6-5.4, p < 0.01) than in the SCPG. Similarly, RSV positivity was significantly associated with SCNG patients (OR = 2.9, 95% CI: 2-4, p < 0.01). For subgroup analysis, cold-like symptoms, including fever, cough, sore throat, headache, myalgia, diarrhea, and nausea/vomiting, were positively associated (p < 0.05) with the SCPG. In conclusion, these results show that the pooled prevalence of FluV and RSV were significantly higher in the SCNG than in the SCPG during the early phase of the COVID-19 pandemic.

Keywords: SARS-CoV-2-negative; a systematic review; influenza virus; non-COVID-19; respiratory syncytial virus.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Clinical features among SCNG versus SCPG patients [46,47,51,54,59].
Figure 2
Figure 2
Forest plot with FluV, FluAV, and FluBV positivity among SCNG patients. The black diamonds in gray squares indicate the mean of the ratio of viral positivity, while the size of the grey square represents the weight (population size) contributed by each study in the meta-analysis. The horizontal lines in black represent their 95% CI. The blue diamond represents the pooled ratio of positives and its 95% CI. Id = identification of the study; Var5 = FluV positivity/total; ES = effect size [36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,52,53,54,55,56,57,58,59,60,61,62].
Figure 3
Figure 3
Forest plot with RSV positivity among SCNG patients. Id = identification of the study; Var5 = RSV positivity/Total; Var6 = place of study; ES = effect size [36,37,38,39,40,41,42,43,44,45,46,48,50,51,52,53,54,55,57,58,59,60,61,62].
Figure 4
Figure 4
Map illustrating the geographical distribution of the included studies containing positivity values for FluV and RSV.
See this image and copyright information in PMC

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