Influenza A viruses dual and multiple infections with other respiratory viruses and risk of hospitalisation and mortality
Article first published online: 19 OCT 2012
© 2012 Blackwell Publishing Ltd
Influenza and Other Respiratory Viruses
How to Cite
Goka, E., Vallely, P., Mutton, K. and Klapper, P. (2012), Influenza A viruses dual and multiple infections with other respiratory viruses and risk of hospitalisation and mortality. Influenza and Other Respiratory Viruses. doi: 10.1111/irv.12020
- Article first published online: 19 OCT 2012
- Accepted 22 August 2012. Published online 19 October 2012.
- dual or multiple infections;
- influenza A viruses;
- Influenza B virus;
- respiratory virus infections
Please cite this paper as: Goka et al. (2012) Influenza A viruses dual and multiple infections with other respiratory viruses and risk of hospitalisation and mortality. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12020.
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.