Viral co-infections are associated with increased rates of hospitalization in those with influenza

Kerry L Shannon; Valerie O Osula; Kathryn Shaw-Saliba; Justin Hardick; Breana McBryde; Andrea Dugas; Yu-Hsiang Hsieh; Bhakti Hansoti; Richard E Rothman; Emergency Department National Influenza Network Investigators

doi:10.1111/irv.12967

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Viral co-infections are associated with increased rates of hospitalization in those with influenza

Journal article

Open access

Peer reviewed

Viral co-infections are associated with increased rates of hospitalization in those with influenza

Kerry L Shannon, Valerie O Osula, Kathryn Shaw-Saliba, Justin Hardick, Breana McBryde, Andrea Dugas, Yu-Hsiang Hsieh, Bhakti Hansoti, Richard E Rothman and Emergency Department National Influenza Network Investigators

Influenza and other respiratory viruses, Vol.16(4), pp.780-788

07/2022

DOI: 10.1111/irv.12967

PMCID: PMC9178061

PMID: 35302283

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Abstract

Influenza causes significant morbidity and mortality in the United States. Among patients infected with influenza, the presence of bacterial co-infection is associated with worse clinical outcomes; less is known regarding the clinical importance of viral co-infections. The objective of this study was to determine rates of viral co-infections in emergency department (ED) patients with confirmed influenza and association of co-infection with disease severity. Secondary analysis of a biorepository and clinical database from a parent study where rapid influenza testing was implemented in four U.S. academic EDs, during the 2014-2015 influenza season. Patients were systematically tested for influenza virus using a validated clinical decision guideline. Demographic and clinical data were extracted from medical records; nasopharyngeal specimens from influenza-positive patients were tested for viral co-infections (ePlex, Genmark Diagnostics). Patterns of viral co-infections were evaluated using chi-square analysis. The association of viral co-infection with hospital admission was assessed using univariate and multivariate regression. The overall influenza A/B positivity rate was 18.1% (1071/5919). Of the 999 samples with ePlex results, the prevalence of viral co-infections was 7.9% (79/999). The most common viral co-infection was rhinovirus/enterovirus (RhV/EV), at 3.9% (39/999). The odds of hospital admission (OR 2.33, 95% CI: 1.01-5.34) increased significantly for those with viral co-infections (other than RhV/EV) versus those with influenza A infection only. Presence of viral co-infection (other than RhV/EV) in ED influenza A/B positive patients was independently associated with increased risk of hospital admission. Further research is needed to determine clinical utility of ED multiplex testing.

Coinfection - epidemiology

Hospitalization

Humans

Influenza, Human - complications

Influenza, Human - epidemiology

Orthomyxoviridae

Respiratory Tract Infections - epidemiology

Virus Diseases - complications

Virus Diseases - epidemiology

Viruses

Details

Title: Subtitle: Viral co-infections are associated with increased rates of hospitalization in those with influenza
Creators: Kerry L Shannon - Johns Hopkins Medicine
Valerie O Osula - Johns Hopkins Medicine
Kathryn Shaw-Saliba - Johns Hopkins University School of Medicine
Justin Hardick - Johns Hopkins Medicine
Breana McBryde - Johns Hopkins Medicine
Andrea Dugas - Johns Hopkins Medicine
Yu-Hsiang Hsieh - Johns Hopkins Medicine
Bhakti Hansoti - Johns Hopkins Medicine
Richard E Rothman - Johns Hopkins Medicine
Emergency Department National Influenza Network Investigators
Contributors: David A Talan (Contributor) - University of Iowa, Emergency Medicine
Resource Type: Journal article
Publication Details: Influenza and other respiratory viruses, Vol.16(4), pp.780-788
DOI: 10.1111/irv.12967
PMID: 35302283
PMCID: PMC9178061
NLM abbreviation: Influenza Other Respir Viruses
ISSN: 1750-2640
eISSN: 1750-2659
Grant note: IDSEP150026-01-00 / US Department of Health and Human Services Biomedical Advanced Research and Development Authority IDSEP130014-01-00 / US Department of Health and Human Services Biomedical Advanced Research and Development Authority IDSEP160031-01-00 / US Department of Health and Human Services Biomedical Advanced Research and Development Authority Johns Hopkins University HHSN272201400007C / NIAID NIH HHS
Language: English
Date published: 07/2022
Academic Unit: Emergency Medicine; Internal Medicine
Record Identifier: 9984296979902771

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