Prevalence and trends in mono- and co-infection of COVID-19, influenza A/B, and respiratory syncytial virus, January 2018-June 2023

A Case of Triple Respiratory Coinfection: COVID-19, Enterovirus, and Parainfluenza

We report a case of a 34-year-old female who presented to the emergency department with fever, nausea, vomiting, and diarrhea following a suspected foodborne illness. She tested positive for COVID-19, human parainfluenza virus type 4, and enterovirus/rhinovirus in the hospital. She subsequently developed hypoxia, hypotension, and sepsis. Blood work revealed leukocytosis and elevated inflammatory markers. Imaging of her abdomen showed fluid-filled bowel loops suggesting acute gastroenteritis and colitis of infectious or inflammatory etiology. She was initially treated with antibiotics for a suspected bacterial infection. However, her cultures resulted negative and her symptoms slowly improved with supportive care including probiotics and a low-fat diet. Due to her persistent shortness of breath related to her COVID-19 infection, she was started on a course of oral prednisone due to the anti-inflammatory effects of steroids. She was discharged home in stable condition with close outpatient follow-up. This study highlights the clinical challenges of managing multiple viral infections, particularly with concurrent COVID-19.

The impact of the COVID-19 pandemic on respiratory failure caused by respiratory viruses in children and adolescents

Background

In addition to the direct impact of the coronavirus disease 2019 (COVID-19) pandemic on child/adolescent health, changes in infections caused by other viruses have been observed. Respiratory syncytial virus (RSV) and influenza are important agents of acute respiratory failure (ARF) in these age groups. This study presents an analysis of the influence of the pandemic on the seasonal and clinical patterns of ARF caused by RSV and influenza.

Methods

A retrospective ecological study was performed. The data of individuals younger than 20 years who were hospitalized with ARF and who were diagnosed with RSV, influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 2019 and 2022 were analysed. The data were collected from the governmental system.

Results

Among 367,136 individuals, the incidence of ARF increased annually. During the pandemic, the number of infected schoolchildren, adolescents, and nonwhite people; intensive care admissions; and mortality rates increased. Older age, SARS-CoV-2 infection, and residence in North Brazil/Northeast Brazil were associated with lower odds of intensive care unit admission but greater odds of death. Comorbidities were important risk factors for severe disease. There was a drastic reduction in the number of RSV and influenza infections, with a resurgence in 2021. After the resurgence in 2021, the number of influenza-related deaths remained above the 2019 level, which did not occur in 2022. After 2021, RSV infection was associated with greater odds of intensive care admission but not death.

Conclusions

During the pandemic, older children, adolescents, and individuals with comorbidities were more vulnerable to ARF. There was a reduction in the prevalence and severity of RSV and influenza infections. After this reduction, a resurgence with an out-of-season pattern, but without higher odds of death than in the prepandemic year, was observed for both in 2022.

Changes in Epidemiology and Antibiotic Prescription of Influenza: Before and after the Emergence of COVID-19

BACKGROUND

The appearance of COVID-19 had a major impact on healthcare and the epidemiology of other diseases. Following the cessation of non-pharmacologic interventions destined to limit the spread of COVID-19, influenza reemerged. The aim of this study was to compare the pre-pandemic influenza seasons with the influenza seasons after the emergence of the COVID-19 pandemic, and to identify differences in terms of clinical characteristics, risk factors, complications, outcomes, and antiviral and antibiotic treatments.

METHODS

We conducted a retrospective cohort study from the Teaching Hospital of Infectious Diseases database in Cluj-Napoca, Romania. We analyzed four pre-pandemic seasons and the seasons after the onset of COVID-19. We included adult patients hospitalized with confirmed influenza between October 2016 and August 2023. Variables such as age, sex, duration of hospitalization, severity, clinical manifestations, comorbidities, and Charlson comorbidity index were assessed.

RESULTS

A total of 941 patients were included in the analysis. The percentage of severe influenza was similar in both groups, but mortality from influenza was significantly lower after 2022. Virtually all patients were prescribed antivirals; antibiotic prescriptions decreased in the post-COVID-19 influenza seasons.

CONCLUSION

The present study suggests that influenza seasons after 2022 had lower mortality and attenuated clinical presentation.