Epidemiology, disease severity and outcome of SARS-CoV-2 and influenza
viruses co infection seen at Egypt Integrated Acute Respiratory
Infections surveillance, 2020-2022.
Background: Co-circulation of influenza and SARS-CoV-2 (SARS-CoV-2/Flu)
represent public health concern as it may worsen the severity and
increase fatality from COVID-19. An increase in number of patients with
coinfection was recently reported. We studied epidemiology, severity,
and outcome of SARS-CoV-2/Flu coinfections seen at Egypt acute
respiratory (ARI) surveillance eight hospitals to better describe
disease impact and guide effective preventive measures. Methods: Every
fifth patient admitted and first two outpatients seen daily with ARI are
enrolled. Standardized questionnaire is used to interview patients who
provide nasopharyngeal swabs to be tested weekly at the central
laboratory for SARS-CoV-2 and influenza by RT-PCR. Data of all patients
with coinfection extracted from surveillance database and descriptive
analysis performed for demographics, clinical course, and outcome.
Results: Of 18,160 patients enrolled January 2020-April 2022,
6,453(35.5%) were positive for viruses including 52(0.8%) coinfection.
Of them 36(69.2%) coinfected with FluA/H3, 9(17.3%) Flu-B and
7(13.5%) FluA/H1. Patients’ mean age was 33.2±21, and 55.8% were
males, 20(38.5%) hospitalized, mean hospital days (6.7±6). At hospital
14(70.0%) developed pneumonia, 6(30.0%) ICU admitted, and 4(20.0%)
died. Hospitalization rate among coinfection with Flu-B and FluA/H3 was
(55.6 and 41.7%), mean hospital days (8.0±6 and 6.4±6), pneumonia (40.0
and 80.0%), ICU admission (40.0 and 26.7%), and death (20.0% for
both), while no patients hospitalized with A/H1. Conclusions: An
increasing number of SARS-CoV-2/Flu coinfection identified in Egypt with
severe course and high fatality. Patients coinfected with Flu-B and
FluA/H3 had severe disease than A/H1. Monitoring disease severity and
impact is required to guide preventive strategy.