Prevalence and associated outcomes of coinfection between SARS-CoV-2 and influenza: a systematic review and meta-analysis

Xiaolong Yan; Ke Li; Zhiqun Lei; Jiayao Luo; Qi Wang; Sheng Wei

doi:10.1016/j.ijid.2023.08.021

Prevalence and associated outcomes of coinfection between SARS-CoV-2 and influenza: a systematic review and meta-analysis

Int J Infect Dis. 2023 Nov:136:29-36. doi: 10.1016/j.ijid.2023.08.021. Epub 2023 Aug 28.

Authors

Xiaolong Yan¹, Ke Li², Zhiqun Lei¹, Jiayao Luo¹, Qi Wang¹, Sheng Wei³

Affiliations

¹ School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Public Health and Preventive Medicine, Medical College, Shihezi University, Shihezi, China.
³ School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China. Electronic address: ws2008cn@gmail.com.

PMID: 37648094
DOI: 10.1016/j.ijid.2023.08.021

Abstract

Objectives: To estimate the prevalence of influenza coinfection in COVID-19 patients and investigate its association with severe clinical outcomes.

Methods: We systematically searched the Web of Science, PubMed, Scopus, Embase, The Cochrane Library, and CNKI for studies published between January 01, 2020, and May 31, 2023. Meta-analysis was performed to estimate the pooled prevalence of coinfection and the impact on clinical outcomes. Systematic review registered in PROSPERO (CRD42023423113).

Results: A total of 95 studies involving 62,107 COVID-19 patients were included. The pooled prevalence of coinfection with influenza virus was 2.45% (95% confidence interval [CI]: 1.67-3.58%), with a high proportion of influenza A. Compared with mono-infected patients (COVID-19 only), the odds ratio (OR) for severe outcomes (including intensive care unit admission [OR = 2.20, 95% CI: 1.68-2.87, P < 0.001], mechanical ventilation support [OR = 2.73, 95% CI: 1.46-5.10, P = 0.002], and mortality [OR = 2.92, 95% CI: 1.16-7.30, P = 0.022]) was significantly higher among patients coinfected influenza A.

Conclusion: Although the prevalence of coinfection is low, coinfected patients are at higher risk of severe outcomes. Enhanced identification of both viruses, as well as individualized treatment protocols for coinfection, are recommended to reduce the occurrence of serious disease outcomes in the future.

Keywords: Clinical outcomes; Co-infection; Influenza; Meta-analysis; Prevalence; SARS-CoV-2.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

COVID-19* / epidemiology
COVID-19* / therapy
Coinfection* / epidemiology
Humans
Influenza, Human* / complications
Influenza, Human* / epidemiology
Influenza, Human* / therapy
Prevalence
SARS-CoV-2