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Influenza A viruses dual and multiple infections with other respiratory viruses and risk of hospitalisation and mortality.

ABSTRACT: 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.To identify the association between influenza A and respiratory viruses co-infections with disease outcome.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.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.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.

SUBMITTER: Goka E

PROVIDER: S-EPMC4634299 | biostudies-other | 2013 Nov

REPOSITORIES: biostudies-other

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Project description:BackgroundExacerbations in chronic respiratory diseases (CRDs) are sensitive to seasonal variations in exposure to respiratory infectious agents and allergens and patient factors such as non-adherence. Hence, regular general practitioner (GP) contact is likely to be important in order to recognise symptom escalation early and adjust treatment.ObjectiveTo examine the association of regularity of GP visits with all-cause mortality and first CRD hospitalisation overall and within groups of pharmacotherapy level in older CRD patients.DesignA retrospective cohort design using linked hospital, mortality, Medicare and pharmaceutical data for participant, exposure and outcome ascertainment. GP visit pattern was measured during the first 3 years of the observation period. Patients were then followed for a maximum of 11.5 years for ascertainment of hospitalisations and deaths.ParticipantsWe studied 108,455 patients aged >or=65 years with CRD in Western Australia (WA) during 1992-2006.Main measuresA GP visit regularity score (range 0-1) was calculated and divided into quintiles. A clinician consensus panel classified levels of pharmacotherapy. Cox proportional hazards models, controlling for multiple factors including GP visit frequency, were used to calculate hazard ratios and confidence intervals.Key resultsDifferences in survival curves and hospital avoidance pattern between the GP visit regularity quintiles were statistically significant (p = 0.0279 and p < 0.0001, respectively). The protective association between GP visit regularity and death appeared to be confined to the highest pharmacotherapy level group (P for interaction = 0.0001). Higher GP visit regularity protected against first CRD hospitalisation compared with the least regular quintile regardless of pharmacotherapy level (medium regular: HR = 0.84, 95% CI = 0.77-0.92; 2nd most regular: HR = 0.74, 95% CI = 0.67-0.82; most regular HR = 0.77, 95% CI = 0.68-0.86).ConclusionsThe findings indicate that regular and proactive 'maintenance' primary care, as distinct from 'reactive' care, is beneficial to older CRD patients by reducing their risks of hospitalisation and death.

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Influenza A viruses dual and multiple infections with other respiratory viruses and risk of hospitalisation and mortality.

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