Using routine testing data to understand circulation patterns of influenza A, respiratory syncytial virus and other respiratory viruses in Victoria, Australia.

O H Price,C Sutterby,K S Carville,J Druce,S G Sullivan

doi:10.1017/s0950268819001055

Abstract

Several studies have reported evidence of interference between respiratory viruses: respiratory viruses rarely reach their epidemic peak concurrently and there appears to be a negative association between infection with one respiratory virus and co-infection with another. We used results spanning 16 years (2002-2017) of a routine diagnostic multiplex panel that tests for nine respiratory viruses to further investigate these interactions in Victoria, Australia. Time series analyses were used to plot the proportion positive for each virus. The seasonality of all viruses included was compared with respiratory syncytial virus (RSV) and influenza A virus using cross-correlations. Logistic regression was used to explore the likelihood of co-infection with one virus given infection with another. Seasonal peaks were observed each year for influenza A and RSV and less frequently for influenza B, coronavirus and parainfluenza virus. RSV circulated an average of 6 weeks before influenza A. Co-infection with another respiratory virus was less common with picornavirus, RSV or influenza A infection. Our findings provide further evidence of a temporal relationship in the circulation of respiratory viruses. A greater understanding of the interaction between respiratory viruses may enable better prediction of the timing and magnitude of respiratory virus epidemics.

Highlights

Influenza, respiratory syncytial virus (RSV) and other respiratory viruses are the cause of substantial morbidity and mortality, with children under 5 years of age and the elderly disproportionately burdened [1]
Time series analyses indicated the annual occurrence of epidemics for influenza A and RSV and less recurrent epidemics for influenza B, coronavirus and parainfluenza virus
RSV epidemics generally began in autumn and peaked early winter, while influenza A began mid-winter and peaked late winter

Summary

Introduction

Respiratory syncytial virus (RSV) and other respiratory viruses are the cause of substantial morbidity and mortality, with children under 5 years of age and the elderly disproportionately burdened [1] Both influenza and RSV display distinct seasonality, the exact timing and magnitude of their annual epidemics remain difficult to predict [2]. Studies investigating viral interference since the pandemic are sparser, though two studies reported that the timing and magnitude of respiratory virus epidemics were affected by the timing of the seasonal influenza A peak [15, 16]. These observations suggest interference may prevent respiratory viruses reaching their epidemic peaks concurrently, and underscore the complexity of these interactions

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