Influenza Co-infection Research Articles

Burdening of healthcare system by expected second wave of COVID-19 with influenza co-infection

Burdening of healthcare system by expected second wave of COVID-19 with influenza co-infection

COVID-19: Immunogenetics and Immuno-Epidemiological Parameters

As of February 15, 2020, 51,800 cases of COVID-19 disease, including more than 1,600 COVID-19-related deaths, had been laboratory-confirmed in mainland China, mainly in Hubei province. Additionally, 526 laboratory-confirmed cases have been reported across 25 other countries. Approximately, 15% of cases reported to the World Health Organization (WHO) are severe, 3% are critical, and 82% are mild clinical manifestations, whereas the estimated overall case fatality rate is approximately 2% but the figure outside of Hubei province is approximately 0.05% or less, not different from the fatality identified in the seasonal influenza. The mean age of COVID-19 patients is 52.4 years, whereas children and adolescents are the least likely group to be infected with the COVID-19, occurring in only 2 % of cases 19 years of age or younger. When the younger-age group get sick, they will get a mild form of COVID-19 without serious complications, with an average death rate of 0.2 %. Men constitute more than two-thirds of the reported COVID-19 cases (73 % vs. 27 %) and are more than 1.5 times more likely to die from COVID-19 (death rate : 2.8 % vs. 1.7 %). This sexual distinction of the anti-viral immunity between men and women is due to the genetic factors, hormonal factors, and environmental factors. The unanswered questions include the pathophysiology of pulmonary clinical infection, influenza and other viral co-infection, and the rate of bacterial complications. SARS-CoV-2 (COVID-19) infection has evolved to become a pandemic, in contrast to infections with SARS and MERS, whereas SARS-CoV-2 (COVID-19) has demonstrated having the similarities of genome sequence, receptor affinity, pathogenesis, and disease manifestation. In conclusion, although genomic evidence does not support the belief that COVID-19 is a laboratory construct, currently it is impossible to disprove or prove the theories of its origin. To identify the COVID-19 origin, obtaining virus sequences from immediate non-human animal sources would be the most definite method. In the absence of proper cure of COVID-19, it is necessary to identify the factors that may assist in assessment of the COVID-19 disease severity before rapid progression of the disease

The potential efficacy of influenza vaccines in prevention from cardiovascular complications of COVID-19

Cardiovascular complications of COVID-19 are not as common as pulmonary complications, while they could be life-threatening. Also, because there is no prevention strategy with appropriate safety and efficacy for these complications, researchers and clinicians are recommended to evaluate different strategies. Effects of influenza vaccines on reducing inflammatory responses and robust immune system, as well as decreasing probability of SARS-CoV-2/influenza co-infection make it a strategy for prevention from cardiovascular events in patients with COVID-19. We suggest further preclinical and clinical researches be conducted to determine the efficacy of influenza vaccines in the reduction of cardiovascular complications in patients with COVID-19 (10).

Pneumatocele formation in a fatal adult pneumonia patient coinfected with Streptococcus pyogenes emm-type 3 and influenza A: a case report

BackgroundA pneumatocele is a transient thin-walled lesion and rare complication in adult pneumonia.A variety of infectious pathogens have been reported in children with pneumatoceles. We report the first case of adult pneumonia with pneumatocele formation that is likely caused by Streptococcus pyogenes and coinfection with influenza A virus.Case presentationA 64-year-old Japanese man presented with a one-week history of fever, sore throat, and arthralgia. He was referred to our university hospital for respiratory distress. He required mechanical ventilation in the intensive care unit (ICU). Bacterial culture detected S. pyogenes in the bronchoscopic aspirates, which was not detected in blood. Although a rapid influenza antigen test was negative, an influenza A polymerase chain reaction (PCR) test was positive. Therefore, he was diagnosed with coinfection of influenza A and group A streptococcus (GAS) pneumonia complicated by probable streptococcal toxic shock syndrome. A chest radiograph on admission showed diffuse patchy opacification and consolidation in the bilateral lung fields.Multiple thin-walled cysts appeared in both middle lung fields on computed tomography (CT). On the following day, the bilateral cysts had turned into a mass-like opacity. The patient died despite intensive care. An autopsy was performed. The pathology investigation revealed multiple hematomas formed by bleeding in pneumatoceles.ConclusionsThere have been no previous reports of a pneumatocele complicated by S. pyogenes in an adult patient coinfected with influenza A. Further molecular investigation revealed that the S. pyogenes isolate had the sequence type of emm3.

Multiplex Real-Time Reverse-Transcription Polymerase Chain Reaction Assays for Diagnostic Testing of Severe Acute Respiratory Syndrome Coronavirus 2 and Seasonal Influenza Viruses: A Challenge of the Phase 3 Pandemic Setting.

BackgroundPandemic coronavirus disease 2019 (COVID-19) disease represents a challenge for healthcare structures. The molecular confirmation of samples from infected individuals is crucial and therefore guides public health decision making. Clusters and possibly increased diffuse transmission could occur in the context of the next influenza season. For this reason, a diagnostic test able to discriminate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from influenza viruses is urgently needed.MethodsA multiplex real-time reverse-transcription polymerase chain reaction (PCR) assay was assessed using 1 laboratory protocol with different real-time PCR instruments. Overall, 1000 clinical samples (600 from samples SARS-CoV-2–infected patients, 200 samples from influenza-infected patients, and 200 negative samples) were analyzed.ResultsThe assay developed was able to detect and discriminate each virus target and to intercept coinfections. The limit of quantification of each assay ranged between 5 and 10 genomic copy numbers, with a cutoff value of 37.7 and 37.8 for influenza and SARS-CoV-2 viruses, respectively. Only 2 influenza coinfections were detected in COVID-19 samples.ConclusionsThis study suggests that multiplex assay is a rapid, valid, and accurate method for the detection of SARS-CoV-2 and influenza viruses in clinical samples. The test may be an important diagnostic tool for both diagnostic and surveillance purposes during the seasonal influenza activity period.

Influenza, malaria parasitemia, and typhoid fever coinfection in children: Seroepidemiological investigation in four Health-care Centers in Lagos, Nigeria

Objectives: There are similarities in the presentation of influenza-A infection, malaria, and typhoid fever which include their overlapping clinical symptoms such as fever and myalgia. Coinfection may be easily missed and may lead to more severe associated morbidity. This study, therefore, investigated the prevalence of coinfection of influenza A, malaria, and typhoid fever in children in four locations in Lagos and determined their age, gender, and location-related prevalence. Materials and Methods: A cross-sectional hospital-based study was conducted between March and October 2018. Children less than 15 years attending four health centers in Festac, Amuwo, Ojo, and Shibiri were recruited consecutively. Demographic and epidemiological data were obtained using structured questionnaires, to ascertain children with influenza-like symptoms. Their blood samples were then tested with rapid diagnostic method for malaria and typhoid fever. The children were further screened for influenza-A-specific IgM using ELISA method. Descriptive statistics were reported while p-values were determined for comparable parameters using Chi-square. Results: There were 364 children aged <1–14 years including 207 (56.9%) males. Of the 364 children tested, 76/364 (20.9%) were seropositive for influenza-A virus out of which 47/76 (61.8%) had malaria parasitemia, 42/76 (55.3%) had typhoid fever, and 21/76 (27.6%) were coinfected with both malaria parasites and Salmonella enteric Typhi. Children coinfected with influenza-A and malaria were found with a higher frequency of chest pain and cold/chill symptom respectively compared to children having influenza alone (P = 0.0001). Seropositivity for influenza was recorded in all the months studied with the month of March recording the highest influenza-A seropositivity of 20/76 (26.3%) (P = 0.02). Conclusion: This study detected 27.6% trio coinfection seroprevalence of influenza Type-A, malaria, and typhoid fever among children population. The finding is unique being the first of such report, to the best of our knowledge. Children coinfected with influenza-A and malaria had greater morbidity.

Prevalence of Newcastle Disease Virus and Avian Influenza Virus (H7N3) in Poultry at Karachi

Background: Poultry is largest and rapidly growing sector of livestock in Pakistan. It is mainly influenced by viral pathogens such as Newcastle disease virus (NDV) and Avian influenza virus (H7N3). These viruses cause severe disease in poultry and leads to heavy economic losses throughout the world. The outbreaks of these pathogens have been increased in last few decades. Therefore, the study about antigenic prevalence is needed to know about the emergence of these pathogenic viruses, and to get rid of severe ailments associated with reduced poultry production.
 Objectives: To determine the prevalence of Newcastle disease virus (NDV), Avian influenza virus (H7N3) and co-infections in poultry flocks at Karachi.
 Methodology: For detection of NDV and H7N3, a total of 200 tracheal swabs were collected and tested through Virus Isolation (V.I); the sample with positive virus isolation were tested through Agar gel precipitation (AGP) and then the RNA was isolated through TRI Reagent, which was further tested through Reverse transcription polymerase chain reaction (RT-PCR).
 Results: The virus isolation showed that 58% of samples were positive for various viruses. Agar gel precipitation (AGP) revealed that the occurrence of NDV, H7N3 and ND+H7 were 50%, 8% and 38%, respectively. RT-PCR for F and HA gene of NDV and H7N3 confirmed the presence of NDV and H7N3 in the poultry.
 Conclusion: It is concluded that NDV and H7N3 are circulating in the flocks causing co-infections, therefore it is important to know the field challenge of viruses and to prepare vaccine of circulating serotype of virus to mitigate the rate of infection.

Lopinavir/ritonavir is associated with pneumonia resolution in COVID-19 patients with influenza coinfection: A retrospective matched-pair cohort study.

During the early stages of the pandemic, some coronavirus disease (COVID‐19) patients were misdiagnosed as having influenza, which aroused the concern that some deaths attributed to influenza were actually COVID‐19‐related. However, little is known about whether coinfection with influenza contributes to severity of COVID‐19 pneumonia, and the optimal therapeutic strategy for these patients. We retrospectively studied 128 hospitalized patients with COVID‐19 pneumonia. All patients were positive severe acute respiratory syndrome coronavirus 2 positive by nucleic acid detection. Sixty‐four cases were coinfected with influenza A/B and the other 64 were influenza negative, matched by age, sex, and days from onset of symptoms. Among the 64 coinfected patients, 54 (84.4%) were coinfected with influenza A, and 10 (15.6%) with influenza B. The median duration of viral shedding time from admission was longer for patients with influenza coinfection (17.0 days) than for those without influenza coinfection (12.0 days) (P < .001). The multivariable Cox proportional hazards model showed that the hazards ratio of resolution in lung involvement was 1.878 (P = .020) for patients administered lopinavir/ritonavir, compared with those not administered lopinavir/ritonavir (95% confidence interval: 1.103‐3.196). Among influenza coinfected patients, those treated with lopinavir/ritonavir exhibited faster pneumonia resolution within 2 weeks after symptom onset (37% vs 1%; P = .001). There was no difference in lung involvement between influenza coinfected and noninfected groups. Lopinavir/ritonavir eliminated the difference of lung involvement between influenza coinfected and noninfected groups, indicating that lopinavir/ritonavir is associated with pneumonia resolution in COVID‐19.

Are coinfections with COVID-19 and influenza low or underreported? An observational study examining current published literature including three new unpublished cases.

As the coronavirus disease-2019 (COVID-19) pandemic continues, one major point of uncertainty is the impact this novel pathogen will have during the upcoming 2020 to 2021 flu season. While the influenza virus is a known contributor to human morbidity and mortality, the question of how a coinfection between COVID-19 and influenza might manifest is of utmost concern. The aim of this study was to review the limited cases of COVID-19/influenza coinfection currently available in the literature, along with cases in the community of El Paso, TX, to determine whether any patterns of clinical presentation and morbidity emerged. An international review of the literature was conducted. Six published articles describing COVID-19/influenza coinfection were identified, with a total of 13 patients described therein. Three additional patients were identified from the El Paso, TX data. The most common presenting symptoms were fever and cough. The most common laboratory findings were elevated C-reactive protein and lymphocytopenia. Thirteen patients presented with viral pneumonia findings on CT, and nine had findings of ground-glass opacity. Finally, complications were reported in six patients, with most common complication being acute respiratory distress syndrome. The results of the review indicate that, due to the similarity in presentation between COVID-19 and influenza, further analysis will be required to understand the effects of coinfection on morbidity and mortality. However, the limited number of coinfection cases in the literature indicates that the implementation of COVID-19 control measures may continue to play a role in limiting the spread of these human respiratory pathogens.

COVID-19 and Tuberculosis.

On March 11, 2020, the WHO declared that coronavirus disease 2019 (COVID-19) can be characterized as a pandemic based on the alarming levels of spread and severity and on the alarming levels of inaction. COVID-19 has received worldwide attention as emergency, endangering international public health and economic development. There is a growing body of literatures regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as COVID-19. This review will focus on the latest advance of epidemiology, pathogenesis, and clinical characteristics about COVID-19. Meanwhile, tuberculosis (TB) remains the leading representative respiratory tract communicable disease threatening public health. There are limited data on the risk of severe disease or outcomes in patients with concurrence of TB and COVID-19. Nevertheless, co-infection of some virus would aggravate TB, such as measles. And tuberculosis and influenza co-infection compared with tuberculosis single infection was associated with increased risk of death in individuals. This review will also introduce the characteristics about the concurrence of TB and emerging infectious diseases to provide a hint to manage current epidemic.

The clinical characteristics of severe influenza virus pneumonia complicated with invasive pulmonary aspergillosis: a retrospective study of 15 cases

Objective: To explore the clinical characteristics, risk factors and possible inflammatory response mechanisms in critically ill patients with influenza and invasive pulmonary aspergillosis co-infection. Methods: Sixty-four patients with severe influenza virus pneumonia were included in the RICU of the China-Japanese Friendship Hospital from November 1(st), 2017 to March 31(th), 2018. There were 33 males and 31 females, with an average age of (55±14) years. T-tests or χ(2) test were applied for comparisons between the two groups. Fifteen patients were complicated with IPA and were classified as the IPA group, while the other 49 served as the control group. The clinical characteristics, laboratory examinations, and endoscopic manifestations were compared between the two groups and the risk factors for severe influenza virus pneumonia with IPA were analyzed by multivariate logistic regression. The possible mechanisms of inflammatory response were explored by comparing the differences of plasma inflammatory factors between the two groups. Results: Seven patients (7/15, 47.7%) in the IPA group died. The percentage of wheezing in the IPA group (n=13) was significantly higher than that in the control group (n=25) (P<0.05). The values of WBC [(11.0±2.7)×10(9)/L], and the levels of blood GM [(2.46±0.80) μg/L] and BALF GM [(5.30±0.98) μg/L] in the IPA group were significantly higher than those in the control group, while PCT was lower than that in the control group[(6.1±3.3)×10(9)/L, (0.33±0.07) μg/L and (0.73±0.17) μg/L, respectively] (P<0.01). Compared with the control group, the chest CT of the IPA group showed more nodules along the bronchial bundle (n=11), massive consolidation shadow (n=9), halo sign (n=3) and cavity/air crescent sign (n=5) (control group: 8, 11, 0 and 4, respectively) (P<0.05). Airway mucosal pseudomembrane formation (n=12) and airway stenosis (n=10) were significantly higher in the IPA group than in the control group (2 and 17) (P<0.05). Multivariate logistic regression analysis suggested that the history of glucocorticoid use after ICU admission, normal PCT, multiple nodules, halo signs and pseudomembrane formation under endoscopy were risk factors for severe influenza virus pneumonia with IPA. The plasma pro-inflammatory factors IFN-γ [IPA group: 34.9 (20.6-64.0) μg/L] and IL-2 [16.2 (8.9-20.7) μg/L] were significantly lower than in patients without IPA [control group: 65.2 (43.8-124.5) μg/L and 20.4 (14.6-28.8) μg/L, respectively] (P<0.05); while the inflammatory inhibitors IL-4 [51.6 (32.7-69.7) μg/L) and IL-10 [15.7 (11.8-92.5) μg/L] were higher in IPA group [control group 8.9 (6.1-15.0) μg/L and 7.8 (3.6-21.8) μg/L] (P<0.05). SOFA scores showed a negative correlation with IFN-γ (r=-0.658, P=0.02) and IL-6 (r=-0.602, P=0.038), but a positive correlation with IL-10 (r=0.641, P=0.025) by Spearman correlation analysis. Conclusions: Some relatively specific clinical characteristics could be found in severe influenza pneumonia complicated with IPA. IPA should be highly suspected when a patient had a history of glucocorticoid use after ICU admission, high WBCs in the course of treatment without significant increase of PCT,multiple nodules along the airway distribution and the characteristic pseudomembrane formation under bronchoscopy. Influenza virus caused imbalance of immune responses, leading to a weakened pro-inflammatory response and a strengthened inflammatory suppression, which might be a possible mechanism for IPA development.

COVID-19: don't neglect antimicrobial stewardship principles!

COVID-19: don't neglect antimicrobial stewardship principles!

Lower Respiratory Tract Infection due to coinfection of Influenza A Virus and Human Metapneumovirus in A 4.5-Month-Old Infant With

Alt solunum yolu enfeksiyonları (ASYE) çoğunlukla respiratuvar sinsisyal virüs (RSV), influenza, parainfluenza, rhinovirüs ve adenovirüs kaynaklıdır. Ancak, son yıllarda bu virüslere ek olarak insan metapnömovirüs (iMPV), parainfluenza 4 ve bocavirüs gibi virüslerinde ASYE’ye sebep olduğu gösterilmiştir. Çocukluk çağında birden fazla virüsün ko-enfeksiyonu ile bronşiolit geliştiği unutulmamalıdır. Bu çalışmamızda, ateş ve öksürük şikâyeti ile hastanemize başvuran 4.5 aylık erkek bir bebekte iki farklı virüsün (iMPV ve influenza A) ko-enfeksiyonu sonucu gelişen bronşiolit olgu sunumu anlatılmıştır.

Influenza and Bacterial Coinfection in Adults With Community-Acquired Pneumonia Admitted to Conventional Wards: Risk Factors, Clinical Features, and Outcomes.

BackgroundRelevance of viral and bacterial coinfection (VBC) in non-intensive care unit (ICU) hospitalized adults with community-acquired pneumonia (CAP) is poorly characterized. We aim to determine risk factors, features, and outcomes of VBC-CAP in this setting.MethodsThis is a prospective cohort of adults admitted to conventional wards with CAP. Patients were divided into VBC-CAP, viral CAP (V-CAP), and bacterial CAP (B-CAP) groups. Independent risk and prognostic factors for VBC-CAP were identified.ResultsWe documented 1123 episodes: 57 (5.1%) VBC-CAP, 98 (8.7%) V-CAP, and 968 (86.1%) B-CAP. Patients with VBC-CAP were younger than those with B-CAP (54 vs 71 years; P < .001). Chronic respiratory disease was more frequent in patients with VBC-CAP than in those with V-CAP (26.3% vs 14.3%%; P = .001). Among those with influenza (n = 153), the VBC-CAP group received empirical oseltamivir less often (56.1% vs 73.5%; P < .001). Patients with VBC-CAP also had more respiratory distress (21.1% VBC-CAP; 19.4% V-CAP, and 9.8% B-CAP; P < .001) and required ICU admission more often (31.6% VBC-CAP, 31.6% V-CAP, and 12.8% B-CAP; P < .001). The 30-day case-fatality rate was 3.5% in the VBC-CAP group, 3.1% in the V-CAP group, and 6.3% in the B-CAP group (P = .232). Furthermore, VBC-CAP was associated with severity criteria (odds ratio [OR], 5.219; P < .001) and lack of empirical oseltamivir therapy in influenza cases (OR, 0.401; P < .043).ConclusionsViral and bacterial coinfection-CAP involved younger patients with comorbidities and with poor influenza vaccination rate. Patients with VBC-CAP presented more respiratory complications and more often required ICU admission. Nevertheless, 30-day mortality rate was low and related either to severity criteria or to delayed initiation of oseltamivir therapy.

Symptoms associated with influenza vaccination and experimental human pneumococcal colonisation of the nasopharynx

BackgroundNasopharyngeal colonisation by S. pneumoniae is a prerequisite for invasive pneumococcal infections. Influenza co-infection leads to increased susceptibility to secondary pneumonia and mortality during influenza epidemics. Increased bacterial load and impaired immune responses to pneumococcus caused by influenza play a role in this increased susceptibility. Using an Experimental Human Challenge Model and influenza vaccines, we examined symptoms experienced by healthy adults during nasal co-infection with S. pneumoniae and live attenuated influenza virus. MethodsRandomised, blinded administration of Live Attenuated Influenza Vaccine (LAIV) or Tetravalent Inactivated Influenza Vaccine (TIV) either preceded bacterial inoculation or followed it, separated by a 3-day interval. The presence and density of S. pneumoniae was determined from nasal washes. Participants completed a symptom questionnaire from the first intervention until 6 days post second intervention. ResultsThe timing and type of influenza vaccination and presence of S. pneumoniae in the nasopharynx significantly affected symptom reporting. In the study where influenza vaccination preceded bacterial inoculation: nasal symptoms were less common in the LAIV group than the TIV group (OR 0.57, p < 0.01); with colonisation status only affecting the TIV group where more symptoms were reported by colonised participants compared to non-colonised participants following inoculation (n = 12/23 [52.17%] vs n = 13/38 [34.21%], respectively; p < 0.05). In the study where influenza vaccination followed bacterial inoculation: no difference was seen in the symptoms reported between the LAIV and TIV groups following inoculation and subsequent vaccination; and symptoms were unaffected by colonisation status. ConclusionSymptoms experienced during live viral vaccination and bacterial co-infection in the nasopharynx are directly affected by the precedence of the pathogen acquisition. Symptoms were directly affected by nasal pneumococcal colonisation but only when TIV was given prior to bacterial exposure.

Analisis Kestabilan Model Matematika Ko-infeksi Virus Influenza A dan Pneumokokus pada Sel Inang

Co-infection of influenza A virus and pneumococcus is caused by influenza A virus and pneumococcus bacteria which infected host cell at the same time. The purpose of this thesis is to analyze stability of equilibrium point on mathematical model within-host co-infection of influenza A and pneumococcus. Based on anlytical result of the model there are four quilibrium points, non endemic co-infection equilibrium (E0), endemic influenza A virus equilibrium (E1), endemic pneumococcus equilbrium (E2) and endemic co-infection equilibrium (E3). By Next Generation Matrix (NGM), we obtain two basic reproduction number, which are basic reproduction number for influenza A virus (R0v) and basic reproduction number for pneumococcus (R0b). Existence of equilibrium point and local stability of equilibrium point dependent on basic reproduction number. Non endemic co-infection equilibrium is locally asymtotically stable if R0v &lt; 1 and R0b &lt; 1; influenza A virus endemic equilibrium is locally asymtotically stable if R0v &gt; 1 and R0b &gt; 1; pneumococcus endemic equilibrium is locally asymtotically stable if R0v &lt; 1 and R0b &gt; 1. Meanwhile, the co-infection endemic equilibrium is locally asymtotically stable if R0v &gt; 1 and R0b &gt; 1. From the numerical simulation result, it was shown that increasing the number of influenza A virus and pneumococcus made the number of population cell infected by influenza A virus and pneumococcus (co-infection) also increased.

АнвиМакс® – оптимальное средство борьбы с ОРВИ и гриппом

In the epidemiological season 2019–2020, the situation with the incidence of ARVI and influenza was more critical and significantly compounded by concurrent outbreak and spread of new infection COVID-19 in the Russian Federation, resulting in increased hospitalization rates of people at risk with COVID-19 and influenza co-infection. Список литературы

2313. Influenza and Respiratory Syncytial Virus (RSV) Surveillance in the US Department of Veterans Affairs (VA): 2018–2019 Season

BackgroundVA conducts ongoing surveillance for viral respiratory infections, notably influenza and more recently RSV. VA’s large elderly population is at higher risk for influenza and RSV complications, including hospitalization and death. Herein we summarize VA’s 2018–19 national surveillance data.MethodsInfluenza telephone triage, influenza-like-illness (ILI) encounters and antiviral prescriptions plus outpatient visits, laboratory testing (antibody tests excluded), hospitalizations and deaths for both influenza and RSV were obtained from VA data sources (9/30/18–3/31/19) and compared with prior seasons. Influenza vaccinations were captured starting 8/1/2018. Vaccination rates were calculated based on VA users during the fiscal year.ResultsSurveillance metrics are presented (Table, Figure). ILI visits ranged from 0.9%-3.3% during the season. RSV peaked earlier than influenza (Week 1 vs. Week 11). Testing revealed 1,674 RSV positives out of 31,404 tests performed (5.3%) and 15,052 influenza positives out of 105,760 tests performed (14.2%). We identified 22 cases of RSV and influenza co-infection (positive test results on the same date or within 3 days). 22% of laboratory-confirmed influenza cases were hospitalized (same proportion as the prior season) while 35% of RSV cases were hospitalized. Median length of stay was longer for RSV hospitalizations (4 days vs. 3 days for influenza).ConclusionThe 2018–2019 influenza season was less severe than the 2017–2018 season, and most like the 2016–2017 season. 2018–2019 saw relatively little Influenza B in VA patients, despite elevated activity into the spring. High-dose/adjuvanted vaccine administration increased over the seasons evaluated. RSV surveillance for 2018–2019 demonstrated an earlier peak in activity and the percentage of patients with laboratory-confirmed RSV who were hospitalized and died during their hospitalization was higher compared with influenza. Although fewer RSV tests were performed and testing practices were variable across VA facilities, the weekly trend aligned closely with influenza. Surveillance for both viruses is important in VA given their associated morbidity and mortality. Disclosures All authors: No reported disclosures.

2793. Influenza and Bacterial Pneumonia Coinfection: Rates and Outcomes

BackgroundLimited evidence suggests that influenza leads not only to bacterial colonization and greater risk of bacterial pneumonia, but to poor outcomes and increased mortality. We compared bacterial culture results between patients positive (FLU+) and negative (FLU-) for influenza in the setting of community-acquired pneumonia (CAP). Among FLU+ patients we compared bacterial etiology, characteristics, treatment and outcomes between patients with and without bacterial coinfection.MethodsWe included adults admitted with pneumonia 2010–2015 to 179 US hospitals participating in the Premier database. Pneumonia was identified using an ICD-9-CM algorithm. Among patients tested for FLU, we limited the microbiology results to the first 14 hospital days. We assessed inpatient mortality, ICU admission, use of vasopressors, mechanical ventilation (MV), cost, and LOS using mixed multiple logistic regression and gamma generalized linear mixed models.ResultsAmong 166,273 patients hospitalized with CAP, 38,665 (23.3%) were tested for influenza and 4,313 (11.15%) were positive. In FLU+ patients the most common bacterial co-infection was Staphylococcus aureus (37.6%) followed by Streptococcus pneumoniae (25.9%) and Pseudomonas aeruginosa (10.9%), varying based on the day of coinfection (days 1–3 vs. days 4–14) (Figure 1). In FLU- patients, S. pneumoniae (30.5%) and S. aureus (30.3%) were similarly common, followed by P. aeruginosa (10.0%). FLU+ patients with bacterial co-infection were younger (66.3 vs. 69.1 years), with more comorbidities (3.2 vs. 2.7) than influenza patients with no bacterial co-infection (all comparisons P < 0.001). Bacterial co-infection was also associated with increased odds of in-hospital mortality (OR 1.86, 95% CI,1.31–2.65), ICU admission (OR 3.46, 2.44–4.9), use of vasopressors (OR 3.74, 2.61–5.36), and MV (OR 3.51, 2.49–5.36), increased cost (risk-adjusted ratio of geometric means, 1.6, (1.47–1.73) and LOS (risk-adjusted ratio of geometric means 1.42, (1.33–1.52).ConclusionIn a large US inpatient sample hospitalized for CAP, 11% of patients with influenza had or acquired a bacterial co-infection. Bacterial co-infection was associated with significantly worse outcomes and higher cost. Disclosures All authors: No reported disclosures.

Influenza and tuberculosis co-infection: A systematic review.

IntroductionThere are limited data on risk of severe disease or outcomes in patients with influenza and pulmonary tuberculosis (PTB) co‐infection compared to those with single infection.MethodsWe conducted a systematic review of published literature on the interaction of influenza viruses and PTB. Studies were eligible for inclusion if they presented data on prevalence, disease association, presentation or severity of laboratory‐confirmed influenza among clinically diagnosed or laboratory‐confirmed PTB cases. We searched eight databases from inception until December 2018. Summary characteristics of each study were extracted, and a narrative summary was presented. Cohort or case‐control studies were assessed for potential bias using the Newcastle‐Ottawa scale.ResultsWe assessed 5154 abstracts, reviewed 146 manuscripts and included 19 studies fulfilling selection criteria (13 human and six animal). Of seven studies reporting on the possible effect of the underlying PTB disease in patients with influenza, three of four analytical studies reported no association with disease severity of influenza infection in those with PTB, whilst one study reported PTB as a risk factor for influenza‐associated hospitalization.An association between influenza infection and PTB disease was found in three of five analytical studies; whereas the two other studies reported a high frequency of PTB disease progression and complications among patients with seasonal influenza co‐infection.ConclusionHuman analytical studies of an association between co‐infection and severe influenza‐ or PTB‐associated disease or increased prevalence of influenza co‐infection in individuals' hospitalized for PTB were not conclusive. Data are limited from large, high‐quality, analytical epidemiological studies with laboratory‐confirmed endpoints.