TY - JOUR
T1 - Viral co-infections are associated with increased rates of hospitalization in those with influenza
AU - Emergency Department National Influenza Network Investigators
AU - Shannon, Kerry L.
AU - Osula, Valerie O.
AU - Shaw-Saliba, Kathryn
AU - Hardick, Justin
AU - McBryde, Breana
AU - Dugas, Andrea
AU - Hsieh, Yu Hsiang
AU - Hansoti, Bhakti
AU - Rothman, Richard E.
AU - Steele, Mark
AU - Stubbs, Amy
AU - Kemble, Laurie
AU - Beckham, Danielle
AU - Neal, Niccole
AU - Lovecchio, Frank
AU - Mulrow, Mary
AU - Talan, David
AU - Moran, Greg
AU - Krishnadasan, Anusha
AU - Pathmarajah, Kavitha
AU - Torrez, Raquel
AU - Gonzalez, Eva
AU - Martin, Gabina
AU - Quinteros Urzagaste, Noemi
AU - Furoy, Jacklyn
AU - Hernandez, Mayra
AU - Collison, Claire
AU - Dugas, Andrea
AU - Duval, Anna
AU - Beard, Raphaelle
AU - Avornu, Ama
AU - Medina, Rebecca
N1 - Funding Information:
This work was supported by a cooperative agreement between Johns Hopkins University (JHU) and the US Department of Health and Human Services Biomedical Advanced Research and Development Authority (BARDA; grant number IDSEP150026-01-00, IDSEP130014-01-00 and IDSEP160031-01-00). Work was also supported in part by the National Institute of Allergy and Infectious Diseases Contract HHSN272201400007C awarded to the Johns Hopkins Center for Influenza Research and Surveillance (JHCEIRS) at the Johns Hopkins University. Any opinions, finding, conclusions, or recommendations expressed in this publication are those of the author(s) and do not represent the policy or position of NIAID or NIH.
Funding Information:
This work was supported by a cooperative agreement between Johns Hopkins University (JHU) and the US Department of Health and Human Services Biomedical Advanced Research and Development Authority (BARDA; grant number IDSEP150026‐01‐00, IDSEP130014‐01‐00 and IDSEP160031‐01‐00). Work was also supported in part by the National Institute of Allergy and Infectious Diseases Contract HHSN272201400007C awarded to the Johns Hopkins Center for Influenza Research and Surveillance (JHCEIRS) at the Johns Hopkins University. Any opinions, finding, conclusions, or recommendations expressed in this publication are those of the author(s) and do not represent the policy or position of NIAID or NIH.
Publisher Copyright:
© 2022 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.
PY - 2022/7
Y1 - 2022/7
N2 - Background: Influenza causes significant morbidity and mortality in the United States. Among patients infected with influenza, the presence of bacterial co-infection is associated with worse clinical outcomes; less is known regarding the clinical importance of viral co-infections. The objective of this study was to determine rates of viral co-infections in emergency department (ED) patients with confirmed influenza and association of co-infection with disease severity. Methods: Secondary analysis of a biorepository and clinical database from a parent study where rapid influenza testing was implemented in four U.S. academic EDs, during the 2014–2015 influenza season. Patients were systematically tested for influenza virus using a validated clinical decision guideline. Demographic and clinical data were extracted from medical records; nasopharyngeal specimens from influenza-positive patients were tested for viral co-infections (ePlex, Genmark Diagnostics). Patterns of viral co-infections were evaluated using chi-square analysis. The association of viral co-infection with hospital admission was assessed using univariate and multivariate regression. Results: The overall influenza A/B positivity rate was 18.1% (1071/5919). Of the 999 samples with ePlex results, the prevalence of viral co-infections was 7.9% (79/999). The most common viral co-infection was rhinovirus/enterovirus (RhV/EV), at 3.9% (39/999). The odds of hospital admission (OR 2.33, 95% CI: 1.01–5.34) increased significantly for those with viral co-infections (other than RhV/EV) versus those with influenza A infection only. Conclusion: Presence of viral co-infection (other than RhV/EV) in ED influenza A/B positive patients was independently associated with increased risk of hospital admission. Further research is needed to determine clinical utility of ED multiplex testing.
AB - Background: Influenza causes significant morbidity and mortality in the United States. Among patients infected with influenza, the presence of bacterial co-infection is associated with worse clinical outcomes; less is known regarding the clinical importance of viral co-infections. The objective of this study was to determine rates of viral co-infections in emergency department (ED) patients with confirmed influenza and association of co-infection with disease severity. Methods: Secondary analysis of a biorepository and clinical database from a parent study where rapid influenza testing was implemented in four U.S. academic EDs, during the 2014–2015 influenza season. Patients were systematically tested for influenza virus using a validated clinical decision guideline. Demographic and clinical data were extracted from medical records; nasopharyngeal specimens from influenza-positive patients were tested for viral co-infections (ePlex, Genmark Diagnostics). Patterns of viral co-infections were evaluated using chi-square analysis. The association of viral co-infection with hospital admission was assessed using univariate and multivariate regression. Results: The overall influenza A/B positivity rate was 18.1% (1071/5919). Of the 999 samples with ePlex results, the prevalence of viral co-infections was 7.9% (79/999). The most common viral co-infection was rhinovirus/enterovirus (RhV/EV), at 3.9% (39/999). The odds of hospital admission (OR 2.33, 95% CI: 1.01–5.34) increased significantly for those with viral co-infections (other than RhV/EV) versus those with influenza A infection only. Conclusion: Presence of viral co-infection (other than RhV/EV) in ED influenza A/B positive patients was independently associated with increased risk of hospital admission. Further research is needed to determine clinical utility of ED multiplex testing.
KW - co-infection
KW - emergency department
KW - hospitalization
KW - influenza
KW - multiplex
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U2 - 10.1111/irv.12967
DO - 10.1111/irv.12967
M3 - Article
C2 - 35302283
AN - SCOPUS:85131771142
SN - 1750-2640
VL - 16
SP - 780
EP - 788
JO - Influenza and other Respiratory Viruses
JF - Influenza and other Respiratory Viruses
IS - 4
ER -