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. 2021 Nov 29;11(11):e053768.
doi: 10.1136/bmjopen-2021-053768.

SARS-CoV-2 and influenza virus coinfection among patients with severe acute respiratory infection during the first wave of COVID-19 pandemic in Bangladesh: a hospital-based descriptive study

Zubair Akhtar  1 , Md Ariful Islam  2 , Mohammad Abdul Aleem  2   3 , Syeda Mah-E-Muneer  2 , M Kaousar Ahmmed  2 , Probir K Ghosh  2 , Mustafizur Rahman  2 , Mohammed Ziaur Rahman  2 , Mariya Kibtiya Sumiya  2 , Md Mahfuzur Rahman  2 , Tahmina Shirin  4 , A S M Alamgir  4 , Sayera Banu  2 , Mahmudur Rahman  2   5 , Fahmida Chowdhury  2
Affiliations

SARS-CoV-2 and influenza virus coinfection among patients with severe acute respiratory infection during the first wave of COVID-19 pandemic in Bangladesh: a hospital-based descriptive study

Zubair Akhtar et al. BMJ Open. .

Abstract

Objective: To estimate the proportion of SARS-CoV-2 and influenza virus coinfection among severe acute respiratory infection (SARI) cases-patients during the first wave of COVID-19 pandemic in Bangladesh.

Design: Descriptive study.

Setting: Nine tertiary level hospitals across Bangladesh.

Participants: Patients admitted as SARI (defined as cases with subjective or measured fever of ≥38 C° and cough with onset within the last 10 days and requiring hospital admission) case-patients.

Primary and secondary outcomes: Proportion of SARS-CoV-2 and influenza virus coinfection and proportion of mortality among SARI case-patients.

Results: We enrolled 1986 SARI case-patients with a median age: 28 years (IQR: 1.2-53 years), and 67.6% were male. Among them, 285 (14.3%) were infected with SARS-CoV-2; 175 (8.8%) were infected with the influenza virus, and five (0.3%) were coinfected with both viruses. There was a non-appearance of influenza during the usual peak season (May to July) in Bangladesh. SARS-CoV-2 infection was significantly more associated with diabetes (14.0% vs 5.9%, p<0.001) and hypertension (26.7% vs 11.5%, p<0.001). But influenza among SARI case-patients was significantly less associated with diabetes (4.0% vs 7.4%, p=0.047) and hypertension (5.7% vs 14.4%, p=0.001). The proportion of in-hospital deaths among SARS-CoV-2 infected SARI case-patients were higher (10.9% (n=31) vs 4.4% (n=75), p<0.001) than those without SARS-CoV-2 infection; the proportion of postdischarge deaths within 30 days was also higher (9.1% (n=25) vs 4.6% (n=74), p=0.001) among SARS-CoV-2 infected SARI case-patients than those without infection. No in-hospital mortality or postdischarge mortality was registered among the five coinfected SARI case-patients.

Conclusions: Our findings suggest that coinfection with SARS-CoV-2 and influenza virus was not very common and had less disease severity considering mortality in Bangladesh. There was no circulating influenza virus during the influenza peak season during the COVID-19 pandemic in 2020. Future studies are warranted for further exploration.

Keywords: COVID-19; epidemiology; infectious diseases.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study sites of the hospital-based influenza surveillance system: Public hospitals (1. RMCH: Rajshahi Medical College Hospital, Rajshahi; 2. CuMCH: Cumilla Medical College Hospital, Cumilla; 3. KMCH: Khulna Medical College Hospital, Khulna; 4. SBMCH: Sher-e-Bangla Medical College Hospital, Barishal; 5. CMCH: Chattogram Medical College Hospital, Chattogram; 6. MARMCH: M Abdur Rahim Medical College Hospital, Dinajpur; 7. JGH Jashore 250 bed General Hospital, Jashore) Private hospitals* (1. JIMCH: Jahurul Islam Medical College Hospital, Kishoregonj; 2. JRRMCH: Jalalabad Ragib-Rabeya Medical College Hospital, Sylhet.)
Figure 2
Figure 2
SARS-CoV-2, influenza virus and coinfection during March–December 2020 among SARI case patients in Bangladesh. SARI, severe acute respiratory infection.
See this image and copyright information in PMC

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