Co-infection of SARS‐CoV‐2 and influenza A/B among patients with COVID-19: a systematic review and meta-analysis
Abstract Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) is a public health problem and may result in co-infection with other pathogens such as influenza virus. This review investigates the co-infection of SARS-CoV-2 and inf...
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2025-01-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-025-10521-5 |
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| author | Monireh Golpour Hossein Jalali Reza Alizadeh-Navaei Masoumeh Rezaei Talarposhti Tahoora Mousavi Ali Asghar Nadi Ghara |
| author_facet | Monireh Golpour Hossein Jalali Reza Alizadeh-Navaei Masoumeh Rezaei Talarposhti Tahoora Mousavi Ali Asghar Nadi Ghara |
| author_sort | Monireh Golpour |
| collection | DOAJ |
| description | Abstract Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) is a public health problem and may result in co-infection with other pathogens such as influenza virus. This review investigates the co-infection of SARS-CoV-2 and influenza A/B among patients with COVID-19. Methods This meta- analysis included 38 primary studies investigating co-infection of SARS-CoV-2 with influenza in confirmed cases of COVID-19. The global online databases were used to identify relevant studies published between December 2019 and July 2024. Data analysis was performed using STATA Ver. 17 software, and standard errors of prevalence were calculated using the binomial distribution formula. Heterogeneity of study results was evaluated using the I-square and Q index, and publication bias was examined using the Begg’s and Egger’s tests, as well as funnel plot. A random effects model was used to determine prevalence rates, and a forest plot diagram was used to present results with 95% confidence intervals. In addition, sensitivity analyses were performed to check the impact of each primary study on the overall estimate. Result The analysis found that the prevalence of influenza in co-infected patients at 95% confidence interval using a random effect model was 14% (95% CI: 8–20%). Significant heterogeneity was observed in the random-effects model for influenza A, 11% (95% CI: 5-18%) and B, 4% (95% CI: 2-7%) in co-infected patients. The highest prevalence of influenza A/B (21%), influenza A (17%) and influenza B (20%) was shown in Asia and Europe respectively. Subgroup analysis by study year showed that the co-prevalence of COVID-19 and influenza A/B was similar in the pre-2021 and post-2021 time periods, at 14% (95% CI: 5-23%) for pre-2021 and 6-22% for 2021 and post-2021. Also, the overall prevalence of influenza A and B in COVID-19 patients is 11% and 4%, and there was no significant difference between the time periods before and after 2021. Meta-regression with a random-effects model showed that the variables location, year group, and total patients showed only 2.71% of very high heterogeneity (I² = 99.92%), and none of these variables had a significant effect on the co-prevalence of COVID-19 and influenza A/B (p > 0.05). Also, meta-regression results showed that these variables had no significant effect on influenza A and B prevalence (p > 0.05) and showed only a small proportion of the very high heterogeneity (I² = 99.72%), (I² = 68.78%). In our study, Egger’s test indicated that there was publication bias or small study effects in this meta-analysis (p = 0.0000). Conclusion The combination of SARS-CoV-2 with influenza and other respiratory viruses requires the best treatment protocols to reduce the severity of the disease. In this approach, high vaccination coverage against seasonal influenza and SARS-CoV-2 could reduce the risk of co-infection in the recent pandemic. |
| format | Article |
| id | doaj-art-47b012e6bdc243c183fec048baad8bde |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj-art-47b012e6bdc243c183fec048baad8bde2025-02-02T12:10:40ZengBMCBMC Infectious Diseases1471-23342025-01-0125112110.1186/s12879-025-10521-5Co-infection of SARS‐CoV‐2 and influenza A/B among patients with COVID-19: a systematic review and meta-analysisMonireh Golpour0Hossein Jalali1Reza Alizadeh-Navaei2Masoumeh Rezaei Talarposhti3Tahoora Mousavi4Ali Asghar Nadi Ghara5Cancer Research Center, Health Research Institute, Babol University of Medical SciencesThalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical SciencesGastrointestinal Cancer Research Center, None-communicable Disease Institute, Mazandaran University of Medical SciencesNational Institute of Genetic Engineering and BiotechnologyMolecular and Cell Biology Research Center, Hemoglobinopathy Institute, Faculty of Medicine, Mazandaran University of Medical SciencesHealth Sciences Research Center, Mazandaran University of Medical SciencesAbstract Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) is a public health problem and may result in co-infection with other pathogens such as influenza virus. This review investigates the co-infection of SARS-CoV-2 and influenza A/B among patients with COVID-19. Methods This meta- analysis included 38 primary studies investigating co-infection of SARS-CoV-2 with influenza in confirmed cases of COVID-19. The global online databases were used to identify relevant studies published between December 2019 and July 2024. Data analysis was performed using STATA Ver. 17 software, and standard errors of prevalence were calculated using the binomial distribution formula. Heterogeneity of study results was evaluated using the I-square and Q index, and publication bias was examined using the Begg’s and Egger’s tests, as well as funnel plot. A random effects model was used to determine prevalence rates, and a forest plot diagram was used to present results with 95% confidence intervals. In addition, sensitivity analyses were performed to check the impact of each primary study on the overall estimate. Result The analysis found that the prevalence of influenza in co-infected patients at 95% confidence interval using a random effect model was 14% (95% CI: 8–20%). Significant heterogeneity was observed in the random-effects model for influenza A, 11% (95% CI: 5-18%) and B, 4% (95% CI: 2-7%) in co-infected patients. The highest prevalence of influenza A/B (21%), influenza A (17%) and influenza B (20%) was shown in Asia and Europe respectively. Subgroup analysis by study year showed that the co-prevalence of COVID-19 and influenza A/B was similar in the pre-2021 and post-2021 time periods, at 14% (95% CI: 5-23%) for pre-2021 and 6-22% for 2021 and post-2021. Also, the overall prevalence of influenza A and B in COVID-19 patients is 11% and 4%, and there was no significant difference between the time periods before and after 2021. Meta-regression with a random-effects model showed that the variables location, year group, and total patients showed only 2.71% of very high heterogeneity (I² = 99.92%), and none of these variables had a significant effect on the co-prevalence of COVID-19 and influenza A/B (p > 0.05). Also, meta-regression results showed that these variables had no significant effect on influenza A and B prevalence (p > 0.05) and showed only a small proportion of the very high heterogeneity (I² = 99.72%), (I² = 68.78%). In our study, Egger’s test indicated that there was publication bias or small study effects in this meta-analysis (p = 0.0000). Conclusion The combination of SARS-CoV-2 with influenza and other respiratory viruses requires the best treatment protocols to reduce the severity of the disease. In this approach, high vaccination coverage against seasonal influenza and SARS-CoV-2 could reduce the risk of co-infection in the recent pandemic.https://doi.org/10.1186/s12879-025-10521-5SARS-CoV-2Co-infectionCOVID-19Influenza virus ARespiratory syndrome coronavirus 2Coronavirus |
| spellingShingle | Monireh Golpour Hossein Jalali Reza Alizadeh-Navaei Masoumeh Rezaei Talarposhti Tahoora Mousavi Ali Asghar Nadi Ghara Co-infection of SARS‐CoV‐2 and influenza A/B among patients with COVID-19: a systematic review and meta-analysis BMC Infectious Diseases SARS-CoV-2 Co-infection COVID-19 Influenza virus A Respiratory syndrome coronavirus 2 Coronavirus |
| title | Co-infection of SARS‐CoV‐2 and influenza A/B among patients with COVID-19: a systematic review and meta-analysis |
| title_full | Co-infection of SARS‐CoV‐2 and influenza A/B among patients with COVID-19: a systematic review and meta-analysis |
| title_fullStr | Co-infection of SARS‐CoV‐2 and influenza A/B among patients with COVID-19: a systematic review and meta-analysis |
| title_full_unstemmed | Co-infection of SARS‐CoV‐2 and influenza A/B among patients with COVID-19: a systematic review and meta-analysis |
| title_short | Co-infection of SARS‐CoV‐2 and influenza A/B among patients with COVID-19: a systematic review and meta-analysis |
| title_sort | co infection of sars cov 2 and influenza a b among patients with covid 19 a systematic review and meta analysis |
| topic | SARS-CoV-2 Co-infection COVID-19 Influenza virus A Respiratory syndrome coronavirus 2 Coronavirus |
| url | https://doi.org/10.1186/s12879-025-10521-5 |
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