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2030-12-31
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THE BURDEN, CLINICAL FEATURES AND OUTCOMES OF SARS-COV-2, INFLUENZA AND CO-INFECTIONS DURING CONCURRENTLY OUT-OF-SEASON OUTBREAKS IN BRAZIL
Affilliation
Hospital de Clínicas de Porto Alegre. Departamento de Doenças Infecciosas. Porto Alegre, RS, Brazil.
Fundação Oswaldo Cruz. Fiocruz Mato Grosso do Sul. Campo Grande, MS, Brazil / Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brazil / Department of Epidemiology of Microbial Diseases. Yale School of Public Health. New Haven, CT, USA.
Pontifical Catholic University of Rio de Janeiro. Department of Industrial Engineering. Rio de Janeiro, RJ, Brazil / Pontifical Catholic University of Rio de Janeiro. Tecgraf Institute. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. National Institute of Infectious Disease Evandro Chagas. Rio de Janeiro, RJ, Brazil / D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
Barcelona Institute for Global Health. ISGlobal. Hospital Clinic-Universitat de Barcelona. Barcelona, Spain / Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Instituto do Coração. Divisão Pulmonar. São Paulo, SP, Brazil.
Fundação Oswaldo Cruz. Fiocruz Mato Grosso do Sul. Campo Grande, MS, Brazil / Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brazil / Department of Epidemiology of Microbial Diseases. Yale School of Public Health. New Haven, CT, USA.
Pontifical Catholic University of Rio de Janeiro. Department of Industrial Engineering. Rio de Janeiro, RJ, Brazil / Pontifical Catholic University of Rio de Janeiro. Tecgraf Institute. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. National Institute of Infectious Disease Evandro Chagas. Rio de Janeiro, RJ, Brazil / D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
Barcelona Institute for Global Health. ISGlobal. Hospital Clinic-Universitat de Barcelona. Barcelona, Spain / Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Instituto do Coração. Divisão Pulmonar. São Paulo, SP, Brazil.
Abstract
Objectives: Little is known about the burden and the clinical presentation and prognosis of individuals with Influenza and SARS-CoV-2 during concurrent outbreaks. We aimed to describe the burden, clinical characteristics and outcomes of hospitalized adults during the Influenza A/H3N2 and Omicron outbreaks in Brazil. Study design: Cross-sectional analysis of national surveillance data. Methods: We described the health system burden and clinical features of confirmed cases of Influenza and/or SARS-CoV-2 reported in the national surveillance system during the Influenza A H3N2 out-of-season outbreak and the first Omicron surge between November 2021 and March 2022 in Brazil. A multilevel mixed-effects logistic regression model adjusted by a priori defined confounders was used to evaluate the association between the infection type and resource use and mortality. Results: The outbreaks occurred simultaneously across all Brazilian regions. Coinfected patients had clinical features from both infections. Influenza coinfected cases had similar odds for requiring ICU admission (adjusted odds ratio, aOR 0.96, 95 % CI, 0.80-1.15, p = 0.634), mechanical ventilation (aOR 0.88, 95 % CI, 0.70-1.11, p = 0.290), and in-hospital mortality (aOR 1.02, 95 % CI, 0.84-1.23, p = 0.847) compared to COVID-19 only. Influenza had lower odds for requiring ICU admission, mechanical ventilation and in-hospital mortality compared to COVID-19 only. Conclusions: Simultaneous surges of Influenza and SARS-CoV-2 increased the pressure on the health system of Brazil. Coinfection was not associated with higher resource use or death; Influenza was associated with better outcomes, compared to COVID-19.
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