A retrospective look at influenza during the COVID-19 pandemic

Abstract

Aim: Influenza is the main cause of acute respiratory disease worldwide and is transmitted via the respiratory secretions of infected individuals. The aim of this study was to retrospectively investigate influenza, a virus with which we have a longer history, during a period in which the COVID-19 pandemic has dominated current events in terms of viral infections. Material and Method: Epidemiological and laboratory data of patients over 18 years of age who tested positive for influenza infection and received inpatient treatment in the Erzurum Regional Training and Research Hospital between January 1, 2019 and December 31, 2020 according to the influenza management algorithm of the Public Health Institution of Turkey were evaluated retrospectively. Results: Of the 164 patients included in our study, 129 were hospitalized due to influenza A and 35 due to influenza B. Procalcitonin, aspartate transaminase, alanine transaminase, creatine kinase, total bilirubin, and direct bilirubin levels were significantly higher in the influenza A group compared to the influenza B group (p=0.002, 0.005, 0.006, 0.030, 0.010, and 0.004, respectively). Ten of the patients in the study died; there was no significant difference in mortality based on influenza subtype or presence of comorbidity (p=0.999 and 0.756, respectively). Forty-one (54.7%) of the patients with comorbidities had received an influenza vaccine. Conclusion: Although COVID-19 has dominated the global stage since the pandemic started, the effects of periodic pandemics of our old acquaintance influenza still continue. Vaccination, which is our strongest weapon against pandemics, can reduce mortality in patients with comorbidities, as seen in our study.

Keywords

• Influenza
• pandemic
• comorbidities

References

1. Hutchinson EC. Influenza virus. Trends Microbiol 2018; 26: 809-10.
2. Palese P, Young JF. Variation of influenza A, B, and C viruses. Science 1982 ; 215: 1468-74.
3. Webster RG. Antigenic variation in influenza viruses. Origin and evolution of viruses: Elsevier; 1999. p. 377-90.
4. Madjid M, Miller CC, Zarubaev VV, et al. Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: results from 8 years of autopsies in 34 892 subjects. Eur Heart J 2007; 28: 1205-10.
5. Jackson ML, Chung JR, Jackson LA, et al. Influenza vaccine effectiveness in the United States during the 2015–2016 season. New Engl J Med 2017; 377: 534-43.
6. Ellis JS, Zambon MC. Molecular diagnosis of influenza. Rev Med Virol 2002; 12: 375-89.
7. Wiselka M. Influenza: diagnosis, management, and prophylaxis. BMJ 1994; 308: 1341-5.
8. Hayden FG, de Jong MD. Emerging influenza antiviral resistance threats. Oxford University Press; 2011.

9. Oh DY, Hurt AC. Using the ferret as an animal model for investigating influenza antiviral effectiveness. Front Microbiol 2016; 7: 80.
10. Republic of Turkey MoH. National Action Plan in Pandemic Influenzae. Ankara2006. p. 77-82.
11. Mostafa A, Abdelwhab EM, Mettenleiter TC, Pleschka S. Zoonotic potential of influenza A viruses: a comprehensive overview. Viruses 2018; 10: 497.
12. Gamblin SJ, Skehel JJ. Influenza hemagglutinin and neuraminidase membrane glycoproteins. J Biol Chem 2010; 285: 28403-9.
13. Mitnaul LJ, Matrosovich MN, Castrucci MR, et al. Balanced hemagglutinin and neuraminidase activities are critical for efficient replication of influenza A virus. J Virol 2000; 74: 6015-20.
14. Monto AS, Gravenstein S, Elliott M, Colopy M, Schweinle J. Clinical signs and symptoms predicting influenza infection. Arch Intern Med 2000; 160: 3243-7.
15. Van Reeth K, Brown IH, Dürrwald R, et al. Seroprevalence of H1N1, H3N2 and H1N2 influenza viruses in pigs in seven European countries in 2002–2003. Influenza and other respiratory viruses 2008; 2: 99-105.
16. Kerget B, Çelik E, Kerget F, Aksakal A, Uçar EY, Araz Ö, et al. Evaluation of 3‐month follow‐up of patients with post‐acute COVID‐19 syndrome. J Med Virol 2022; 94: 2026-34.
17. Wilhelm M. Influenza in older patients: a call to action and recent updates for vaccinations. Am J Manag Care 2018; 24: S15-S24.
18. Zimmerman RK, Santibanez TA, Janosky JE, et al. What affects influenza vaccination rates among older patients? An analysis from inner-city, suburban, rural, and Veterans Affairs practices. Am J Med 2003; 114: 31-8.
19. Güngörer B. Baseline demographic, clinical and laboratory risk factors for predicting admission to intensive care unit in patients diagnosed with COVID-19 in the emergency department. Anatolian Curr Med J 2021; 3: 279-83.
20. Kerget B, Kerget F, Aksakal A, Aşkın S, Uçar EY, Sağlam L. Evaluation of the relationship between KIM‐1 and suPAR levels and clinical severity in COVID‐19 patients: A different perspective on suPAR. J Med Virol 2021; 93: 5568-73.