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J Infect. 2011 Oct;63(4):260-6. doi: 10.1016/j.jinf.2011.04.004. Epub 2011 Apr 15.

Rate and influence of respiratory virus co-infection on pandemic (H1N1) influenza disease.

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  • 1Case Western Reserve University, Cleveland, OH 44106, United States. Frank.Esper@UHhospitals.org

Abstract

OBJECTIVES:

Many patients with influenza have more than one viral agent with co-infection frequencies reported as high as 20%. The impact of respiratory virus copathogens on influenza disease is unclear. We sought to determine if respiratory virus co-infection with pandemic H1N1 altered clinical disease.

METHODS:

Respiratory samples from 229 and 267 patients identified with and without H1N1 influenza respectively were screened for the presence of 13 seasonal respiratory viruses by multiplex RT-PCR. Disease severity between coinfected and monoinfected H1N1 patients were quantified using a standardized clinical severity scale. Influenza viral load was calculated by quantitative RT-PCR.

RESULTS:

Thirty (13.1%) influenza samples screened positive for the presence of 31 viral copathogens. The most prominent copathogens included rhinovirus (61.3%), and coronaviruses (16.1%). Median clinical severity of both monoinfected and coinfected groups were 1. Patients coinfected with rhinovirus tended to have lower clinical severity (median 0), whereas non-rhinovirus co-infections had substantially higher clinical severity (median 2). No difference in H1N1 viral load was observed between coinfected and monoinfected groups.

CONCLUSIONS:

Respiratory viruses co-infect patients with influenza disease. Patients coinfected with rhinovirus had less severe disease while non-rhinovirus co-infections were associated with substantially higher severity without changes in influenza viral titer.

Copyright © 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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