Bidirectional Synergistic Interaction Between Influenza Virus and SARS-CoV-2 in the Postpandemic Era: A Modeling Study

IF 3.9 4区医学 Q1 INFECTIOUS DISEASES

Influenza and Other Respiratory Viruses Pub Date : 2026-10-12 DOI:10.1111/irv.70326

Zhen Qin, Yongyue Wei, Junwen Zhou, Zhicheng Du, Shi Zhao, Zhihang Peng, Yuantao Hao

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引用次数: 0

Abstract

Introduction

Influenza and COVID-19 are major respiratory diseases whose co-circulation dynamics are not fully understood. Surveillance data from the postpandemic period, free from the confounding effects of nonpharmaceutical interventions (NPIs), provide a unique opportunity to study their interactions. This study aimed to (1) estimate the direction and strength of the epidemiological interactions between influenza virus and SARS-CoV-2 and (2) quantify the impact of these interactions on the cumulative disease burden.

Methods

We developed a deterministic influenza virus × SARS-CoV-2 12-compartmental model SIR × SEIR using weekly laboratory surveillance data from Hong Kong between 2023 and 2025. Interaction parameters were introduced across multiple pathways to quantify the effect of one virus on the transmission of the other. Model parameters were estimated via maximum likelihood estimation (MLE), with uncertainty assessed using bootstrap resampling. Counterfactual simulations were conducted to evaluate the impact of interactions on cumulative infection incidence. Sensitivity analyses were performed to evaluate the robustness of our findings.

Results

The model identified a significant bidirectional synergistic interaction. Specifically, prior exposure to SARS-CoV-2 was associated with a relative risk of influenza virus infection that was 1.24 (95% CI: 1.13, 1.35) times higher compared to the scenario without interaction, while SARS-CoV-2 infection and recovery from it were associated with relative risks of influenza virus infection that were 2.43 (2.20, 2.66) and 12.04 (10.93, 13.17) times higher, respectively. Additionally, influenza virus infection was associated with a relative risk of SARS-CoV-2 infection that was 2.39 (2.17, 2.62) times higher, and recovery from influenza was associated with a relative risk of SARS-CoV-2 infection that was 9.92 (9.00, 10.84) times higher. Counterfactual analysis demonstrated that this interaction substantially amplified epidemic sizes.

Conclusions

This study provides strong epidemiological evidence that influenza virus and SARS-CoV-2 exhibit a bidirectional synergistic interaction at the population level, which significantly elevates the total disease burden. These findings underscore the urgent need for multifaceted public health preparedness, including enhanced clinical management and multiplex testing, optimized vaccination strategies, and integrated multipathogen surveillance to mitigate the amplified burden from influenza virus-SARS-CoV-2 synergy.

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流感病毒与SARS-CoV-2在大流行后时代的双向协同作用：模型研究

简介：流感和COVID-19是主要的呼吸道疾病，其共循环动力学尚未完全了解。大流行后时期的监测数据不受非药物干预措施的混杂影响，为研究它们之间的相互作用提供了独特的机会。本研究旨在(1)估计流感病毒与SARS-CoV-2之间流行病学相互作用的方向和强度；(2)量化这些相互作用对累积疾病负担的影响。方法：利用2023年至2025年香港每周实验室监测数据建立了确定性流感病毒× SARS-CoV-2 12室室模型SIR × SEIR。在多个途径中引入相互作用参数，以量化一种病毒对另一种病毒传播的影响。模型参数通过最大似然估计（MLE）估计，不确定性通过自举重采样评估。进行反事实模拟来评估相互作用对累积感染发生率的影响。进行敏感性分析以评估我们研究结果的稳健性。结果：该模型确定了显著的双向协同作用。具体而言，先前暴露于SARS-CoV-2与流感病毒感染的相对风险相关，比没有相互作用的情况高1.24倍（95% CI: 1.13, 1.35），而SARS-CoV-2感染和康复与流感病毒感染的相对风险相关，分别高2.43倍（2.20,2.66）和12.04倍（10.93,13.17）。此外，流感病毒感染与SARS-CoV-2感染的相对风险相关，为2.39（2.17,2.62）倍，流感康复与SARS-CoV-2感染的相对风险相关，为9.92（9.00,10.84）倍。反事实分析表明，这种相互作用大大扩大了流行病的规模。结论：本研究提供了强有力的流行病学证据，表明流感病毒和SARS-CoV-2在人群水平上表现出双向协同相互作用，显著提高了疾病总负担。这些发现强调迫切需要多方面的公共卫生准备，包括加强临床管理和多种检测，优化疫苗接种策略，以及综合多病原体监测，以减轻流感病毒- sars - cov -2协同作用带来的加重负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Influenza and Other Respiratory Viruses 医学-病毒学

CiteScore

7.20

自引率

4.50%

发文量

120

审稿时长

6-12 weeks

期刊介绍： Influenza and Other Respiratory Viruses is the official journal of the International Society of Influenza and Other Respiratory Virus Diseases - an independent scientific professional society - dedicated to promoting the prevention, detection, treatment, and control of influenza and other respiratory virus diseases. Influenza and Other Respiratory Viruses is an Open Access journal. Copyright on any research article published by Influenza and Other Respiratory Viruses is retained by the author(s). Authors grant Wiley a license to publish the article and identify itself as the original publisher. Authors also grant any third party the right to use the article freely as long as its integrity is maintained and its original authors, citation details and publisher are identified.