Modeling the co-circulation of influenza and COVID-19 in Hong Kong, China

Background

After abandoning the zero-case strategy for COVID-19 in December 2022 in mainland China, the Hong Kong Special Administrative Region of China (HKSAR) has undergone an anticipated surge of the prevalence of COVID-19, as well as other influenzas, such as influenza A/H1N1, influenza A/H3N2, and influenza B as well. Noteworthy, people are usually concerned about the mutual influences between two families of respiratory viruses, like co-circulation or co-infection.

Methods

We fitted a unified model to weekly reported severe COVID-19 cases and the confirmed influenza A laboratory cases in HKSAR, respectively, using the R package POMP to obtain the best fitting and parameter estimates. The reconstructed transmission rates of the COVID-19 (/influenza A) versus the weekly reported influenza A (/COVID-19) confirmations between April 2022 and April 2024 were also compared.

Results

Our numerical results suggest that influenza confirmations remained either at a very low level or were absent before 2023, while starting from 2023, the influenza epidemic re-emerged as expected because of the resumption of international travels and other social communications. Besides, the peak of influenza cases in April 2023 favored the form of the peak of COVID-19 between May–June, 2023.

Additionally, during the sudden abolishment of the zero-case policy in mainland China (December 2022 to January 2023), we estimated that there were approximately 381 cases imported from mainland China into HKSAR.

Conclusions

We estimated the potential number of imported COVID-19 severe cases from mainland China to Hong Kong and revealed some potential population-level interference between the two families of respiratory viruses.