{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:57:48Z","timestamp":1790683068133,"version":"4.1.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2019,4,29]],"date-time":"2019-04-29T00:00:00Z","timestamp":1556496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Secretariat of Health of Rio Grande do Sul"},{"name":"Ministry of Health of Brazil"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Influenza surveillance is important for disease control and should consider possible coinfection with different viruses, which can be associated with disease severity. This study analyzed 34 459 patients with respiratory infection from 2009 to 2018, of whom 8011 were positive for influenza A virus (IAV) or influenza B virus (IBV). We found 18 cases of dual influenza virus infection, including coinfection with 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09) and influenza A(H3N2) virus (1 case), A(H1N1)pdm09 and IBV (6 cases), A(H3N2) and IBV (8 cases), and nonsubtyped IAV and IBV (3 cases); and 1 case of triple infection with A(H3N2), A(H1N1)pdm09, and IBV. Compared with 76 monoinfected patients, coinfection was significantly associated with cardiopathy and death. Besides demographic characteristics and clinical symptoms, we assessed vaccination status, antiviral treatment, timeliness of antiviral use, hospitalization, and intensive care unit admission, but no significant differences were found between coinfected and monoinfected cases. Our findings indicate that influenza virus coinfection occurs more often than previously reported and that it can lead to a worse disease outcome.<\/jats:p>","DOI":"10.1093\/infdis\/jiz221","type":"journal-article","created":{"date-parts":[[2019,4,27]],"date-time":"2019-04-27T15:10:39Z","timestamp":1556377839000},"page":"961-968","source":"Crossref","is-referenced-by-count":33,"title":["Dual and Triple Infections With Influenza A and B Viruses: A Case-Control Study in Southern Brazil"],"prefix":"10.1093","volume":"220","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9912-9060","authenticated-orcid":false,"given":"Tatiana Sch\u00e4ffer","family":"Gregianini","sequence":"first","affiliation":[{"name":"Laborat\u00f3rio Central, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana R Santos","family":"Varella","sequence":"additional","affiliation":[{"name":"Grupo Hospitalar Concei\u00e7\u00e3o, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Fisch","sequence":"additional","affiliation":[{"name":"Grupo Hospitalar Concei\u00e7\u00e3o, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Let\u00edcia Garay","family":"Martins","sequence":"additional","affiliation":[{"name":"Centro Estadual de Vigil\u00e2ncia em Sa\u00fade da Secretaria de Sa\u00fade do Estado do Rio Grande do Sul, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana B G","family":"Veiga","sequence":"additional","affiliation":[{"name":"Universidade Federal de Ci\u00eancias da Sa\u00fade de Porto Alegre, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,5,29]]},"reference":[{"key":"2019080903144885200_CIT0001","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1038\/s41579-018-0115-z","article-title":"Host and viral determinants of influenza A virus species specificity","volume":"17","author":"Long","year":"2018","journal-title":"Nat Rev Microbiol"},{"key":"2019080903144885200_CIT0002","first-page":"33","article-title":"Why is coinfection with influenza virus and bacteria so difficult to control?","volume":"19","author":"Cauley","year":"2015","journal-title":"Discov Med"},{"key":"2019080903144885200_CIT0003","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.1002\/hsr2.47","article-title":"Comparison of the nasopharynx microbiome between influenza and non-influenza cases of severe acute respiratory infections: a pilot study","volume":"1","author":"Borges","year":"2018","journal-title":"Health Sci Rep"},{"key":"2019080903144885200_CIT0004","doi-asserted-by":"crossref","first-page":"e99392","DOI":"10.1371\/journal.pone.0099392","article-title":"Clinical disease severity of respiratory viral co-infection versus single viral infection: a systematic review and meta-analysis","volume":"9","author":"Asner","year":"2014","journal-title":"PLoS One"},{"key":"2019080903144885200_CIT0005","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1111\/j.1469-0691.2011.03529.x","article-title":"Evaluation of multiple commercial molecular and conventional diagnostic assays for the detection of respiratory viruses in children","volume":"17","author":"Gharabaghi","year":"2011","journal-title":"Clin Microbiol Infect"},{"key":"2019080903144885200_CIT0006","first-page":"180","article-title":"Respiratory viral coinfection among hospitalized patients with H1N1 2009 during the first pandemic wave in Brazil","volume":"16","author":"Camargo","year":"2012","journal-title":"Braz J Infect Dis"},{"key":"2019080903144885200_CIT0007","doi-asserted-by":"crossref","first-page":"877","DOI":"10.11150\/kansenshogakuzasshi1970.79.877","article-title":"[Eleven cases of co-infection with influenza type A and type B suspected by use of a rapid diagnostic kit and confirmed by RT-PCR and virus isolation]","volume":"79","author":"Takao","year":"2005","journal-title":"Kansenshogaku Zasshi"},{"key":"2019080903144885200_CIT0008","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.jcv.2007.11.003","article-title":"Dual infections by influenza A\/H3N2 and B viruses and by influenza A\/H3N2 and A\/H1N1 viruses during winter 2007, Corsica Island, France","volume":"41","author":"Falchi","year":"2008","journal-title":"J Clin Virol"},{"key":"2019080903144885200_CIT0009","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1186\/1743-422X-8-502","article-title":"Report of two cases of Influenza virus A\/H1N1v and B co-infection during the 2010\/2011 epidemics in the Italian Veneto Region","volume":"8","author":"Calistri","year":"2011","journal-title":"Virol J"},{"key":"2019080903144885200_CIT0010","doi-asserted-by":"crossref","first-page":"290609","DOI":"10.1155\/2013\/290609","article-title":"Report on influenza A and B viruses: their coinfection in a Saudi leukemia patient","volume":"2013","author":"Almajhdi","year":"2013","journal-title":"Biomed Res Int"},{"key":"2019080903144885200_CIT0011","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.eimc.2013.06.007","article-title":"[Co-infection with influenza type A (H1N1)pdm09 and influenza type B in a patient with human immunodeficiency virus infection]","volume":"32","author":"Reina","year":"2014","journal-title":"Enferm Infecc Microbiol Clin"},{"key":"2019080903144885200_CIT0012","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1007\/s10096-016-2620-1","article-title":"Bouza E. Influenza A and B co-infection: a case-control study and review of the literature","volume":"35","author":"P\u00e9rez-Garc\u00eda","year":"2016","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2019080903144885200_CIT0013","year":"2017"},{"key":"2019080903144885200_CIT0014","author":"Brasil. Minist\u00e9rio da Sa\u00fade"},{"key":"2019080903144885200_CIT0015","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade. Portaria de consolida\u00e7\u00e3o n\u00ba 4 de 28 de setembro de 2017: Consolida\u00e7\u00e3o das normas sobre os sistemas e os subsistemas do Sistema \u00danico de Sa\u00fade. Cap\u00edtulo II, anexos II, III e IV. http:\/\/bvsms.saude.gov.br\/bvs\/saudelegis\/gm\/2017\/prc0004_03_10_2017.html. Accessed 10 March 2019."},{"key":"2019080903144885200_CIT0016"},{"key":"2019080903144885200_CIT0017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1742-5573-8-1","article-title":"WINPEPI updated: computer programs for epidemiologists, and their teaching potential","volume":"8","author":"Abramson","year":"2011","journal-title":"Epidemiol Perspect Innov"},{"key":"2019080903144885200_CIT0018","first-page":"13","article-title":"Diagn\u00f3stico Laboratorial da Influenza no Rio Grande do Sul, 2009 a 2011. In: CEVS (Ed.) Centro Estadual de Vigil\u00e2ncia em Sa\u00fade, Porto Alegre","volume":"13","author":"Gregianini","year":"2011","journal-title":"Boletim Epidemiol"},{"key":"2019080903144885200_CIT0019","author":"NICs\/FIOCRUZ\/MS"},{"key":"2019080903144885200_CIT0020","first-page":"1","volume-title":"Secretaria de Vigil\u00e2ncia em Sa\u00fade - Minist\u00e9rio da Sa\u00fade, Informe Epidemiol\u00f3gico - Influenza: Monitoramento at\u00e9 a Semana Epidemiol\u00f3gica 52 de 2018, S.d.V.e","author":"Brasil. Minist\u00e9rio da Sa\u00fade","year":"2019"},{"key":"2019080903144885200_CIT0021","doi-asserted-by":"crossref","first-page":"618","DOI":"10.7326\/0003-4819-152-9-201005040-00021","article-title":"Co-infection with pandemic H1N1 and seasonal H3N2 influenza viruses","volume":"152","author":"Lee","year":"2010","journal-title":"Ann Intern Med"},{"key":"2019080903144885200_CIT0022","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1086\/652143","article-title":"Mixed infections of pandemic H1N1 and seasonal H3N2 viruses in 1 outbreak","volume":"50","author":"Liu","year":"2010","journal-title":"Clin Infect Dis"},{"key":"2019080903144885200_CIT0023","first-page":"RRN1011","article-title":"Fitness of Pandemic H1N1 and Seasonal influenza A viruses during Co-infection: Evidence of competitive advantage of pandemic H1N1 influenza versus seasonal influenza","volume":"1","author":"Perez","year":"2009","journal-title":"PLOS Currents Influenza"},{"key":"2019080903144885200_CIT0024","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.tim.2014.12.002","article-title":"Reverse zoonosis of influenza to swine: new perspectives on the human-animal interface","volume":"23","author":"Nelson","year":"2015","journal-title":"Trends Microbiol"},{"key":"2019080903144885200_CIT0025","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jcv.2015.11.008","article-title":"Natural co-infection of influenza A\/H3N2 and A\/H1N1pdm09 viruses resulting in a reassortant A\/H3N2 virus","volume":"73","author":"Rith","year":"2015","journal-title":"J Clin Virol"},{"key":"2019080903144885200_CIT0026","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.epidem.2012.10.003","article-title":"Co-circulation of influenza A virus strains and emergence of pandemic via reassortment: the role of cross-immunity","volume":"5","author":"Zhang","year":"2013","journal-title":"Epidemics"},{"key":"2019080903144885200_CIT0027","doi-asserted-by":"crossref","first-page":"10778","DOI":"10.1128\/JVI.01440-14","article-title":"Influenza A and B virus intertypic reassortment through compatible viral packaging signals","volume":"88","author":"Baker","year":"2014","journal-title":"J Virol"},{"key":"2019080903144885200_CIT0028","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1038\/nature13087","article-title":"A predictive fitness model for influenza","volume":"507","author":"Luksza","year":"2014","journal-title":"Nature"},{"key":"2019080903144885200_CIT0029","doi-asserted-by":"crossref","first-page":"5335","DOI":"10.1073\/pnas.1522921113","article-title":"Reticulate evolution is favored in influenza niche switching","volume":"113","author":"Ma","year":"2016","journal-title":"Proc Natl Acad Sci U S A"},{"key":"2019080903144885200_CIT0030","doi-asserted-by":"crossref","first-page":"e00830","DOI":"10.1128\/JVI.00830-17","article-title":"Seasonal H3N2 and 2009 pandemic H1N1 influenza A viruses reassort efficiently but produce attenuated progeny","volume":"91","author":"Phipps","year":"2017","journal-title":"J Virol"}],"container-title":["The Journal of Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jid\/advance-article-pdf\/doi\/10.1093\/infdis\/jiz221\/28702198\/jiz221.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jid\/article-pdf\/220\/6\/961\/29113062\/jiz221.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,8,9]],"date-time":"2019-08-09T03:15:19Z","timestamp":1565320519000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jid\/article\/220\/6\/961\/5481580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,29]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,5,29]]},"published-print":{"date-parts":[[2019,8,9]]}},"URL":"https:\/\/doi.org\/10.1093\/infdis\/jiz221","relation":{},"ISSN":["0022-1899","1537-6613"],"issn-type":[{"value":"0022-1899","type":"print"},{"value":"1537-6613","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,9,15]]},"published":{"date-parts":[[2019,5,29]]}}}