{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:40:51Z","timestamp":1792370451860,"version":"4.4.0"},"reference-count":54,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2024YFC2311500"],"award-info":[{"award-number":["2024YFC2311500"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["12401648"],"award-info":[{"award-number":["12401648"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Influenza Resp Viruses"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Influenza and COVID\u201019 are major respiratory diseases whose co\u2010circulation 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\u2010CoV\u20102 and (2) quantify the impact of these interactions on the cumulative disease burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a deterministic influenza virus \u00d7 SARS\u2010CoV\u20102 12\u2010compartmental model SIR \u00d7 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The model identified a significant bidirectional synergistic interaction. Specifically, prior exposure to SARS\u2010CoV\u20102 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\u2010CoV\u20102 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\u2010CoV\u20102 infection that was 2.39 (2.17, 2.62) times higher, and recovery from influenza was associated with a relative risk of SARS\u2010CoV\u20102 infection that was 9.92 (9.00, 10.84) times higher. Counterfactual analysis demonstrated that this interaction substantially amplified epidemic sizes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study provides strong epidemiological evidence that influenza virus and SARS\u2010CoV\u20102 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\u2010SARS\u2010CoV\u20102 synergy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/irv.70326","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:06:21Z","timestamp":1791871581000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bidirectional Synergistic Interaction Between Influenza Virus and SARS\u2010CoV\u20102 in the Postpandemic Era: A Modeling Study"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5018-7664","authenticated-orcid":false,"given":"Zhen","family":"Qin","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health Peking University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1132-1796","authenticated-orcid":false,"given":"Yongyue","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health Peking University  Beijing China"},{"name":"Peking University Center for Public Health and Epidemic Preparedness &amp; Response  Beijing China"},{"name":"Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junwen","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health Peking University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1155-8443","authenticated-orcid":false,"given":"Zhicheng","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, School of Public Health, Sun Yat\u2010sen Global Health Institute, Center for Health Information Research Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8722-6149","authenticated-orcid":false,"given":"Shi","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Public Health Tianjin Medical University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihang","family":"Peng","sequence":"additional","affiliation":[{"name":"National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4146-9262","authenticated-orcid":false,"given":"Yuantao","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health Peking University  Beijing China"},{"name":"Peking University Center for Public Health and Epidemic Preparedness &amp; Response  Beijing China"},{"name":"Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"195","article-title":"The Effects of the COVID\u201019 Pandemic on Community Respiratory Virus Activity","volume":"21","author":"Chow E. J.","year":"2023","journal-title":"Nature Reviews. Microbiology"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-21430-x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-023-01724-w"},{"key":"e_1_2_9_5_1","unstructured":"\u201cInfluenza (seasonal) \u201d accessed 31 October 2025 Available athttps:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/influenza\u2010(seasonal)."},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2021.100103"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.23392"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.abh3986"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-024-53872-4"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1002464"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1098\/rspb.2005.3454"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis307"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1098\/rspb.1998.0537"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.18.3.541-555.2005"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200504-032AW"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41422-021-00473-1"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2020.04.035"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s42003-022-03753-7"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/v16050793"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1011167"},{"key":"e_1_2_9_21_1","unstructured":"\u201cCentre for Health Protection \u201d accessed 17 September 2025 Available athttps:\/\/www.chp.gov.hk\/en\/index.html."},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-850"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0001399"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1009050"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1002135"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwm375"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab746"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2023.02.011"},{"key":"e_1_2_9_29_1","unstructured":"\u201cCensus and Statistics Department \u201d accessed 17 September 2025 Available athttps:\/\/www.censtatd.gov.hk\/en\/."},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.1002383"},{"key":"e_1_2_9_31_1","doi-asserted-by":"crossref","DOI":"10.1177\/1176934321989695","article-title":"Temperature and Latitude Correlate With SARS\u2010CoV\u20102 Epidemiological Variables but Not With Genomic Change Worldwide","volume":"17","author":"Burra P.","year":"2021","journal-title":"Evolutionary Bioinformatics Online"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0238339"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1012996"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01386-22"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/pnasnexus\/pgac071"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10238-023-01116-y"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1128\/jvi.01873-21"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00383-X"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmv.2179"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.0030151"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1607747113"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-74089-7"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.abc2535"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.antiviral.2020.104742"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.0527"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(20)30085-1"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30918-1"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(21)00384-4"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-7568(22)00035-6"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01741-X"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid3002.230768"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(20)30090-6"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6937a6"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwab089"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiu224"}],"container-title":["Influenza and Other Respiratory Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/irv.70326","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/irv.70326","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/irv.70326","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:03:37Z","timestamp":1792368217000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/irv.70326"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":54,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/irv.70326"],"URL":"https:\/\/doi.org\/10.1111\/irv.70326","archive":["Portico"],"relation":{},"ISSN":["1750-2640","1750-2659"],"issn-type":[{"value":"1750-2640","type":"print"},{"value":"1750-2659","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-04-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70326"}}