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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 68  |  Issue : 4  |  Page : 590-591

Concurrent outbreak of influenza A and dengue infection: a probability analysis for dengue and influenza A coinfection


1 KMT Primary Care Center, Bangkok, Thailand
2 Department of Community Medicine, Dr D. Y. Patil University, Pune, Maharashtra, India

Date of Submission17-Oct-2018
Date of Acceptance01-Jan-2019
Date of Web Publication8-Nov-2019

Correspondence Address:
PhD Sora Yasri
KMT Primary Care Center, Bangkok, 10150
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejcdt.ejcdt_155_18

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  Abstract 


The influenza A is an important viral respiratory disease. This infection is seen worldwide and is considered an important global public health problem. In the tropical countries, influenza A is also common, and there might be a chance of coinfection with other common tropical diseases including dengue. Here, the authors perform a probability analysis for dengue and influenza A coinfection based on the previous available clinical epidemiological data in Thailand, a tropical country in Indochina. According to the analysis, the coinfection is possible and should be kept in mind of the practitioner. When one deals with either influenza A or dengue, one should recognize the possibility that there might be a case of coinfection.

Keywords: coinfection, dengue, influenza A


How to cite this article:
Yasri S, Wiwanitkit V. Concurrent outbreak of influenza A and dengue infection: a probability analysis for dengue and influenza A coinfection. Egypt J Chest Dis Tuberc 2019;68:590-1

How to cite this URL:
Yasri S, Wiwanitkit V. Concurrent outbreak of influenza A and dengue infection: a probability analysis for dengue and influenza A coinfection. Egypt J Chest Dis Tuberc [serial online] 2019 [cited 2020 Jan 28];68:590-1. Available from: http://www.ejcdt.eg.net/text.asp?2019/68/4/590/270515




  Introduction Top


The influenza A is an important viral respiratory disease. It can result in serious lower respiratory tract infection and can result in death in severe cases. This infection is seen worldwide and considered an important global public health problem [1]. Pandemic outbreaks of influenza has occurred several times in medical history, and each outbreak is considered a huge global problem. In each year, small epidemic of influenza A can be seen in several countries around the world.

In the tropical countries, influenza A is also common, and there might be a chance of coinfection with other common tropical diseases including dengue. Here, the authors perform a probability analysis for dengue and influenza A coinfection based on the previous available clinical epidemiological data in Thailand, a tropical country in Indochina. According to the analysis, the coinfection is possible and should be kept in mind among the practitioner. When one deals with either influenza A or dengue, one should recognize the possibility that there might be a case of coinfection.


  Patients and methods Top


The aim of this study is to assess the chance of coinfection between influenza A and dengue based on the setting in Thailand, a tropical Indochina country. This work is a mathematical model study and there is no animal/human subject or speciment study and requires no IRB/Ethics committee approval or signed consent form. To find the probability, a mathematical model for probability analysis is done. For construction of the mentioned mathematical model, the authors first sought for the data from the database (PubMed, Sci, and ThaiIndexMedicus) regarding the outbreak of influenza A and dengue in Thailand.

The primary clinical epidemiological data on the concurrent outbreak of influenza A and dengue [2] and the observed incidence of coinfection [3] are used as primary data for further analysis. The calculation for the probability of the coinfection is done by jointed probability analysis. In brief, the final summative probability is derived by multiplication of the probabilities of each component. In this study, the final chance of coinfection between influenza A and dengue will be equal to the result from multiplication of observed rate of disease by observed rate of coinfection.


  Results Top


In Thailand, the data on concurrent outbreak of influenza A and dengue shows that 9/34 (26.47%) and 12/34 (35.29%) cases of acute febrile illness during a concurrent outbreak of acute fever have influenza A and dengue. For the observed coinfection between influenza A and dengue, 3/150 (2%) patients with influenza A have dengue as coinfection at the time of first diagnosis.

The calculated jointed probability for influenza A and dengue coinfection in case of an acute fever outbreak in Thailand is equal to 0.53% (=35.29×2%) if the patient has the first diagnosis of influenza A and 0.70% (=26.47×2%) if the patient has the first diagnosis of dengue ([Table 1]).
Table 1 Primary data for developing model to assess the chance of coinfection between influenza A and dengue

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  Discussion Top


The diagnosis of acute fever problem in tropical country is sometimes difficult and requires many diagnostic tests. There are many common tropical infections that can result in similar clinical signs and symptoms. A variety of diseases can cause acute febrile illness, and the definitive diagnosis needs careful clinical and laboratory assessment of the patient. The chance that the incorrect diagnosis is made is not uncommon. In a recent report from tropical Africa, the common causes of acute febrile illness include mosquito-borne infection, respiratory tract infection, and gastrointestinal infection [4].

Of several medical disorders, respiratory tract infection is a common problem seen in clinical practice. The influenza A is an important infection that can be seen worldwide and is still the public health problem in several tropical countries. At present, influenza A is still an important public health problem in tropical countries including Thailand [4]. The infection can result in acute febrile illness, and the practitioner might incorrectly diagnose as other infections. According to a recent report, the missed diagnosis of the first provisional diagnosis of influenza A in patients with acute fever problem accounts for 60.5% [5]. The high rate of misdiagnosis is an interesting consideration. In this report, the authors assessed the local data in an endemic area of dengue and can show that the coinfection might be easily underdiagnosed. According to this report, it can additionally confirm that there is a high chance of missed diagnosis of coinfection. During an outbreak of acute fever disorder, a single diagnosis for influenza A or dengue can be a missed diagnosis of a case of coinfection. Indeed, similar problem is reported from Guatemala [6]. Chacon et al. [6] concluded that the practitioner had to consider the diagnosis of influenza among the patients with suspected dengue [6]. In the Guatemala report, 1% of cases with acute febrile illness problem have coinfection of dengue and influenza.In the tropical setting, where dengue and influenza seasons overlap, it will be very difficult for making a diagnosis on influenza A or dengue [7]. This problem can be seen in our setting and other tropical countries where dengue is still endemic such as Brazil [7]. The cases with coinfection of both diseases also have an increased risk of lung complication [8] and fatality [9]. Hence, it is necessary that the practitioner recognizes the possibility of the coinfection.


  Conclusion Top


There is a possibility for coinfection between influenza A and dengue in our setting. It is suggested that the practitioners should recognize and be aware of the possibility of hidden coinfection when they deal with a case of acute fever disorder.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rao BL. Epidemiology and control of influenza. Natl Med J India 2003; 16:143–149.  Back to cited text no. 1
    
2.
Silarug N, Foy HM, Kupradinon S, Rojanasuphot S, Nisalak A, Pongsuwant Y. Epidemic of fever of unknown origin in rural Thailand, caused by influenza A (H1N1) and dengue fever. Southeast Asian J Trop Med Public Health 1990; 21:61–67.  Back to cited text no. 2
    
3.
Chaiwarith R, Prommee N, Liwsrisakun C, Oberdorfer P, Nuntachit N, Pothirat C. A novel influenza A H1N1 clinical manifestations in patients at Chiang Mai University Hospital. J Med Assoc Thai 2011; 94:908–915.  Back to cited text no. 3
    
4.
Boggild AK, Esposito DH, Kozarsky PE, Ansdell V, Beeching NJ, Campion D et al. Differential diagnosis of illness in travelers arriving from Sierra Leone, Liberia, or Guinea: a cross-sectional study from the GeoSentinel Surveillance Network. Ann Intern Med 2015; 162:757–764.  Back to cited text no. 4
    
5.
Cowling BJ, Caini S, Chotpitayasunondh T, Djauzi S, Gatchalian SR, Huang QS et al. Global Influenza Initiative. Influenza in the Asia-Pacific region: findings and recommendations from the Global Influenza Initiative. Vaccine 2017; 35:856–864.  Back to cited text no. 5
    
6.
Chacon R, Clara AW, Jara J, Armero J, Lozano C, El Omeiri N et al. Influenza illness among case-patients hospitalized for suspected dengue, El Salvador, 2012. PLoS ONE 2015; 10:e0140890.  Back to cited text no. 6
    
7.
Perdigão AC, Ramalho IL, Guedes MI, Braga DN, Cavalcanti LP, Melo ME et al. Coinfection with influenza A (H1N1)pdm09 and dengue virus in fatal cases. Mem Inst Oswaldo Cruz 2016; 111:588–591.  Back to cited text no. 7
    
8.
Schmid MA, González KN, Shah S, Peña J, Mack M, Talarico LB et al. Influenza and dengue virus co-infection impairs monocyte recruitment to the lung, increases dengue virus titers, and exacerbates pneumonia. Eur J Immunol 2017; 47:527–539.  Back to cited text no. 8
    
9.
Lochindarat S, Bunnag T. Clinical presentations of pandemic2009 influenza A (H1N1) virus infection in hospitalized Thai children. J Med Assoc Thai 2011; 94 (Suppl 3):S107–S112.  Back to cited text no. 9
    



 
 
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Abstract
Introduction
Patients and methods
Results
Discussion
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References
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