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. 2017 Dec 16;17(1):772.
doi: 10.1186/s12879-017-2888-5.

Possible Interference Between Seasonal Epidemics of Influenza and Other Respiratory Viruses in Hong Kong, 2014-2017

Free PMC article

Possible Interference Between Seasonal Epidemics of Influenza and Other Respiratory Viruses in Hong Kong, 2014-2017

Xueying Zheng et al. BMC Infect Dis. .
Free PMC article


Background: Unlike influenza viruses, little is known about the prevalence and seasonality of other respiratory viruses because laboratory surveillance for non-influenza respiratory viruses is not well developed or supported in China and other resource-limited countries. We studied the interference between seasonal epidemics of influenza viruses and five other common viruses that cause respiratory illnesses in Hong Kong from 2014 to 2017.

Methods: The weekly laboratory-confirmed positive rates of each virus were analyzed from 2014 to 2017 in Hong Kong to describe the epidemiological trends and interference between influenza viruses, respiratory syncytial virus (RSV), parainfluenza virus (PIV), adenovirus, enterovirus and rhinovirus. A sinusoidal model was established to estimate the peak timing of each virus by phase angle parameters.

Results: Seasonal features of the influenza viruses, PIV, enterovirus and adenovirus were obvious, whereas annual peaks of RSV and rhinovirus were not observed. The incidence of the influenza viruses usually peaked in February and July, and the summer peaks in July were generally caused by the H3 subtype of influenza A alone. When influenza viruses were active, other viruses tended to have a low level of activity. The peaks of the influenza viruses were not synchronized. An epidemic of rhinovirus tended to shift the subsequent epidemics of the other viruses.

Conclusion: The evidence from recent surveillance data in Hong Kong suggests that viral interference during the epidemics of influenza viruses and other common respiratory viruses might affect the timing and duration of subsequent epidemics of a certain or several viruses.

Keywords: Influenza; Interference; Respiratory viruses; Seasonal epidemics.

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Not applicable.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Fig. 1
Fig. 1
Weekly number of specimens and positivity rates of laboratory-confirmed cases for six viruses in Hong Kong, 2014–2017
Fig. 2
Fig. 2
Time series of weekly laboratory-confirmed positive rates of influenza viruses and parainfluenza viruses (PIV) with subtypes in Hong Kong, 2014–2017. a influenza viruses; b parainfluenza viruses
Fig. 3
Fig. 3
Three-week moving averages of weekly positive rates for six viruses in Hong Kong, 2014–2017. a influenza viruses; b respiratory syncytial virus; c parainfluenza viruses; d rhinovirus; e adenovirus; f enterovirus
Fig. 4
Fig. 4
Estimates for annual and semi-annual peak timings of six viruses in Hong Kong, 2014–2017. Open circles represent point estimates from seasonal regression models and horizontal lines represent 95% block-bootstrap confidence intervals based on 1000 replications

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    1. Nair H, Brooks WA, Katz M, Roca A, Berkley JA, Madhi SA, Simmerman JM, Gordon A, Sato M, Howie S, et al. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet. 2011;378(9807):1917–1930. doi: 10.1016/S0140-6736(11)61051-9. - DOI - PubMed
    1. Guo RN, Zheng HZ, Li JS, Sun LM, Li LH, Lin JY, He JF. A population-based study on incidence and economic burden of influenza-like illness in south China, 2007. Public Health. 2011;125(6):389. doi: 10.1016/j.puhe.2011.03.004. - DOI - PubMed
    1. Tang JW, Lam TT, Zaraket H, Lipkin WI, Drews SJ, Hatchette TF, Heraud JM, Koopmans MP. Investigators I: global epidemiology of non-influenza RNA respiratory viruses: data gaps and a growing need for surveillance. Lancet Infect Dis. 2017; - PMC - PubMed
    1. Goka E, Vallely P, Mutton K, Klapper P, Influenza A. Viruses dual and multiple infections with other respiratory viruses and risk of hospitalisation and mortality. Influenza Other Respir Viruses. 2013;7(6):1079–1087. doi: 10.1111/irv.12020. - DOI - PMC - PubMed
    1. Galindo-Fraga A, Ortiz-Hernandez AA, Ramirez-Venegas A, Vazquez RV, Moreno-Espinosa S, Llamosas-Gallardo B, Perez-Patrigeon S, Salinger M, Freimanis L, Huang CY, et al. Clinical characteristics and outcomes of influenza and other influenza-like illnesses in Mexico City. Int J Infect Dis. 2013;17(7):e510–e517. doi: 10.1016/j.ijid.2013.01.006. - DOI - PMC - PubMed

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