High prevalence of SARS-CoV-2 and influenza A virus (H1N1) coinfection in dead patients in Northeastern Iran

J Med Virol. 2021 Feb;93(2):1008-1012. doi: 10.1002/jmv.26364. Epub 2020 Aug 13.


In the last months of 2019, an outbreak of fatal respiratory disease started in Wuhan, China, and quickly spread to other parts of the world. It was named COVID-19, and to date, thousands of cases of infection and death are reported worldwide. This disease is associated with a wide range of symptoms, which makes accurate diagnosis of it difficult. During previous severe acute respiratory syndrome (SARS) pandemic in 2003, researchers found that the patients with fever, cough, or sore throat had a 5% influenza virus-positive rate. This finding made us think that the wide range of symptoms and also relatively high prevalence of death in our patients may be due to the coinfection with other viruses. Thus, we evaluated the coinfection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with other respiratory viruses in dead patients in North Khorasan. We evaluated the presence of influenza A/B virus, human metapneumovirus, bocavirus, adenovirus, respiratory syncytial virus (RSV), and parainfluenza viruses in 105 SARS-CoV-2 positive dead patients, using polymerase chain reaction (PCR) and reverse transcription PCR tests. We found coinfection with influenza virus in 22.3%, RSV, and bocavirus in 9.7%, parainfluenza viruses in 3.9%, human metapneumovirus in 2.9%, and finally adenovirus in 1.9% of SARS-CoV-2 positive dead cases. Our findings highlight a high prevalence of coinfection with influenza A virus and the monopoly of coinfection with Human metapneumovirus in children.

Keywords: SARS-Cov-2; adenovirus; bocavirus; coinfection; human metapneumovirus; influenza virus; parainfluenza virus; respiratory syncytial virus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • COVID-19 / epidemiology*
  • Cadaver
  • Child
  • Child, Preschool
  • China / epidemiology
  • Coinfection / epidemiology
  • Coinfection / mortality*
  • Coinfection / virology*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Influenza, Human / epidemiology*
  • Iran / epidemiology
  • Male
  • Middle Aged
  • Orthomyxoviridae / isolation & purification
  • Prevalence
  • Respiratory Syncytial Virus, Human / isolation & purification
  • SARS-CoV-2 / isolation & purification
  • Viruses / classification
  • Viruses / isolation & purification*
  • Young Adult