Co-infection with SARS-CoV-2 and influenza A/H1 in a patient seen at Influenza like-Illness surveillance site in Egypt: Case-report (Preprint)

BACKGROUND Influenza like Illness (ILI) sentinel surveillance in Egypt started in year 2000 in 8 sentinel sites geographically distributed all over the country. In response to the COVID-19 pandemic, SARS-CoV-2 was added to the viral testing panel by PCR for the first two patients with ILI seen at one of the sentinel sites. We report the first SARS-CoV-2 and influenza A/H1 virus co-infection with mild symptoms detected through routine influenza like-illness surveillance (ILI) in Egypt. OBJECTIVE This report aims at describing how the case was identified and the patient's demographic and clinical characteristics and outcomes. METHODS The case was identified by the central public health laboratory staff who contacted the ILI sentinel surveillance officer at Ministry of Health. The case was contacted through phone call. Detailed information about patient clinical picture, course of disease and outcome. Patient's contacts were investigated for acute respiratory symptoms, disease confirmation and outcome. RESULTS Among 510 specimens collected from patients with ILI symptoms from October 2019 to August 2020. Of them 61 (12.0%) were COVID-19 positive and 29 (5.7%) were positive for influenza including 15 (51.7%) A/H1, 11 (38.0%) A/H3, and 3 (10.3%) Flu-B. A 21-year-old female was confirmed as SARS-CoV-2 and influenza A/H1 virus co-infection. She had high fever of 40.2°C and mild respiratory symptoms that resolved within two days with symptomatic treatment. All her five family contacts had mild respiratory symptoms 2-3 days after exposure to the confirmed case and symptoms resolved without treatment or investigations. CONCLUSIONS The case highlights the possible occurrence of co-infection in younger and healthy people who might resolve the infection rapidly. We emphasize the usefulness of surveillance system for detection of viral causative agent(s) of ILI and recommend the broadening of testing panel especially if it could guide case management. CLINICALTRIAL