Systematic Molecular Influenza A/B Screening Upon Hospital Admission in Belgium, January-April 2022: Positivity Ratios and Viral Loads According to Symptomatology, Age, and Vaccination Status

Abstract

Three hospitals implemented molecular point-of-care tests (POCTs) to screen patients for SARS-CoV-2 infection upon admission during the 2021/2022 influenza season, which in Belgium lasted from January to April 2022. The samples were simultaneously tested for influenza A/B. Influenza positivity at admission was examined in relation to patient characteristics and symptomatology. Influenza POCTs were performed on all patients requiring urgent hospitalization, regardless of the admission reason. A total of 9327 patients were included in the study, of which 411 (4.4%) tested positive for influenza A/B. Asymptomatic infection and mild illness accounted for respectively 11.2% (95% CI: 8.5%-14.6%), and 43.3% (95% CI: 38.6%-48.1%) of the cases. A total of 66% (95% CI: 60%-72%) of all patients in these symptom categories (asymptomatic and mild illness) showed a high viral load (cycle threshold [Ct] < 24). Only in 30 (7.3%, 95% CI: 5.2%-10.2%) of all cases and in two (4.4%, 95% CI: 1.2%-14.5%) of the asymptomatic cases, the symptomatology worsened during hospital stay. Coinfections with both influenza and SARS-CoV-2 occurred in 35 patients (8.5% of all influenza positive patients). There was no difference in symptomatology between patients with co-infections and those with an influenza mono-infection. Patients could not be reliably categorized into carriers with low versus high viral loads based on symptomatology, age, and vaccination status. More than half of the influenza-positive individuals were either asymptomatic or had mild symptoms upon admission, while often carrying high viral loads. Our results show that without screening of patients at hospital admission, a considerable number of patients with a high viral load may be incorrectly classified as being not infectious.