INFLUENZA OUTBREAK DURING THE SURGE OF SARS-CoV-2 OMICRON IN A
METROPOLITAN AREA FROM SOUTHERN BRAZIL: GENOMIC SURVEILLANCE.
Abstract
Influenza circulation was significantly affected in 2020–21 by the
COVID-19 pandemic. During this time, few influenza cases were recorded.
However, in the summer of 2021–22, an increase in atypical influenza
cases was observed, leading to the resurgence of influenza in the
southernmost state of Brazil, Rio Grande do Sul (RS). The present study
aimed to identify FLUAV, FLUBV, and SARS-CoV-2 circulation and
characterize influenza genomes in suspected COVID-19 patients using
high-throughput sequencing technology. Respiratory samples (n = 694)
from patients in RS were selected between July 2021 and August 2022. The
samples were typed reverse transcriptase real-time PCR (RT-qPCR) and
showed 32.13% (223/694) of the samples to be positive for SARS-CoV-2,
7.06% for FLUAV (49/694). FLUBV was not detected. RT-qPCR data also
showed 0.57% of the cases had FLUAV and SARS-CoV-2 co-infections. Whole
genome sequencing of the FLUAV positive specimens produced 15 complete
genomes of H3N2 subtype with phylogenetic placement in the
3C.2a1b.2a.2a.3 subclade. Mutation analysis showed 73 amino acid
substitutions in addition to several nonsynonymous mutations. The
detected percentage of FLUAV (7.06%) is relatively similar to the total
number of flu cases requiring hospitalization in RS state (8.9%),
including those admitted to intensive care units for severe
complications. This study provides insights into influenza virus
circulation in the south of Brazil during the Omicron wave of the
COVID-19 pandemic and reinforces the importance of H3N2 as a major
driver of severe respiratory disease in the region along with the
SARS-CoV-2 Omicron wave at the beginning of 2022.