Sequential infection with H1N1 and SARS-CoV-2 aggravated COVID-19 pathogenesis in a mammalian model, and co-vaccination as an effective method of prevention of COVID-19 and influenza

Signal Transduct Target Ther. 2021 May 20;6(1):200. doi: 10.1038/s41392-021-00618-z.

Abstract

Influenza A virus may circulate simultaneously with the SARS-CoV-2 virus, leading to more serious respiratory diseases during this winter. However, the influence of these viruses on disease outcome when both influenza A and SARS-CoV-2 are present in the host remains unclear. Using a mammalian model, sequential infection was performed in ferrets and in K18-hACE2 mice, with SARS-CoV-2 infection following H1N1. We found that co-infection with H1N1 and SARS-CoV-2 extended the duration of clinical manifestation of COVID-19, and enhanced pulmonary damage, but reduced viral shedding of throat swabs and viral loads in the lungs of ferrets. Moreover, mortality was increased in sequentially infected mice compared with single-infection mice. Compared with single-vaccine inoculation, co-inoculation of PiCoVacc (a SARS-CoV-2 vaccine) and the flu vaccine showed no significant differences in neutralizing antibody titers or virus-specific immune responses. Combined immunization effectively protected K18-hACE2 mice against both H1N1 and SARS-CoV-2 infection. Our findings indicated the development of systematic models of co-infection of H1N1 and SARS-CoV-2, which together notably enhanced pneumonia in ferrets and mice, as well as demonstrated that simultaneous vaccination against H1N1 and SARS-CoV-2 may be an effective prevention strategy for the coming winter.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • COVID-19* / immunology
  • COVID-19* / pathology
  • COVID-19* / virology
  • Coinfection* / immunology
  • Coinfection* / pathology
  • Coinfection* / virology
  • Disease Models, Animal
  • Ferrets
  • Humans
  • Influenza A Virus, H1N1 Subtype / immunology*
  • Male
  • Mice
  • Mice, Transgenic
  • Orthomyxoviridae Infections* / immunology
  • Orthomyxoviridae Infections* / pathology
  • Orthomyxoviridae Infections* / virology
  • SARS-CoV-2 / immunology*