Influenza, malaria parasitemia, and typhoid fever coinfection in children: Seroepidemiological investigation in four Health-care Centers in Lagos, Nigeria

Abstract

Objectives: There are similarities in the presentation of influenza-A infection, malaria, and typhoid fever which include their overlapping clinical symptoms such as fever and myalgia. Coinfection may be easily missed and may lead to more severe associated morbidity. This study, therefore, investigated the prevalence of coinfection of influenza A, malaria, and typhoid fever in children in four locations in Lagos and determined their age, gender, and location-related prevalence. Materials and Methods: A cross-sectional hospital-based study was conducted between March and October 2018. Children less than 15 years attending four health centers in Festac, Amuwo, Ojo, and Shibiri were recruited consecutively. Demographic and epidemiological data were obtained using structured questionnaires, to ascertain children with influenza-like symptoms. Their blood samples were then tested with rapid diagnostic method for malaria and typhoid fever. The children were further screened for influenza-A-specific IgM using ELISA method. Descriptive statistics were reported while p-values were determined for comparable parameters using Chi-square. Results: There were 364 children aged <1–14 years including 207 (56.9%) males. Of the 364 children tested, 76/364 (20.9%) were seropositive for influenza-A virus out of which 47/76 (61.8%) had malaria parasitemia, 42/76 (55.3%) had typhoid fever, and 21/76 (27.6%) were coinfected with both malaria parasites and Salmonella enteric Typhi. Children coinfected with influenza-A and malaria were found with a higher frequency of chest pain and cold/chill symptom respectively compared to children having influenza alone (P = 0.0001). Seropositivity for influenza was recorded in all the months studied with the month of March recording the highest influenza-A seropositivity of 20/76 (26.3%) (P = 0.02). Conclusion: This study detected 27.6% trio coinfection seroprevalence of influenza Type-A, malaria, and typhoid fever among children population. The finding is unique being the first of such report, to the best of our knowledge. Children coinfected with influenza-A and malaria had greater morbidity.