Els, FionaKleynhans, JackieWolter, NicoleDu Plessis, MignonMoosa, FahimaTempia, StefanoMakhasi, MvuyoNel, JeremyDawood, HalimaMeiring, SusanVon Gottberg, AnneCohen, CherylWalaza, sibongile2024-11-272024-11-272024-07-26Els, F., Kleynhans, J., Wolter, N.. et al. Comparing adults with severe SARS-CoV-2 or influenza infection: South Africa, 2016–2021. Southern African Journal of Infectious Diseases 2024;39(1), a574. https://DOI.org/10.4102/sajid.v39i1.574.2312-0053 (print)2313-1810 (online)10.4102/sajid.v39i1.574http://hdl.handle.net/2263/99420DATA AVAILABILITY : Data were generated at various facilities in the pneumonia surveillance programme. Derived data supporting the findings of this study are available from the corresponding author, F.E. on request.BACKGROUND : Comparisons of the characteristics of individuals hospitalised with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or seasonal influenza in low-to middleincome countries with high human immunodeficiency virus (HIV) prevalence are limited. OBJECTIVES : Determine the epidemiological differences with those hospitalised with influenza or SARS-CoV-2 infection. METHOD : We investigated hospitalised individuals ≥18 years of age testing positive for seasonal influenza (2016–2019) or SARS-CoV-2 (2020–2021). We used random effects multivariable logistic regression, controlling for clustering by site, to evaluate differences among adults hospitalised with influenza or SARS-CoV-2 infection. RESULTS : Compared to individuals with influenza, individuals with SARS-CoV-2 infection were more likely to be diabetic (adjusted odds ratio [aOR]: 1.70, 95% confidence interval [CI]: 1.11–2.61) or die in hospital (aOR: 2.57, 95% CI: 1.61–4.12). Additionally, those with SARSCoV- 2 infection were less likely to be living with HIV (not immunosuppressed) (aOR: 0.50, 95% CI: 0.34–0.73) or living with HIV (immunosuppressed) (aOR: 0.27, 95% CI: 0.18–0.39) compared to not living with HIV and less likely to be asthmatic (aOR: 0.21, 95% CI: 0.13–0.33) rather than those living with influenza. CONCLUSION : Individuals hospitalised with SARS-CoV-2 had different characteristics to individuals hospitalised with influenza before the coronavirus disease 2019 (COVID-19) pandemic. Risk factors should be considered in health management especially as we move into an era of co-circulation of SARS-CoV-2 and influenza pathogens. CONTRIBUTION : Identifying groups at high risk of severe disease could help to better monitor, prevent and control SARS-CoV-2 or influenza severe disease.en© 2024. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.Pneumonia surveillanceRisk factorsSevere respiratory illnessPre-pandemicCOVID-19 pandemicCoronavirus disease 2019 (COVID-19)Human immunodeficiency virus (HIV)Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)SDG-03: Good health and well-beingArticle