We included patients ≥ 18 years old who were admitted to a hospital ward and/or intensive care unit for acute illness. For patients with more than one positive PCR in one seasonal period, the first episode was considered for study purposes. We excluded samples obtained from health-care workers in the setting of occupational health screening and those from patients discharged to an outpatient setting within 24 h. Pregnant patients were excluded as were those deemed to have nosocomial infection, which was considered when both LRTI-related symptom onset and PCR sampling took place > 72 h after admission. Co-infections with more than one virus or more than one Influenza type/subtype were also excluded.

We collected data on demographics, co-morbidities, laboratory molecular identification, radiological presentation, clinical course until discharge or death and outcome of admission. Co-morbidities were assessed on the basis of baseline clinical history depictions and/or assessments made during admission which determined their presence. Patient smoking status was considered when current at the time of admission, malignancy when active, heart failure if class II NYHA disease or worse, chronic kidney disease stage 3A disease or worse. Laboratory identification, typing and subtyping results for Influenza (A H1N1, A H3N2 and B) and RSV were made using multiplex PCR on oral and naso-pharyngeal swab specimens using Cepheid’s GeneXpert Flu/RSV ® (Sunnyvale, CA, USA), Biomerieux’s Filmarray respiratory panel ® (Marcy-l’Étoile, France) and Seegene’s Allplex respiratory panel ® (Seoul, Republic of Korea).

Primary outcomes were in-hospital death and invasive mechanical ventilation (IMV), secondary outcomes were non-invasive ventilation (NIV) and length of stay. Pneumonia was considered when a radiological infiltrate was present on the chest X-ray and/or CT scan performed on presentation. Use of CPAP was not considered as NIV.

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