Correlation of Influenza Vaccination and Influenza Incidence on COVID-19 Severity

50 Pages Posted: 10 Apr 2020 Last revised: 8 Oct 2020

See all articles by Mark Christopher Arokiaraj

Mark Christopher Arokiaraj

Pondicherry Institute of Medical Sciences - Cardiology

Date Written: April 10, 2020


The pandemic of Covid-19 is evolving worldwide, and it is associated with high mortality and morbidity. There is a growing need to discuss the elements of a coordinated strategy to control the spread and mitigate the severity and mortality of Covid-19. H1N1 vaccine and streptococcus pneumonia vaccines are available. The current analysis was performed to correlate the severity of Covid-19 and influenza (H1N1) vaccination statistics and also influenza lower respiratory tract incidence. There is a correlation between Covid-19 related mortality and morbidity and influenza vaccination status, which appears protective. The tendency of correlation is more visualized as the pandemic is evolving. The case incidence and recovery parameters also showed a beneficial trend. Since evolutionarily, influenza is close to SARS-CoV-2 viruses and shares some common epitopes and mechanisms, partial protection is possible to reduce the Covid-19 related severity using the influenza vaccination. In countries where influenza immunization is less, there is a correlation between lower respiratory tract infections (LRI) and influenza attributable to lower respiratory tract infections incidence and Covid-19 severity, which is beneficial. Receiver operating curve (ROC) statistics showed an area under the curve of 0.86 (CI 0.78 to 0.944, P <0.0001) to predict Covid-19 mortality >150/million, and a decreasing trend of influenza LRI episodes. The odd's ratio for the influenza LRI parameter was −0.681 (CI −1.147 to −0.214, P = 0.004) to predict the Covid19 mortality/cases (case-fatality) rate >5 percent. Population density*influenza LRI incidence is a useful parameter to predict higher Covid-19 mortality (OR -2.7, CI -4.86 to -0.53, P<0.0001). WHO regions with an increased incidence of LRI associated mortality was associated with a reduction in Covid19 mortality by about 16%. Influenza (H1N1) vaccination is cost-effective and safe.The influenza LRI parameter has an odd’s ratio of -0.601 (CI -0.981 to -0.222, P=0.002; Oct 4, 2020) to indicate Covid19 mortality >250/million.

Peer reviewed article
Considering Interim Interventions to Control COVID-19 Associated Morbidity and Mortality—Perspectives. Front Public Health 8:444. (Sept 22, 2020)

Note: Funding: None.

Conflict of Interest: None.

Keywords: COVID-19, Influenza vaccination, Influenza lower respiratory tract infections, Mortality, Morbidity, Immunity

JEL Classification: I, E

Suggested Citation

Arokiaraj, Mark Christopher, Correlation of Influenza Vaccination and Influenza Incidence on COVID-19 Severity (April 10, 2020). Available at SSRN: or

Mark Christopher Arokiaraj (Contact Author)

Pondicherry Institute of Medical Sciences - Cardiology ( email )


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