Abstract
Public health practices including handwashing and vaccinations help reduce the spread and impact of infections. Nevertheless, the global burden of infection is high, and additional measures are necessary. Acute respiratory tract infections, for example, were responsible for approximately 2.38 million deaths worldwide in 2016. The role nutrition plays in supporting the immune system is well-established. A wealth of mechanistic and clinical data show that vitamins, including vitamins A, B6, B12, C, D, E, and folate; trace elements, including zinc, iron, selenium, magnesium, and copper; and the omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid play important and complementary roles in supporting the immune system. Inadequate intake and status of these nutrients are widespread, leading to a decrease in resistance to infections and as a consequence an increase in disease burden. Against this background the following conclusions are made: (1) supplementation with the above micronutrients and omega-3 fatty acids is a safe, effective, and low-cost strategy to help support optimal immune function; (2) supplementation above the Recommended Dietary Allowance (RDA), but within recommended upper safety limits, for specific nutrients such as vitamins C and D is warranted; and (3) public health officials are encouraged to include nutritional strategies in their recommendations to improve public health.
Highlights
Acute respiratory tract infections are a major cause of morbidity and mortality across the globe, as illustrated by both seasonal influenza epidemics, and the recent outbreak of the coronavirus disease, COVID-19, caused by SARS-CoV-2 infection
A number of standard public health practices have been developed to help limit the spread and impact of respiratory viruses, such as regular hand washing, avoiding those showing symptoms of infection, and covering coughs [5]. For certain viruses, such as influenza, annual vaccination campaigns designed to prime the immune response in case of exposure exist in many countries
Influenza is caused by a single-stranded RNA virus, and as such exhibits high mutation rates and rapid evolution, which may allow these viruses to escape from pre-existing neutralizing antibodies in the host [6]
Summary
Acute respiratory tract infections are a major cause of morbidity and mortality across the globe, as illustrated by both seasonal influenza epidemics, and the recent outbreak of the coronavirus disease, COVID-19, caused by SARS-CoV-2 infection. A number of standard public health practices have been developed to help limit the spread and impact of respiratory viruses, such as regular hand washing, avoiding those showing symptoms of infection, and covering coughs [5]. For certain viruses, such as influenza, annual vaccination campaigns designed to prime the immune response in case of exposure exist in many countries. In the US, the Centers for Disease Control and Prevention estimate the current year influenza vaccine to be 45% effective for preventing medically attended, laboratory-confirmed influenza virus. The morbidity and mortality numbers cited above highlight the need for additional strategies to support the immune system, in order to reduce the impact of respiratory and other infections
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