Respiratory Virus Disease Research Articles

Pulmonology: What You May Have Missed in 2023.

The field of pulmonology saw significant advances in 2023. The publications highlighted in this article address advances and changes in practice related to asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, pleural disorders, and sleep-disordered breathing. One article reviews data examining the efficacy of vaccination against respiratory syncytial virus, a respiratory viral illness that has had devastating effects globally. Four studies evaluate the role of various therapies in COPD, including dupilumab, ensifentrine, pulmonary rehabilitation programs, and lung volume reduction versus endobronchial valves. Another study explores the effect on vascular events of positive-pressure ventilation in patients with sleep-disordered breathing and recent stroke. The use of combination therapy with rituximab and mycophenolate mofetil on progression-free survival in patients with nonspecific interstitial pneumonia is the topic of another study. We also highlight an update of clinical recommendations for the evaluation of patients with pleural disorders and a systematic review analyzing the effectiveness of inhaled corticosteroids as a supplement to dual therapy for COPD.

Vaccines for Respiratory Syncytial Virus Prevention in Older Adults.

This review evaluates the efficacy and safety of novel respiratory syncytial virus (RSV) vaccines approved for adults aged 60 years and older. A literature search through February 27, 2024 was conducted using search terms, such as RSV, viral respiratory illness, vaccine, RSVpreF, RSVpreF3, Prefusion F, Abrysvo, and Arexvy. Data from primary literature and vaccine prescribing information were reviewed, encompassing evaluations of clinical pharmacology, efficacy, safety, adverse events, warnings, and precautions. The literature review process resulted in 10 articles included within this article's scope, including the results of 2 major phase III trials presented in detail. Two RSV vaccines, Respiratory Syncytial Virus Vaccine (recombinant [adjuvanted]; RSVpreF3-ASO1E, Arexvy) and Respiratory Syncytial Virus Vaccine (recombinant; RSVpreF, Abrysvo), approved for preventing RSV-associated lower respiratory tract disease (LRTD) in adults aged 60 years or older in the United States are discussed. Results from Phase III trials have demonstrated the efficacy of 1 dose of these vaccines in preventing RSV-associated LRTD across 2 RSV seasons. The Advisory Committee on Immunization Practices currently recommends use of these vaccines under shared clinical decision-making for adults aged 60 years or older. Most common adverse effects include injection site reactions (eg, site pain, redness, and swelling). Administration requires a single intramuscular injection of 0.5 mL, reconstituted prior to administration. The RSVpreF3-ASO1E and RSVpreF vaccines effectively prevent RSV-associated LRTD in adults aged 60 years and older.

Epidemiological Study of Bovine Parainfluenza 3 Virus in Sheep: Seroprevalence, Risk Factors, and Distribution in Two Regions of Algeria

Background: Respiratory viral diseases, including the bovine parainfluenza 3 virus, cause significant economic losses in ruminants. There is no available data regarding the epidemiological situation of this virus in Algeria. Objectives: The present study aims to determine the seroprevalence and the associated risk factors of bovine parainfluenza 3 virus (BPI3V) in sheep in two different climatic regions of Algeria. Methods: A total of 108 serum samples were collected from sheep at different ages and tested for antibodies against BPI3V using an indirect enzyme-linked immunosorbent assay (ELISA). A real-time polymerase chain reaction (PCR) test was also performed on nasal swabs to detect the viral genome. Results: At the animal level, out of 108 sera tested, 82 (75.93%, 95% CI, 66.75%, 83.63%) showed antibodies against BPI3V. At the herd level, all 23 herds tested (100%) had at least one animal with BPI3V antibodies. Our results showed no association between the presence of BPI3V antibodies and the region (P=0.72). However, at the herd level, risk factors such as flock size and predisposing factors like climate change, feed deficit, postpartum stress, and dust were identified. At the animal level, a highly significant association was found between BPI3V seroprevalence and the age of the animals (P<0.0001). Notably, the sheep group over 3 years was more susceptible than other age groups. Furthermore, a significant difference in BPI3V seroprevalence based on sex was observed (P<0.003). All collected nasal swabs were negative for BPI3V genome detection using real-time PCR. Conclusion: This study is the first serological survey on BPI3V in Algeria, confirming its presence in sheep from two regions. The high serum prevalence of BPI3V observed in the study population highlights addressing this viral disease to mitigate economic losses in ruminants.

Use of Immunoglobulin Y Antibodies: Biosensor-based Diagnostic Systems and Prophylactic and Therapeutic Drug Delivery Systems for Viral Respiratory Diseases.

Respiratory viruses have caused many pandemics from past to present and are among the top global public health problems due to their rate of spread. The recently experienced COVID-19 pandemic has led to an understanding of the importance of rapid diagnostic tests to prevent epidemics and the difficulties of developing new vaccines. On the other hand, the emergence of resistance to existing antiviral drugs during the treatment process poses a major problem for society and global health systems. Therefore, there is a need for new approaches for the diagnosis, prophylaxis, and treatment of existing or new types of respiratory viruses. Immunoglobulin Y antibodies (IgYs) obtained from the yolk of poultry eggs have significant advantages, such as high production volumes, low production costs, and high selectivity, which enable the development of innovative and strategic products. Especially in diagnosing respiratory viruses, antibody-based biosensors in which these antibodies are integrated have the potential to provide superiority in making rapid and accurate diagnosis as a practical diagnostic tool. This review article aims to provide information on using IgY antibodies in diagnostic, prophylactic, and therapeutic applications for respiratory viruses and to provide a perspective for future innovative applications.

Individualized Prediction of SARS-CoV-2 Infection in Mexico City Municipality during the First Six Waves of the Pandemic.

After COVID-19 emerged, alternative methods to laboratory tests for the individualized prediction of SARS-CoV-2 were developed in several world regions. The objective of this investigation was to develop models for the individualized prediction of SARS-CoV-2 infection in a large municipality of Mexico. The study included data from 36,949 patients with suspected SARS-CoV-2 infection who received a diagnostic tested at health centers of the Alvaro Obregon Jurisdiction in Mexico City registered in the Epidemiological Surveillance System for Viral Respiratory Diseases (SISVER-SINAVE). The variables that were different between a positive test and a negative test were used to generate multivariate binary logistic regression models. There was a large variation in the prediction variables for the models of different pandemic waves. The models obtained an overall accuracy of 73% (63-82%), sensitivity of 52% (18-71%), and specificity of 84% (71-92%). In conclusion, the individualized prediction models of a positive COVID-19 test based on SISVER-SINAVE data had good performance. The large variation in the prediction variables for the models of different pandemic waves highlights the continuous change in the factors that influence the spread of COVID-19. These prediction models could be applied in early case identification strategies, especially in vulnerable populations.

Association Between Ethnicity and Mortality Outcomes in Patients with COVID-19: A Mayo Clinic VIRUS Registry Cohort Study.

Hispanic populations face significant disparities in health and healthcare.The COVID-19 pandemic highlighted and sometimes further exacerbated these disparities. We conducted a multisite, retrospective cohort study of 6494 hospitalized adult patients admitted between March 2020 and January 2022 with a diagnosis of COVID-19 from five sites including academic hospitals in MN, AZ, and FL and community hospitals in MN and WI. This is an ancillary project of the Viral Infection and Respiratory illness Universal Study (VIRUS) registry, supplemented by electronic health record data. We compared in-hospital mortality and length of stay outcomes between Hispanic and non-Hispanic populations admitted with COVID-19 using propensity matched scores to account for imbalances in demographic and clinical covariables. Among a total of 6494 patients, 512 (7.9%) patients were reported deceased and 5982 (92.1%) alive at discharge. We did not find a statistically significant difference between in-hospital mortality nor length of stay between the two groups.

Persistence of human respiratory viral RNA in wastewater-settled solids.

Wastewater-based epidemiology has emerged as a valuable tool for monitoring respiratory viral diseases within communities by analyzing concentrations of viral nucleic-acids in wastewater. However, little is known about the fate of respiratory virus nucleic-acids in wastewater. Two important fate processes that may modulate their concentrations in wastewater as they move from household drains to the point of collection include sorption or partitioning to wastewater solids and degradation. This study investigated the decay kinetics of genomic nucleic-acids of seven human respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), respiratory syncytial virus (RSV), human coronavirus (HCoV)-OC43, HCoV-229E, HCoV-NL63, human rhinovirus (HRV), and influenza A virus (IAV), as well as pepper mild mottle virus (PMMoV) in wastewater solids. Viruses (except for PMMoV) were spiked into wastewater solids and their concentrations were followed for 50 days at three different temperatures (4°C, 22°C, and 37°C). Viral genomic RNA decayed following first-order kinetics with decay rate constants k from 0 to 0.219 per day. Decay rate constants k were not different from 0 for all targets in solids incubated at 4°C; k values were largest at 37°C and at this temperature, k values were similar across nucleic-acid targets. Regardless of temperature, there was limited viral RNA decay, with an estimated 0% to 20% reduction, over the typical residence times of sewage in the piped systems between input and collection point (<1 day). The k values reported herein can be used directly in fate and transport models to inform the interpretation of measurements made during wastewater surveillance.IMPORTANCEUnderstanding whether or not the RNA targets quantified for wastewater-based epidemiology (WBE) efforts decay during transport between drains and the point of sample collection is critical for data interpretation. Here we show limited decay of viral RNA targets typically measured for respiratory disease WBE.

Acceptability and Satisfaction of Patients and Providers With Telemedicine During the COVID-19 Pandemic: A Systematic Review.

COVID-19, also known as coronavirus disease 2019, is an extremely contagious viral sicknesscaused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After the first cases of this primarily respiratory viral illness were recorded in Wuhan, Hubei Province, China, in late December 2019, SARS-CoV-2 rapidly disseminated across the globe. Consequently, on March 11, 2020, the World Health Organization (WHO) declared it a global pandemic. The rapid spread of the COVID-19 virus, coupled with subsequent lockdowns and social distancing measures, profoundly disrupted traditional healthcare delivery systems. Amidst the COVID-19 pandemic, telemedicine emerged as a pivotal solution for delivering healthcare services while minimizing exposure to the virus. This study aims to assess patient and provider satisfaction with telemedicine during this unprecedented period. A systematic literature search was conducted on PubMed and Google Scholar using specific MeSH terms and Preferred Reporting Items for Systematic Literature Reviews and Meta-Analyses (PRISMA) guidelines to summarize patient and provider satisfaction concerning telemedicine using all the facts, evidence, and published literature. The analysis showed that although providers were generally satisfied with telemedicine, they were less satisfied than patients due to technical issues and difficulties transmitting documents. Patients reported high satisfaction with telemedicine, citing convenience and cost savings as major benefits. However, a lack of provider compensation was identified as a potential barrier to adoption. Most providers believed that telemedicine was only necessary in emergencieswhile a few recognized its potential for routine care. The study concludes that telemedicine has the potential to improve healthcare access and efficiency, but more research is needed to address technical and reimbursement issues and to determine the appropriate scope of telemedicine use. Overall, the findings of this study can inform future healthcare policies and regulations to ensure that telemedicine is used effectively and to the satisfaction of both patients and providers.

A novel data augmentation approach for influenza A subtype prediction based on HA proteins

Influenza, a pervasive viral respiratory illness, remains a significant global health concern. The influenza A virus, capable of causing pandemics, necessitates timely identification of specific subtypes for effective prevention and control, as highlighted by the World Health Organization. The genetic diversity of influenza A virus, especially in the hemagglutinin protein, presents challenges for accurate subtype prediction. This study introduces PreIS as a novel pipeline utilizing advanced protein language models and supervised data augmentation to discern subtle differences in hemagglutinin protein sequences. PreIS demonstrates two key contributions: leveraging pre-trained protein language models for influenza subtype classification and utilizing supervised data augmentation to generate additional training data without extensive annotations. The effectiveness of the pipeline has been rigorously assessed through extensive experiments, demonstrating a superior performance with an impressive accuracy of 94.54% compared to the current state-of-the-art model, the MC-NN model, which achieves an accuracy of 89.6%. PreIS also exhibits proficiency in handling unknown subtypes, emphasizing the importance of early detection. Pioneering the classification of HxNy subtypes solely based on the hemagglutinin protein chain, this research sets a benchmark for future studies. These findings promise more precise and timely influenza subtype prediction, enhancing public health preparedness against influenza outbreaks and pandemics. The data and code underlying this article are available in https://github.com/CBRC-lab/PreIS.

Faecalibacterium duncaniae as a novel next generation probiotic against influenza.

The gut-lung axis is critical during viral respiratory infections such as influenza. Gut dysbiosis during infection translates into a massive drop of microbially produced short-chain fatty acids (SCFAs). Among them, butyrate is important during influenza suggesting that microbiome-based therapeutics targeting butyrate might hold promises. The butyrate-producing bacterium Faecalibacterium duncaniae (formerly referred to as F. prausnitzii) is an emerging probiotic with several health-promoting characteristics. To investigate the potential effects of F. duncaniae on influenza outcomes, mice were gavaged with live F. duncaniae (A2-165 or I-4574 strains) five days before infection. Supplementation of F. duncaniae was associated with less severe disease, a lower pulmonary viral load, and lower levels of lung inflammation. F. duncaniae supplementation impacted on gut dysbiosis induced by infection, as assessed by 16S rRNA sequencing. Interestingly, F. duncaniae administration was associated with a recovery in levels of SCFAs (including butyrate) in infected animals. The live form of F. duncaniae was more potent that the pasteurized form in improving influenza outcomes. Lastly, F. duncaniae partially protected against secondary (systemic) bacterial infection. We conclude that F. duncaniae might serve as a novel next generation probiotic against acute viral respiratory diseases.

Testing pulmonary physiology in ventilated non-human primates.

Animal models of respiratory viral infections are essential for investigating disease pathogenesis and the efficacy of antivirals and vaccine candidates. A major limitation in the research of respiratory diseases in animal models is correlating clinically relevant changes in pulmonary physiology with cellular and molecular mechanistic studies. Few animal models have captured and correlated physiologic changes in lung function and immune response within same experiment, which is critical given the heterogeneous nature of lung disease due to viral infections. In ventilated human patients, pulmonary physiology testing can be used to not only capture oxygenation, ventilation, but also pulmonary mechanics to yield quantitative measures of lung function and scalar tracings of flow-volume and pressure-volume loops. Application of this protocol during mechanical ventilation in non-human (NHP) models would represent a major advance in respiratory viral disease research. We have applied and optimized a human pulmonary physiology testing protocol to ventilated pigtail macaques (Macaca nemestrina) at baseline and 5 days after influenza A (IAV) viral inoculation. The NHPs manifested clinical disease with hypothermia and loss of body weight. Declines in lung function were striking with a 66%-81% decline in P/F ratio, a measure of oxygenation reflecting the ratio of partial pressure of oxygen in arterial blood (PaO2 ) to the fraction of inspiratory oxygen concentration (FiO2 ). There was also a 16%-45% decline in lung compliance. We describe a new approach to performing pulmonary physiology testing protocol in non-human primates to better capture quantitative correlates of respiratory disease and demonstrate protection by therapeutics and vaccines.

The relationship between autophagy and respiratory viruses.

Respiratory viruses have caused severe global health problems and posed essential challenges to the medical community. In recent years, the role of autophagy as a critical process in cells in viral respiratory diseases has been noticed. One of the vital catabolic biological processes in the body is autophagy. Autophagy contributes to energy recovery by targeting and selectively directing foreign microorganisms, organelles, and senescent intracellular proteins to the lysosome for degradation and phagocytosis. Activation or suppression of autophagy is often initiated when foreign pathogenic organisms such as viruses infect cells. Because of its antiviral properties, several viruses may escape or resist this process by encoding viral proteins. Viruses can also use autophagy to enhance their replication or prolong the persistence of latent infections. Here, we provide an overview of autophagy and respiratory viruses such as coronavirus, rhinovirus, parainfluenza, influenza, adenovirus, and respiratory syncytial virus, and examine the interactions between them and the role of autophagy in the virus-host interaction process and the resulting virus replication strategy.

At-home testing for respiratory viruses: a minireview of the current landscape.

The landscape of at-home testing using over-the-counter (OTC) tests has been evolving over the last decade. The United States Food and Drug Administration Emergency Use Authorization rule has been in effect since the early 2000s, and it was widely employed during the severe acute respiratory syndrome coronavirus 2 pandemic to authorize antigen and nucleic acid detection tests for use in central laboratories as well as OTC. During the pandemic, the first at-home tests for respiratory viruses became available for consumer use, which opened the door for additional respiratory virus OTC tests. Concerns may exist regarding the public's ability to properly collect samples, perform testing, interpret results, and report results to public health authorities. However, favorable comparison studies between OTC testing and centralized laboratory test results suggest that OTC testing may have a place in healthcare, and it is likely here to stay. This mini-review of OTC tests for viral respiratory diseases will briefly cover the regulatory and reimbursement environment, current OTC test availability, as well as the advantages and limitations of OTC tests.

Proteomic and Lipidomic Profiling of Calves Experimentally Co-Infected with Influenza D Virus and Mycoplasma bovis: Insights into the Host-Pathogen Interactions.

The role of Influenza D virus (IDV) in bovine respiratory disease remains unclear. An in vivo experiment resulted in increased clinical signs, lesions, and pathogen replication in calves co-infected with IDV and Mycoplasma bovis (M. bovis), compared to single-infected calves. The present study aimed to elucidate the host-pathogen interactions and profile the kinetics of lipid mediators in the airways of these calves. Bronchoalveolar lavage (BAL) samples collected at 2 days post-infection (dpi) were used for proteomic analyses by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Additionally, lipidomic analyses were performed by LC-MS/MS on BAL samples collected at 2, 7 and 14 dpi. Whereas M. bovis induced the expression of proteins involved in fibrin formation, IDV co-infection counteracted this coagulation mechanism and downregulated other acute-phase response proteins, such as complement component 4 (C4) and plasminogen (PLG). The reduced inflammatory response against M. bovis likely resulted in increased M. bovis replication and delayed M. bovis clearance, which led to a significantly increased abundance of oxylipids in co-infected calves. The identified induced oxylipids mainly derived from arachidonic acid; were likely oxidized by COX-1, COX-2, and LOX-5; and peaked at 7 dpi. This paper presents the first characterization of BAL proteome and lipid mediator kinetics in response to IDV and M. bovis infection in cattle and raises hypotheses regarding how IDV acts as a co-pathogen in bovine respiratory disease.

A Study to Assess the Effectiveness of Self Instructional Module on Knowledge Regarding Respiratory Viral Diseases and Its Prevention among Adolescents in Selected Schools at Perinthalmanna

Introduction: Respiratory viral diseases are disease of respiratory system caused by respiratory viruses. Respiratory viruses are the most frequent causative agents of diseases in humans with significant impact on morbidity and mortality worldwide. In present study we assessed the effectiveness of self-instructional module on knowledge regarding respiratory viral diseases and its prevention among adolescents in selected schools at Perinthalmanna. Methodology: Quantitative one group pre-test post-test approach was used in this study. 60 samples were selected by using non probability convenient sampling technique. Structured knowledge questionnaire including demographic variables was used for the study. Result: Pre-test result shows that 29(48.33%) of adolescents had good knowledge, 27(45%) of adolescents had average knowledge and 4(6.67%) of adolescents had poor knowledge. Post-test knowledge shows that 38(63.34%) had excellent knowledge, 20(33.33%) had good knowledge, 2(3.33%) had average knowledge and none of the adolescent had poor knowledge. The effectiveness of self-instructional module was assessed by paired ‘t’ test. The calculated value was (t=19.3047) higher than the table value (t59=2.0010), it shows the self-instructional module was effective. There was no association between pre-test knowledge score of adolescents with selected demographic variables such as age, gender, class, religion, education of mother, education of father, occupation of father, occupation of mother. There was a significant association found between pretest knowledge score of adolescents with values of previous source of knowledge. The mean post-test score (15.03) was higher than the mean pre-test knowledge score (9.17). Conclusion: The present study revealed that the self-instructional module was effective as it improved the knowledge level of post-test.

BT100, a three-in-one, multipurpose disinfecting, deodorizing, and air-cleaning solution with an effective, gradual, and continuous gaseous chlorine dioxide-releasing substance

Aerosols carrying viruses that are released from the oral cavity of infected individuals are the primary, if not the only, means of transmission during viral respiratory disease epidemics. This makes crowded rooms and tiny, enclosed public areas like bathrooms prime environments for the transmission of diseases. Volatile organic compounds (VOCs) and formaldehyde are two contaminants that pose serious threats to human health and well-being in indoor environments. The varied disinfectant properties of chlorine dioxide (ClO2) make it a key player in treating a range of air quality issues. To balance effectiveness and safety, however, the careful application of chlorine dioxide is essential to achieving the best results in air quality while preserving human health and well-being. This study explores the many functions of chlorine dioxide, including the prevention of the spread of viruses, the elimination of harmful gases like ammonia and hydrogen sulfide, and its effects on formaldehyde and total volatile organic compounds (TVOCs) in indoor environments using BT100. The results indicate a reduction of 98.5%, 81.01%, 62.22%, 46.5%, and 63.84% in minimizing aerosolized viruses, ammonia, and hydrogen sulfide gas in addition to formaldehyde and total volatile organic compounds.

The impact of undergoing elective pediatric lung resection during respiratory syncytial virus peak season on patient outcomes: A nationwide retrospective analysis.

Observational data to support delaying elective pediatric thoracic surgery during peak respiratory viral illness season is lacking. This study evaluated whether lung surgery during peak viral season is associated with differences in postoperative outcomes and resource utilization. A retrospective observational cohort study was performed using the Pediatric Health Information System (PHIS). Patients with a congenital lung malformation (CLM) who underwent elective lung resection between 1 January 2016 and 29 February 2020 were included. Respiratory syncytial virus (RSV) incidence was used as a proxy for respiratory viral illness circulation. Monthly hospital-specific RSV incidence was calculated from PHIS data, and peak RSV season was defined by Centers for Disease Control data. Multivariable regression models were built to identify predictors of postoperative mechanical ventilation, which was the main outcome measure, as well as secondary outcomes including 30-day readmission after lung resection, postoperative length of stay (LOS) and hospital billing charges. Of 1542 CLM patients identified, 344 (22.3%) underwent lung resection during peak RSV season. 38% fewer operations were performed per month during peak RSV season than during off-peak months (p < .001). Children who underwent surgery during peak RSV season did not differ from the off-peak group in terms of age at operation, race, or comorbid conditions (i.e., congenital heart disease, newborn respiratory distress, and preoperative pneumonia). There was no association between hospital-specific RSV incidence at the time of surgery and postoperative mechanical ventilation, postoperative LOS, 30-day readmission rate or hospital billing charges. Performing elective lung surgery in children with CLMs during peak viral season is not associated with adverse surgical outcomes or increased utilization of healthcare resources.

Implementation of a Prospective Index-Cluster Sampling Strategy for the Detection of Presymptomatic Viral Respiratory Infection in Undergraduate Students.

Index-cluster studies may help characterize the spread of communicable infections in the presymptomatic state. We describe a prospective index-cluster sampling strategy (ICSS) to detect presymptomatic respiratory viral illness and its implementation in a college population. We enrolled an annual cohort of first-year undergraduates who completed daily electronic symptom diaries to identify index cases (ICs) with respiratory illness. Investigators then selected 5-10 potentially exposed, asymptomatic close contacts (CCs) who were geographically co-located to follow for infections. Symptoms and nasopharyngeal samples were collected for 5 days. Logistic regression model-based predictions for proportions of self-reported illness were compared graphically for the whole cohort sampling group and the CC group. We enrolled 1379 participants between 2009 and 2015, including 288 ICs and 882 CCs. The median number of CCs per IC was 6 (interquartile range, 3-8). Among the 882 CCs, 111 (13%) developed acute respiratory illnesses. Viral etiology testing in 246 ICs (85%) and 719 CCs (82%) identified a pathogen in 57% of ICs and 15% of CCs. Among those with detectable virus, rhinovirus was the most common (IC: 18%; CC: 6%) followed by coxsackievirus/echovirus (IC: 11%; CC: 4%). Among 106 CCs with a detected virus, only 18% had the same virus as their associated IC. Graphically, CCs did not have a higher frequency of self-reported illness relative to the whole cohort sampling group. Establishing clusters by geographic proximity did not enrich for cases of viral transmission, suggesting that ICSS may be a less effective strategy to detect spread of respiratory infection.

Summary of key viral respiratory infectious diseases surveillance in some countries and regions in the world

Respiratory virus infections spread quickly, and some diseases are even more likely to cause a global epidemic. In order to explore how better to carry out surveillance of viral respiratory infectious diseases, the author searched the surveillance situation of key viral respiratory infectious diseases in America, Europe, and China, et al., then put forward several suggestions such as strengthening application of information technology, broaden monitoring channels, building early monitoring and early warning mechanisms.

Pidotimod as an Immunomodulator: An Unsung Warrior to Restore Immune Dysregulation in Acute and Chronic Lung Disease

Immune dysregulation has been observed in the majority of the infective and non-infectious respiratory illnesses with impact on the natural course of illness in pediatric to geriatric age groups. Immune regulation between Th1 and Th2 is altered and reversal of proportion between these two differential cells and ultimately homeostasis, with predominance Th2 cells will increase susceptibility for recurrent illnesses; is typically documented in pediatric age groups with first respiratory infection during early neonatal period with respiratory viral etiologies. Apart from recurrent childhood infections, pediatric cases with immune dysregulation will have recurrent wheezing in childhood and are prone for development of childhood asthma in adolescent age groups; if immune dysregulation does not restore in time. In adults, respiratory illnesses due acute viral infective etiology will cause immune dysregulation as documented after coronavirus, influenza and respiratory syncytial virus infections. Immune dysregulation has also been documented in chronic respiratory illnesses such bronchial asthma, chronic bronchitis and COPD. Immune dysregulation will cause recurrent exacerbations in these inflammatory conditions. Pidotimod is an immunomodulator which will work as an immunostimulant molecule due to its unique pharmacological actions on antigen presenting cells, and have novel action on immune cell proliferation and differentiation. In spite of three decades of research of this novel drug Pidotimod, still; it is less used as of today for respiratory ailments in spite of need of a molecule with an immunomodulatory effect for prevention and or cure of illnesses; and modification of natural course of recurrent or relapsing course of chronic illnesses. COVID-19 pandemic has taught us many pathways of immune dysregulation which evolved during natural course of disease and now documented with respiratory viral illnesses such as RSV; and its long-term impact as long covid presenting due to immune dysregulation occurred as a natural course in recovered cases. It’s unclear whether long covid is reversible as of now, but the majority of symptoms have been resolved and shown response to versatile molecules such as steroid, multivitamins, L-arginine, Paxlovid, beta blockers with variable results and long-term outcomes. Pidotimod can be used in acute COVID-19 illness without pneumonia and comorbidities in stable cases in outdoor settings, and also; considered as potential option in long covid cases with recurrent respiratory infections. In this review we have discussed basic aspects of Pidotimod, and its role in immunomodulatory effects in acute and chronic respiratory illness which have shown positive outcomes.