Insights from respiratory virus co-infections

Table 1 Virological interactions in co-infections

Co-infection combination	Interaction type	Impact on disease progression
Dengue virus + secondary virus	Competitive	Increased risk of severe dengue outcomes (DHF, DSS)
RSV + influenza	Cooperative/competitive	Prolongs disease, increases severity and duration in some cases
RSV + other respiratory viruses (e.g., hMPV)	Varies; neutral in some models	Little to no increase in pathogenicity in some animal models

DHF: Dengue hemorrhagic fever; DSS: Dengue shock syndrome; hMPV: Human metapneumovirus; RSV: Respiratory syncytial virus.

Table 2 Public health strategies and recommendations

Strategy	Recommendation
Enhanced surveillance systems	Focus on high-risk groups for better identification and control of co-infections
Targeted vaccination campaigns	Develop vaccines considering common co-infecting viruses, especially for high-risk groups
Multiplex PCR testing implementation	Implement in clinical settings for simultaneous diagnosis of multiple respiratory viruses
Education on infection control measures	Increase awareness among public and healthcare workers regarding transmission risks
Development of broad-spectrum antivirals	Encourage R&D for antivirals effective against multiple viruses to address co-infections

R&D: Research and Development.