Author: Adams, Laura E ; Rivera-Amill, Vanessa ; Wong, Joshua M ; Yang, Yang ; Pasarell, Jorge Bertrán ; Madewell, Zachary J ; Paz-Bailey, Gabriela ; Sainz de la Peña, Diego ; Thayer, Maile B

BACKGROUNDUnderstanding virus-virus interactions is important for evaluating disease transmission and severity. Positive interactions suggest concurrent circulation, while negative interactions indicate reduced transmission of one virus when another is prevalent. This study examines interactions among seven respiratory viruses using a Bayesian approach that accounts for seasonality and long-term trends.METHODSWe analyzed data from 43,385 acute febrile illness cases in the Sentinel Enhanced Dengue Surveillance System in Puerto Rico (2013-2023). Viruses studied included influenza A (IAV), influenza B (IBV), respiratory syncytial virus (RSV), human parainfluenza viruses 1 and 3 (HPIV-1, HPIV-3), human adenovirus (HAdV), and human metapneumovirus (HMPV). Wavelet coherence analysis investigated synchronous or asynchronous viral co-variation, while a Bayesian hierarchical model estimated pairwise interactions.RESULTSAmong 43,385 participants, 26.0% tested positive for at least one virus, with IAV (9.5%), HAdV (4.1%), RSV (3.6%), and IBV (3.6%) being most frequent. Coinfections occurred in 0.5% of cases, often involving HAdV. Wavelet coherence identified significant synchronization among RSV/HMPV, HPIV-1/HMPV, and other virus pairs, with minimal coherence during the COVID-19 pandemic. Bayesian modeling suggested five virus-virus associations: four positive (RSV/HPIV-3, HMPV/HPIV-1, IBV/HAdV, IBV/HMPV) and one negative (IAV/HAdV). However, when restricting the analysis to the prepandemic period, fewer associations remained statistically credible.CONCLUSIONRespiratory viruses in Puerto Rico demonstrate patterns of co-circulation that may reflect complex interactions, but these associations appear context-dependent. Findings highlight the need for continued surveillance to better understand virus-virus dynamics and their implications for public health interventions.

27 Mar 2025·Open Forum Infectious Diseases

A Randomized Phase 1 Clinical Trial of a Respiratory Syncytial Virus and Human Metapneumovirus Combination Protein-Based Virus-like Particle Vaccine in Adults 60–75 Years of Age

Article

Author: Shapiro, Craig ; Rida, Wasima ; Kanesa-thasan, Niranjan ; Engram, April E ; Price, Jennifer ; Sánchez-Crespo, Nelia ; Ciarlet, Max ; Wen, Judy ; Hourguettes, Nicholas ; Adams, Elizabeth M

AbstractBackgroundRespiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are important causes of severe lower respiratory tract disease (LRTD) in adults ≥65 years of age. We report safety and immunogenicity for IVX-A12, a combination, protein-based virus-like particle (VLP) vaccine against RSV- and hMPV-associated LRTD.MethodsThis phase 1 trial (NCT05664334) randomized healthy adults 60–75 years of age to receive 1 intramuscular dose of IVX-A12 at low (75 µg RSV/75 µg hMPV), medium (75 µg RSV/150 µg hMPV), or high dose levels (75 µg RSV/225 µg hMPV) ± oil-in-water adjuvant MF59® (low and medium dose levels only), or placebo. Safety and immunogenicity were assessed through day 365 postvaccination.ResultsOverall, 140 participants received IVX-A12 (n = 117) or placebo (n = 23). Solicited adverse reactions (ARs) were transient, with mild to moderate severity; ARs were reported by 47.0% (n = 55/117) and 34.8% (n = 8/23) of IVX-A12 and placebo recipients, respectively. There were no vaccine-related serious adverse events. All IVX-A12 dose levels and formulations boosted preexisting RSV- and hMPV-specific neutralizing antibody (nAb) responses; from baseline to day 28, nAb titers against RSV A or B increased up to 4- or 3-fold, and nAb titers against hMPV A or B increased up to 5- or 4-fold, respectively. Neutralizing responses in IVX-A12 recipients through day 365 were maintained above or around baseline and exceeded those in placebo recipients.ConclusionsIVX-A12 was well-tolerated and elicited RSV- and hMPV-specific antibody responses in adults 60–75 years of age. These data support the ongoing clinical development of the RSV/hMPV combination VLP vaccine IVX-A12.

14 Feb 2025·ACS ES&T Water

Respiratory Virus Season Surveillance in the United States Using Wastewater Metrics, 2023–2024

Article

Author: Chan, Elana M. G. ; Boehm, Alexandria B.

Wastewater measurements represent an entire contributing population and can be available within 24 h. Enhanced information about disease occurrence can improve population health through better timing of policies and interventions. We aimed to infer seasonal occurrence patterns for common respiratory viruses alongside transmission dynamics for SARS-CoV-2 across the USA using wastewater samples. We used wastewater RNA concentrations of influenza A and B (IAV/IBV), respiratory syncytial virus (RSV), human metapneumovirus (HMPV), and SARS-CoV-2 from 175 treatment plants (July 2023-June 2024). For IAV, IBV, RSV, and HMPV, we determined epidemic onset, offset, peak, and duration at national and subnational scales. For SARS-CoV-2, we categorized wastewater measurements based on recent wastewater levels and trends. Epidemic onset occurred in November for IAV and RSV which aligned with prepandemic norms. Onset occurred in January for IBV and April for HMPV which were later than expected according to historical data. Duration was longer for IAV and shorter for IBV, RSV, and HMPV than expected based on historical data. Epidemic peak dates were consistent with prepandemic norms for all viruses. Peak dates for influenza and RSV coincided with high, upward trending SARS-CoV-2 RNA concentrations, suggesting potential co-occurrence of SARS-CoV-2 with these viruses.

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Indication	Highest Phase	Country/Location	Organization	Date
Metapneumovirus infection	Preclinical	China	Innorna Co. Ltd	06 May 2024

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