Public Health and Molecular Markers Importance of Respiratory Viruses

Edrees, Yaser and Munir, Muhammad and Unterholzner, Leonie (2026) Public Health and Molecular Markers Importance of Respiratory Viruses. PhD thesis, Lancaster University.

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Abstract

Acute respiratory infections are a leading cause of global morbidity and mortality, especially in children and older adults. Despite advances in care, respiratory viruses, including influenza, respiratory syncytial virus (RSV), and rhinovirus, continue to strain healthcare systems. Integrated research is needed to address viral burden, mechanisms, and practical diagnostics for clinical decision-making including healthcare facilities with limited resources. This thesis used three approaches. First, a systematic review and meta-analysis quantified the age-stratified burden of seven major respiratory viruses in Saudi Arabia. Second, in vitro transcriptomic profiling investigated host gene expression during single and dual viral infections with influenza and rhinovirus. Third, an outpatient cross-sectional study in Riyadh evaluated circulating viruses and assessed the diagnostic value of inflammatory biomarkers. The systematic review found RSV imposed a substantial pediatric burden, with pooled hospitalization and intensive care admission proportions among infected young children, though pooled mortality remained low. Influenza A and B also caused a significant clinical burden. Notably, rhinovirus was linked to severe outcomes, while evidence for other key viruses was sparse, highlighting critical surveillance gaps. Transcriptomic analysis revealed a key contrast in which single infections were primarily suppressive, while dual infections triggered robust gene activation, with infection order shaping outcomes consistent with viral interference. The outpatient study confirmed the seasonal circulation of multiple respiratory viruses and revealed distinct patterns of biomarkers associated with specific viral infections. These findings demonstrate the substantial healthcare burden of respiratory viruses in the region, highlight the biological complexity of dual infections, and establish that distinct inflammatory biomarker profiles warrant future investigation for their potential to aid in the early evaluation of respiratory infections. They provide public health stakeholders with valuable information to better guide surveillance, clinical preparedness, and efficient resources allocation. Future research should standardize healthcare burden assessment and validate functional gene- and biomarker-based diagnostic approaches.