Winter poses a recurrent challenge for healthcare systems worldwide because of seasonal surges in respiratory tract infections (RTIs). These infections disproportionately affect “vulnerable” subpopulations — namely the elderly, infants and children, pregnant women, immunocompromised persons, and those with chronic comorbidities.
In intensive care practice — including in a cosmopolitan city such as Dubai with a diverse population — the burden of severe RTIs becomes evident each winter. Pneumonia, acute respiratory distress syndrome, exacerbation of chronic diseases, and multi-organ complications frequently present in high-risk patients admitted to ICUs. Preventive strategies, both at individual and public health level, are therefore of paramount importance.
This article synthesizes recent updates in medical literature (2024–2025) on prevention of RTIs, explores practical challenges from ICU experience, and advocates for strengthened measures to protect high-risk groups, especially during winter.
A 2025 cross-disciplinary position paper from the United Arab Emirates specifically highlights that respiratory infections remain a major cause of mortality among young children and adults — particularly the elderly or those with underlying conditions — despite available vaccines and antiviral treatments.
According to guidelines from global health authorities, high-risk subpopulations are defined to include: children (especially infants), older adults, pregnant or postpartum women, immunocompromised individuals, and those with chronic diseases (e.g., cardiopulmonary, metabolic, renal).
For pregnant women, the stakes are even higher: a recent systematic review of human cases of avian influenza (A[H5]) during pregnancy reported maternal mortality as high as 90 %, and perinatal mortality (stillbirth/neonatal death) ~86.7 % among reported cases — underlining the extreme vulnerability of this population in the face of novel or zoonotic influenza viruses.
Moreover, infants and young children (<5 years) remain highly susceptible to viral lower RTIs: for example, Respiratory Syncytial Virus (RSV) induces a considerable global burden, with millions of hospitalizations and a high death toll in low- and middle-income countries.
Therefore, preventive measures must be prioritized — especially among these high-risk groups — to reduce both direct morbidity/mortality and downstream burdens on intensive care resources
| Group | Reasons for Increased Risk | Clinical Impact |
| Pregnant women | Immunological shifts, reduced lung capacity | Severe pneumonia, preterm birth, fetal compromise |
| Infants & young children | Immature immune system | RSV bronchiolitis, viral pneumonia |
| Elderly | Immunosenescence, comorbidities | High hospitalization & mortality rates |
| Immunocompromised | Reduced viral clearance | Prolonged infections, severe disease |
| Chronic disease patients | Reduced physiological reserve | Exacerbations of COPD, asthma, CHF |
Recent literature underscores the critical role of vaccination against major respiratory viruses. A narrative review published December 2024 demonstrated that immunization against SARS-CoV-2, influenza, and RSV significantly reduces severe disease, hospitalizations, and mortality among vulnerable individuals — including older adults and those with frailty or comorbidities.
For pregnant women, the guidance recently updated by the American College of Obstetricians and Gynecologists (ACOG) emphasizes that COVID-19 vaccination (including booster doses) is safe during pregnancy, and beneficial both for the mother and the newborn. Vaccination reduces maternal complications, preterm birth, stillbirth, and provides passive immunity to infants during early life.
Moreover, maternal immunization has demonstrated effectiveness in reducing neonatal and infant morbidity and mortality from respiratory viral infections. A 2025 review from India found that maternal immunization (e.g., influenza) substantially lowered deaths and severe outcomes in newborns — a critical consideration for countries with diverse perinatal populations.
In addition to influenza and COVID-19 vaccines, emerging preventive options for RSV are gaining traction; current evidence supports passive immunization in early infancy (e.g., monoclonal antibodies), and active immunization strategies are under development.
Finally, there may be indirect benefits from vaccines targeting bacterial pathogens: a systematic review showed that pneumococcal conjugate vaccines (PCVs) may reduce the incidence of viral RTIs by disrupting viral-bacterial interactions in the respiratory tract.
Given this, comprehensive immunization strategies — integrating influenza, COVID-19, RSV (as vaccines/antibodies become available), and pneumococcus — should form a central pillar of prevention, especially for high-risk individuals.
Vaccination alone is not sufficient. According to guidance from the World Health Organization (WHO) Europe region, standard measures remain vital: staying home when ill, rigorous hand hygiene, cough etiquette, ensuring adequate indoor ventilation, and, in high-risk settings or crowded indoor spaces, mask-wearing and physical distancing when appropriate.
In healthcare settings — especially ICUs or wards managing severe RTIs — timely identification and triage, isolation or cohorting of suspected cases, use of droplet/contact (and when indicated, airborne) precautions during aerosol-generating procedures, and rapid initiation of antivirals (e.g., for influenza) are essential.
Also, the 2025 UAE position paper called for improved communication between healthcare professionals and patients to close gaps in vaccine uptake and adherence to prevention guidelines.
Based on the convergence of recent evidence and practical ICU experience, I propose the following prioritized actions:
| Level | Measure | Evidence & Impact |
| Individual | Annual influenza vaccine | Reduces severe disease & ICU admissions |
| COVID-19 vaccine/booster | Reduces hospitalization & maternal-fetal risks | |
| Maternal vaccines (influenza, COVID-19, RSV) | Protects mothers + newborns | |
| Household | Staying home when ill | WHO recommends as first-line prevention |
| Good ventilation & hygiene | Reduces viral concentration indoors | |
| Masking when symptomatic | Particularly important for protecting infants | |
| Healthcare system | Early testing & antiviral use | Reduces complications if started early |
| Isolation/cohorting | Limits nosocomial transmission | |
| Public health communication | Enhances vaccine uptake (UAE 2025 position paper) | |
| Community | Surveillance & seasonal alerts | Supports early preparedness |
Failure to implement preventive measures results not only in increased morbidity and mortality among vulnerable individuals, but also in broader health system strain. When ICUs are saturated with severe pneumonia cases, other critical care needs (e.g., trauma, surgery, non-respiratory emergencies) may be compromised.
Moreover, viral RTIs in high-risk populations — especially infants and the elderly — can lead to long-term sequelae (e.g., chronic lung disease, developmental issues in children, exacerbation of comorbidities in older adults). Preventive measures, therefore, contribute to healthier ageing and reduced long-term healthcare burden.
Finally, prevention — especially through vaccination — has societal and economic value: reduced hospitalizations, fewer workdays lost, lower risk of outbreaks in communities, and preservation of healthcare resources.
Seasonal surges in respiratory tract infections during winter remain a formidable challenge — particularly for high-risk groups such as pregnant women, children, and the elderly. Recent evidence (2024–2025) reaffirms that vaccination (influenza, COVID-19, and eventually RSV) combined with non-pharmaceutical measures are the most effective way to protect these vulnerable populations.
A coordinated approach — integrating public health outreach, perinatal care, community education, and healthcare system preparedness — is essential.
In the coming seasons, given the ever-present threat of viral evolution (including influenza and zoonotic viruses), robust prevention strategies are not optional — they are lifesaving.
Dr. Mahmoud Medhat Aboumousa
Critical Care Specialist
International Modern Hospital Dubai
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