Spectrum of viral infections and asymptomatic viral shedding in a cohort of Indian children with inborn errors of immunity

Inborn Errors of Immunity (IEI), result in heightened susceptibility to pathogens in general including viruses, yet data on viral burden and immune correlates in Indian paediatric population remain scarce. This study aimed to characterize the spectrum of viral infections in Indian children with IEI and evaluate the association between specific immune cell deficiencies and virus shedding, and the clinical outcomes. A cohort of 102 genetically confirmed IEI patients were systematically screened for viral infections. RT-PCR was performed on nasopharyngeal swabs, serum, and stool samples to detect active viral presence. Our findings revealed a strikingly high prevalence of viral infections (67%), predominantly involving Adenovirus (31%), Norovirus (24%), and Parvovirus B19 (21%) in the Indian cohort. Sixty three percent of the infected IEI patients were asymptomatic, among patients with intrinsic and innate immune defects as well as predominantly antibody deficiencies. Importantly, patients receiving intravenous immunoglobulin (IVIg) therapy were able to limit the viral shedding, suggesting a therapeutic benefit in mitigating viral burden. Our findings have relevance in terms of community transmission of viruses as well as infection control practices in IEI children in the hospital and can provide data that can inform the development of targeted surveillance systems, early diagnostic protocols, and effective treatment workflows.