Viral Surveillance of Children with Acute Respiratory Infection in Two Main Hospitals in Northern Jordan, Irbid, during Winter of 2016

Samah Awad; Yousef Khader; Moa'th Mansi; Dawood Yusef; Salah Alawadin; Walaa Qudah; Ruba Khasawneh

doi:10.1055/s-0039-1692972

Journal of Pediatric Infectious Diseases, Table of Contents

J Pediatr Infect Dis 2020; 15(01): 001-010
DOI: 10.1055/s-0039-1692972

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Viral Surveillance of Children with Acute Respiratory Infection in Two Main Hospitals in Northern Jordan, Irbid, during Winter of 2016

Authors

Samah Awad

¹Department of Pediatrics and Neonatology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
Yousef Khader

²Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
Moa'th Mansi

¹Department of Pediatrics and Neonatology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
Dawood Yusef

¹Department of Pediatrics and Neonatology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
Salah Alawadin

¹Department of Pediatrics and Neonatology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
Walaa Qudah

¹Department of Pediatrics and Neonatology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
Ruba Khasawneh

³Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan

Abstract

Acute lower respiratory infection (ALRI) is a major cause of morbidity and mortality worldwide. Data regarding the etiology of acute respiratory infection (ARI) is scarce in developing countries. The aim of this study was to identify the viral etiology of ARI/ALRI in hospitalized children and factors associated with increased length of stay (LoS) and severe disease presentation in Northern Jordan. This was a prospective viral surveillance study using real-time reverse transcriptase-polymerase chain reaction in children younger than 5 years admitted with ARI to two main hospitals in Northern Jordan during the winter of 2016. Nasopharyngeal swabs were obtained and tested for respiratory syncytial virus (RSV) and other viruses. Demographic and clinical characteristics of RSV-positive patients were compared with those of RSV-negative patients. There were 479 patients hospitalized with ARI. Their mean age (standard deviation) was 10.4 (11.6) months. 53.9% tested positive for at least one virus, with RSV being the most commonly detected virus (34%). Compared with RSV-negative patients, RSV-positive patients were younger, more likely to have chronic lung disease, and more likely to present with cough, rhinorrhea, difficulty in breathing, retraction, flaring, grunting, wheezing, and a higher respiratory rate. Prematurity, presence of a chronic illness, oxygen saturation < 90%, and atelectasis and consolidation on chest X-rays were significantly associated with an increased mean LoS. Patients with a history of prematurity had higher risk of severe disease (odds ratio = 2.6; 95% confidence interval: 1.5, 4.7; p = 0.001). Compared with patients 6 months old and younger, patients aged 6.1 to 12 months were less likely to have severe disease. Human metapneumovirus (HMPV)-positive ALRI was associated with increased odds of severe disease. Viruses are recognized as etiological agent of ARI/ALRI-associated morbidity in developing countries that need more attention and implementation of targeted strategies for prevention and detection. HMPV can be a cause of severe ALRI.

Keywords

acute respiratory infection - children - Jordan - respiratory syncytial virus - RT-PCR

Full Text

References

References
1 Walker CLF, Rudan I, Liu L. , et al. Global burden of childhood pneumonia and diarrhoea. Lancet 2013; 381 (9875): 1405-1416
2 Nair H, Nokes DJ, Gessner BD. , et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 2010; 375 (9725): 1545-1555
3 Hall CB, Weinberg GA, Iwane MK. , et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med 2009; 360 (06) 588-598
4 Shi T, McAllister DA, O'Brien KL. , et al; RSV Global Epidemiology Network. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet 2017; 390 (10098): 946-958
5 Shi T, McLean K, Campbell H, Nair H. Aetiological role of common respiratory viruses in acute lower respiratory infections in children under five years: a systematic review and meta-analysis. J Glob Health 2015; 5 (01) 010408
6 Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet 2011; 377 (9773): 1264-1275
7 Horton KC, Dueger EL, Kandeel A. , et al. Viral etiology, seasonality and severity of hospitalized patients with severe acute respiratory infections in the Eastern Mediterranean Region, 2007-2014. PLoS One 2017; 12 (07) e0180954
8 Nokes DJ, Cane P. Respiratory Syncytial Virus Disease Burden in the Developing World. In: Perspectives in Medical Virology: Respiratory Syncytial Virus. 14th ed. Elsevier; 2007: 183-230
9 Peltola V, Ruuskanen O. Editorial commentary: respiratory viral infections in developing countries: common, severe, and unrecognized. Clin Infect Dis 2008; 46 (01) 58-60
10 Haynes AK, Manangan AP, Iwane MK. , et al. Respiratory syncytial virus circulation in seven countries with Global Disease Detection Regional Centers. J Infect Dis 2013; 208 (Suppl. 03) S246-S254
11 American Academy of Pediatrics Committee on Infectious Diseases; American Academy of Pediatrics Bronchiolitis Guidelines Committee. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics 2014; 134 (02) e620-e638
12 Modjarrad K, Giersing B, Kaslow DC, Smith PG, Moorthy VS. ; WHO RSV Vaccine Consultation Expert Group. WHO consultation on Respiratory Syncytial Virus Vaccine Development Report from a World Health Organization Meeting held on 23-24 March 2015. Vaccine 2016; 34 (02) 190-197
13 Henrickson KJ, Hall CB. Diagnostic assays for respiratory syncytial virus disease. Pediatr Infect Dis J 2007; 26 (11, Suppl): S36-S40
14 Khuri-Bulos N, Williams JV, Shehabi AA. , et al. Burden of respiratory syncytial virus in hospitalized infants and young children in Amman, Jordan. Scand J Infect Dis 2010; 42 (05) 368-374
15 Kaplan NM, Dove W, Abd-Eldayem SA, Abu-Zeid AF, Shamoon HE, Hart CA. Molecular epidemiology and disease severity of respiratory syncytial virus in relation to other potential pathogens in children hospitalized with acute respiratory infection in Jordan. J Med Virol 2008; 80 (01) 168-174
16 Miller EK, Khuri-Bulos N, Williams JV. , et al. Human rhinovirus C associated with wheezing in hospitalised children in the Middle East. J Clin Virol 2009; 46 (01) 85-89
17 Ali SA, Williams JV, Chen Q. , et al. Human metapneumovirus in hospitalized children in Amman, Jordan. J Med Virol 2010; 82 (06) 1012-1016
18 Halasa N, Williams J, Faouri S. , et al. Natural history and epidemiology of respiratory syncytial virus infection in the Middle East: hospital surveillance for children under age two in Jordan. Vaccine 2015; 33 (47) 6479-6487
19 Bradley JS, Byington CL, Shah SS. , et al. Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011;53(7):617–630
20 AmpliSens® ARVI-screen-FRT. AmpliSens ARVI-screen-FRT PCR kit Instruction Manual. Available at: http://www.interlabservice.ru/upload/iblock/de8/ARVI-screen-FRT (R-V57–100-F(RG,iQ,Dt)-CE)_270617.pdf . Accessed August 31, 2017
21 Preterm birth. Available at: https://www.who.int/news-room/fact-sheets/detail/preterm-birth . Accessed March 5, 2019
22 Organization WH. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. 2nd ed. World Health Organization; 2004 Low Birth Weight. Available at: https://www.who.int/classifications/icd/en/ . Accessed March 5, 2019
23 Janahi I, Abdulkayoum A, Almeshwesh F, Alkuwari M, Al Hammadi A, Alameri M. Viral aetiology of bronchiolitis in hospitalised children in Qatar. BMC Infect Dis 2017; 17 (01) 139
24 Amer HM, Alshaman MS, Farrag MA, Hamad ME, Alsaadi MM, Almajhdi FN. Epidemiology of 11 respiratory RNA viruses in a cohort of hospitalized children in Riyadh, Saudi Arabia. J Med Virol 2016; 88 (06) 1086-1091
25 Khamis FA, Al-Kobaisi MF, Al-Areimi WS, Al-Kindi H, Al-Zakwani I. Epidemiology of respiratory virus infections among infants and young children admitted to hospital in Oman. J Med Virol 2012; 84 (08) 1323-1329
26 Toivonen L, Schuez-Havupalo L, Karppinen S. , et al. Rhinovirus infections in the first 2 years of life. Pediatrics 2016; 138 (03) e20161309-e20161309
27 Schuster JE, Khuri-Bulos N, Faouri S. , et al. Human metapneumovirus infection in Jordanian children: epidemiology and risk factors for severe disease. Pediatr Infect Dis J 2015; 34 (12) 1335-1341
28 Edwards KM, Zhu Y, Griffin MR. , et al; New Vaccine Surveillance Network. Burden of human metapneumovirus infection in young children. N Engl J Med 2013; 368 (07) 633-643
29 Martin ET, Kuypers J, Wald A, Englund JA. Multiple versus single virus respiratory infections: viral load and clinical disease severity in hospitalized children. Influenza Other Respir Viruses 2012; 6 (01) 71-77
30 Chorazy ML, Lebeck MG, McCarthy TA, Richter SS, Torner JC, Gray GC. Polymicrobial acute respiratory infections in a hospital-based pediatric population. Pediatr Infect Dis J 2013; 32 (05) 460-466
31 Hall CB, Weinberg GA, Blumkin AK. , et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics 2013; 132 (02) e341-e348
32 Fryzek JP, Martone WJ, Groothuis JR. Trends in chronologic age and infant respiratory syncytial virus hospitalization: an 8-year cohort study. Adv Ther 2011; 28 (03) 195-201
33 Stein RT, Bont LJ, Zar H. , et al. Respiratory syncytial virus hospitalization and mortality: systematic review and meta-analysis. Pediatr Pulmonol 2017; 52 (04) 556-569
34 Rossi GA, Medici MC, Arcangeletti MC. , et al; Osservatorio RSV Study Group. Risk factors for severe RSV-induced lower respiratory tract infection over four consecutive epidemics. Eur J Pediatr 2007; 166 (12) 1267-1272
35 von Linstow M-L, Høgh M, Nordbø SA, Eugen-Olsen J, Koch A, Høgh B. A community study of clinical traits and risk factors for human metapneumovirus and respiratory syncytial virus infection during the first year of life. Eur J Pediatr 2008; 167 (10) 1125-1133
36 Bradley JP, Bacharier LB, Bonfiglio J. , et al. Severity of respiratory syncytial virus bronchiolitis is affected by cigarette smoke exposure and atopy. Pediatrics 2005; 115 (01) e7-e14
37 Langley GF, Anderson LJ. Epidemiology and prevention of respiratory syncytial virus infections among infants and young children. Pediatr Infect Dis J 2011; 30 (06) 510-517
38 Greenough A, Cox S, Alexander J. , et al. Health care utilisation of infants with chronic lung disease, related to hospitalisation for RSV infection. Arch Dis Child 2001; 85 (06) 463-468
39 Liese JG, Grill E, Fischer B, Roeckl-Wiedmann I, Carr D, Belohradsky BH. ; Munich RSV Study Group. Incidence and risk factors of respiratory syncytial virus-related hospitalizations in premature infants in Germany. Eur J Pediatr 2003; 162 (04) 230-236
40 Meissner HC. Viral bronchiolitis in children. N Engl J Med 2016; 374 (18) 1793-1794
41 Shi T, Balsells E, Wastnedge E. , et al. Risk factors for respiratory syncytial virus associated with acute lower respiratory infection in children under five years: systematic review and meta-analysis. J Glob Health 2015; 5 (02) 020416
42 Ralston SL, Lieberthal AS, Meissner HC. , et al; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134 (05) e1474-e1502
43 Sommer C, Resch B, Simões EAF. Risk factors for severe respiratory syncytial virus lower respiratory tract infection. Open Microbiol J 2011; 5 (01) 144-154
44 Simoes EAF. Environmental and demographic risk factors for respiratory syncytial virus lower respiratory tract disease. J Pediatr 2003; 143 (5, Suppl): S118-S126
45 Stevens TP, Sinkin RA, Hall CB, Maniscalco WM, McConnochie KM. Respiratory syncytial virus and premature infants born at 32 weeks' gestation or earlier: hospitalization and economic implications of prophylaxis. Arch Pediatr Adolesc Med 2000; 154 (01) 55-61
46 Dornelles CTL, Piva JP, Marostica PJC. Nutritional status, breastfeeding, and evolution of infants with acute viral bronchiolitis. J Health Popul Nutr 2007; 25 (03) 336-343
47 Nishimura T, Suzue J, Kaji H. Breastfeeding reduces the severity of respiratory syncytial virus infection among young infants: a multi-center prospective study. Pediatr Int 2009; 51 (06) 812-816
48 Shaw KN, Bell LM, Sherman NH. Outpatient assessment of infants with bronchiolitis. Am J Dis Child 1991; 145 (02) 151-155
49 Al-Abdallat M, Dawson P, Haddadin AJ. , et al. Influenza hospitalization epidemiology from a severe acute respiratory infection surveillance system in Jordan, January 2008-February 2014. Influenza Other Respir Viruses 2016; 10 (02) 91-97