Severe outcomes associated with respiratory viruses in newborns and infants: a prospective viral surveillance study in Jordan

Abstract

ObjectiveTo assess virus-specific hospitalisation rates, risk factors for illness severity and seasonal trends in children hospitalised with acute respiratory infections (ARI).DesignProspective cohort study.SettingA government hospital serving low-income and middle-income population in Amman, Jordan.ParticipantsChildren under 2 years of age hospitalised with fever and/or respiratory symptoms (n=3168) from 16 March 2010 to 31 March 2013. Children with chemotherapy-associated neutropenia and newborns who had never been discharged after birth were excluded from the study.Outcome measuresHospitalisation rates and markers of illness severity: admission to intensive care unit (ICU), mechanical ventilation (MV), oxygen therapy, length of stay (LOS) and death.ResultsOf the 3168 subjects, 2581 (82%) had at least one respiratory virus detected, with respiratory syncytial virus (RSV) being the most predominant pathogen isolated. During admission, 1013 (32%) received oxygen therapy, 284 (9%) were admitted to ICU, 111 (4%) were placed on MV and 31 (1%) children died. Oxygen therapy was higher in RSV-only subjects compared with human rhinovirus-only (42%vs29%, p<0.001), adenovirus-only (42%vs21%, p<0.001) and human parainfluenza virus-only (42%vs23%, p<0.001) subjects. The presence of an underlying medical condition was associated with oxygen therapy (adjusted OR (aOR) 1.95, 95% CI 1.49 to 2.56), ICU admission (aOR 2.51, 95% CI 1.71 to 3.68), MV (aOR 1.91, 95% CI 1.11 to 3.28) and longer LOS (aOR1.71, 95% CI 1.37 to 2.13). Similarly, younger age was associated with oxygen therapy (0.23, 95% CI 0.17 to 0.31), ICU admission (aOR 0.47, 95% CI 0.30 to 0.74), MV (0.28, 95% CI 0.15 to 0.53) and longer LOS (aOR 0.47, 95% CI 0.38 to 0.59). Pneumonia was strongly associated with longer LOS (aOR 2.07, 95% CI 1.65 to 2.60), oxygen therapy (aOR 2.94, 95% CI 2.22 to 3.89), ICU admission (aOR 3.12, 95% CI 2.16 to 4.50) and MV (aOR 3.33, 95% CI 1.85 to 6.00). Virus-specific hospitalisation rates ranged from 0.5 to 10.5 per 1000 children.ConclusionRespiratory viruses are associated with severe illness in Jordanian children hospitalised with ARI. Prevention strategies such as extended breast feeding, increased access to palivizumab and RSV vaccine development could help decrease hospitalisation rates and illness severity, particularly in young children with underlying medical conditions.

Clinical characteristics, predictors, and performance of case definition—Interim results from the WHO global respiratory syncytial virus surveillance pilot

“…25 Apnea, though it lacked sensitivity, was a significant clinical predictor for severe RSV infection requiring hospitalization in infants <6 months. 22,[26][27][28] The reason for sepsis to be significantly less common amongst RSV-positive hospitalized young infants in this study in contrast to other studies 29,30 is unclear.…”

Viral and Atypical Pathogens Epidemiology of a Large Cohort of Patients with Acute Respiratory Tract Infections in Shaanxi Province, Northwest China

“…19 Although viral infection is the dominant cause of ARIs, the proportion of infections with atypical pathogens is increasing due to the abuse of antibiotics and the development of detection technology. [9][10][11] At present, several studies on the epidemiology and etiology of respiratory pathogens of children in different areas have been reported, 7,16,[20][21][22][23] The result of this study shows that the top three most prevalent pathogens were MP (18.12%, 2816/5597),Flu B (11.65%, 1811/5597) and CP (7.00%, 1088/5597). The total positive detection rate is 36.01% (5597/15443) in Xi'an, which was similar with the previous study in Turkey (33.4 ) and Shandong province in China (35.75 ), 12,18 and signi cantly higher than that reported in Beijing (5.64%), Shenzhen (14.55%), Suzhou (13.6%) and Gansu province in China (29.2%), [13][14][15][16] but lower than that reported in north China (39.3%).…”

Role of Respiratory Syncytial Virus in Pediatric Pneumonia

“…Nascimento and colleagues reported a lower incidence (approximately 15% for RSV-A and 12% for RSV-B) of RSV cases in patients with community-acquired pneumoniae (CAP), which was not as severe as hospitalization [ 57 ]. Additionally, the Khuri-Bulos group detected >95% viral infections during the winter period in their studied population, with a predominance of RSV, mainly in younger patients (approximately 20% in subjects younger than 6 months) and in those with pneumonia (approximately 35%) [ 58 ].…”

“…In general, signs and symptoms appear after a short incubation period, as for the majority of viruses, of approximately 4 days [ 78 ]. The already cited prospective viral surveillance study of Khuri-Bulos and colleagues reported a significantly lower presence of fever but a high probability of cough, shortness of breath, and flaring in patients with RSV infection [ 58 ]. It has been observed that RSV-A causes more severe illness than RSV-B; in fact, the two serotypes elicit a different response in terms of cytokine and neutrophil production [ 74 , 79 ].…”