The burden of influenza and other respiratory viruses in hospitalized infants and children in a university hospital, Jordan

The burden of influenza and other respiratory viruses in hospitalized infants and children in a university hospital, Jordan

Authors

Keywords:

Influenza, Jordan, acute lower respiratory infections, pediatrics, RT-PCR

Abstract

Background: Acute lower respiratory infection (ALRI) is a major cause of morbidity and mortality worldwide in young children and is predominately caused by viral respiratory pathogens. This study aims to identify the viral etiologies of acute ALRI in hospitalized children in Jordan University Hospital and compare the clinical characteristics of influenza virus infection with other respiratory viruses.
Methods: a retrospective viral surveillance study that included 152 children below 15 years of age admitted with ALRI from December 2018  through April 2019. We recorded results of real-time reverse transcriptase-polymerase chain reaction (RT- PCR ) for common respiratory viruses. Clinical and demographic information of the study population was collected from patients’ electronic medical records.
Results: 152 were identified with a median age of 1 year (mean was 2.1 years). Ninety-five patients (62.5%) were males. One or more viral respiratory pathogens were detected in 145 (95.3%) children. Respiratory syncytial virus was the most commonly detected virus in 68 patients (44.8%). Influenza virus was detected in 25 (16.4%). Children with influenza infection had more fever and less leukocyte count compared to children infected with other viruses. The severity of the ALRI correlated significantly with several factors, including age less than 6 months and the presence of neuromuscular disease (p<0.05).
Conclusion: Viral detection was common among children admitted with viral ALRI. Viruses, including influenza, are recognized as major contributors to the morbidity associated with ALRI. More attention is needed on strategies for the prevention and detection of viral ALRI in developing countries.

References

Fischer Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet 2013;381:1405-16.

Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis 2002;2:25-32.

Glezen P, Denny FW. Epidemiology of acute lower respiratory disease in children. N Engl J Med 1973;288:498-505.

Pavia AT. Viral infections of the lower respiratory tract: Old viruses, new viruses, and the role of diagnosis. Clin Infect Dis 2011;52:S284-9.

Shay DK, Holman RC, Roosevelt GE, Clarke MJ, Anderson LJ. Bronchiolitis-associated mortality and estimates of respiratory syncytial virus-associated deaths among US children, 1979-1997. J Infect Dis 2001;183:16-22.

Alharbi S, Van Caeseele P, Consunji-Araneta R, Zoubeidi T, Fanella S, Souid A-K, Alsuwaid AR. Epidemiology of severe pediatric adenovirus lower respiratory tract infections in Manitoba, Canada, 1991-2005. BMC Infect Dis 2012;12:55.

Calvo C, García-García ML, Blanco C, Pozo F, Casas Flecha I, Pérez-Breña P. Role of rhinovirus in hospitalized infants with respiratory tract infections in Spain. Pediatr Infect Dis J 2007;26:904-8.

Henrickson KJ, Kuhn SM, Savatski LL. Epidemiology and cost of infection with human parainfluenza virus types 1 and 2 in young children. Clin Infect Dis 1994;18:770-9.

World Health Organization. Influenza transmission zones 2018. Available from: https://www.who.int/influenza/surveillance_monitoring/updates/Influenza_Transmission_Zones20180914.pdf

World Life Expectancy [Internet]. Influenza and pneumonia in Jordan. Available from: https://www.worldlifeexpectancy.com/jordan-influenza-pneumonia

World Health Organization. Influenza (Seasonal). Available from: https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)

Centers for Disease Control and Prevention [Internet]. Weekly U.S. Influenza Surveillance Report. Available from: https://www.cdc.gov/flu/weekly/index.htm

Centers for Disease Control and Prevention [Internet]. Influenza-associated pediatric mortality. Available from: https://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html

Bender JM, Ampofo K, Gesteland P, Sheng X, Korgenski K, Raines B, et al. Influenza virus infection in infants less than three months of age. Pediatr Infect Dis J 2010;29:6-9.

World Health Organization. Influenza vaccines. Available from: https://www.who.int/wer/2005/wer8033.pdf?ua=1

Garten R, Blanton L, Abd Elal AI, Alabi N, Barnes J, Biggerstaff M, et al. Update: Influenza activity in the United States during the 2016-17 season and composition of the 2017-18 influenza vaccine. MMWR Morb Mortal Wkly Rep 2018;67:634-42.

Horton KC, Dueger EL, Kandeel A, Abdallat M, El-Kholy A, Al-Awaidy S, 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:e0180954.

Abusrewil S, Algeer A, Aljifri A, Al Slail F, Andrew MK, Awad Tag Eldin M, et al. Influenza surveillance in Middle East, North, East and South Africa: Report of the 8th MENA Influenza Stakeholders Network. Influenza Other Respir Viruses 2019;13:298-304.

Al-Abdallat M, Dawson P, Jeries Haddadin A, El-Shoubary W, Dueger E, Al-Sanouri T, et al. Influenza hospitalization epidemiology from a severe acute respiratory infection surveillance system in Jordan, January 2008-February 2014. Influenza Other Respir Viruses 2016;10:91-7.

Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, 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;53:617-30.

World Health Organization. Eleventh revision of the International Classification of Diseases. 2019. Available from: https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_29-en.pdf

Naeim F, Rao N, Song AX, Grody WW. Atlas of hematopathology: morphology, immunophenotype, cytogenetics, and molecular approaches. Amsterdam: Elsevier; 2013.

Uyeki TM, Bernstein HH, Bradley JS, Englund JA, File TM, Fry AM, et al. Clinical practice guidelines by the Infectious Diseases Society of America: 2018 Update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clin Infect Dis 2019;68:e1-e47.

Awad S, Khader Y, Mansi M, Yusef D, Alawadin S, Qudah W, Khasawneh R. Viral surveillance of children with acute respiratory infection in two main hospitals in northern Jordan, Irbid, during winter of 2016. J Pediatr Infect Dis 2020;15:1-10.

Khuri-Bulos N, Lawrence L, Piya B, Wang L, Fonnesbeck C, Faouri S, et al. Severe outcomes associated with respiratory viruses in newborns and infants: A prospective viral surveillance study in Jordan. BMJ Open 2018;8:e021898.

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;17:139.

Farrag MA, Hamed ME, Amer HM, Almajhdi FN. Epidemiology of respiratory viruses in Saudi Arabia: toward a complete picture, Arch Virol 2019;164:1981-96.

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;84:1323-9.

Al-Ayed MS, Asaad AM, Qureshi MA, Ameen MS. Viral etiology of respiratory infections in children in southwestern Saudi Arabia using multiplex reverse-transcriptase polymerase chain reaction Saudi Med J 2014;35:1348-53.

Pickles RJ, DeVincenzo JP. Respiratory syncytial virus (RSV) and its propensity for causing bronchiolitis. J Pathol 2015;235:266-76.

Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, Staat MA, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med 2009;360:588-98.

Smith DK, Seales S, Budzik C. Respiratory syncytial virus bronchiolitis in children. Am Fam Physician 2017;95:94-9.

Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, 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;375:1545-55.

Oosterheert JJ, van Loon AM, Schuurman R, Hoepelman AIM, Hak E, Thijsen S, et al. Impact of rapid detection of viral and atypical bacterial pathogens by real-time polymerase chain reaction for patients with lower respiratory tract infection. Clin Infect Dis 2005;41:1438-44.

Centers for Disease Control and Prevention [Internet]. Cold versus flu. Available from: https://www.cdc.gov/flu/symptoms/coldflu.htm

Monto AS, Gravenstein S, Elliott M, Colopy M, Schweinle J. Clinical signs and symptoms predicting influenza infection. Arch Inter Med 2000;160:3243-47.

Merekoulias G, Alexopoulos EC, Belezos T, Panagiotopoulou E, Jelastopulu E. Lymphocyte to monocyte ratio as a screening tool for influenza. PLoS Curr 2010;2:RRN1154.

Cunha B, Pherez F, Schoch P. Diagnostic importance of relative lymphopenia as a marker of swine influenza (H1N1) in adults. Clin Infect Dis 2009;49:1454-6.

Izurieta HS, Thompson WW, Kramarz P, Shay DK, Davis RL, DeStefano F, et al. Influenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl J Med 2000;342:232-9.

Mistry RD, Fischer JB, Prasad PA, Coffin SE, Alpern ER. Severe complications in influenza-like illnesses. Pediatrics 2014;134:e684-90.

Plesca DA, Cora F, Buzoianu E, Moiceanu M, Hurduc V. Risk factors for severe bronchiolitis - A retrospective study. Eur Respir J 2012;40:P4660.

Praznik A, Vinšek N, Prodan A, Erčulj V, Pokorn M, Mrvič T, Paro D, et al. Risk factors for bronchiolitis severity: A retrospective review of patients admitted to the university hospital from central region of Slovenia. Influenza Other Respir Viruses 2018;12:765-71.

Lanari M, Prinelli F, Adorni F, Di Santo S, Vandini S, Silvestri M, Musicco M. Risk factors for bronchiolitis hospitalization during the first year of life in a multicenter Italian birth cohort. Ital J Pediatr 2015;41:40.

Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med 2008;121: 219-25.

Menéndez R, Cremades MJ, Martínez-Moragón E, Soler JJ, Reyes S, Perpiña M. Duration of length of stay in pneumonia: Influence of clinical factors and hospital type. Eur Respir J 2003;22:643-8.

Youssef HA, Nasseh S, Hafiz HA, Gawesh A. Evaluation of diagnostic and prognostic value of high sensitivity C reactive protein (Hs-CRP) in community acquired pneumonia. Egypt J Chest Dis Tuberc 2013;6:301-4.

McClain L, Hall M, Shah SS, Tieder JS, Myers AL, Auger K, et al. Admission chest radiographs predict illness severity for children hospitalized with pneumonia. J Hosp Med 2014;9:559-64.

Reynolds JH, McDonald G, Alton H, Gordon SB. Pneumonia in the immunocompetent patient. Br J Radiol 2010;83:998-1009.

Coon ER, Young PC, Quinonez RA, Morgan DJ, Dhruva SS, Schroeder AR. Update on pediatric overuse. Pediatrics 2017;139:e20162797.

v. Houten CB, Cohen A, Engelhard D, Hays JP, Karlsson R, Moore E. Antibiotic misuse in respiratory tract infections in children. Eur J Clin Microbiol Infect Dis 2019;38:505-14.

Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax 2011;66:ii1-23.

Guo W, Wang J, Sheng M, Zhou M, Fang L. Radiological findings in 210 paediatric patients with viral pneumonia: a retrospective case study. Br J Radiol 2012;85:1385-9.

Bux S, Mohd Ramli N, Ahmad Sarji S, Kamarulzaman A. Chest imaging features of patients afflicted with influenza A (H1N1) in a Malaysian tertiary referral centre. Biomed Imaging Interv J 2010;6:e35.

Shaw KN, Bell LM, Sherman NH. Outpatient assessment of infants with bronchiolitis. Am J Dis Child 1991;145:151-5.

Cawcutt K, Kalil AC. Pneumonia with bacterial and viral coinfection. Curr Opin Crit Care 2017;23:385-90.

Burk M, El-Kersh K, Saad M, Wiemken T, Ramirez J, Cavallazzi R. Viral infection in community-acquired pneumonia: a systematic review and meta-analysis. Eur Respir Rev 2016;25:178-88.

van Gageldonk-Lafeber AB, Wever BC, van der Lubben IM, de Jager CPC, Meijer A, de Vries MC, et al. The aetiology of community-acquired pneumonia and implications for patient management. Neth J Med 2013;71:418-25.

Tran DN, Trinh QD, Pham NTK, Vu MP, Ha MT, Nguyen TQN, et al. Clinical and epidemiological characteristics of acute respiratoryvirus infections in Vietnamese children. Epidemiol Infect 2016;144:527-36.

DiFranza JR, Masaquel A, Barrett AM, Colosia AD, Mahadevia PJ. Systematic literature review assessing tobacco smoke exposure as a risk factor for serious respiratory syncytial virus disease among infants and young children. BMC Pediatr 2012;12:81.

Aujard Y, Fauroux B. Risk factors for severe respiratory syncytial virus infection in infants. Respir Med 2002;96:S9-14.

Downloads

Published

11-11-2021

Issue

Section

Original Research Articles

How to Cite

“The Burden of Influenza and Other Respiratory Viruses in Hospitalized Infants and Children in a University Hospital, Jordan ”. 2021. Multidisciplinary Respiratory Medicine 16 (November). https://doi.org/10.4081/mrm.2021.763.