Burden of respiratory syncytial virus in hospitalized infants and young children in Amman, Jordan

Abstract

Acute respiratory infections (ARI) play a major role in hospitalizations in the Middle East, but the specific viral causes are unknown. We conducted prospective viral surveillance in children <5 y of age admitted with ARI and/or fever at 2 dissimilar hospitals in Amman, Jordan during peak respiratory syncytial virus (RSV) season. We collected prospective clinical and demographic data and obtained nose/throat swabs for testing for RSV by real-time polymerase chain reaction (RT-PCR). We obtained clinical and laboratory data for 728/743 (98%) subjects enrolled. The children's median age was 4.3 months, 58.4% were males, 87% were breastfed, 4% attended day care, 67% were exposed to smokers, 7% were admitted to the intensive care unit, and 0.7% died (n = 5). Out of 728 subjects, 467 (64%) tested positive by RT-PCR for RSV. Comparing RSV-positive with RSV-negative subjects, the RSV-positive subjects had lower median age (3.6 vs 6.4 months, p < 0.001) and fewer males (55% vs 64%, p = 0.02). RSV-positive children had higher rates of oxygen use (72% vs 42%, p < 0.001), a longer hospital stay (5 vs 4 days, p = 0.001), and higher hospital charges (US$538 vs US$431, p < 0.001) than RSV-negative children. In young hospitalized Jordanian infants, the medical and financial burden of RSV was found to be high. Effective preventive measures, such as an RSV vaccine, would have a significant beneficial impact.

Acknowledgements

The authors would like to thank the children and families enrolled in the study, and Ms Manar Dweik and Ms Ghadeer Azizi for data collection and specimen processing. We would also like to thank Ms Amy Podsiad for her assistance with RT-PCR assays.

Funding sources: Support was received from the Vanderbilt-Meharry Global Health Framework Program for Global Health grant from the Fogarty International Center, National Institutes of Health (R25 TW007766), the Vanderbilt International Office, the Vanderbilt Institute for Global Health, and the Monroe Carell Jr. Children's Hospital at Vanderbilt.

Declaration of interest: Dr Williams has served as a consultant for MedImmune and Novartis. Dr Halasa receives grant support from MedImmune and she has served as a consultant for Novartis. Dr Ali receives grant support from MedImmune. Dr Vermund serves on a maraviroc data monitoring committee for Pfizer, Inc. Otherwise, the authors have no conflicts of interest to disclose.