title: Natural history and epidemiology of respiratory syncytial virus infection in the Middle East: Hospital surveillance for children under age two in Jordan.
abstract: Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and viral pneumonia in infants and young children worldwide. In the Middle East and Arab countries, the burden of RSV-associated hospitalizations is not well characterized. We sought to determine the burden and clinical/epidemiological characteristics of RSV hospitalization in young children in Amman, Jordan. We investigated risk factors for severity including vitamin D levels.
  
  
  METHODS
  We conducted viral surveillance with clinical and demographic data in children <2 years admitted with respiratory symptoms and/or fever at the Al-Bashir Government Hospital from March16, 2010 to March 31, 2013. Nasal/throat swabs were obtained and placed into lysis buffer, and frozen at -80°C until testing by real-time RT-PCR for 11 respiratory viruses. Heel stick blood or sera samples for 25-hydroxyvitamin D [25(OH)D] levels were obtained and sent to a central laboratory for mass spectrometry.
  
  
  RESULTS
  Of the 3168 children, >80% testing positive for one virus, with RSV the most common virus detected (44%). The RSV-associated hospitalization rate was highest in children <6 months with an annual range of 21.1-25.9 per 1000, compared to 6.0-8.0 in 6-11-month-olds and 1.6-2.5 in 12-23-month-olds. RSV-positive children compared with RSV-negative were more likely to be previously healthy without underlying medical conditions, less likely to be born prematurely, had a higher frequency of supplemental oxygen use, and had lower median vitamin D levels. Risk factors for oxygen use in RSV-positive children included underlying medical conditions, lack of breastfeeding, younger age, and higher viral load.
  
  
  CONCLUSIONS
  RSV is a major cause of illness in hospitalized Jordanian children and is associated with increased severity compared to other respiratory viruses. Children with RSV in the Middle East would benefit from future RSV vaccines and antiviral therapy.
authors: Departments of Pediatrics, Vanderbilt University, Nashville, TN, USA; Institute for Global Health, Vanderbilt University, Nashville, TN, USA. Electronic address: natasha.halasa@vanderbilt.edu.
authors: Natasha
authors: N
authors: Halasa
authors: Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: jvw@chp.edu.
authors: John
authors: J
authors: Williams
authors: Department of Pediatrics, Al Bashir Hospital, Amman, Jordan. Electronic address: samirf1952@yahoo.com.
authors: Samir
authors: S
authors: Faouri
authors: Department of Pathology-Microbiology at University of Jordan, Amman, Jordan. Electronic address: ashehabi@go.com.jo.
authors: Asem
authors: A
authors: Shehabi
authors: Departments of Pediatrics, Vanderbilt University, Nashville, TN, USA; Institute for Global Health, Vanderbilt University, Nashville, TN, USA. Electronic address: sten.vermund@vanderbilt.edu.
authors: Sten H
authors: SH
authors: Vermund
authors: Department of Biostatistics, Vanderbilt University, Nashville, TN, USA. Electronic address: Li.wang@vanderbilt.edu.
authors: Li
authors: L
authors: Wang
authors: Department of Biostatistics, Vanderbilt University, Nashville, TN, USA. Electronic address: Christopher.fonnebeck@vanderiblt.edu.
authors: Christopher
authors: C
authors: Fonnesbeck
authors: Department of Pathology-Microbiology at University of Jordan, Amman, Jordan. Electronic address: Najwa.Khuri@gmail.com.
authors: Najwa
authors: N
authors: Khuri-Bulos
mesh_terms: D062665:Epidemiological Monitoring; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007597:Jordan / Q000453:epidemiology; D008297:Male; D013058:Mass Spectrometry; D009297:Nasal Mucosa / Q000821:virology; D010614:Pharynx / Q000821:virology; D015995:Prevalence; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: Acute respiratory tract infection; Child; Infant; Jordan; Middle East; Respiratory syncytial virus; Surveillance