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Systematic Review of the Respiratory Syncytial Virus (RSV) Prevalence, Genotype Distribution, and Seasonality in Children from the Middle East and North Africa (MENA) Region. Microorganisms 2020; 8:microorganisms8050713. [PMID: 32403364 PMCID: PMC7284433 DOI: 10.3390/microorganisms8050713] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/28/2022] Open
Abstract
Respiratory syncytial virus (RSV) is one of the most common viruses to infect children worldwide and is the leading cause of lower respiratory tract illness (LRI) in infants. This study aimed to conduct a systematic review by collecting and reviewing all the published knowledge about the epidemiology of RSV in the Middle East and North Africa (MENA) region. Therefore, we systematically searched four databases; Embase, Medline, Scopus, and Cochrane databases from 2001 to 2019 to collect all the information related to the RSV prevalence, genotype distribution, and seasonality in children in MENA region. Our search strategy identified 598 studies, of which 83 met our inclusion criteria, which cover the past 19 years (2000–2019). Odds ratio (OR) and confidence interval (CI) were calculated to measure the association between RSV prevalence, gender, and age distribution. An overall prevalence of 24.4% (n = 17,106/69,981) of respiratory infections was recorded for RSV. The highest RSV prevalence was reported in Jordan (64%, during 2006–2007) and Israel (56%, 2005–2006). RSV A subgroup was more prevalent (62.9%; OR = 2.9, 95%CI = 2.64–3.13) than RSV B. RSV was most prevalent in children who were less than 12 months old (68.6%; OR = 4.7, 95%CI = 2.6–8.6) and was higher in males (59.6%; OR = 2.17, 95%CI = 1.2–3.8) than in female infants. Finally, the highest prevalence was recorded during winter seasons in all countries, except for Pakistan. RSV prevalence in the MENA region is comparable with the global one (24.4% vs. 22%). This first comprehensive report about RSV prevalence in the MENA region and our data should be important to guide vaccine introduction decisions and future evaluation.
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Halasa N, Williams J, Faouri S, Shehabi A, Vermund SH, Wang L, Fonnesbeck C, Khuri-Bulos N. Natural history and epidemiology of respiratory syncytial virus infection in the Middle East: Hospital surveillance for children under age two in Jordan. Vaccine 2015; 33:6479-87. [PMID: 26314623 PMCID: PMC7115487 DOI: 10.1016/j.vaccine.2015.08.048] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 12/11/2022]
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. Conclusion 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.
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Affiliation(s)
- Natasha Halasa
- Departments of Pediatrics, Vanderbilt University, Nashville, TN, USA; Institute for Global Health, Vanderbilt University, Nashville, TN, USA.
| | - John Williams
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Samir Faouri
- Department of Pediatrics, Al Bashir Hospital, Amman, Jordan.
| | - Asem Shehabi
- Department of Pathology-Microbiology at University of Jordan, Amman, Jordan.
| | - Sten H Vermund
- Departments of Pediatrics, Vanderbilt University, Nashville, TN, USA; Institute for Global Health, Vanderbilt University, Nashville, TN, USA.
| | - Li Wang
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA.
| | | | - Najwa Khuri-Bulos
- Department of Pathology-Microbiology at University of Jordan, Amman, Jordan.
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Almajhdi FN, Farrag MA, Amer HM. Genetic diversity in the G protein gene of group A human respiratory syncytial viruses circulating in Riyadh, Saudi Arabia. Arch Virol 2013; 159:73-81. [PMID: 23884633 DOI: 10.1007/s00705-013-1792-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/07/2013] [Indexed: 11/26/2022]
Abstract
Human respiratory syncytial virus (HRSV) is a frequent cause of hospitalization and mortality in children worldwide. The molecular epidemiology and circulation pattern of HRSV in Saudi Arabia is mostly uncharted. In the current study, the genetic variability and phylogenetic relationships of HRSV type A strains circulating in Riyadh Province were explored. Nasopharyngeal aspirates were collected from hospitalized children with acute respiratory symptoms during the winter-spring seasons of 2007/08 and 2008/09. Among 175 samples analyzed, 39 (22.3 %) were positive for HRSV by one-step RT-PCR (59 % type A and 41 % type B). Propagation of positive samples in HEp-2 cells permitted the recovery of the first Saudi HRSV isolates. Genetic variability among Saudi HRSV-A strains was evaluated by sequence analysis of the complete attachment (G) protein gene. The nucleotide sequence was compared to representatives of the previously identified HRSV-A genotypes. Sequence and phylogenetic analysis showed that the strains examined in this study were very closely related at both the nucleotide and amino acid level, and all of them are clustered in the GA2 genotype (and mostly belonged to the NA-1 subtype). A total of 23 mutation sites, 14 of which resulted in an amino acid change, were recorded only in Saudi strains. This is the first report on genetic diversity of HRSV-A strains in Saudi Arabia. Further analysis of strains on a geographical and temporal basis is needed to fully understand HRSV-A circulation patterns in Saudi Arabia.
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Affiliation(s)
- Fahad N Almajhdi
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia,
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Delayed RSV diagnosis in a stem cell transplant population due to mutations that result in negative polymerase chain reaction. Diagn Microbiol Infect Dis 2013; 75:426-30. [PMID: 23415542 DOI: 10.1016/j.diagmicrobio.2012.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/19/2012] [Accepted: 12/24/2012] [Indexed: 11/24/2022]
Abstract
Respiratory syncytial virus (RSV) is a serious cause of morbidity and mortality in the adult hematopoietic stem cell transplant (HSCT) population. The timely diagnosis of RSV infection in this population is important for initiating therapy and instituting appropriate infection prevention measures. Molecular multiplex assays now offer increased sensitivity for a more accurate diagnosis. This study presents 5 cases of RSV infection in HSCT patients in which diagnosis was delayed due to false-negative results from a multiplex polymerase chain reaction (PCR) assay. The false-negative result was due to a single base-pair mutation in the RSV strain. These false results delayed the appropriate treatment of patients. This study shows that a combination of a multiplex PCR assay, viral antigen, and/or culture should be used to detect variants of RSV in patients and that multiplex respiratory viral assays should develop a more robust design that includes multiple genetic target per virus to prevent missing viruses that continue to have genetic variances.
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Khuri-Bulos N, Williams JV, Shehabi AA, Faouri S, Al Jundi E, Abushariah O, Chen Q, Ali SA, Vermund S, Halasa NB. Burden of respiratory syncytial virus in hospitalized infants and young children in Amman, Jordan. ACTA ACUST UNITED AC 2010; 42:368-74. [PMID: 20100116 DOI: 10.3109/00365540903496544] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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.
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Affiliation(s)
- Najwa Khuri-Bulos
- Department of Paediatrics and Pathology-Microbiology, Jordan University, Amman, Jordan
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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; 80:168-74. [PMID: 18041044 PMCID: PMC7166429 DOI: 10.1002/jmv.21067] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Human respiratory syncytial virus (HRSV) is the major viral cause of acute lower respiratory tract infections in children. Few data about the molecular epidemiology of respiratory syncytial virus in developing countries, such as Jordan, are available. The frequency and severity of infections caused by HRSV were assessed in hospitalized Jordanian children <5 years of age compared with other potential etiological agents. Overall a potential pathogen was detected in 78% (254/326) of the children. HRSV was detected in 43% (140/326) of the nasopharyngeal aspirates. HRSV was found more frequently during the winter (January/February), being less frequent or negligible by spring (March/April). Analysis of 135 HRSV‐positive strains using restriction fragment length polymorphism showed that 94 (70%) belonged to subgroup A, and 41 (30%) to subgroup B. There were also two cases of mixed genotypic infection. Only four of the six previously described N genotypes were detected with NP4 predominating. There were no associations between subgroup or N‐genogroup and disease severity. HRSV was significantly associated with more severe acute respiratory infection and the median age of children with HRSV was lower than for those without. Next in order of frequency were adenovirus (116/312: 37%), human bocavirus (57/312: 18%), rhinovirus (36/325: 11%), Chlamydia spp. (14/312: 4.5%), human metapneumovirus (8/326: 2.5%), human coronavirus NL63 (4/325: 1.2%), and influenza A virus (2/323: 0.6%). Influenza B; parainfluenza viruses 1–4, human coronavirus HKU1 and Mycoplasma pneumoniae were not detected. J. Med. Virol. 80:168–174, 2008. © 2007 Wiley‐Liss, Inc.
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Affiliation(s)
- Nasser M Kaplan
- Department of Microbiology, King Hussein Medical Centre, Amman, Jordan
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Al-Toum R, Bdour S, Ayyash H. Epidemiology and clinical characteristics of respiratory syncytial virus infections in Jordan. J Trop Pediatr 2006; 52:282-7. [PMID: 16476671 DOI: 10.1093/tropej/fml002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study was carried out to determine the prevalence, seasonal distribution of RSV, the signs and symptoms associated with it in Jordan. A total of 200 nasopharyngeal aspirates were obtained from hospitalized children (below 2 years old). RSV was detected in 12.5% of patients using direct immunofluorescence technique. Most infections were associated with bronchilolitis, and higher rates of hypoxemia, retractions, tachypnea, hyperinflation and interstitial infiltrates in 1 to 3 months old children. RSV showed a clear temporal periodicity. The epidemic began in December and disappeared in March with a peak of incidence during February 2003 and January 2004. The seasonal distribution showed a significant correlation with temperature, rainfall and relative humidity. This study provides further information on RSV epidemiology which could help in planning of prevention and control programs in Jordan, distinguishing RSV infections on the basis of the clinical picture and considering RSV between December and March each year.
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Affiliation(s)
- Rani Al-Toum
- Department of Biological Sciences, Faculty of Science, University of Jordan, Amman, Jordan
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Tsuchiya LRRV, Costa LMD, Raboni SM, Nogueira MB, Pereira LA, Rotta I, Takahashi GRA, Coelho M, Siqueira MM. Viral respiratory infection in Curitiba, Southern Brazil. J Infect 2005; 51:401-7. [PMID: 16321652 DOI: 10.1016/j.jinf.2004.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2004] [Accepted: 12/04/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Viral infection is the major cause of respiratory tract pathology affecting individuals of all ages, especially children and immunocompromised patients. There is a paucity of data on etiological and epidemiological infection caused by virus, in Southern Brazil. The aim of this study was to evaluate the seasonality, and the incidence of the viruses involved in respiratory infections in Curitiba, South Brazil. METHODS Two hundred seventy-three nasopharyngeal aspirates (NPA) from primary care health units and 1348 NPA or bronchoalveolar lavages from a tertiary-care teaching hospital were studied. Viruses were identified by indirect immunofluorescence and cellular culture. RESULTS Thirty percent of tested samples scored positive for the presence of virions. The percentages of infection for each virus from outpatients and hospitalized, respectively, were 3.3, 19.3 for respiratory syncytial virus; 13.9, 3.5 for influenza A, 3.0, 1.7 for influenza B; 3.3, 5.6 for parainfluenza virus and 2.2, 0.8 for adenovirus. A higher incidence of positive results was found during the winter season, thus showing a pattern of seasonality. CONCLUSION Viral agents are one of the main etiologies of respiratory tract pathology in the population studied.
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Affiliation(s)
- Luine R R V Tsuchiya
- Laboratory of Virology, Hospital de Clínicas da Universidade Federal do Paraná, Brazil.
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Ribes JA, Seabolt JP, Overman SB. Performance characteristics of VIDAS and directigen respiratory syncytial virus (RSV) antigen detection assays and culture for the identification of RSV in respiratory specimens. J Clin Microbiol 2002; 40:1818-20. [PMID: 11980966 PMCID: PMC130936 DOI: 10.1128/jcm.40.5.1818-1820.2002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2001] [Revised: 11/28/2001] [Accepted: 02/10/2002] [Indexed: 11/20/2022] Open
Abstract
In a comparison of the Directigen and VIDAS respiratory syncytial virus antigen detection assays with viral culture, the sensitivity, specificity, positive and negative predictive values, and testing efficiency were 86, 93.1, 82.7, 94.6, and 91.2% for Directigen; 96.1, 90.8, 80.3, 98.3, and 92.3% for VIDAS; and 88.2, 100, 100, 95.7, and 96.8% for viral culture, respectively.
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Affiliation(s)
- Julie A Ribes
- Department of Pathology and Laboratory Medicine, MS-117 Medical Center, 800 Rose Street, University of Kentucky, Lexington, KY 40536-0293, USA.
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