Research Article: Viral etiology, seasonality and severity of hospitalized patients with severe acute respiratory infections in the Eastern Mediterranean Region, 2007–2014

Date Published: July 13, 2017

Publisher: Public Library of Science

Author(s): Katherine C. Horton, Erica L. Dueger, Amr Kandeel, Mohamed Abdallat, Amani El-Kholy, Salah Al-Awaidy, Abdul Hakim Kohlani, Hanaa Amer, Abel Latif El-Khal, Mayar Said, Brent House, Guillermo Pimentel, Maha Talaat, Dena L. Schanzer.

http://doi.org/10.1371/journal.pone.0180954

Abstract

Little is known about the role of viral respiratory pathogens in the etiology, seasonality or severity of severe acute respiratory infections (SARI) in the Eastern Mediterranean Region.

Sentinel surveillance for SARI was conducted from December 2007 through February 2014 at 20 hospitals in Egypt, Jordan, Oman, Qatar and Yemen. Nasopharyngeal and oropharyngeal swabs were collected from hospitalized patients meeting SARI case definitions and were analyzed for infection with influenza, respiratory syncytial virus (RSV), adenovirus (AdV), human metapneumovirus (hMPV) and human parainfluenza virus types 1–3 (hPIV1-3). We analyzed surveillance data to calculate positivity rates for viral respiratory pathogens, describe the seasonality of those pathogens and determine which pathogens were responsible for more severe outcomes requiring ventilation and/or intensive care and/or resulting in death.

At least one viral respiratory pathogen was detected in 8,753/28,508 (30.7%) samples tested for at least one pathogen and 3,497/9,315 (37.5%) of samples tested for all pathogens–influenza in 3,345/28,438 (11.8%), RSV in 3,942/24,503 (16.1%), AdV in 923/9,402 (9.8%), hMPV in 617/9,384 (6.6%), hPIV1 in 159/9,402 (1.7%), hPIV2 in 85/9,402 (0.9%) and hPIV3 in 365/9,402 (3.9%). Multiple pathogens were identified in 501/9,316 (5.4%) participants tested for all pathogens. Monthly variation, indicating seasonal differences in levels of infection, was observed for all pathogens. Participants with hMPV infections and participants less than five years of age were significantly less likely than participants not infected with hMPV and those older than five years of age, respectively, to experience a severe outcome, while participants with a pre-existing chronic disease were at increased risk of a severe outcome, compared to those with no reported pre-existing chronic disease.

Viral respiratory pathogens are common among SARI patients in the Eastern Mediterranean Region. Ongoing surveillance is important to monitor changes in the etiology, seasonality and severity of pathogens of interest.

Partial Text

Acute respiratory infections (ARI) are the most common cause of morbidity worldwide [1, 2] and the leading infectious cause of death for children under five years of age [3]. In 2010, ARI were responsible for nearly 1.4 million deaths in children under five years of age, 18.3% of total deaths in this age group [3].

Results from seven years of SARI surveillance at hospitals in five countries in the Eastern Mediterranean Region provide important insight into the etiology, seasonality and severity of viral respiratory pathogens among hospitalized patients in this region. Influenza, RSV and AdV were the most common pathogens identified among SARI patients tested for viral respiratory pathogens, although levels of infection varied across countries and over years of surveillance. All pathogens examined were more frequently identified in participants less than five years of age than in older participants. Monthly variation, indicating seasonal differences in levels of infection, was observed for all pathogens. Participants with hMPV infections and participants less than five years of age were significantly less likely than participants not infected with hMPV and those older than five years of age, respectively, to experience a severe outcome, while participants with a pre-existing chronic disease were at increased risk of a severe outcome, compared to those with no reported pre-existing chronic disease.

 

Source:

http://doi.org/10.1371/journal.pone.0180954

 

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