Natural history and epidemiology of respiratory syncytial virus infection in the Middle East: Hospital surveillance for children under age two in Jordan
Vaccine, In Press, Uncorrected Proof, Available online 24 August 2015
Natasha Halasa, John Williams, Samir Faouri, Asem Shehabi, Sten H. Vermund, Li Wang, Christopher Fonnesbeck, Najwa Khuri-Bulos
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.
RSV detection more often when vitamin D levels are typically low
RSV strongly associated with previous use of antibiotics as well as low vitamin D
Low vitamin D in children is associated with a wide range of breathing problems
- Indoor pollution is a problem with obese black asthmatic children – May 2018
- Both parents smoke – child’s vitamin D level was 30 percent lower and worse asthma – May 2018
- Influenza -A infections half as often in children getting 1200 IU of vitamin D – RCT Jan 2018
- Rapid newborn breathing (transient tachypnea) associated with low vitamin D – Dec 2017
- Premature infants with poor lungs (Respiratory distress syndrome) have low levels of vitamin D – Nov 2017
- Risk of infant Asthma cut in half if mother supplemented Vitamin D to get more than 30 ng – RCT Oct 2017
- Respiratory infection in infant was 7 X more likely if low cord Vitamin D – March 2017
- Viral Pneumonia in children 52 X more-likely if very low vitamin D (trend) – June 2017
- Childhood asthma problems eliminated for months by 600,000 IU of Vitamin D – June 2017
- Childhood allergy, asthma and eczema associated with repeated low vitamin D tests – Oct 2016
- Childhood asthma about 1.3 times more likely if poor Vitamin D Receptor – meta-analysis Aug 2016
- Five times less mite allergy when vitamin D added in mid pregnancy and to infant – RCT April 2016
- Hay fever (allergic rhinitis) risk reduced 20 percent for each 100 IU of vitamin D during early pregnancy – Feb 2016
- Asthma in 3 year olds decreased somewhat with 4,000 IU during pregnancy – RCT Jan 2016
- Respiratory tract infections in childhood – vitamin D is needed, no consensus of how much – Oct 2015
- RSV (bronchitis and viral pneumonia) in infants associated with low vitamin D and antibiotics – Aug 2015
- Respiratory distress after preterm birth is more likely if low vitamin D – review April 2015
- All preemies with Chronic Lung Disease had low vitamin D levels– July 2015
- Low dose Vitamin D during pregnancy and infancy results in strange acute respiratory infection response – April 2015
- Newborn acute lower respiratory tract infection associated with low maternal vitamin D – March 2015
- Low vitamin D during pregnancy associated with four health problems in children – Jan 2015
- Acute Lower Respiratory Infections in Children - associated with low vitamin D – meta-analysis Dec 2014
- Respiratory Tract visits 2.5 less likely with vitamin D: Pregnancy 2000 IU, Infant 800 IU – RCT Oct 2014
- No premie had even 30 ng of vitamin D, lower D associated with more Respiratory Distress – Aug 2013
- Asthma is not treated by weekly 14,000 IU of vitamin D (proven yet again) July 2014
- 2000 IU of vitamin D should improve toddlers health in winter – RCT almost completed Feb 2014
- More Hypertension in obese children with low vitamin D, especially at night – Dec 2013
- Largest cause of infant deaths is respiratory infections, which is associated with low vitamin D – April 2011
- Vitamin D Deficiency is a Strong Predictor (4X) of Asthma in Children – Oct 2012
- Acute lower respiratory infection 5X more frequent with low vitamin D intake – June 2012
- Recurrence of child pneumonia delayed by 100000 IU of vitamin D – RCT Oct 2010
- Vitamin D Genes associated with Childhood Asthma And Lung Function - April 2012
- Allergy - Overview
- Severe asthma children 31X more likely to develop chronic obstructive lung disease -May 2010
- R.S.V.? She Hadn’t Heard of It. Then Her Child Was Hospitalized New York Times Jan 2018
"While it affects both children and adults, it is most dangerous — and can even be fatal — in babies who are born prematurely and people with weak immune systems, heart disease or lung disease. But even babies who were born full-term and healthy can develop severe symptoms . . "
"Each year, on average, the virus results in more than 57,000 hospitalizations among children younger than 5, according to the Centers for Disease Control."
"There is no antiviral therapy for R.S.V., and there isn’t a vaccine: Children are typically treated with hydration, nasal suctioning and oxygen."
An immunoglobulin therapy called Synagis costing $5,000 provides some degree of protection
Protection by Vitamin D is not mentioned in the article