514. Influenza Illness in Hospitalized Children in Amman, Jordan over Three-Year Study Period
Session: Poster Abstract Session: Respiratory Infections: Pediatric
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • influenza poster good IDSA 2015.pdf (922.8 kB)
  • Background:

    Influenza (flu) virus causes disease in children worldwide; however, the burden of respiratory disease attributable to flu in Jordanian hospitalized children is unknown. 

    Methods: We conducted a prospective year-round viral surveillance study in children <2 years Sunday-Thursday from 3/16/2010-3/31/2013. Clinical and demographic data were collected. Nasal/throat swabs were collected and tested by real-time RT-PCR for respiratory syncytial virus (RSV), metapneumovirus (HMPV), rhinovirus (HRV), flu A, B, and C, adenovirus,& parainfluenza viruses 1, 2, 3 (PIV1-3) at Vanderbilt. We then obtained HA and NA sequences of Flu A positive samples and conducted molecular and phylogenetic analysis.

    Results: A total of 3168 subjects were enrolled and 119 (3.8%) had flu detected (71 flu A, 29 flu B, and 19 flu C) and 2462 (78%) had the other viruses detected.  Table 1 reveals comparisons between flu+ and all other virus+ subjects. The three children that died, all had flu A and 2 had osteogenesis imperfecta. Figure 1 reveals the seasonality of flu. Phylogenetic analysis of the HA and NA genes of pandemic H1N1 viruses revealed that the Jordanian 2011-2013 viruses belonged to three antigenic groups: 5, 6, and 7. The genetic analysis showed that all viruses in this study had 1 mutation in antigenic site Sb (S185T) and 1 mutation in antigenic site Ca1 (S203T). Viruses belonging to antigenic group 6.A had 1 mutation at antigenic site Ca2 (H183R). Phylogenetic analysis of H3 revealed that the viruses belong to the A/Victoria/361/2011 genetic clade and fall under two antigenic groups: 3 and 6. Markers of oseltamivir resistance were not detected in any of the viruses.  

    FLU+

    N=119

    VIRUS+

    N=2462

    P-value

    Age (months, median)

    7.5

    5.7

    0.01

    Fever

    73%

    53%

    <0.01

    Shortness of breath

    53%

    64%

    0.02

    Flaring on exam

    34%

    45%

    0.02

    Bronchiolitis

    12%

    20%

    0.03

    Oxygen

    25%

    35%

    0.03

    Death

    2.5%

    0.7%

    0.04

    Conclusion:   Flu+ subjects were older, more likely to present with fever, and had higher mortality compared to the other virus+ children.  November and December are the peak months for flu virus seasonality.  Since flu vaccine is not routinely given in Jordan, the introduction of flu vaccine may be beneficial given the majority of children were >6 months, including those with underlying chronic illnesses. 

    Natasha Halasa, MD, MPH, FPIDS1, Annabelle De St Maurice, MD, MPH2, Samir Faouri, MD3, Asem Shehabi, DSC4, John Willams, MD5, Ghazi Kayali, PhD, MPH6 and Najwa Khuri-Bulos, MD, FIDSA4,7, (1)School of Medicine, Vanderbilt University, Nashville, TN, (2)Vanderbilt University, Nashville, TN, (3)Al-Bashir Hospital, Amman, Jordan, (4)University of Jordan, Amman, Jordan, (5)University of Pittsburgh Medical Center, Pittsburgh, PA, (6)St. Jude's Children's Research Hospital, Memphis, TN, (7)Pediatrics, Professor Pediatric Infectious Disease, Amman, Jordan

    Disclosures:

    N. Halasa, Sanofi Pasteur: Grant Investigator , Grant recipient , Research grant and Research support
    Gilead: Grant Investigator , Research support
    Pfizer: Grant Investigator , Grant recipient , Research grant and Research support
    Baxter: Grant Investigator , Grant recipient , Research grant and Research support
    Biocryst: Grant Investigator , Research support

    A. De St Maurice, None

    S. Faouri, None

    A. Shehabi, None

    J. Willams, Quidel: Scientific Advisor , Consulting fee

    G. Kayali, None

    N. Khuri-Bulos, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.