1479. WHO Severe Acute Respiratory Infections (SARI) Definition often Underdiagnoses Serious Respiratory Viral Infections in Hospitalized Jordanian Children
Session: Poster Abstract Session: Pediatric Viral Infections
Friday, October 6, 2017
Room: Poster Hall CD

Background:

The World Health Organization (WHO) case definition of severe acute respiratory infections (SARI) is anyone with an acute respiratory infection with symptoms within 10 days of presentation, cough, fever, and hospitalization. This is used to standardize global influenza surveillance with the caveat not all cases will be captured. We sought to determine the proportion of hospitalized Jordanian children admitted with acute respiratory illnesses meeting the SARI definition.

Methods:

We conducted 3-year viral surveillance study in children <2 years admitted with acute respiratory symptoms and/or fever into a large government hospital in Amman. Demographic and clinical data were collected. We tested nasal/throat swabs for 11 viruses using q-RT-PCR. We compared children who met SARI definition to non-SARI.

Results:

We enrolled 3168 children. Table 1 compares those children who met SARI definition versus those who did not. Figure 1 compares % of children who were virus-positive and met SARI definition.

Table 1.

N (%)

SARI

(n=1198)

Non-SARI

(n=1970)

p-values

Male

729 (60.9)

1183 (60.1)

0.655

Median Age

6.7 months

2.3 months

0.000

Underlying medical condition

160 (13.4)

215 (10.9)

0.039

Pneumonia

192 (16.0)

202 (10.3)

0.000

Sepsis

150 (12.5)

750 (38.1)

0.000

Bronchiolitis

169 (14.1)

378 (19.2)

0.000

Bronchopneumonia

656 (54.8)

364 (18.5)

0.000

≤10-day duration

1198 (100)

1848 (93.8)

0.000

Cough

1198 (100)

1172 (59.5)

0.000

Fever

1198 (100)

649 (32.9)

0.000

Fever & Cough

1198 (100)

48 (2.4)

0.000

Virus positive

1076 (89.8)

1505 (76.4)

0.000

Rhinovirus

438 (36.6)

800 (40.6)

0.024

Adenovirus

201 (16.8)

274 (13.9)

0.028

Parainfluenza 1-3

75 (6.3)

100 (5.1)

0.157

Respiratory Syncytial Virus

635 (53.0)

762 (38.7)

0.000

Influenza A-C

61 (5.1)

58 (2.9)

0.002

Human Metapneumovirus

153 (12.8)

120 (6.1)

0.000

Conclusion:

Children who met the definition of SARI were more likely to be older, have an underlying medical condition, have the diagnoses of pneumonia and bronchopneumonia, and be virus-positive compared to non-SARI children. Since nearly 2/3 of virus positive cases did not meet the SARI definition, policy makers should be cautious if using SARI criteria to estimate viral burden since it likely leads to an underestimation of viral burden, especially for young hospitalized children.

 

Najwa Khuri-Bulos, MD, FIDSA, University of Jordan, Amman, Jordan, Bhinnata Piya, MPH, Vanderbilt University Medical Center, Nashville, TN, Asem Shehabi, DSC, Jordan University, Amman, Jordan, Samir Faouri, MD, Al-Bashir, Amman, Jordan, John V. Williams, MD, Children's Hospital of Pittsburgh, Pittsburgh, PA, Sten Vermund, MD, PhD, FIDSA, Yale, New Haven, CT and Natasha B. Halasa, MD, MPH, FPIDS, Vanderbilt University School of Medicine, Nashville, TN

Disclosures:

N. Khuri-Bulos, None

B. Piya, None

A. Shehabi, None

S. Faouri, None

J. V. Williams, Quidel: Scientific Advisor , Consulting fee
GlaxoSmithKline: Scientific Advisor , Consulting fee

S. Vermund, None

N. B. Halasa, Sanofi Pasteur: Research Contractor , Research support
Astra Zeneca: Research Contractor , Grant recipient

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