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.
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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
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Pages listed in BOTH the categories Breathing and Infant/Child
Low vitamin D in children is associated with a wide range of breathing problems
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- Respiratory infection, children and Vitamin D - many studies
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- RSV kills 100,000 children annually around the world (Vitamin D can help)– May 2022
- Small doses of Vitamin D do not reduce childhood breathing allergies – meta-analysis Oct 2022
- Vitamin D reduces childhood allergic airway diseases (confirmed by metabolomics this time) – May 2022
- Wheezing and asthmatic children have weaker Vitamin D responses - May 2022
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- Allergy medications may be improved by Vitamin D (6X for birch pollen in this case) – Aug 2021
- Infant Respiratory Infections not reduced by mothers taking small amount of vitamin D (28,000 weekly)– RCT July 2021
- Recurrent RTI treatment success: Conventional 71 pcnt, Vitamin D 96 pcnt – March 2021
- The 6 percent of infants hospitalized for ARI are 2.2 X more likely to be Vitamin D deficient – April 2021
- Acute pneumonia in children 3X less likely if greater than 30 ng of vitamin D – Jan 2021
- Preemie Respiratory Distress Syndrome is 5X more likely if low vitamin D – Dec 2020
- Recurrent Wheezing in children is associated with low Vitamin D – several studies
- Respiratory viral infection (RSV) and low vitamin D - many studies
- Lower Respiratory Tract Infection in Infants reduced 5.9 X by daily 600 IU of vitamin D (China) - March 2020
- Gene which predicts wheezing is associated with low vitamin D – Oct 2019
- Bronchiolitis in children associated with both pollution and low solar – July 2019
- Allergic Rhinitis in infants treated by 1,000 IU vitamin D daily – June 2019
- Asthmatic children 5X more likely to have a poor Vitamin D Receptor – June 2019
- Babies 3.6X more likely to go to hospital for asthma if asthmatic mother had low vitamin D while pregnant – June 2019
- Childhood Asthma somewhat reduced by 2400 IU vitamin D late in pregnancy (néed more, earlier) March 2019
- Respiratory Distress Syndrome in preemies 5 X more likely if poor vitamin D receptor – Feb 2019
- Black infant recurrent wheezing rate dropped from 42 percent to 31 percent with just 400 IU of vitamin D – RCT Dec 2018
- Asthma in child 2.3 X more likely if both parents asthmatic (unless add Vitamin D) – VDAART Nov 2018
- Immature lungs in immature newborns – Vitamin D helps – Sept 2018
- Bronchiolitis had 1.3 X longer hospitalization if low Vitamin D (1016 infants) – Sept 2018
- Pneumonia in Egyptian Children 3.6 X more likely if poor Vitamin D Receptor – Aug 2018
- Childhood pneumonia not treated by 100,000 IU of vitamin D – Cochrane (need more, inhaled) – July 2018
- Pneumonia is increasing (now 1 in 6 child deaths), more vitamin D studies needed – June 2018
- Childhood Respiratory Health hardly improved with 600 IU of vitamin D (need much more) – May 2018
- 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
- Allergic rhinitis in children reduced somewhat during pollen season by just 1,000 IU of vitamin D – RCT Jan 2018
- Half the risk of Influenza -A in infants taking 1200 IU of vitamin D for 4 months – RCT Jan 2018
- Rapid newborn breathing (transient tachypnea) associated with low vitamin D – Dec 2017
- Preemies 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 injection – 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
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- 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