Olla Hamdan

Background and Aims: Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection (ARI) in children, particularly in low‐ and middle‐income countries. Rapid diagnosis is important for management and infection control. We aimed to evaluate diagnostic accuracy of Sofia 2 RSV fluorescent immunoassay (FIA) compared to reverse‐transcription quantitative PCR (RT‐qPCR) in children under 2 years hospitalized with ARI in Amman, Jordan. Methods: We conducted a prospective viral surveillance study from January 26, 2020 to March 17, 2020, at Al‐Bashir Hospital. Sofia 2 RSV FIA was performed on nasal swabs and compared to RT‐qPCR. We calculated sensitivity, specificity, and Cohen's κ with 95% confidence intervals and assessed factors associated with RSV detection by FIA using logistic regression. Results: Of 458 children enrolled, 356 (77.7%) had RSV detected by RT‐qPCR. Sofia 2 RSV FIA demonstrated 76.1% sensitivity (95% CI: 71.3, 80.5%) and 94.1% specificity (95% CI: 87.6, 97.8%) relative to RT‐qPCR. Lower RT‐qPCR cycle threshold value (inversely related to viral load) was significantly associated with Sofia 2 RSV FIA positivity (aOR = 0.75; 95% CI: 0.70, 0.81; p < 0.001). Conclusion: Sofia 2 RSV FIA demonstrates potential as a rapid diagnostic test in resource‐limited settings. Further research on its clinical outcomes and cost‐effectiveness could enhance RSV management in children.

Background: Human adenovirus (HAdV) is a common cause of pediatric acute respiratory illness (ARI), contributing to 5–13% of cases worldwide. Clinical manifestations vary by HAdV species and type; therefore, delineating type-specific disease presentations and understanding severity of specific HAdV types' disease may help develop targeted interventions. Methods: We conducted a multicenter, prospective study within the New Vaccine Surveillance Network to characterize HAdV types. Children <18 years old with ARI were enrolled in the emergency department or inpatient setting at 7 US children's hospitals from 1 December 2016 to 30 November 2019. Respiratory specimens were collected and tested for HAdV and other viruses. Subsequently, typing was conducted on HAdV specimens using single-plex real-time PCR assays targeting sequences in the hexon gene. Comparisons between HAdV types were performed to determine differences in characteristics and outcomes. Generalized linear mixed effects models were used to evaluate severity. Results: Among the 1843 HAdV-positive cases, 1402 specimens (76%) were typed. The most common types detected were HAdV-C1 (n = 439), HAdV-C2 (n = 393), and HAdV-B3 (n = 221). Children with HAdV-B7 (n = 78) had higher odds of severe outcomes compared to those with other HAdV types (aOR = 2.05; 95% CI: 1.24, 3.40). Symptom presentation varied across types within species B, C, and E; while all species had high frequency of upper respiratory symptoms, species B cases presented with a higher frequency of non-respiratory manifestations. Conclusions: Among children with HAdV-positive ARI, those with HAdV-B7 had higher odds of severe outcomes. These findings suggest heterogeneity in clinical presentation and severity among HAdV types, emphasizing the importance of HAdV type in future prevention and treatment strategies.

Respiratory syncytial virus (RSV) is a leading cause of hospitalization in young children. Understanding RSV burden and seasonality is crucial for implementing effective preventive strategies, especially in the wake of disruptions related to the coronavirus disease 2019 (COVID-19) pandemic. We aimed to determine RSV burden and seasonality among young children hospitalized in Jordan. We conducted a prospective viral surveillance study at Al-Bashir Hospital (1 November 2023 to 4 April 2024). Children n = 680 [30.0%]). Children with RSV were more likely than those without RSV to receive low-flow oxygen (74.9% vs 23.2%; P < 0.001) and high-flow nasal cannulation (3.2% vs 1.2%; P < 0.001) and were more likely to be admitted to the intensive care unit (13.2% vs 8.2%; P < 0.001). At least one other respiratory virus was co-detected with RSV in 244 children (34.2%). During the 2023–2024 season, RSV circulation exhibited a clear winter seasonality, consistent with historical patterns. In conclusion, the burden of RSV in children in Jordan remains substantial following the COVID-19 pandemic. The return to historical winter seasonality has important implications for the timing of preventive interventions. Continued surveillance is crucial for monitoring RSV epidemiology in this region. IMPORTANCE: This study confirms the persistent and significant burden of respiratory syncytial virus (RSV) among young, hospitalized children in Jordan. Crucially, our data reveal the normalization of RSV circulation patterns in 2024 following disruptions related to the coronavirus disease 2019 pandemic. This finding has important implications for optimizing the timing of preventive interventions, such as monoclonal antibodies and maternal vaccination, particularly in a resource-limited setting where they are costly and limited in availability. By providing these contemporary surveillance data from the Eastern Mediterranean—where sentinel surveillance platforms are lacking—this work has the potential to inform public health strategies directly and emphasizes the critical need for sustained monitoring to guide effective RSV prevention and control efforts.

Background: Influenza contributes to a high burden of pediatric emergency department (ED) visits annually. Guidelines recommend outpatient antiviral treatment for children at higher risk of severe influenza and recommend considering treatment for those who present within 2 days of symptom onset. We describe antiviral prescription in children with influenza presenting to the ED.Methods: We analyzed data from the New Vaccine Surveillance Network (2016–2020), including children presenting to the ED and enrolled with confirmed influenza at one of seven pediatric academic centers. We compared characteristics of children prescribed antivirals to those who were not, using generalized estimating equations models to identify predictors of antiviral prescription. Children were considered at higher risk of severe influenza if they were < 5 years old or had an underlying condition.Results: Overall, 2472 (15%) of 16,915 enrolled children tested positive for influenza virus. Among these, 1931 (78%) were at higher risk of severe influenza; only 622 (32%) received an antiviral. Among 233 (9%) children not at high risk with symptom onset ≤ 2 days, 62 (27%) were prescribed an antiviral. Children prescribed an antiviral had a shorter duration of illness prior to presenting to the ED. For children at higher risk of severe influenza, odds of antiviral prescription were higher for those clinically tested for influenza and with underlying conditions.Conclusion: Clinical testing and having an underlying condition were associated with antiviral prescription in children at higher risk of severe influenza. However, only 1/3 of those at higher risk were prescribed an antiviral. Strategies to increase antiviral use for children at higher risk for influenza in the ED are needed.

Inappropriate antibiotic use drives antimicrobial resistance, a global health threat causing increased morbidity and mortality. Understanding antibiotic practices in low-resource settings is essential to identify intervention targets. This study investigates antibiotic prescription practices in Amman, Jordan. We conducted three prospective viral surveillance studies at the largest public hospital in Amman, Jordan (2010–2013, 2020, and 2023) and included children Watch group. One or more respiratory viruses were detected in 3,911 children (82.8%). Providers ordered cultures most often for children 0–2 months old ( n = 1,579 [73.5%]) and those with an admission diagnosis of rule-out sepsis ( n = 1,164 [95.4%]). Antibiotic use and testing practices were consistent across study years, age groups, and admission diagnoses. In conclusion, widespread antibiotic use despite the preponderance of viral infections highlights a significant discrepancy in aligning treatment practices with disease etiology. Strengthening diagnostic and preventive capabilities in low-resource settings is crucial to combat antimicrobial resistance. IMPORTANCE: In this study of 4,724 children under 2 years old hospitalized in the largest public hospital in Jordan between 2010 and 2023, 92.6% received antibiotics despite 82.8% testing positive for respiratory viruses and only 13.9% of collected cultures suggesting bacterial infection. Despite the predominance of viral infections, the widespread use of antibiotics, particularly from the World Health Organization Watch group, highlights the need for improved antibiotic stewardship and diagnostic capabilities in Jordan.

Background: Guidelines state that all hospitalized children with suspected or confirmed influenza receive prompt treatment with influenza-specific antivirals. We sought to determine the frequency of, and factors associated with, antiviral receipt among hospitalized children. Methods: We conducted active surveillance of children presenting with fever or respiratory symptoms from 1 December 2016 to 31 March 2020 at 7 pediatric medical centers in the New Vaccine Surveillance Network. The cohort consisted of children hospitalized with influenza A or B confirmed by clinical or research testing. The primary outcome was frequency of antiviral receipt during hospitalization. We used logistic regression to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with antiviral receipt. Results: A total of 1213 children with laboratory-confirmed influenza were included. Overall, 652 children (53.8%) received an antiviral. Roughly 63.0% of children received clinical influenza testing. Among those with clinical testing, 67.4% received an antiviral. Factors associated with higher odds of antiviral receipt included hematologic (aOR = 1.76; 95% CI = 1.03–3.02) or oncologic/immunocompromising (aOR = 2.41; 95% CI = 1.13–5.11) disorders, prehospitalization antiviral receipt (aOR = 2.34; 95% CI = 1.49–3.67), clinical influenza testing (aOR = 3.07; 95% CI = 2.28–4.14), and intensive care unit admission (aOR = 1.53; 95% CI = 1.02–2.29). Symptom duration >2 days was associated with lower odds of antiviral treatment (aOR = 0.40; 95% CI = .30–.52). Antiviral receipt varied by site with a 5-fold difference across sites. Conclusions: Almost half of children hospitalized with influenza did not receive antivirals. Additional efforts to understand barriers to guideline adherence are crucial for optimizing care in children hospitalized with influenza.

Background: Influenza is associated with significant global morbidity and mortality, with vaccination being the primary preventive strategy. Despite recommendations, influenza vaccine uptake among healthcare providers (HCPs) remains suboptimal, especially in the Eastern Mediterranean. We aimed to assess the attitudes and practices of HCPs in Jordan regarding seasonal influenza vaccination and assess sources of variation thereof. Methods: We conducted a cross-sectional survey study among a sample of HCPs practicing in Jordan (12/29/2020–04/26/2021). Participants completed a questionnaire assessing demographics, influenza vaccination history, attitudes, and practices. We used logistic regression to evaluate factors related to vaccine receipt and reasons for non-vaccination. We used proportional odds models to evaluate factors related to HCP recommendations and to compare opinions on influenza vaccination between ever- and never-vaccinated HCPs. Results: Of 305 survey initiates, 206 HCPs (67.5%) comprised the analytic sample. The median age was 35 years; 61.2% were women, and 43.7% were pharmacists. Over half (52.9%) never received an influenza vaccine; however, older age and self-identifying as a physician were associated with higher odds of having ever received the influenza vaccine. The main reasons for non-vaccination were related to the misassessment of risks and benefits. Prior receipt of influenza vaccination was strongly associated with odds of recommending vaccination (or = 10.5; 95% CI = [5.38–20.3]; p<0.001). The COVID-19 pandemic reportedly enhanced influenza vaccine acceptance among 48.5% of HCPs surveyed. Conclusions: Low influenza vaccine uptake among healthcare providers in Jordan is related to misassessment of risks and benefits. Enhancing attitudes and confidence through tailored education is crucial to overcoming hesitancy and promoting sustained improvements in vaccination attitudes and practices among HCPs in Jordan.