The Epidemiology , Health and Economic Burden of RSV Amongst Hospitalized Children Under 5 Years of Age in Jordan (RSV-JO)

The Epidemiology , Health and Economic Burden of Respiratory Syncytial Virus Amongst Hospitalized Children Under 5 Years of Age in Jordan: National Multi-center Cross-sectional Study

RSV has a global healthcare burden and vaccine in the main preventive measure. There are no recent published studies that have evaluated the burden of RSV infections in the Middle East in term of incidence at a national level, complication rates, mortality rates, hospitalizations, secondary infections, or the direct and indirect costs. Most studies have been limited to identifying genotypes or calculating the incidence in selected sites. In order to facilitate the introduction of an effective preventive measure for control of RSV infections, it is essential at a national and regional levels to assess the burden of disease, molecular epidemiology, and economic burden based on direct and indirect costs of RSV infections.

Study Overview

• Status: Recruiting
• Conditions: Respiratory Syncytial Virus Infections

Detailed Description

A Multi-center cross-sectional study. A total of 4 study centers will be included distributed in central, Northern and southern regions of Jordan as follows; 1. Princess Rahma Hospital for Children, Irbid, 2. Zarqa Hospital serving center and east of Jordan 3. Jordan University Hospital, Amman 4.Al Karak Public Hospital, Al Karak.

Case definition: 46 Diagnosis of acute respiratory infection: Defined as "an illness presenting with one or more of the following symptoms for less than 7 days: Fever, cough, earache, nasal congestion, rhinorrhea, sore throat, vomiting after coughing, Crackles, and labored, rapid or shallow breathing".

Study population:

Children <5 years of age admitted to study sites with

1. At least one sign of acute infection (temperature ≥38 °C or <35.5 °C, abnormal white blood cell [WBC] count or abnormal differential) and
2. At least 1 of the following respiratory signs or symptoms for less than 7 days: tachypnea, cyanosis, cough, sputum production, pleuritic chest pain, hemoptysis, dyspnea, sore throat. cough, runny nose, grunting, wheeze, apnoea, difficulty in breathing.

The main sample of 1000 children will be from hospitalized children The focus on the hospitalized patients to assess the role of RSV infections in hospitalization, complications and economic burden.

An additional sample of 200 children from emergency department and a representative outpatients or healthcare center at sample from emergency and outpatients clinics at Princess Rahma Governmental Hospital in Irbid and Jordan University Hospital in Amman, to assess the proportion of RSV positivity and cost burden of the visit.

This will be conducted at sample from emergency and outpatients clinics at Princess Rahma Governmental Hospital in Irbid and Jordan University Hospital in Amman.

Sample collection and processing:

• Nasopharyngeal (NP) specimen will be collected from each patient, who meets inclusion criteria and consent for the study, using NP swab then Multiplex viral (RT)PCR will be performed on each Nasopharyngeal specimen testing
• PCR will be used to diagnosed cases with RSV at the included sites.
• RSV positive samples will be further analyzed for genotyping.

Packaging and shipment of clinical specimens Specimens for virus detection from nasopharyngeal and oropharyngeal will be collected using Dacron or polyester flocked swabs in a viral transport medium (VTM) containing antifungal and antibiotic supplements. Specimens will be transported to the laboratory as soon as possible after collection. Specimens that cannot be delivered promptly to the laboratory will be stored and shipped at 2-8°C for up to 3 days.. For the Bronchoalveolar lavage, the same as applied on the nasopharyngeal and oropharyngeal specimens except that the storage 2-8°C will be up to 2 days and at - 20°C or ideally -70°C and shipped on dry ice if further delays are expected for more than 2 days. 50,51

• Samples will be analyzed at central laboratory using the same kits throughout the study.

• Multiplex viral (RT)PCR will be performed on each Nasopharyngeal specimen testing for respiratory viruses, namely:

  4 Viruses + RSV genotyping

• Flu A
• Flu B
• RSV-A
• RSV-B
• SARS-CoV-2
• Quality assurance measures will be performed throughout the study.
• Pharmacoeconomics data:The economic burden of RSV will be assessed. Applying societal perspective, all direct medical, direct non-medical and indirect costs will be quantified (collected). With micro-costing approach, multiplication of utilization of resource quantity and unit cost will be used. At first, all required resources to treat an episode of RSV cases will be identified, through including the quantity and/or frequency of medications, medical supplies, diagnostic tests, number of hospital bed days, ambulatory clinic visits, travel time and cost, work absence (hours or days absent) and/or productivity losses of caregivers, and informal care visits.

• Study Type: Observational
• Enrollment (Anticipated): 1200

Contacts and Locations

• Study Contact: Name: Dr Munir Abu-Helalah, MD; Phone Number: 00962776981554; Email: cmo@mena-rdi.org
• Study Contact Backup: Name: Dr Mohamed Abu Lubbad, PhD; Phone Number: 00962799105198; Email: abu-lubbad@mena-rdi.org

Study Locations

• Jordan
  • Amman, Jordan
    • Recruiting
    • Jordan University Hospital
    • Contact: Dr Einas Zayadneh

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 second to 5 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Case definition: Diagnosis of acute respiratory infection: Defined as "an illness presenting with one or more of the following symptoms for less than 7 days: Fever, cough, earache, nasal congestion, rhinorrhea, sore throat, vomiting after coughing, Crackles, and labored, rapid or shallow breathing".

Study population:

Children <5 years of age admitted to study sites with

1. At least one sign of acute infection (temperature ≥38 °C or <35.5 °C, abnormal white blood cell [WBC] count or abnormal differential) and
2. At least 1 of the following respiratory signs or symptoms for less than 7 days: tachypnea, cyanosis, cough, sputum production, pleuritic chest pain, hemoptysis, dyspnea, sore throat. cough, runny nose, grunting, wheeze, apnoea, difficulty in breathing.

outpatients and emergency department is of value, An additional sample of 200 children from emergency department and outpatients who meet above criteria will be also enrolled.

Description

Inclusion Criteria:

-

Inclusion criteria:

A.-Patients age less than 5 years permanently resident in the study areas - hospitalized with acute respiratory infection according to below definition and criteria: hildren <5 years of age admitted to study sites with

1. At least one sign of acute infection (temperature ≥38 °C or <35.5 °C, abnormal white blood cell [WBC] count or abnormal differential) and
2. At least 1 of the following respiratory signs or symptoms for less than 7 days: tachypnea, cyanosis, cough, sputum production, pleuritic chest pain, hemoptysis, dyspnea, sore throat. cough, runny nose, grunting, wheeze, apnoea, difficulty in breathing.

outpatients and emergency department is of value,

B-An additional sample of 200 children from emergency and outpatients clinics who meets above criteria.

Exclusion Criteria:

A. Not permanently resident in Jordan.

-

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Cross-Sectional

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
to measure epidemiological burden of RSV infection in Jordan among hospitalized children under 5 years of age, proportion of RSV infections along with showing the data for the age 0-24 months and 25-59 months	to measure the total epidemiological burden of RSV infection in Jordan among hospitalized children under 5 years of age, proportion of RSV infections along with showing the data for the age 0-24 months and 25-59 months separately.	9 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To measure the Odds ratio for risk factors of RSV infections	To measure the odds ratio for risk factors for RSV infection: (Infants: especially premature infants or babies who are 6 months or younger, congenital heart disease, chronic respiratory disease such as cystic fibrosis, immune deficiency: primary or secondary to medical condition or treatment), neuromuscular disorders, such as muscular dystrophy)	9 months
To measure selected clinical characteristics of RSV infections requiring hospital admissions and complications rates	To measure the rates of clinical characteristics of RSV infections requiring hospital admissions and complications rates: duration of hospitalization, reason for admission, hypoxia, ICU admissions, pneumonia, ventilation, respiratory failure, Otitis media perforate or not perforated, presence of secondary infections, readmission, mortality rate particularly amongst premature infants or immunocompromised patients.	9 months
To measure the proportion of RSV positivity amongst children hospitalized with acute respiratory infections.	To measure the proportion of RSV positivity amongst children hospitalized with acute respiratory infections.	9 months
To quantify the direct and indirect costs of RSV infections both at the community and hospital levels including readmissions, direct and indirect medical and societal costs:	To quantify the direct and indirect costs of RSV infections both at the community and hospital levels including readmissions, direct and indirect medical and societal costs:	12 months
To measure the distribution of RSV genotypes using representative national sample.	To measure the distribution of RSV genotypes using representative national sample.	6 months
To measure the positivity rate for RSV, without genotyping, amongst a selected sample from emergency and outpatients clinics	To measure the positivity rate for RSV, without genotyping, amongst a selected sample from emergency and outpatients clinics at Princess Rahma Governmental Hospital in Irbid and Jordan University Hospital in Amman to measure the health and cost burden. Follow up of these subjects for revisits or admissions will be performed	9 months

Collaborators and Investigators

• Sponsor: MENA Center for Research & Development and Internship
• Collaborators: Merck Sharp & Dohme LLC

Publications and helpful links

General Publications

• GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018 Nov;18(11):1191-1210. doi: 10.1016/S1473-3099(18)30310-4. Epub 2018 Sep 19.
• Groothuis JR, Hoopes JM, Jessie VG. Prevention of serious respiratory syncytial virus-related illness. I: Disease pathogenesis and early attempts at prevention. Adv Ther. 2011 Feb;28(2):91-109. doi: 10.1007/s12325-010-0100-z. Epub 2011 Feb 4.

Study record dates

Study Major Dates

• Study Start (Actual): November 20, 2022
• Primary Completion (Anticipated): June 30, 2023
• Study Completion (Anticipated): August 31, 2023

Study Registration Dates

• First Submitted: September 28, 2022
• First Submitted That Met QC Criteria: September 28, 2022
• First Posted (Actual): October 3, 2022

Study Record Updates

• Last Update Posted (Actual): December 15, 2022
• Last Update Submitted That Met QC Criteria: December 13, 2022
• Last Verified: December 1, 2022

More Information

Terms related to this study

• Keywords: Epidemiology; Jordan; Clinical burden; Economic burden
• Additional Relevant MeSH Terms: Behavioral Symptoms; RNA Virus Infections; Virus Diseases; Infections; Paramyxoviridae Infections; Mononegavirales Infections; Stress, Psychological; Pneumovirus Infections; Respiratory Syncytial Virus Infections; Financial Stress
• Other Study ID Numbers: RSV-Jo.Burden2022

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No