WHO Severe Acute Respiratory Infections (SARI) Definition often Underdiagnoses Serious Respiratory Viral Infections in Hospitalized Jordanian Children

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 vs. those who did not. Figure 1 compares % of children who were virus-positive and met SARI definition. 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 with 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. DISCLOSURES: J. V. Williams, Quidel: Scientific Advisor, Consulting fee; GlaxoSmithKline: Scientific Advisor, Consulting fee; N. B. Halasa, sanofi pasteur: Research Contractor, Research support; Astra Zeneca: Research Contractor, Grant recipient