Temporal and climate characteristics of respiratory syncytial virus bronchiolitis in neonates and children in Sousse, Tunisia, during a 13-year surveillance
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This study established the correlation between respiratory syncytial virus (RSV) bronchiolitis and climate factors in the area of Sousse, Tunisia, during 13 years (2003–2015), from neonates and children <= 5 years old and hospitalized in Farhat Hached University-Hospital of Sousse. The meteorological data of Sousse including temperature, rainfall, and humidity were obtained. RSV detection was carried out with the direct immunofluorescence assay. The impact of climate factors on viral circulation was statistically analyzed. From 2003 to 2015, the total rate of RSV bronchiolitis accounted for 34.5% and peaked in 2007 and 2013. RSV infection was higher in male cases and pediatric environment (p<0.001) and was detected in 47.3% of hospitalizations in intensive care units. The epidemic of this pathogen started in October and peaked in January (41.6%). When the infectivity of RSV was at its maximum, the monthly average rainfall was high (31 mm) and the monthly average temperature and the monthly average humidity were at their minimum (11 °C and 66%, respectively). RSV activity was negatively correlated with temperature (r = − 0.78, p = 0.003) and humidity (r = − 0.62, p = 0.03). Regression analysis showed that the monthly average temperature fits into a linear model (R2 = 61%, p < 0.01). No correlation between RSV activity and rainfall was observed (p = 0.48). The meteorological predictions of RSV outbreaks with specific Tunisian climate parameters will help in determining the optimal timing of appropriate preventive strategies. In the area of Sousse, preventive measures should be enhanced since October especially, when the temperature is around 11 °C and humidity is above 60%.
KeywordsRSV Climate factors Seasonality Neonates Children Tunisia
This study was supported by the Ministry of Higher Education and Scientific Research of Tunisia (Unit Research for Genomic Characterization of Infectious Agents, UR12SP34, Farhat Hached University-Hospital of Sousse, Tunisia). We are thankful to our collaborators from the pediatric and neonatology wards at Farhat Hached University-Hospital of Sousse, Tunisia, for sampling procedures. We are grateful to Jamila Jammeli and Fawzi Ben Chedli, technicians in the Laboratory of Microbiology in same hospital, for their cooperation with RSV detection techniques. We are beholden to Dr. Sana Bhiri from the Department of Epidemiology and Medical Statistics in same hospital and to statisticians from the Department of Community Medicine (Sousse Medical University, Tunisia), for their assistance about the statistical calculations.
This study was funded by the Ministry of Higher Education and Scientific Research in Tunisia (Unit Research for Genomic Characterization of Infectious Agents, UR12SP34, Farhat Hached University-hospital of Sousse, Tunisia).
Compliance with ethical standards
This study did not involve any human experimentation. The only human material used was respiratory samples obtained by special physicians for the routine laboratory testing of RSV bronchiolitis using rapid diagnostic assays. The present study was approved with a formal authorization by the Scientific and Ethical Committee of Farhat Hached University-Hospital of Sousse, Tunisia. The approval number is IRB 00008931, provided by OHRP.
Conflict of interest
The authors declare that they have no conflict of interest relative to this manuscript.
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