Abstract
The World Health Organization created the Severe Acute Respiratory Infection (SARI) criteria in 2011 to monitor influenza (flu)-related hospitalization. Many studies have since used the SARI case definition as inclusion criteria for surveillance studies. We sought to determine the sensitivity, specificity, positive predictive value, and negative predictive value of the SARI criteria for detecting ten different respiratory viruses in a Middle Eastern pediatric cohort. The data for this study comes from a prospective acute respiratory surveillance study of hospitalized children <2 years in Amman, Jordan from March 16, 2010 to March 31, 2013. Participants were recruited if they had a fever and/or respiratory symptoms. Nasal and throat swabs were obtained and tested by real-time RT-PCR for eleven viruses. Subjects meeting SARI criteria were determined post-hoc. Sensitivity, specificity, positive predictive value, and negative predictive value of the SARI case definition for detecting ten different viruses were calculated and results were stratified by age. Of the 3,175 patients enrolled, 3,164 were eligible for this study, with a median age of 3.5 months, 60.4% male, and 82% virus-positive (44% RSV and 3.8% flu). The sensitivity and specificity of the SARI criteria for detecting virus-positive patients were 44% and 77.9%, respectively. Sensitivity of SARI criteria for any virus was lowest in children <3 months at 22.4%. Removing fever as a criterion improved the sensitivity by 65.3% for detecting RSV in children <3 months; whereas when cough was removed, the sensitivity improved by 45.5% for detecting flu in same age group. The SARI criteria have poor sensitivity for detecting RSV, flu, and other respiratory viruses-particularly in children <3 months. Researchers and policy makers should use caution if using the criteria to estimate burden of disease in children.
Highlights
Respiratory infections are the second leading cause of global years of life lost in all ages, and the leading cause of mortality in children under five years [1]
In 2011, the World Health Organization (WHO) created a case definition for Severe Acute Respiratory Infection (SARI) in an attempt to standardize global surveillance of hospitalization related to influenza—allowing national health authorities to interpret their data in an international context [2]
Several studies, including at least nine in the Eastern Mediterranean region, have been published since 2011 using the SARI case definition as inclusion criteria to report a combination of clinical characteristics, risk factors, viral burden, or outcomes in adult and pediatric populations for flu and other respiratory viruses [5,6,7,8,9,10,11,12,13]
Summary
Respiratory infections are the second leading cause of global years of life lost in all ages, and the leading cause of mortality in children under five years [1]. In 2011, the World Health Organization (WHO) created a case definition for Severe Acute Respiratory Infection (SARI) in an attempt to standardize global surveillance of hospitalization related to influenza (flu)—allowing national health authorities to interpret their data in an international context [2]. Several studies, including at least nine in the Eastern Mediterranean region, have been published since 2011 using the SARI case definition as inclusion criteria to report a combination of clinical characteristics, risk factors, viral burden, or outcomes in adult and pediatric populations for flu and other respiratory viruses [5,6,7,8,9,10,11,12,13]. Only one of these studies stratified age to include a group of children less than three months old, and studies of this type from the Eastern Mediterranean region are lacking [17]
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