Acute Respiratory Infections Epidemiology and Etiology in Hospitalized Moroccan Children under 15 Years


Acute respiratory infections
Multiplex PCR

How to Cite

Ighid N, El Akil S, Aghrouch M, Hassaini N, Izaabel EH. Acute Respiratory Infections Epidemiology and Etiology in Hospitalized Moroccan Children under 15 Years. Integr J Med Sci [Internet]. 2020Aug.29 [cited 2020Oct.22];7. Available from:


Introduction: Acute respiratory infections (ARIs) are serious infections with multiple etiologies. Viral etiology is mostly common worldwide, especially in pediatric patients.
Materials and methods: This study aims to describe epidemiology and etiology of ARIs in Moroccan children under 15 years old, through patients’ clinical features analysis and genetic detection of pathogens within 84 patients admitted to Hassan II regional hospital of Agadir, Morocco, from September 2015 to September 2016. Detection of pathogens was carried out using Multiplex real-time reverse transcription polymerase chain reaction (rRT-PCR) with Fast Track Diagnostic kit respiratory pathogens 21 plus.
Results: Results gave 61.9% of positive viral and bacterial infections and 19.23% of co-infections by at least two pathogens. Males were mainly infected and the respiratory syncytial virus (RSV) was the most common in 53.8% of patients. Children aged less than 2 years were the most infected by ARIs pathogens, and especially by RSV virus. Concerning seasonality pattern, all ARIs pathogens showed a seasonal spreading mainly in winter.
Conclusion: This study summarizes a great insight about epidemiology and etiology of ARIs among children under 15 years in Morocco. We observed that ARIs constituted a real health problem in infancy and the viruses are the commonest cause.


Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis. 2002 Jan 1;2(1):25–32. DOI: 10.1016/s1473-3099(01)00170-0

Parveen S, Sullender WM, Fowler K, Lefkowitz EJ, Kapoor SK, Broor S. Genetic variability in the G protein gene of group A and B respiratory syncytial viruses from India. J Clin Microbiol. 2006 Sep 1;44(9):3055–64. DOI: 10.1128/JCM.00187-06

World Health Organization. Up to 650 000 people die of respiratory diseases linked to seasonal flu each year [Internet]. 2017. [cited 2020 Aug 29]. Available from:

Jroundi I, Mahraoui C, Benmessaoud R, Moraleda C, Benjelloun BS, Bassat Q. Knowledge gaps on paediatric respiratory infections in Morocco, Northern Africa. Arch Public Heal. 2015 Dec 15;73(1):28. DOI: 10.1186/s13690-015-0076-x

Alonso WJ, Laranjeira BJ, Pereira SAR, Florencio CMGD, Moreno EC, Miller MA, et al. Comparative dynamics, morbidity and mortality burden of pediatric viral respiratory infections in an equatorial city. Pediatr Infect Dis J. 2012 Jan;31(1). DOI: 10.1097/INF.0b013e31823883be

Banerjee D, Kanwar N, Hassan F, Essmyer C, Selvarangan R. Comparison of six sample-to-answer influenza A/B and respiratory syncytial virus nucleic acid amplification assays using respiratory specimens from children. Loeffelholz MJ, editor. J Clin Microbiol. 2018 Sep 5;56(11). DOI: 10.1128/JCM.00930-18

Marcil S, Kabbaj H, Jroundi I, Barakat A, Mahraoui C, Kettani S et al. Epidemiology and diagnosis of the severe acute viral respiratory infections in patients admitted at IBN Sina University Hospital Rabat- Morocco. Dis Disord. 2018;2(1). DOI : 10.15761/JDD.1000112

Elhakim M, Hafiz Rasooly M, Fahim M, Sheikh Ali S, Haddad N, Cherkaoui I, et al. Epidemiology of severe cases of influenza and other acute respiratory infections in the Eastern Mediterranean Region, July 2016 to June 2018. J Infect Public Health. 2020 Mar 1;13(3):423–9. DOI: 10.1016/j.jiph.2019.06.009

World Health Organization. WHO surveillance definitions for ILI and SARI [Internet]. WHO. World Health Organization; 2014 [cited 2020 Aug 29]. p. 1–2. Available from:,

Njouom R, Yekwa EL, Cappy P, Vabret A, Boisier P, Rousset D. Viral Etiology of Influenza-Like Illnesses in Cameroon, January–December 2009. J Infect Dis. 2012 Dec 15;206(suppl_1):S29–35. DOI: 10.1093/infdis/jis573

Stahl JP. La grippe en face, Y. Buisson, E. Nicand, P. Saliou. Éditions Xavier-Montauban (2007). Médecine et Maladies Infectieuses. 2008 Nov 29 ;38(11):620. DOI : 10.1016/j.medmal.2008.09.001

Essa S, Al-Tawalah H, Alshamali S, Al-Nakib W. The potential influence of human parainfluenza viruses detected during hospitalization among critically ill patients in Kuwait, 2013-2015. Virol J. 2017 Feb 3;14(1) :19. DOI: 10.1186/s12985-017-0681-0

Halaji M, Hashempour T, Moayedi J, Pouladfar GR, Khansarinejad B, Khashei R, et al. Viral etiology of acute respiratory infections in children in Southern Iran. Rev Soc Bras Med Trop. 2019;52. DOI: 10.1590/0037-8682-0249-2018

Malhotra B, Swamy MA, Janardhan Reddy P V., Gupta ML. Viruses causing severe acute respiratory infections (SARI) in children ≤5 years of age at a tertiary care hospital in rajasthan, india. Indian J Med Res. 2016 Dec 1;144(DECEMBER):877–85. DOI: 10.4103/ijmr.IJMR_22_15

Kumar P, Medigeshi GR, Mishra VS, Islam M, Randev S, Mukherjee A, et al. Etiology of Acute Respiratory Infections in Infants: A Prospective Birth Cohort Study. Pediatr Infect Dis J. 2017 Jan 1;36(1):25–30. DOI: 10.1097/INF.0000000000001359

Rhedin S, Hamrin J, Naucler P, Bennet R, Rotzén-Östlund M, Färnert A, et al. Respiratory Viruses in Hospitalized Children with Influenza-Like Illness during the H1n1 2009 Pandemic in Sweden. PLoS One. 2012;7(12):e51491. DOI: 10.1371/journal.pone.0051491

Puzelli S, Valdarchi C, Ciotti M, Dorrucci M, Farchi F, Babakir-Mina M, et al. Viral causes of influenza-like illness: Insight from a study during the winters 2004-2007. J Med Virol. 2009 Dec;81(12):2066–71. DOI: 10.1002/jmv.21610

Laguna-Torres VA, Gómez J, Ocaña V, Aguilar P, Saldarriaga T, Chavez E, et al. Influenza-like illness sentinel surveillance in Peru. PLoS One. 2009 Jul 1;4(7):e6118. DOI: 10.1371/journal.pone.0006118

Jroundi I, Mahraoui C, Benmessaoud R, Moraleda C, Tligui H, Seffar M, et al. The epidemiology and aetiology of infections in children admitted with clinical severe pneumonia to a university hospital in Rabat, Morocco. J Trop Pediatr. 2014 Aug 1;60(4):270–8. DOI : 10.1093/tropej/fmu010

Khor CS, Sam IC, Hooi PS, Quek KF, Chan YF. Epidemiology and seasonality of respiratory viral infections in hospitalized children in Kuala Lumpur, Malaysia: A retrospective study of 27 years. BMC Pediatr. 2012 Mar 20;12. DOI: 10.1186/1471-2431-12-32

Nguyen HK Le, Nguyen SV, Nguyen AP, Hoang PMV, Le TT, Nguyen TC, et al. Surveillance of severe acute respiratory infection (SARI) for hospitalized patients in Northern Vietnam, 2011–2014. Jpn J Infect Dis. 2017;70(5):522–7. DOI: 10.7883/yoken.JJID.2016.463

Hall CB. Respiratory syncytial virus and parainfluenza virus. N Engl J Med. 2001 Jun 21;344(25):1917–28. DOI: 10.1056/NEJM200106213442507

Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, Staat MA, et al. The Burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009 Feb 5;360(6):588–98. DOI: 10.1056/NEJMoa0804877

Shi T, McAllister DA, O’Brien KL, Simoes EAF, Madhi SA, Gessner BD, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017 Sep 2;390(10098):946–58. DOI: 10.1016/S0140-6736(17)30938-8

Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375(9725):1545–55. DOI: 10.1016/S0140-6736(10)60206-1

Hall CB. Respiratory syncytial virus: Its transmission in the hospital environment. Vol. 55, Yale Journal of Biology and Medicine. Yale Journal of Biology and Medicine; 1982. p. 219–23.

Pitzer VE, Viboud C, Alonso WJ, Wilcox T, Metcalf CJ, Steiner CA, et al. Environmental Drivers of the Spatiotemporal Dynamics of Respiratory Syncytial Virus in the United States. PLoS Pathog. 2015; 11(1):e1004591. DOI: 10.1371/journal.ppat.1004591

Rameix-Welti M-A, Rameix-Welti M-A, Gault E. Le virus respiratoire syncytial (VRS) : état actuel des connaissances. Feuill Biol. 2017;(N°335).

Gutfraind A, Galvani AP, Meyers LA. Efficacy and optimization of palivizumab injection regimens against respiratory syncytial virus infection. JAMA Pediatr. 2015 Apr 1;169(4):341–8. DOI: 10.1001/jamapediatrics.2014.3804

Tecu C, Mihai ME, Alexandrescu VI, Orǎşeanu D, Zapucioiu C, Ivanciuc AE, et al. Single and multipathogen viral infections in hospitalized children with acute respiratory infections. Roum Arch Microbiol Immunol. 2013;72(4):242–9.

Bonzel L, Tenenbaum T, Schroten H, Schildgen O, Schweitzer-Krantz S, Adams O. Frequent detection of viral coinfection in children hospitalized with acute respiratory tract infection using a real-time polymerase chain reaction. Pediatr Infect Dis J. 2008;27(7):589–94. DOI: 10.1097/INF.0b013e3181694fb9

De Freitas Souza LS, Gonçalves Ramos EA, Carvalho FM, Ribeiro Guedes VMC, Souza LS, Rocha CM, et al. Viral respiratory infections in young children attending day care in urban Northeast Brazil. Pediatr Pulmonol. 2003 Mar 1;35(3):184–91. DOI: 10.1002/ppul.10194

Ambrosioni J, Bridevaux PO, Wagner G, Mamin A, Kaiser L. Epidemiology of viral respiratory infections in a tertiary care centre in the era of molecular diagnosis, Geneva, Switzerland, 2011-2012. Clin Microbiol Infect. 2014 Sep 1;20(9):O578–84. DOI: 10.1111/1469-0691.12525

El-Hajje MJ, Moulin F, de Suremain N, Marc E, Cosnes-Lambe C, Pons-Catalano C, et al. La fréquence du virus respiratoire syncytial et des autres virus respiratoires dans les hospitalisations de l’enfant. Une enquête de 3 ans. Press Medicale. 2008 Jan;37(1 I):37–43. DOI: 10.1016/j.lpm.2007.06.023

Bhuyan GS, Hossain MA, Sarker SK, Rahat A, Islam MT, Haque TN, et al. Bacterial and viral pathogen spectra of acute respiratory infections in under-5 children in hospital settings in Dhaka city. PLoS One. 2017 Mar 1;12(3):e0174488. DOI: 10.1371/journal.pone.0174488

Assane D, Makhtar C, Abdoulaye D, Amary F, Djibril B, Amadou D, et al. Viral and Bacterial Etiologies of Acute Respiratory Infections Among Children Under 5 Years in Senegal. Microbiol Insights. 2018 Jan;11:117863611875865. DOI: 10.1177/1178636118758651

Lagare A, Maïnassara HB, Issaka B, Sidiki A, Tempia S. Viral and bacterial etiology of severe acute respiratory illness among children < 5 years of age without influenza in Niger. BMC Infect Dis. 2015 Nov 14;15(1):515. DOI: 10.1186/s12879-015-1251-y

Weber MW, Mulholland EK, Greenwood BM. Respiratory syncytial virus infection in tropical and developing countries. Trop Med Int Heal. 1998;3(4):268–80. DOI: 10.1046/j.1365-3156.1998.00213.x

Borchers AT, Chang C, Gershwin ME, Gershwin LJ. Respiratory syncytial virus - A comprehensive review. Vol. 45, Clinical Reviews in Allergy and Immunology. Clin Rev Allergy Immunol; 2013. p. 331–79. DOI: 10.1007/s12016-013-8368-9

Chew FT, Doraisingham S, Ling AE, Kumarasinghe G, Lee BW. Seasonal trends of viral respiratory tract infections in the tropics. Epidemiol Infect. 1998 Aug;121(1):121–8. DOI: 10.1017/s0950268898008905

Shaman J, Kohn M. Absolute humidity modulates influenza survival, transmission, and seasonality. Proc Natl Acad Sci U S A. 2009 Mar 3;106(9):3243–8. DOI: 10.1073/pnas.0806852106

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2020 Nassima Ighid, Soumaya El Akil, Mohamed Aghrouch, Nadia Hassaini, El Hassan Izaabel