TY - JOUR
T1 - Epidemiology of human metapneumovirus among children with severe or very severe pneumonia in high pneumonia burden settings
T2 - the Pneumonia Etiology Research for Child Health (PERCH) study experience
AU - Miyakawa, Ryo
AU - Zhang, Haijun
AU - Brooks, W. Abdullah
AU - Prosperi, Christine
AU - Baggett, Henry C.
AU - Feikin, Daniel R.
AU - Hammitt, Laura L.
AU - Howie, Stephen R.C.
AU - Kotloff, Karen L.
AU - Levine, Orin S.
AU - Madhi, Shabir A.
AU - Murdoch, David R.
AU - O'Brien, Katherine L.
AU - Scott, J. Anthony G.
AU - Thea, Donald M.
AU - Antonio, Martin
AU - Awori, Juliet O.
AU - Bunthi, Charatdao
AU - Driscoll, Amanda J.
AU - Ebruke, Bernard
AU - Fancourt, Nicholas S.
AU - Higdon, Melissa M.
AU - Karron, Ruth A.
AU - Moore, David P.
AU - Morpeth, Susan C.
AU - Mulindwa, Justin M.
AU - Park, Daniel E.
AU - Rahman, Mohammed Ziaur
AU - Rahman, Mustafizur
AU - Salaudeen, Rasheed A.
AU - Sawatwong, Pongpun
AU - Seidenberg, Phil
AU - Sow, Samba O.
AU - Tapia, Milagritos D.
AU - Deloria Knoll, Maria
N1 - Publisher Copyright:
© 2024 European Society of Clinical Microbiology and Infectious Diseases
PY - 2025/3
Y1 - 2025/3
N2 - Objectives: After respiratory syncytial virus (RSV), human metapneumovirus (hMPV) was the second-ranked pathogen attributed to severe pneumonia in the PERCH study. We sought to characterize hMPV-positive cases in high-burden settings, which have limited data, by comparing with RSV-positive and other cases. Methods: Children aged 1–59 months hospitalized with suspected severe pneumonia and age/season-matched community controls in seven African and Asian countries had nasopharyngeal/oropharyngeal swabs tested by multiplex PCR for 32 respiratory pathogens, among other clinical and lab assessments at admission. Odds ratios adjusted for age and site (adjusted OR [aOR]) were calculated using logistic regression. Aetiologic probability was estimated using Bayesian nested partial latent class analysis. Latent class analysis identified syndromic constellations of clinical characteristics. Results: hMPV was detected more frequently among cases (267/3887, 6.9%) than controls (115/4976, 2.3%), among cases with pneumonia chest X-ray findings (8.5%) than without (5.5%), and among controls with respiratory tract illness (3.8%) than without (1.8%; all p ≤ 0.001). HMPV-positive cases were negatively associated with the detection of other viruses (aOR, 0.18), especially RSV (aOR, 0.11; all p < 0.0001), and positively associated with the detection of bacteria (aORs, 1.77; p 0.03). No single clinical syndrome distinguished hMPV-positive from other cases. Among hMPV-positive cases, 65.2% were aged <1 year and 27.5% had pneumonia danger signs; positive predictive value for hMPV aetiology was 74.5%; mortality was 3.9%, similar to RSV-positive (2.4%) and lower than that among other cases (9.6%). Discussion: HMPV-associated severe paediatric pneumonia in high-burden settings was predominantly in young infants and clinically indistinguishable from RSV. HMPV-positives had low case fatality, similar to that in RSV-positives.
AB - Objectives: After respiratory syncytial virus (RSV), human metapneumovirus (hMPV) was the second-ranked pathogen attributed to severe pneumonia in the PERCH study. We sought to characterize hMPV-positive cases in high-burden settings, which have limited data, by comparing with RSV-positive and other cases. Methods: Children aged 1–59 months hospitalized with suspected severe pneumonia and age/season-matched community controls in seven African and Asian countries had nasopharyngeal/oropharyngeal swabs tested by multiplex PCR for 32 respiratory pathogens, among other clinical and lab assessments at admission. Odds ratios adjusted for age and site (adjusted OR [aOR]) were calculated using logistic regression. Aetiologic probability was estimated using Bayesian nested partial latent class analysis. Latent class analysis identified syndromic constellations of clinical characteristics. Results: hMPV was detected more frequently among cases (267/3887, 6.9%) than controls (115/4976, 2.3%), among cases with pneumonia chest X-ray findings (8.5%) than without (5.5%), and among controls with respiratory tract illness (3.8%) than without (1.8%; all p ≤ 0.001). HMPV-positive cases were negatively associated with the detection of other viruses (aOR, 0.18), especially RSV (aOR, 0.11; all p < 0.0001), and positively associated with the detection of bacteria (aORs, 1.77; p 0.03). No single clinical syndrome distinguished hMPV-positive from other cases. Among hMPV-positive cases, 65.2% were aged <1 year and 27.5% had pneumonia danger signs; positive predictive value for hMPV aetiology was 74.5%; mortality was 3.9%, similar to RSV-positive (2.4%) and lower than that among other cases (9.6%). Discussion: HMPV-associated severe paediatric pneumonia in high-burden settings was predominantly in young infants and clinically indistinguishable from RSV. HMPV-positives had low case fatality, similar to that in RSV-positives.
KW - Africa
KW - Asia
KW - Human metapneumovirus (hMPV)
KW - Paediatric
KW - Severe pneumonia
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U2 - 10.1016/j.cmi.2024.10.023
DO - 10.1016/j.cmi.2024.10.023
M3 - Article
C2 - 39489292
AN - SCOPUS:85210129111
SN - 1198-743X
VL - 31
SP - 441
EP - 450
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 3
ER -