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Preliminary risk factors identified for human metapneumovirus
51st ICAAC
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CHICAGO — Human metapneumovirus causes a significant amount of disease, yet risk factors for severe disease remain unknown, according to a poster presented here during the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy.
Jesse Papenburg, MD, a staff infectious disease physician at the Montreal Children’s Hospital, McGill University Health Centre in Canada, told Infectious Diseases in Children that human metapneumovirus (hMPV) represented about 10% of the infections in hospitalized patients in the cohort and almost 20% of infections in patients who visited the pediatric clinic with an acute lower respiratory tract infection (RTI).
“It does represent a significant burden of disease,” he said.
Papenburg and colleagues from Canada aimed to identify environmental, host and viral determinants for severe hMPV infection in children aged younger than 3 years to guide rational use of antivirals, vaccines and monoclonal antibodies that are currently under development.
“The aim of our study was to try to identify risk factors either in the host, host environment or in the virus itself that might lead to more severe disease,” Papenburg said. The researchers wanted to build rational preventive strategies for hMPV in the same manner palivizumab (Synagis, MedImmune) has been used to prevent respiratory syncytial virus (RSV).
The prospective cohort study involved 1,039 children who presented with symptoms of lower RTI to Quebec University Hospital Center during 2006-2010. Nasopharyngeal aspirates were obtained and tested by a multiplex PCR/DNA hybridization assay that detects hMPV genotypes A and B and 22 other respiratory viruses, according to Papenburg.
The investigation identified hMPV in 58 of 305 (19.0%) outpatients and 69 of 734 (9.4%) hospitalized patients. Papenburg said that hMPV was second only to RSV in both settings (48.2% and 63.4%, respectively).
Compared with patients with hMPV who were seen in the clinic, hospitalized patients with hMPV were younger (mean age, 10.3 vs. 13.8 months; P=.008), more frequently born at fewer than 33 weeks gestation (10.1% vs. 0.0%; P =.015) and had a higher proportion of underlying cardiac disease (10.1% vs. 0.0%; P=.015).
“We also found that if there were more than three children in the household, it was a risk factor for being hospitalized vs. just being seen in the clinic,” he said. “
Among hospitalized patients, Papenburg said the following were associated with severe disease: prematurity (OR=13.97; 95% CI, 1.50-130.0); female sex (OR=4.32; 95% CI, 1.3-14.9); and hMPV genotype B (OR=4.34; 95% CI, 1.26-14.9).
“The finding about female sex was a bit of a surprise, because we know for RSV that male sex is a risk factor for more severe disease. Even though we know hMPV and RSV are very similar paramyxoviruses, if we are going to have public health strategies for hMPV, we need to really assess this virus independently from RSV and not just base everything in RSV results,” Papenburg said.
Disclosure: Dr. Papenburg reports no relevant financial disclosures.
For more information:
- Papenburg J. #V-1553. Risk Factors for Human Metapneumovirus Disease Severity in Children Aged <3 Years. Presented at: 51st ICAAC. Sept. 17-20, 2011. Chicago.
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