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HMPV common pathogen among preemies with respiratory infections
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Respiratory syncytial virus dominated as a primary pathogen that caused lower respiratory infection in premature infants, but human metapneumovirus was not far behind, according to recent study results.
Evan J. Anderson, MD, previously of Northwestern University Feinberg School of Medicine, and colleagues reported on data from a study of 1,126 babies who had been hospitalized with lower respiratory tract infection and had been born with prematurity, chronic lung disease or cardiac disease.
According to Anderson and colleagues, respiratory syncytial virus (RSV) was the most commonly noted pathogen associated with respiratory disease. However, the researchers identified human metapneumovirus (HMPV) in 9% of these high-risk children, making HMPV the second most common pathogen associated with respiratory disease in this group of patients.
The researchers noted some common characteristics among children who were more prone to HMPV; specifically, that they were more likely to have chronic lung disease and to have been more prematurely born than other infants in the analysis. Also, babies who were exposed to children aged 6 to 12 years were more likely to have HMPV. The researchers also noted that the peak HMPV was later in the typical cold season than RSV.
“Efforts to develop immunoprophylactic or therapeutic strategies should be intensified for high-risk infants and young children because HMPV is the etiologic agent of a substantial proportion of [lower respiratory tract infections] requiring hospitalization in these children,” the researchers concluded.
Evan J. Anderson, MD, can be reached at Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30303; email: evanjanderson3@gmail.com.
Disclosure: The study was supported by MedImmune, and several researchers report financial relationships with MedImmune or are employees of MedImmune.
Perspective
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Jeffrey S. Kahn, MD, PhD
Since its discovery in 2001, HMPV has been recognized as a ubiquitous respiratory virus that is responsible for a substantial proportion of respiratory tract disease in infants and young children. The disease caused by HMPV is essentially indistinguishable from other common respiratory viruses, specifically RSV.
This report confirms many previous observations of HMPV and its epidemiology. For example, the peak of HMPV circulation tends to follow the peak of RSV circulation for reasons which remain entirely unclear. Also, children hospitalized with HMPV tend to be slightly older than children hospitalized with RSV infection. Perhaps the most significant finding of this prospective, multinational, multiyear observational study is that of those children with a history of prematurity, hospitalized children with HMPV infection were born more prematurely than children hospitalized with RSV. This is likely explained, in part, by the protective effect of palivizumab (Synagis, MedImmune) against RSV disease.
Given the similarities of HMPV and RSV (both are paramyxoviruses), it seems that a humanized monoclonal antibody, like palivizumab, that targets HMPV would be a reasonable approach to protect preterm infants from severe HMPV disease. Ultimately, vaccines for both HMPV and RSV are needed.
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