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HMPV prevalent among children older than 1 year
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Human metapneumovirus, or HMPV, is a common cause of illness among young children, according to research published online.
Study researcher John V. Williams, MD, and colleagues in the CDC New Vaccine Surveillance Network tested samples taken from more than 10,000 young children from 2003 to 2009. The network included sites in Cincinnati, Nashville, Tenn., and Rochester, N.Y.
John V. Williams
“HMPV was detected in 200 of 3,490 hospitalized children, 222 of 3,257 children in outpatient clinics, 224 of 3,001 children in the emergency department, and 10 of 770 asymptomatic controls,” the researchers wrote.
Williams, along with lead author and Infectious Diseases in Children Editorial Board member Kathryn M. Edwards, MD, and colleagues reported that rates of hospitalization associated with HMPV increased for children the younger they were. They also said HMPV remained common in children aged older than 1 year, in contrast to respiratory syncytial virus, which is most common in young infants.
“HMPV is a virus that was unknown 10 years ago and yet turns out to be one of the most common causes of severe respiratory infection,” Williams told Infectious Diseases in Children.
The researchers said their study had some limitations, including that the results may not be able to be generalized to the entire US population.
John V. Williams, MD, can be reached at Vanderbilt University Medical Center, D-7235 Medical Center N. 1161 21st Ave. S., Nashville, TN 37232- 2581; email: john.williams@vanderbilt.edu.
Disclosure: Williams serves on the scientific advisory board of Quidel.
Perspective
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Leonard R. Krilov, MD
Since the discovery of human metapneumovirus (HMPV) in 2001, it has been recognized as an important cause of acute respiratory illness with a clinical spectrum similar to respiratory syncytial virus (RSV) – bronchiolitis, pneumonia and exacerbations of reactive airway disease. Edwards and colleagues from the National Virus Surveillance Network (NVSN) recently reported a large prospective study of more than 10,000 children aged younger than 5 years with acute respiratory illnesses assessed for HMPV infection by PCR analysis of respiratory secretions from 2003 through 2009.
Their analyses provide important additional information on the burden of HMPV infection in young children in the hospital and outpatient settings, its seasonality over years and the clinical characteristics of the infection in children.
Hospitalizations for HMPV infection in young children occurred less than for RSV infections but at rates similar to other respiratory viruses, such as influenza and parainfluenza, accounting for approximately 20,000 admissions per year in children aged younger than 5 years. Additionally, more than 250,000 ED and approximately one million outpatient clinic visits per year were attributable to HMPV infection. The highest attack rate was in 6- to 11-month-olds and hospitalizations were highest in infants aged younger than 6 months, while RSV infection are most common and severe in infants aged younger than 6 months.
Additionally HMPV infections continued to occur at high attack rates throughout the first 5 years, while RSV severity decreases after the first year of life. Furthermore, in contrast to RSV infections, HMPV infections were not associated with out-of-home care, exposure to cigarette smoke, lack of breast- feeding, or lower maternal educational level in this study.
Timing of HMPV infections varied by year, but the majority of infections were seen from January through April, a little later than the peak for RSV infection. HMPV was isolated from a small percentage (1%) of asymptomatic controls at a lower viral load than in symptomatic cases.
Dr. Caroline Hall, who recently passed away, was one of the authors on this paper. I was fortunate to serve as faculty with her at one of the Annual Infectious Diseases in Children Symposiums in New York City in the early 1990s, where she discussed vaccine issues included in the AAP Red Book, while I got to present an update on RSV infections with her present!
In a primitive attempt to honor her contributions and her literary eloquence I began my talk with a brief “poetic” tribute:
RSV infects one and all
And is severe in some of our small
Within this arena
Our understanding’s much keener
Because of the works of C. Hall.
This manuscript offers such significant insight into HMPV, a cousin of RSV, and thus is fitting as one of her last publications.
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