Epidemiology of human metapneumovirus among children with severe or very severe pneumonia in high pneumonia burden settings: the Pneumonia Etiology Research for Child Health (PERCH) study experience.
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Miyakawa Ryo, Zhang Haijun, Brooks W Abdullah, Prosperi Christine, Baggett Henry C, Feikin Daniel R, Hammitt Laura L, Howie Stephen R C, Kotloff Karen L, Levine Orin S, Madhi Shabir A, Murdoch David R, O'Brien Katherine L, Scott J Anthony G, Thea Donald M, Antonio Martin, Awori Juliet O, Bunthi Charatdao, Driscoll Amanda J, Ebruke Bernard, Fancourt Nicholas S, Higdon Melissa M, Karron Ruth A, Moore David P, Morpeth Susan C, Mulindwa Justin M, Park Daniel E, Rahman Mohammed Ziaur, Rahman Mustafizur, Salaudeen Rasheed A, Sawatwong Pongpun, Seidenberg Phil, Sow Samba O, Tapia Milagritos D, Deloria Knoll Maria
Аннотация
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.