Epidemiology of human metapneumovirus among children with severe or very severe pneumonia in high pneumonia burden settings: the PERCH study experience.

IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Clinical Microbiology and Infection Pub Date : 2024-11-01 DOI:10.1016/j.cmi.2024.10.023
Ryo Miyakawa, Haijun Zhang, W Abdullah Brooks, Christine Prosperi, Henry C Baggett, Daniel R Feikin, Laura L Hammitt, Stephen R C Howie, Karen L Kotloff, Orin S Levine, Shabir A Madhi, David R Murdoch, Katherine L O'Brien, J Anthony G Scott, Donald M Thea, Martin Antonio, Juliet O Awori, Charatdao Bunthi, Amanda J Driscoll, Bernard Ebruke, Nicholas S Fancourt, Melissa M Higdon, Ruth A Karron, David P Moore, Susan C Morpeth, Justin M Mulindwa, Daniel E Park, Mohammed Ziaur Rahman, Mustafizur Rahman, Rasheed A Salaudeen, Pongpun Sawatwong, Phil Seidenberg, Samba O Sow, Milagritos D Tapia, Maria Deloria Knoll
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Abstract

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 to 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 (aOR) were calculated using logistic regression. Etiologic 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 was 74.5%; mortality was 3.9%, similar to RSV-positive (2.4%) and lower than other cases (9.6%).

Conclusions: HMPV-associated severe pediatric 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.

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肺炎高负担地区重症或极重症肺炎患儿的人类偏肺病毒流行病学:PERCH 研究经验。
研究目的在 PERCH 研究中,继呼吸道合胞病毒(RSV)之后,人类偏肺病毒(hMPV)是导致重症肺炎的第二大病原体。我们试图通过与 RSV 阳性病例和其他病例进行比较,了解数据有限的高负担环境中 hMPV 阳性病例的特征:方法:七个非洲和亚洲国家的 1-59 个月大疑似重症肺炎住院儿童和年龄/季节匹配的社区对照组在入院时通过多重 PCR 对鼻咽/咽拭子进行了 32 种呼吸道病原体检测,并进行了其他临床和实验室评估。使用逻辑回归法计算了根据年龄和发病部位调整后的比值比(aOR)。病因概率采用贝叶斯嵌套部分潜类分析法进行估算。潜类分析确定了临床特征的综合征:病例(267/3887,6.9%)中检测到 HMPV 的比例高于对照组(115/4976,2.3%),有肺炎胸部 X 光检查结果的病例(8.5%)高于无肺炎胸部 X 光检查结果的病例(5.5%),有呼吸道疾病的对照组(3.8%)高于无呼吸道疾病的对照组(1.8%);所有数据的 p 均小于 0.001。HMPV 阳性病例与其他病毒的检测呈负相关(aOR=0.18),尤其是 RSV(aOR=0.11;所有 p 结论:高负担环境中与 HMPV 相关的小儿重症肺炎主要发生在幼儿身上,临床上与 RSV 无法区分。HMPV阳性病例的死亡率较低,与RSV阳性病例的死亡率相似。
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来源期刊
CiteScore
25.30
自引率
2.10%
发文量
441
审稿时长
2-4 weeks
期刊介绍: Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.
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