Characteristics of human metapneumovirus infection in adults hospitalized for community-acquired influenza-like illness in France, 2012–2018: a retrospective observational study

Abstract

Objectives: To describe the prevalence, clinical features and complications of human metapneumovirus (hMPV) infections in a population of adults hospitalized with influenza-like illness (ILI). Methods: This was a retrospective, observational, multicenter cohort study using prospectively collected data from adult patients hospitalized during influenza virus circulation, for at least 24 h, for communityacquired ILI (with symptom onset <7 days). Data were collected from five French teaching hospitals over six consecutive winters (2012e2018). Respiratory viruses were identified by multiplex reverse transcription polymerase chain reaction (RT-PCR) on nasopharyngeal specimens. hMPV þ patients were compared with hMPVe patients, influenzaþ and respiratory syncytial virus (RSV)þ patients using multivariate logistic regressions. Primary outcome was the prevalence of hMPV in patients hospitalized for ILI. Results: Among the 3148 patients included (1449 (46%) women, 1988 (63%) aged 65 and over; 2508 (80%) with chronic disease), at least one respiratory virus was detected in 1604 (51%, 95% confidence interval (CI) 49e53), including 100 cases of hMPV (100/3148, 3% 95% CI 3e4), of which 10 (10%) were viral coinfection. In the hMPV þ patients, mean length of stay was 7 days, 62% (56/90) developed a complication, 21% (14/68) were admitted to intensive care unit and 4% (4/90) died during hospitalization. In comparison with influenza þ patients, hMPV þ patients were more frequently >65 years old (adjusted odds ratio (aOR) ¼ 3.3, 95% CI 1.9e6.3) and presented more acute heart failure during hospitalization (aOR ¼ 1.8, 95% CI 1.0e2.9). Compared with RSV þ patients, hMPV þ patients had less cancer (aOR ¼ 0.4, 95% CI 0.2e0.9) and were less likely to smoke (aOR ¼ 0.5, 95% CI 0.2e0.9) but had similar outcomes, especially high rates of respiratory and cardiovascular complications.

Clinical characteristics and outcomes in adult patients hospitalized with influenza, respiratory syncytial virus and human metapneumovirus infections

“…In our study, 6.2%, 10.9%, and 17.3% of patients hospitalized with influenza, RSV, and hMPV died within 30 days following admission, respectively. These mortality rates were consistent with those in prior studies of older adults hospitalized with these three viral infections [18,26,27]. Many studies to date have assessed disease severity associated with these three types of viral infections, but the results of these studies have been highly varied.…”

“…ILI was defined as a combination of the following [18]: (ⅰ) at least one of the following systemic symptoms: fever or feverishness, headache, myalgia or malaise, and (ii) at least one of the following respiratory symptoms: cough, sore throat, or dyspnea. Pneumonia was defined based upon radiographic images indicating the presence of newly emergent consolidation or other infiltrates.…”

Clinical characteristics and outcomes of adult patients hospitalized with influenza, respiratory syncytial virus and human metapneumovirus infections: a prospective, cohort study

“…In our study, 6.2%, 10.9%, and 17.3% of patients hospitalized with in uenza, RSV, and hMPV died within 30 days following admission, respectively. These mortality rates were consistent with those in prior studies of older adults hospitalized with these three viral infections [18,[26][27]. Many studies to date have assessed disease severity associated with these three types of viral infections, but the results of these studies have been inconsistent.…”

“…Other complications beyond pneumonia can also contribute to patient death. Loubet et al [18] found that hMPV infection was independently associated with acute cardiac failure. The results were in line with our ndings.…”

“…Disease And Treatment De nitions ILI was de ned as a combination of the following [18]: ( ) at least one of the following systemic symptoms: fever or feverishness, headache, myalgia or malaise, and (ii) at least one of the following respiratory symptoms: cough, sore throat or dyspnea. Pneumonia was de ned based upon radiographic images indicating the presence of newly emergent consolidation or other in ltrates.…”