Epidemiology of Human Metapneumovirus-associated Lower Respiratory Tract Infections in African Children: Systematic Review and Meta-analysis

Abstract

Background: Human metapneumovirus (hMPV) has been associated with upper and lower respiratory tract infections (LRTI) in children and adults. This systematic review evaluated the epidemiology of hMPV-associated LRTI, including severe acute respiratory infection (SARI) hospitalization or clinically diagnosed severe pneumonia, in African children under 5 years of age. Methods: We searched Science Direct, PubMed, Cochrane Central, Scopus, and WHO regional databases using the terms "("Human metapneumovirus" AND "Africa") OR ("hMPV" AND "Africa")" up to September 17, 2020. Other sources included ClinicalTrials.gov to obtain unpublished data. Studies were included if children were less than 5 years of age and hospitalized with hMPV-associated LRTI, SARI or if clinically diagnosed with severe pneumonia in the community. The main outcomes were prevalence of hMPV identified among children with hospitalized LRTI or SARI. We further calculated odds ratios for hMPV in cases with LRTI compared with non-LRTI controls. Pooled results were calculated using a random-effects model. Results: Thirty studies were eligible for inclusion in the review. The prevalence of hMPV-LRTI/SARI among hospitalized and severe pneumonia cases was 4.7% [95% confidence interval (CI): 3.9-5.6, I 2 = 95.0]. The casecontrol studies indicated that hMPV was 2.0-fold (95% CI: 0.9-4.4) more likely to be identified in LRTI cases (10.3%) than controls (6.0%). Three of 5 studies reported hMPV-associated LRTI case fatality risk, with a pooled estimate of 1.3% (95% CI: 0.3-2.9; I 2 = 49). Conclusions: hMPV was associated with approximately 5% of LRTI/SARI hospitalizations or severe pneumonia cases in Africa.

Pediatric burden and seasonality of human metapneumovirus over 5 years in Managua, Nicaragua

“…Human metapneumovirus (hMPV) is a viral respiratory pathogen of global importance. 1 , 2 , 3 , 4 First identified in 2001, hMPV is a single‐stranded negative‐sense RNA pneumovirus which, based on serologic studies, has circulated worldwide in human populations for at least seven decades. 5 HMPV is divided into two genetic groups: A and B, which are further differentiated into six known lineages A1, A2a, A2b, A2c, B1, and B2 6 , 7 , 8 and infects all ages, with severe events occurring in children, the elderly, and the immunocompromised.…”

“… 9 In children, hMPV is pervasive in early life, causing both upper 10 and severe lower respiratory infections. 1 , 11 Indeed, most children are seropositive for hMPV by age five. 5 , 11 , 12 , 13 Severe hMPV infection is also an important cause in respiratory‐associated childhood hospitalization and has globally been estimated to account for 4–18% of acute lower respiratory infection (ALRI) hospital admissions.…”

Comparison of the clinical features of human bocavirus and metapneumovirus lower respiratory tract infections in hospitalized children in Suzhou, China

“…The results of this study demonstrated that the detection rate of hMPV in Suzhou was 2.24%. The prevalence rate is 4.7% in Africa ( 11 ) and 3.6% in Bangkok, Thailand ( 12 ). The median age of children infected with hMPV was 16 months, which was significantly lower than that of children infected with HBoV.…”

Pediatric burden and seasonality of Human Metapneumovirus over five years in Managua, Nicaragua.

“…Human metapneumovirus (hMPV), is a viral respiratory pathogen of global importance [1][2][3][4] . First identified in 2001, hMPV is a single-stranded negative-sense RNA Pneumovirus which, based on serologic studies, has circulated worldwide in human populations for at least seven decades 5 .…”

“…HMPV is divided into two genetic groups: A and B which are further differentiated into 6 known lineages A1, A2a, A2b, A2c, B1, and B2 [6][7][8] and infects all ages, with severe events occurring in children, the elderly, and the immunocompromised 9 . In children, hMPV is pervasive in early-life, causing both upper 10 and severe lower respiratory infections 1,11 . Indeed, most children are seropositive for hMPV by age five 5,[11][12][13] .…”