Human Metapneumovirus Infection in Jordanian Children

Abstract

Background Human metapneumovirus (HMPV) is a leading cause of acute respiratory tract infection (ARTI) in young children. Our objectives were to define HMPV epidemiology and circulating strains and determine markers of severe disease in Jordanian children. Methods We conducted a prospective study March 16, 2010-March 31, 2013 using quantitative RT-PCR to determine the frequency of HMPV infection among children <2 years old admitted with fever and/or acute respiratory illness to a major government hospital in Amman, Jordan. Results HMPV was present in 273/3168 (8.6%) of children presenting with ARTI. HMPV A2, B1, and B2, but not A1, were detected during the 3-year period. HMPV-infected children were older and more likely to be diagnosed with bronchopneumonia than HMPV-negative children. HMPV-infected children with lower respiratory tract infection (LRTI) had higher rates of cough and shortness of breath than children with LRTI infected with other or no identifiable viruses. Symptoms and severity were not different between children with HMPV only compared with HMPV co-infection. Children with HMPV subgroup A infection were more likely to require supplemental oxygen. In a multivariate analysis, HMPV subgroup A and age <6 months were independently associated with supplemental oxygen requirement. Conclusions HMPV is a leading cause of acute respiratory tract disease in Jordanian children <2 years old. HMPV A and young age were associated with severe disease. Ninety percent of HMPV-infected hospitalized children were full-term and otherwise healthy, in contrast to high-income nations; thus, factors contributing to disease severity likely vary depending on geographic and resource differences.

Severe outcomes associated with respiratory viruses in newborns and infants: a prospective viral surveillance study in Jordan

“…Aliquots were shipped on dry ice to Nashville, Tennessee, USA, and were tested by RT-PCR for 11 viruses: RSV; human rhinovirus (HRV); human metapneumovirus (HMPV); influenza (influenza) A, B and C; parainfluenza virus (PIV) 1, 2 and 3; adenovirus (AdV) and Middle East respiratory syndrome coronavirus (MERS-CoV). [14][15][16] Blood was placed directly onto filter paper and air dried for ≥30 min before storage at room temperature and kept dry through shipment to ZRT Laboratory (Beaverton, Oregon, USA) for 25(OH)D (vitamin D) level measurement (techniques published previously). 17 statistical analysis Descriptive statistics were presented as frequency (percentage) or median and IQR where appropriate.…”

“…setting A government hospital serving low-income and middle-income population in Amman, Jordan. Participants Children under 2 years of age hospitalised with fever and/or respiratory symptoms (n=3168) from 16 March 2010 to 31 March 2013. Children with chemotherapy-associated neutropenia and newborns who had never been discharged after birth were excluded from the study.…”

Modulation of Host Immunity by the Human Metapneumovirus

“…Age is one of the major factors influencing disease severity, as evidenced by an increased rate of hospitalizations in infants Ͻ5 months of age, who have prolonged stays in the intensive care unit (ICU), being approximately twice as susceptible as infants 6 to 11 months of age and five times more susceptible than the average for children Ͻ5 years old (18). As for children, elderly individuals also show increased hospitalization rates and prolonged stays in the ICU (12,13,(47)(48)(49)(50)(51)(52)(53)(54). In agreement with this notion, recent studies demonstrated that an important fraction (up to 95%) of children infected with HMPV have no comorbidities and are otherwise healthy (51,53), suggesting that age alone is a major risk factor.…”

Human metapneumovirus in the preterm neonate: current perspectives

“…8,17 Viruses from each subgroup are capable of causing severe LRI, and different subgroup viruses have not been associated convincingly with differing severity of disease. 18,19 In most studies of patients with acute respiratory tract infection, the percentage of HMPV detection varies from 6% to 25%. HMPV infection usually causes clinical disease; the virus is rarely detected in asymptomatic children.…”

“…Dual infection with RSV and HMPV increased the risk of severe disease and pediatric intensive care unit admission compared to RSV alone in one small study, 86 but this finding was not confirmed by subsequent larger reports. 19,87–89 …”