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

Authors

• Ryo Miyakawa, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
• Haijun Zhang, International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China. Electronic address: zhanghj966@gmail.com.
• W Abdullah Brooks, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka and Matlab, Bangladesh.
• Christine Prosperi, International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
• Henry C. Baggett, Division of Global Health Protection, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA.
• Daniel R. Feikin, International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
• Laura L. Hammitt, International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
• Stephen R. Howie, Medical Research Council Unit at the London School of Hygiene and Tropical Medicine, Basse, The Gambia; Department of Paediatrics: Child & Youth Health, University of Auckland, Auckland, New Zealand; College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
• Karen L. Kotloff, Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
• Orin S. Levine, International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
• Shabir A. Madhi, South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa.
• David R. Murdoch, Department of Pathology and Biomedical Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand.
• Katherine L. O'Brien, International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
• J Anthony Scott, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
• Donald M. Thea, Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
• Martin Antonio, Medical Research Council Unit at the London School of Hygiene and Tropical Medicine, Basse, The Gambia; Department of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine, Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK.
• Juliet O. Awori, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
• Charatdao Bunthi, Division of Global Health Protection, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
• Amanda J. Driscoll, International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
• Bernard Ebruke, Medical Research Council Unit at the London School of Hygiene and Tropical Medicine, Basse, The Gambia.
• Nicholas S. Fancourt, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Microbiology Laboratory, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
• Melissa M. Higdon, International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
• Ruth A. Karron, Department of International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
• David P. Moore, South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa; Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa.
• Susan C. Morpeth, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
• Justin M. Mulindwa, Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia.
• Daniel E. Park, International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
• Mohammed Ziaur Rahman, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka and Matlab, Bangladesh.
• Mustafizur Rahman, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka and Matlab, Bangladesh.
• Rasheed A. Salaudeen, Medical Research Council Unit at the London School of Hygiene and Tropical Medicine, Basse, The Gambia; Medical Microbiology Department, Lagos University Teaching Hospital, Lagos, Nigeria.
• Pongpun Sawatwong, Division of Global Health Protection, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
• Phil Seidenberg, Department of Global Health, Boston University School of Public Health, Boston, MA, USA; Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA.

Document Type

Journal Article

Publication Date

3-1-2025

Journal

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

Volume

31

Issue

3

DOI

10.1016/j.cmi.2024.10.023

Keywords

Africa; Asia; Human metapneumovirus (hMPV); Paediatric; Severe pneumonia

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 with 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 (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.

APA Citation

Miyakawa, Ryo; Zhang, Haijun; Brooks, W Abdullah; Prosperi, Christine; Baggett, Henry C.; Feikin, Daniel R.; Hammitt, Laura L.; Howie, Stephen R.; Kotloff, Karen L.; Levine, Orin S.; Madhi, Shabir A.; Murdoch, David R.; O'Brien, Katherine L.; Scott, J Anthony; 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; and Seidenberg, Phil, "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" (2025). GW Authored Works. Paper 6948.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6948

Department

Environmental and Occupational Health