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

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.

Department

Environmental and Occupational Health

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