Ryo Miyakawa, Haijun Zhang, W Abdullah Brooks, Christine Prosperi, Henry C Baggett, Daniel R Feikin, Laura L Hammitt, Stephen R C Howie, Karen L Kotloff, Orin S Levine, Shabir A Madhi, David R Murdoch, Katherine L O'Brien, J Anthony G Scott, Donald M Thea, Martin Antonio, Juliet O Awori, Charatdao Bunthi, Amanda J Driscoll, Bernard Ebruke, Nicholas S Fancourt, Melissa M Higdon, Ruth A Karron, David P Moore, Susan C Morpeth, Justin M Mulindwa, Daniel E Park, Mohammed Ziaur Rahman, Mustafizur Rahman, Rasheed A Salaudeen, Pongpun Sawatwong, Phil Seidenberg, Samba O Sow, Milagritos D Tapia, Maria Deloria Knoll
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We sought to characterize hMPV-positive cases in high-burden settings, which have limited data, by comparing with RSV-positive and other cases.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%).</p><p><strong>Discussion: </strong>HMPV-associated severe paediatric pneumonia in high-burden settings was predominantly in young infants and clinically indistinguishable from RSV. 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引用次数: 0
摘要
研究目的在 PERCH 研究中,继呼吸道合胞病毒(RSV)之后,人类偏肺病毒(hMPV)是导致重症肺炎的第二大病原体。我们试图通过与 RSV 阳性病例和其他病例进行比较,了解数据有限的高负担环境中 hMPV 阳性病例的特征:方法:七个非洲和亚洲国家的 1-59 个月大疑似重症肺炎住院儿童和年龄/季节匹配的社区对照组在入院时通过多重 PCR 对鼻咽/咽拭子进行了 32 种呼吸道病原体检测,并进行了其他临床和实验室评估。使用逻辑回归法计算了根据年龄和发病部位调整后的比值比(aOR)。病因概率采用贝叶斯嵌套部分潜类分析法进行估算。潜类分析确定了临床特征的综合征:病例(267/3887,6.9%)中检测到 HMPV 的比例高于对照组(115/4976,2.3%),有肺炎胸部 X 光检查结果的病例(8.5%)高于无肺炎胸部 X 光检查结果的病例(5.5%),有呼吸道疾病的对照组(3.8%)高于无呼吸道疾病的对照组(1.8%);所有数据的 p 均小于 0.001。HMPV 阳性病例与其他病毒的检测呈负相关(aOR=0.18),尤其是 RSV(aOR=0.11;所有 p 结论:高负担环境中与 HMPV 相关的小儿重症肺炎主要发生在幼儿身上,临床上与 RSV 无法区分。HMPV阳性病例的死亡率较低,与RSV阳性病例的死亡率相似。
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.
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.
期刊介绍:
Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.