Burden of human metapneumovirus infection in young children

Abstract

Background: The inpatient and outpatient burden of human metapneumovirus (HMPV) infection among young children has not been well established.

Methods: We conducted prospective, population-based surveillance for acute respiratory illness or fever among inpatient and outpatient children less than 5 years of age in three U.S. counties from 2003 through 2009. Clinical and demographic data were obtained from parents and medical records, HMPV was detected by means of a reverse-transcriptase polymerase-chain-reaction assay, and population-based rates of hospitalization and estimated rates of outpatient visits associated with HMPV infection were determined.

Results: HMPV was detected in 200 of 3490 hospitalized children (6%), 222 of 3257 children in outpatient clinics (7%), 224 of 3001 children in the emergency department (7%), and 10 of 770 asymptomatic controls (1%). Overall annual rates of hospitalization associated with HMPV infection were 1 per 1000 children less than 5 years of age, 3 per 1000 infants less than 6 months of age, and 2 per 1000 children 6 to 11 months of age. Children hospitalized with HMPV infection, as compared with those hospitalized without HMPV infection, were older and more likely to receive a diagnosis of pneumonia or asthma, to require supplemental oxygen, and to have a longer stay in the intensive care unit. The estimated annual burden of outpatient visits associated with HMPV infection was 55 clinic visits and 13 emergency department visits per 1000 children. The majority of HMPV-positive inpatient and outpatient children had no underlying medical conditions, although premature birth and asthma were more frequent among hospitalized children with HMPV infection than among those without HMPV infection.

Conclusions: HMPV infection is associated with a substantial burden of hospitalizations and outpatient visits among children throughout the first 5 years of life, especially during the first year. Most children with HMPV infection were previously healthy. (Funded by the Centers for Disease Control and Prevention and the National Institutes of Health.).

Figure 1. Study Enrollment

Of 12,363 children enrolled, 10,518 (85%) were included in the study. A total of 646 children who were inpatients or outpatients had confirmed human metapneumovirus (HMPV) infection.

Figure 2. HMPV-Positive Specimens, According to Week of the Year, 2003–2009

Curves for HMPV-positive specimens are shown for all three sites combined during the six November–May seasons of the study period. The number of HMPV-positive specimens, the total number of specimens, and the percentage of HMPV-positive specimens for that season are shown at the right of each graph.