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. 2021 Jun 15;223(12):2072-2079.
doi: 10.1093/infdis/jiaa019.

Role for Maternal Asthma in Severe Human Metapneumovirus Lung Disease Susceptibility in Children

Romina Libster  1   2 , Ignacio Esteban  1   3 , Alejandra Bianchi  1 , Luciano Alva Grimaldi  4 , Karina Dueñas  5 , Andrea Sancillo  5 , Andrea Rodriguez  6 , Fernando Ferrero  7 , Katherine Stein  1 , Patricio L Acosta  1   2 , Fausto M Ferolla  1 , Eduardo Bergel  1 , Mauricio T Caballero  1   2 , Fernando P Polack  1 ; INFANT Respiratory Network
Collaborators, Affiliations

Role for Maternal Asthma in Severe Human Metapneumovirus Lung Disease Susceptibility in Children

Romina Libster et al. J Infect Dis. .

Abstract

Background: Severity of human metapneumovirus (hMPV) lower respiratory illness (LRTI) is considered similar to that observed for respiratory syncytial virus (RSV). However, differences in severity between these pathogens have been noted, suggesting the degree of illness may vary in different populations. Moreover, a potential association between hMPV and asthma also suggests that hMPV may preferentially affect asthmatic subjects.

Methods: In a population-based surveillance study in children aged <2 years admitted for severe LRTI in Argentina, nasopharyngeal aspirates were tested by RT-PCR for hMPV, RSV, influenza A, and human rhinovirus.

Results: Of 3947 children, 383 (10%) were infected with hMPV. The hospitalization rate for hMPV LRTI was 2.26 per 1000 children (95% confidence interval [CI], 2.04-2.49). Thirty-nine (10.2%) patients infected with hMPV experienced life-threatening disease (LTD; 0.23 per 1000 children; 95% CI, .16-.31/1000), and 2 died (mortality rate 0.024 per 1000; 95% CI, .003-.086). In hMPV-infected children birth to an asthmatic mother was an increased risk for LTD (odds ratio, 4.72; 95% CI, 1.39-16.01). We observed a specific interaction between maternal asthma and hMPV infection affecting risk for LTD.

Conclusions: Maternal asthma increases the risk for LTD in children <2 years old hospitalized for severe hMPV LRTI.

Keywords: burden of illness; children; human metapneumovirus; lower respiratory tract infection; maternal asthma; risk factors.

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Figures

Figure 1.
Figure 1.
Viral circulation in infants and children 0–24 months of age during the study period. A, Number of hospitalized patients with human metapneumovirus (hMPV, solid line) lower respiratory tract illness (LRTI) in comparison to respiratory syncytial virus (RSV, dashed line), human rhinovirus (hRV, dotted line), and influenza A (dash dot line), per study year. B, Number of hospitalized patients with hMPV LRTI according to the epidemiological week during the 3 respiratory seasons (2011, solid line; 2012, dashed line; 2013, dotted line).
Figure 2.
Figure 2.
Distribution of life-threatening disease (LTD) in patients with human metapneumovirus (hMPV) severe lower respiratory tract illness according to age. Number of patients with hMPV LTD (LTD; black) or hMPV non LTD (non LTD; gray).
Figure 3.
Figure 3.
Multivariable analysis of risk for life-threatening disease (LTD) according to infecting virus. Odds ratio with 95% confidence interval for LTD (O2 saturation ≤ 87% on admission, requirement for mechanical ventilation, and/or admission to the intensive care unit) in infants and children 0–24 months of age hospitalized for human metapneumovirus single virus or coinfection (hMPV), respiratory syncytial virus (RSV), human rhinovirus (hRV), influenza A single infections, and with no virus detected (no virus) lower respiratory tract illness.
Figure 4.
Figure 4.
Multivariable analysis of risk for life-threatening disease (LTD) according to infecting virus and maternal asthma status. Odds ratio with 95% confidence interval for LTD (O2 saturation ≤ 87% on admission, requirement for mechanical ventilation, and/or admission to the intensive care unit) in infants and children 0–24 months of age hospitalized for human metapneumovirus single virus or coinfection (hMPV), respiratory syncytial virus (RSV), human rhinovirus (hRV), influenza A single infections, and with no virus detected (no virus) lower respiratory tract illness, with maternal asthma.
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