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Multicenter Study
. 2023 Oct;23(6):2725-2737.
doi: 10.1007/s10238-022-00973-3. Epub 2022 Dec 15.

Multicenter epidemiological investigation and genetic characterization of respiratory syncytial virus and metapneumovirus infections in the pre-pandemic 2018-2019 season in northern and central Italy

Alessandra Pierangeli #  1 , Antonio Piralla #  2 , Sara Uceda Renteria  3 , Giovanni Giacomel  3 , Giovanna Lunghi  3 , Elisabetta Pagani  4 , Elisabetta Giacobazzi  4 , Elisa Vian  5 , Valeria Biscaro  5 , Giulia Piccirilli  6 , Tiziana Lazzarotto  7 , Stefano Menzo  8 , Monica Lucia Ferreri  9 , Federica Novazzi  10 , Laura Petrarca  11 , Amelia Licari  12 , Guglielmo Ferrari  2 , Giuseppe Oliveto  13 , Guido Antonelli  13 , Sandro Binda  14 , Cristina Galli  14 , Laura Pellegrinelli  14 , Elena Pariani  14 , Fausto Baldanti  2   12
Affiliations
Multicenter Study

Multicenter epidemiological investigation and genetic characterization of respiratory syncytial virus and metapneumovirus infections in the pre-pandemic 2018-2019 season in northern and central Italy

Alessandra Pierangeli et al. Clin Exp Med. 2023 Oct.

Abstract

Respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) cause a high burden of disease, particularly in children and the elderly. With the aim to add knowledge on RSV and HMPV infections in Italy, a prospective, multicenter study was conducted by eight centers of the Working Group on Respiratory Virus Infections (GLIViRe), from December 2018-April 2019. Weekly distribution and patients' demographic and clinical data were compared in 1300 RSV and 222 HMPV-positive cases. Phylogenetic analysis of the G-glycoprotein coding region was performed to characterize circulating strains. RSV positivity ranged from 6.4% in outpatients of all ages to 31.7% in hospitalized children; HMPV positivity was 4-1.2% with no age-association. RSV season peaked in February and ended in mid-April: HMPV circulation was higher when RSV decreased in early spring. RSV was more frequent in infants, whereas HMPV infected comparatively more elderly adults; despite, their clinical course was similar. RSV-B cases were two-thirds of the total and had similar clinical severity compared to RSV-A. Phylogenetic analysis showed the circulation of RSV-A ON1 variants and the predominance of RSV-B genotype BA10. HMPV genotype A2c was the prevalent one and presented insertions of different lengths in G. This first multicenter Italian report on seasonality, age-specific distribution, and clinical presentation of RSV and HMPV demonstrated their substantial disease burden in young patients but also in the elderly. These data may provide the basis for a national respiratory virus surveillance network.

Keywords: Bronchiolitis; Human metapneumovirus; Molecular epidemiology; Pneumonia; Respiratory syncytial virus; Respiratory viruses.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Weekly distribution of the total number of tested respiratory samples, the respiratory syncytial virus (RSV) and human metapneumovirus (HMPV)-positive cases. On the X-axis, the calendar week of the study period (December 2018–April 2019) is represented; on the left Y-axis, the number of RSV and HMPV-positive patients and on the right Y-axis, the total number of samples tested by the GLIViRe centers are reported
Fig. 2
Fig. 2
Biweekly distribution of the RSV cases in the eight GLIViRe centers. The number of RSV cases per week with respect of the total RSV-positive cases in each center was calculated in percentage and values from two weeks aggregated, as shown in the color legend
Fig. 3
Fig. 3
RSV-A and -B cases weekly distribution. On the X-axis, the calendar week of the study period (December 2018–April 2019) is reported; on the Y-axis, the number of cases positive for RSV is represented. RSV-positive cases that were not typed (NT) are represented in blue; in red are those positive for RSV-A; in green, the positive for RSV–B
Fig. 4
Fig. 4
Phylogenetic analysis of the 2nd half of the G gene of the RSV strains circulating in Italy (December 2018–April 2019). The phylogenetic tree of RSV-A (panel a) includes 77 GLIViRe sequences and 7 reference strains; the RSV-B tree (panel b) includes 181 GLIViRe sequences and 8 reference strains. The legend on the left indicates the symbols’ shape and filling for reference strains and the GLIViRe centers. The number of occurrences of identical RSV sequences from a center is reported in parenthesis. Numbers at nodes are bootstrap values for 1,000 iterations; only bootstrap values of > 50% are shown. Below the trees, scale bar shows the number of substitutions per site
Fig. 5
Fig. 5
Phylogenetic analysis of the G gene of the HMPV strains circulating in Italy (December 2018–April 2019). The phylogenetic tree of HMPV-A (panel a) includes 36 GLIViRe sequences and 4 reference strains; the HMPV-B tree (panel b) includes 19 GLIViRe sequences and 4 reference strains. The legend on the left indicates the symbols’ shape and filling for reference strains and the GLIViRe centers. The number of occurrences of identical HMPV sequences from a center is reported in parenthesis. Numbers at nodes are bootstrap values for 1,000 iterations; only bootstrap values of > 50% are shown. Below the trees, scale bar shows the number of substitutions per site
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