Clinical and Epidemiological Characteristics of Human Metapneumovirus Infections, in Comparison with Respiratory Syncytial Virus A and B

Soo Young Kang; Che Ry Hong; Hyun Mi Kang; Eun Young Cho; Hyun Ju Lee; Eun Hwa Choi; Hoan Jong Lee

doi:10.14776/kjpid.2013.20.3.168

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Kang, Hong, Kang, Cho, Lee, Choi, and Lee: Clinical and Epidemiological Characteristics of Human Metapneumovirus Infections, in Comparison with Respiratory Syncytial Virus A and B

Original Article

Korean Journal of Pediatric Infectious Diseases 2013; 20(3): 168-177.

Published online: 26 December 2013

DOI: https://doi.org/10.14776/kjpid.2013.20.3.168

Clinical and Epidemiological Characteristics of Human Metapneumovirus Infections, in Comparison with Respiratory Syncytial Virus A and B

Soo Young Kang, M.D.^*, Che Ry Hong, M.D.^*, Hyun Mi Kang, M.D.^*, Eun Young Cho, M.D.^*,^†, Hyun Ju Lee, M.D.^*,^‡, Eun Hwa Choi, M.D.^*,^†, Hoan Jong Lee, M.D.^*,^†

^*Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.

^†Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

^‡Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.

Corresponding author (pedeyc@gmail.com)

Received 5 August 2013 Revised 13 October 2013 Accepted 15 October 2013

Abstract

Purpose

To identify the clinical and epidemiological characteristics of human metapneumovirus infections (hMPV) in children compared to respiratory syncytial virus A (RSV A) and B (RSV B).

Method

A retrospective review of medical records was performed in 36 patients with hMPV infection, 106 with RSV A infection, and 51 with RSV B infection, from September 2007 to July 2012.

Results

The peak incidence of hMPV infection was observed in May, whereas for RSV infections in November and December. hMPV infection occurred in older patients compared to RSV A and B infection (29.9±32.5 months vs. 13.6±15.4 months, P<0.001; 29.9±32.5 months vs. 12.1±13.5 months, P<0.001, respectively). hMPV infection was more often associated with fever compared to RSV A (97.2% vs. 67.9%, P<0.001), while wheezing was less frequent compared to RSV A and B infection (16.7% vs. 47.2%, P=0.001; 16.7% vs. 37.3%, P=0.037, respectively). hMPV infection was more often diagnosed as pneumonia compared to RSV A infection (72.2% vs. 50.0%, P=0.047) while bronchiolitis was less frequent than in RSV A (5.6% vs. 34.9%, P=0.001) or RSV B infection (5.6% vs. 29.4%, P=0.006). In addition, intravenous antibiotic was more often prescribed for patients with hMPV infection than those with RSV A and B (69.4% vs. 39.6%, P=0.002; 69.4% vs. 43.1, P=0.015, respectively).

Conclusion

This study identified characteristics of hMPV infection compared to RSV A and B infection. Seasonality in spring, higher age group, and higher proportion of pneumonia in hMPV infections may be a useful guide for management of respiratory viral infections in children.

Keywords: Human metapneumovirus, Respiratory syncytial virus

Figures and Tables

Fig. 1

Study enrollment eliminating patients in exclusion criteria.

Fig. 2

Epidemic pattern of hMPV, RSV A, and RSV B infections, 2007-2012. Abbreviations: hMPV, human metapneumovirus; RSV, respiratory syncytial virus.

Fig. 3

Age distribution of hMPV, RSV A, and B infections. Patients with underlying disease and combined infection were excluded. Proportions were calculated from each virus. No.of cases- hMPV:36, RSV A:106, RSV B:51, <3 mo: 67, 3-12 mo: 41, 13-24 mo: 39, 25 mo-4 yr: 37, ≥5 yr: 9. Abbreviations: hMPV, human metapneumovirus; RSV, respiratory syncytial virus.

Table 1

Detection Frequency of Respiratory Viruses, among 11,377 Nasopharyngeal Specimens Obtained from Children with Respiratory Symptoms, 2007-2012

^*Percentage out of total sums of each detected virus

^†A total of 5,831 viruses were detected from 5,069 specimens and more than 2 viruses were detected in 762 specimens.

Table 2

Comparison of Clinical Characteristics of Human Metapneumovirus, Respiratory Syncytial Virus A and B Infections^*

NOTE. Data are no. (%) of patients, unless otherwise indicated.

Patients with underlying disease and combined infection were excluded.

^*Abbreviations: hMPV; human metapneumovirus, RSV; respiratory syncytial virus

^†Age distribution were significantly different; P<0.001 in hMPV vs. RSV A vs. RSV B, P<0.001 in hMPV vs. RSV A, andP<0.001 in hMPV vs. RSV B.

^‡Fever frequency were significantly different; P=0.001 in hMPV vs. RSV A vs. RSV B, P<0.001 in hMPV vs. RSV A.

^∫Wheezing frequency were significantly different; P=0.005 in hMPV vs. RSV A vs. and RSV B, P=0.001 in hMPV vs. RSV A, and P=0.037 in hMPV vs. RSV B.

^∥Percentage of bronchiolitis were significantly different; P=0.003 in hMPV vs. RSV A vs. RSV B, P=0.001 in hMPV vs. RSV A, and P=0.006 in hMVP vs. RSV B.

^¶Percentage of pneumonia was significantly different; P=0.047 in hMPV vs. RSV A.

^**Percentage of antibiotics given were significantly different; P=0.02 in hMPV vs. RSV A vs. RSV B.

^††Percentage of antibiotics intravenously given were significantly different; P=0.007 in hMPV vs. RSV A vs. RSV B, P=0.002 in hMPV vs. RSV A, and P=0.015 in hMPV vs. RSV B.

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