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General Information | Clinical Symptoms | Epidemiology

Human Metapneumovirus - Epidemiology

Clinical impact

Several epidemiological surveys on hMPV infection have documented cases of metapneumovirus in Europe, Africa, Asia/Australia, Southern America, and Northern America

Europe: [1-8]
Africa: [9;10]
Asia : [11]
Australia : [12;16]
Southern America: [17;18]
Northern America: [19-22]

Worlwide, hMPV accounts for a significant portion of respiratory tract illnesses in hospitalised children, with high incidences occurring during the winter months in moderate climate zones and late spring-early summer in the subtropics. hMPV accounts for roughly 5 to 15% of the respiratory tract illnesses in hospitalised young children, with children <2 years of age being most at risk for serious hMPV infections. hMPV infections, like RSV and influenza virus infections, also account for respiratory tract infections in the elderly population and in patients with underlying disease.

Genetic and antigenic variability of hMPV

At least two genetic lineages of hMPV have been identified, with both lineages circulating during the same season [4; 4; 5; 5; 7; 7;20; 20; 21; 21; 25; 25-27; 27] . The surface glycoproteins , G and SH show the most divergence between the two main lineages, with the G protein being more divergent than observed between human RSV A and B lineages [28] [33][34]. In accordance with the RSV and APV nomenclatures, these two main lineages are defined as serotypes A and B, with each serotype divided into genetic sublineages 1 and 2 [28] .

The identification of two serotypes of hMPV has direct implications for the development of diagnostic assays and possibly for the development of vaccines and other intervention strategies (reviewed in [33]).

References

1. Christensen,A., Nordbo,S.A., Jeansson,S., and Slordahl,S., Lower respiratory tract infection caused by human metapneumovirus in two children: the first report of human metapneumovirus infection in Norway . Scand.J Infect Dis 2003. 35 : 772-774.
2. Freymouth,F., Vabret,A., Legrand,L., Eterradossi,N., Lafay-Delaire,F., Brouard,J., and Guillois,B., Presence of the new human metapneumovirus in French children with bronchiolitis. Pediatr Infect Dis J 2003. 22 : 92-9
3. Jartti,T., van den Hoogen,B., Garofalo,R.P., Osterhaus,A.D., and Ruuskanen,O., Metapneumovirus and acute wheezing in children. Lancet 2002. 360 : 1393-1394.
4. Maggi,F., Pifferi,M., Vatteroni,M., Fornai,C., Tempestini,E., Anzilotti,S., Lanini,L., Andreoli,E., Ragazzo,V., Pistello,M., Specter,S., and Bendinelli,M., Human metapneumovirus associated with respiratory tract infections in a 3-year study of nasal swabs from infants in Italy . J Clin Microbiol 2003. 41 : 2987-2991.
5. Stockton,J., Stephenson,I., Fleming,D., and Zambon,M., Human metapneumovirus as a cause of community-acquired respiratory illness. Emerg Infect Dis 2002. 8 : 897-901.

   Of interest: report of circulation of hMPV in general community in UK

6. van den Hoogen,B.G., van Doornum,G.J., Fockens,J.C., Cornelissen,J.J., Beyer,W.E., Groot,R.R., Osterhaus,A.D., and Fouchier,R.A., Prevalence and clinical symptoms of human metapneumovirus infection in hospitalized patients. J Infect Dis 2003. 188 : 1571-1577.

   Of interest: comparison of hMPV and RSV symptoms, impact in hospitalised patients

7. Viazov,S., Ratjen,F., Scheidhauer,R., Fiedler,M., and Roggendorf,M., High prevalence of human metapneumovirus infection in young children and genetic heterogeneity of the viral isolates. J Clin Microbiol 2003. 41 : 3043-3045.

   Of interest: genetic variability in Germany

8. Vicente,D., Cilla,G., Montes,M., and Perez-Trallero,E., Human metapneumovirus and community-acquired respiratory illness in children ( Spain ). Emerg Infect Dis 2003. 9 : 602-603.
9. Madhi,S.A., Ludewick,H., Abed,Y., Klugman,K.P., and Boivin,G., Human metapneumovirus-associated lower respiratory tract infections among hospitalized human immunodeficiency virus type 1 (HIV-1)-infected and HIV-1-uninfected African infants. Clin Infect Dis 2003. 37 : 1705-1710.
10. Wolf,D.G., Zakay-Rones,Z., Fadeela,A., Greenberg,D., and Dagan,R., High seroprevalence of human metapneumovirus among young children in Israel . J Infect Dis 2003. 188 : 1865-1867.
11. Ebihara,T., Endo,R., Kikuta,H., Ishiguro,N., Ishiko,H., Hara,M., Takahashi,Y., and Kobayashi,K., Human metapneumovirus infection in Japanese children . J Clin Microbiol 2004. 42 : 126-132.
12. Thanasugarn,W., Samransamruajkit,R., Vanapongtipagorn,P., Prapphal,N., Van den,H.B., Osterhaus,A.D., and Poovorawan,Y., Human metapneumovirus infection in Thai children . Scand.J Infect Dis 2003. 35 : 754-756.
13. Takao,S., Shimozono,H., Kashiwa,H., Shimazu,Y., Fukuda,S., Kuwayama,M., and Miyazaki,K., Clinical study of pediatric cases of acute respiratory diseases associated with human metapneumovirus in Japan . Jpn J Infect Dis 2003. 56 : 127-129.
14. Peiris,J.S., Tang,W.H., Chan,K.H., Khong,P.L., Guan,Y., Lau,Y.L., and Chiu,S.S., Children with respiratory disease associated with metapneumovirus in Hong Kong . Emerg Infect Dis 2003. 9 : 628-633.

    Of interest: description and comparison of symptoms in all patients under 18 years; association with asthma

15. Rawlinson WD, Waliuzzaman Z, Carter IW, Belessis YC, Gilbert KM, Morton JR . Asthma exacerbations in children associated with rhinovirus but not human metapneumovirus infection. J Infect Dis . 2003. 187: 1314-8.
16. Nissen MD, Siebert DJ, Mackay IM, Sloots TP, Withers SJ. Evidence of human metapneumovirus in Australian children. Med J Aust. 2002. 176 :188.
17. Cuevas,L.E., Nasser,A.M., Dove,W., Gurgel,R.Q., Greensill,J., and Hart,C.A., Human metapneumovirus and respiratory syncytial virus, Brazil. Emerg.Infect Dis 2003. 9 : 1626-1628.
18. Galiano,M., Videla,C., Puch,S.S., Martinez,A., Echavarria,M., and Carballal,G., Evidence of human metapneumovirus in children in Argentina . J Med Virol 2004. 72 : 299-303.
19. Esper,F., Boucher,D., We,C., Martinello,R.A., and Kahn,J.S., Human metapneumovirus infection in the United States : clinical manifestations associated with a newly emerging respiratory infection in children. Pediatrics 2003. 111 : 1407-1410.
20. Falsey,A.R., Erdman,D., Anderson,L.J., and Walsh,E.E., Human metapneumovirus infections in young and elderly adults. J Infect Dis 2003. 187 : 785-790.

    Of interest: clinical impact of hMPV in adult population

21. Peret,T.C., Boivin,G., Li,Y., Couillard,M., Humphrey,C., Osterhaus,A.D., Erdman,D.D., and Anderson,L.J., Characterization of human metapneumoviruses isolated from patients in North America . J Infect Dis 2002. 185 : 1660-1663.
22. Williams,J.V., Harris,P.A., Tollefson,S.J., Halburnt-Rush,L.L., Pingsterhaus,J.M., Edwards,K.M., Wright,P.F., and Crowe,J.E., Jr., Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children. N Engl J Med 2004. 350 : 443-450.

    Of interest: clinical impact of hMPV during 20 year period; association with asthma exacerbation

23. Bastien,N., Ward,D., Van Caeseele,P., Brandt,K., Lee,S.H., McNabb,G., Klisko,B., Chan,E., and Li,Y., Human metapneumovirus infection in the Canadian population . J Clin Microbiol 2003. 41 : 4642-4646.
24. Boivin,G., Abed,Y., Pelletier,G., Ruel,L., Moisan,D., Cote,S., Peret,T.C., Erdman,D.D., and Anderson,L.J., Virological features and clinical manifestations associated with human metapneumovirus: a new paramyxovirus responsible for acute respiratory-tract infections in all age groups. J Infect Dis 2002. 186 : 1330-1334.
25. Pelletier,G., Dery,P., Abed,Y., and Boivin,G., Respiratory tract reinfections by the new human Metapneumovirus in an immunocompromised child. Emerg Infect Dis 2002. 8 : 976-978.
26. van den Hoogen,B.G. and Herfst,S., Antigenic and genetic variability of human metapneumovirus. Emerg Infect Dis, april 2004 10.
27. Biacchesi,S., Skiadopoulos,M.H., Boivin,G., Hanson,C.T., Murphy,B.R., Collins,P.L., and Buchholz,U.J., Genetic diversity between human metapneumovirus subgroups. Virology 2003. 315 : 1-9.

    Commentaries/reviews:

28. McIntosh,K. and McAdam,A.J., Human metapneumovirus--an important new respiratory virus. N Engl J Med 2004. 350 : 431-433.
29. Mejias,A., Chavez-Bueno,S., and Ramilo,O., Human metapneumovirus: a not so new virus. Pediatr Infect Dis J 2004. 23 : 1-7.
30. Osterhaus,A. and Fouchier,R., Human metapneumovirus in the community. Lancet 2003. 361 : 890-891.
31. Kahn,J.S., Human metapneumovirus, a newly emerging respiratory virus. Pediatr Infect Dis J 2003. 22 : 923-924.
32. Klig,J.E., Current challenges in lower respiratory infections in children. Curr.Opin.Pediatr 2004. 16 : 107-112.
33. van den Hoogen BG, Osterhaus DM, Fouchier RA., Clinical impact and diagnosis of human metapneumovirus infection
34. Crowe,J.E.J. and Williams,J.V., Immunology of viral respiratory tract infection in infancy. Paediatr Respir Rev 2003. 4 : 112-119.