Human metapneumovirus infection in children with a history of prematurity - A condition worth more attention
Journal
Pediatrics and Neonatology
Journal Volume
57
Journal Issue
1
Pages
5-6
Date Issued
2016
Author(s)
Abstract
The rapid advance of molecular technologies in the past few decades has led to the discovery of several previously unknown viral pathogens of common childhood respiratory illness. Human metapneumovirus (hMPV), discovered in 2001,1van den Hoogen B.G. de Jong J.C. Groen J. Kuiken T. de Groot R. Fouchier R.A. et al.A newly discovered human pneumovirus isolated from young children with respiratory tract disease.Nat Med. 2001; 7: 719-724Crossref PubMed Scopus (1666) Google Scholar is one example. Clinical presentations of hMPV infection include bronchiolitis, pneumonia, croup, and asthmatic exacerbations,2Fu L.S. Tsai M.C. Asthma exacerbation in children: a practical review.Pediatr Neonatol. 2014; 55: 83-91Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 3Williams J.V. Harris P.A. Tollefson S.J. Halburnt-Rush L.L. Pingsterhaus J.M. Edwards K.M. et al.Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children.N Engl J Med. 2004; 350: 443-450Crossref PubMed Scopus (762) Google Scholar which are indistinguishable from those caused by other respiratory viruses such as respiratory syncytial virus (RSV). By contrast, with advances of neonatal care technologies in the same period of time, the survival of premature babies also increased significantly. Severely premature babies, especially those with complications resulting from inadequate lung maturity at delivery, theoretically have higher risks of developing severe illness after hMPV infections even after infancy. However, descriptions of clinical manifestations of hMPV in children with a history of prematurity are limited. In a study done by Pancham et al,4Pancham K. Sami I. Perez G.F. Huseni S. Kurdi B. Rose M.C. et al.Human metapneumovirus infection is associated with severe respiratory disease in preschool children with history of prematurity.Pediatr Neonatol. 2016; 57: 27-34Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar comparisons of clinical manifestations of hMPV infections were made between hospitalized preschool children aged ≤ 5 years with and without a history of prematurity. The study clearly demonstrated that children with a history of gestational age < 32 weeks, when infected with hMPV, had need of longer hospitalizations, and new or increased O2 supplement, and also that they had higher severity scores independently of age, ethnicity, and history of asthma.4Pancham K. Sami I. Perez G.F. Huseni S. Kurdi B. Rose M.C. et al.Human metapneumovirus infection is associated with severe respiratory disease in preschool children with history of prematurity.Pediatr Neonatol. 2016; 57: 27-34Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Prematurity has already been identified as a risk factor for hMPV and RSV infections.5Papenburg J. Hamelin M.È. Ouhoummane N. Carbonneau J. Ouakki M. Raymond F. et al.Comparison of risk factors for human metapneumovirus and respiratory syncytial virus disease severity in young children.J Infect Dis. 2012; 206: 178-189Crossref PubMed Scopus (107) Google Scholar The study by Pancham et al4Pancham K. Sami I. Perez G.F. Huseni S. Kurdi B. Rose M.C. et al.Human metapneumovirus infection is associated with severe respiratory disease in preschool children with history of prematurity.Pediatr Neonatol. 2016; 57: 27-34Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar provides additional evidence that prematurity is associated with more severe disease in hMPV infections happen in later years. In earlier studies, about 6–12% of respiratory infections in children were caused by hMPV.3Williams J.V. Harris P.A. Tollefson S.J. Halburnt-Rush L.L. Pingsterhaus J.M. Edwards K.M. et al.Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children.N Engl J Med. 2004; 350: 443-450Crossref PubMed Scopus (762) Google Scholar, 6Edwards K.M. Zhu Y. Griffin M.R. Weinberg G.A. Hall C.B. Szilagyi P.G. et al.Burden of human metapneumovirus infection in young children.N Engl J Med. 2013; 368: 633-643Crossref PubMed Scopus (215) Google Scholar Pancham et al's4Pancham K. Sami I. Perez G.F. Huseni S. Kurdi B. Rose M.C. et al.Human metapneumovirus infection is associated with severe respiratory disease in preschool children with history of prematurity.Pediatr Neonatol. 2016; 57: 27-34Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar study also confirmed that in 11% (63/571) of infants and children aged 5 years or less who were hospitalized due to respiratory illness caused by hMPV. Seroprevalence studies indicated that 100% of young adults were seropositive for hMPV.6Edwards K.M. Zhu Y. Griffin M.R. Weinberg G.A. Hall C.B. Szilagyi P.G. et al.Burden of human metapneumovirus infection in young children.N Engl J Med. 2013; 368: 633-643Crossref PubMed Scopus (215) Google Scholar Taken together, these studies indicate a great disease burden of hMPV on the general population. Specific therapeutic agents or preventive vaccines for hMPV will therefore be of great value, but they are not yet available. The humanized monoclonal antibody, palivizumab, has been used successfully in preventing severe RSV infection in infants at special risk for severe RSV disease. A similar strategy using monoclonal antibodies against hMPV has been tested with some success in animal models.7Schuster J.E. Cox R.G. Hastings A.K. Boyd K.L. Wadia J. Chen Z. et al.A broadly neutralizing human monoclonal antibody exhibits in vivo efficacy against both human metapneumovirus and respiratory syncytial virus.J Infect Dis. 2015; 211: 216-225Crossref PubMed Scopus (52) Google Scholar With the help of identifying specific risk groups, application of monoclonal antibodies or other agents to prevent severe hMPV diseases becomes feasible. Although hMPV has been recognized as an important cause of acute respiratory infection in children and infants relatively recently, understanding of the clinical significance of the virus is accumulating rapidly. Development of specific therapeutic or preventive measures is warranted and highly expected. The author declares no conflicts of interest.
Other Subjects
Human metapneumovirus vaccine; monoclonal antibody; palivizumab; unclassified drug; virus vaccine; child; disease severity; drug efficacy; Editorial; fetus lung maturity; human; Human metapneumovirus; Human metapneumovirus infection; immunization; infection prevention; newborn care; nonhuman; pneumonia; prematurity; seroprevalence; survival rate; viral respiratory tract infection; virus load; attention; hospitalization; infant; Metapneumovirus; prematurity; Attention; Child; Hospitalization; Humans; Infant; Infant, Premature; Metapneumovirus
Publisher
Elsevier (Singapore) Pte Ltd
Type
editorial