VBMI, INSERM U1047, Department of Infectious and Tropical Disease, CHU Nîmes, Univ Montpellier, Nîmes, France; Inserm, F-CRIN, Réseau Innovative Clinical Research in Vaccinology (I-REIVAC), Paris, France.
Université Paris Descartes, Sorbonne Paris Cité, Inserm, CIC Cochin Pasteur, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France.
Clin Microbiol Infect. 2021 Jan;27(1):127.e1-127.e6. doi: 10.1016/j.cmi.2020.04.005. Epub 2020 Apr 10.
To describe the prevalence, clinical features and complications of human metapneumovirus (hMPV) infections in a population of adults hospitalized with influenza-like illness (ILI).
This was a retrospective, observational, multicenter cohort study using prospectively collected data from adult patients hospitalized during influenza virus circulation, for at least 24 h, for community-acquired ILI (with symptom onset <7 days). Data were collected from five French teaching hospitals over six consecutive winters (2012-2018). Respiratory viruses were identified by multiplex reverse transcription polymerase chain reaction (RT-PCR) on nasopharyngeal specimens. hMPV + patients were compared with hMPV- patients, influenza+ and respiratory syncytial virus (RSV)+ patients using multivariate logistic regressions. Primary outcome was the prevalence of hMPV in patients hospitalized for ILI.
Among the 3148 patients included (1449 (46%) women, 1988 (63%) aged 65 and over; 2508 (80%) with chronic disease), at least one respiratory virus was detected in 1604 (51%, 95% confidence interval (CI) 49-53), including 100 cases of hMPV (100/3148, 3% 95% CI 3-4), of which 10 (10%) were viral co-infection. In the hMPV + patients, mean length of stay was 7 days, 62% (56/90) developed a complication, 21% (14/68) were admitted to intensive care unit and 4% (4/90) died during hospitalization. In comparison with influenza + patients, hMPV + patients were more frequently >65 years old (adjusted odds ratio (aOR) = 3.3, 95% CI 1.9-6.3) and presented more acute heart failure during hospitalization (aOR = 1.8, 95% CI 1.0-2.9). Compared with RSV + patients, hMPV + patients had less cancer (aOR = 0.4, 95% CI 0.2-0.9) and were less likely to smoke (aOR = 0.5, 95% CI 0.2-0.9) but had similar outcomes, especially high rates of respiratory and cardiovascular complications.
Adult hMPV infections mainly affect the elderly and patients with chronic conditions and are responsible for frequent cardiac and pulmonary complications similar to those of RSV infections. At-risk populations would benefit from the development of antivirals and vaccines targeting hMPV.
描述人类偏肺病毒（hMPV）感染在因流感样疾病（ILI）住院的成年人群中的流行率、临床特征和并发症。
这是一项回顾性、观察性、多中心队列研究，使用在流感病毒流行期间至少住院 24 小时的社区获得性 ILI（症状出现<7 天）的成年患者前瞻性收集的数据。数据来自法国五所教学医院连续六个冬季（2012-2018 年）的收集。通过多重逆转录聚合酶链反应（RT-PCR）对鼻咽标本进行呼吸道病毒检测。使用多变量逻辑回归比较 hMPV+患者与 hMPV-患者、流感+和呼吸道合胞病毒（RSV）+患者。主要结局是因 ILI 住院患者中 hMPV 的流行率。
在纳入的 3148 例患者中（1449 例女性，1988 例年龄≥65 岁；2508 例有慢性疾病），至少有 1604 例（51%，95%置信区间[CI]为 49-53）检测到至少一种呼吸道病毒，包括 100 例 hMPV（100/3148，3%，95%CI 3-4），其中 10 例（10%）为病毒合并感染。在 hMPV+患者中，平均住院时间为 7 天，62%（56/90）发生并发症，21%（14/68）入住重症监护病房，4%（4/90）住院期间死亡。与流感+患者相比，hMPV+患者年龄较大（年龄≥65 岁）的比例更高（调整后的优势比[aOR]为 3.3，95%CI 1.9-6.3），住院期间急性心力衰竭的发生率更高（aOR 为 1.8，95%CI 1.0-2.9）。与 RSV+患者相比，hMPV+患者癌症的发生率较低（aOR 为 0.4，95%CI 0.2-0.9），吸烟的可能性较低（aOR 为 0.5，95%CI 0.2-0.9），但结局相似，尤其是呼吸道和心血管并发症的发生率较高。
成人 hMPV 感染主要影响老年人和患有慢性疾病的人群，可导致频繁的心脏和肺部并发症，与 RSV 感染相似。高危人群将受益于针对 hMPV 的抗病毒药物和疫苗的研发。
