Foley David A, Yeoh Daniel K, Minney-Smith Cara A, Shin Christine, Hazelton Briony, Hoeppner Tobias, Moore Hannah C, Nicol Mark, Sikazwe Chisha, Borland Meredith L, Levy Avram, Blyth Chris C
Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia.
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
J Paediatr Child Health. 2023 Aug;59(8):987-991. doi: 10.1111/jpc.16445. Epub 2023 May 23.
Western Australian laboratory data demonstrated a decrease in human metapneumovirus (hMPV) detections through 2020 associated with SARS-CoV-2-related non-pharmaceutical interventions (NPIs), followed by a subsequent surge in metropolitan region in mid-2021. We aimed to assess the impact of the surge in hMPV on paediatric hospital admissions and the contribution of changes in testing.
All respiratory-coded admissions of children aged <16 years at a tertiary paediatric centre between 2017 and 2021 were matched with respiratory virus testing data. Patients were grouped by age at presentation and by ICD-10 AM codes into bronchiolitis, other acute lower respiratory infection (OALRI), wheeze and upper respiratory tract infection (URTI). For analysis, 2017-2019 was utilised as a baseline period.
hMPV-positive admissions in 2021 were more than 2.8 times baseline. The largest increase in incidence was observed in the 1-4 years group (incidence rate ratio (IRR) 3.8; 95% confidence interval (CI): 2.5-5.9) and in OALRI clinical phenotype (IRR 2.8; 95% CI: 1.8-4.2). The proportion of respiratory-coded admissions tested for hMPV in 2021 doubled (32-66.2%, P < 0.001), with the greatest increase in wheeze (12-75% in 2021, P < 0.001). hMPV test percentage positivity in 2021 was higher than in the baseline period (7.6% vs. 10.1% in 2021, P = 0.004).
The absence and subsequent surge underline the susceptibility of hMPV to NPIs. Increased hMPV-positive admissions in 2021 can be partially attributable to testing, but test-positivity remained high, consistent with a genuine increase. Continued comprehensive testing will help ascertain true burden of hMPV respiratory diseases.
西澳大利亚州的实验室数据显示，在2020年期间，随着与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）相关的非药物干预措施（NPIs）的实施，人偏肺病毒（hMPV）检测量有所下降，随后在2021年年中，大都市地区出现了检测量的激增。我们旨在评估hMPV激增对儿科住院的影响以及检测变化所起的作用。
将2017年至2021年期间，一家三级儿科中心所有年龄小于16岁、以呼吸道疾病编码入院的儿童病例与呼吸道病毒检测数据进行匹配。患者按就诊时的年龄以及国际疾病分类第十版澳大利亚修正本（ICD-10 AM）编码，分为细支气管炎、其他急性下呼吸道感染（OALRI）、喘息和上呼吸道感染（URTI）。分析时，将2017 - 2019年作为基线期。
2021年hMPV阳性的入院病例数是基线水平的2.8倍多。发病率增幅最大的是1 - 4岁年龄组（发病率比（IRR）为3.8；95%置信区间（CI）：2.5 - 5.9）以及OALRI临床表型组（IRR为2.8；95% CI：1.8 - 4.2）。2021年接受hMPV检测的呼吸道疾病编码入院病例比例翻倍（从32%增至66.2%，P < 0.001），其中喘息病例的增幅最大（2021年从12%增至75%，P < 0.001）。2021年hMPV检测阳性率高于基线期（2021年为7.6%，基线期为10.1%，P = 0.004）。
hMPV检测量先下降后激增，这突出表明了hMPV对NPIs的敏感性。2021年hMPV阳性入院病例增加，部分原因可归咎于检测，但检测阳性率仍居高不下，这与实际增加相符。持续进行全面检测将有助于确定hMPV呼吸道疾病的真实负担。
