高肺炎负担地区重症或极重症肺炎儿童中人间偏肺病毒的流行病学：儿童健康肺炎病因研究（PERCH）的经验

Epidemiology of human metapneumovirus among children with severe or very severe pneumonia in high pneumonia burden settings: the Pneumonia Etiology Research for Child Health (PERCH) study experience.

作者信息

Miyakawa Ryo, Zhang Haijun, Brooks W Abdullah, Prosperi Christine, Baggett Henry C, Feikin Daniel R, Hammitt Laura L, Howie Stephen R C, Kotloff Karen L, Levine Orin S, Madhi Shabir A, Murdoch David R, O'Brien Katherine L, Scott J Anthony G, Thea Donald M, Antonio Martin, Awori Juliet O, Bunthi Charatdao, Driscoll Amanda J, Ebruke Bernard, Fancourt Nicholas S, Higdon Melissa M, Karron Ruth A, Moore David P, Morpeth Susan C, Mulindwa Justin M, Park Daniel E, Rahman Mohammed Ziaur, Rahman Mustafizur, Salaudeen Rasheed A, Sawatwong Pongpun, Seidenberg Phil, Sow Samba O, Tapia Milagritos D, Deloria Knoll Maria

机构信息

Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.

International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.

出版信息

Clin Microbiol Infect. 2025 Mar;31(3):441-450. doi: 10.1016/j.cmi.2024.10.023. Epub 2024 Nov 1.

DOI:10.1016/j.cmi.2024.10.023

PMID:39489292

Abstract

OBJECTIVES

After respiratory syncytial virus (RSV), human metapneumovirus (hMPV) was the second-ranked pathogen attributed to severe pneumonia in the PERCH study. We sought to characterize hMPV-positive cases in high-burden settings, which have limited data, by comparing with RSV-positive and other cases.

METHODS

Children aged 1-59 months hospitalized with suspected severe pneumonia and age/season-matched community controls in seven African and Asian countries had nasopharyngeal/oropharyngeal swabs tested by multiplex PCR for 32 respiratory pathogens, among other clinical and lab assessments at admission. Odds ratios adjusted for age and site (adjusted OR [aOR]) were calculated using logistic regression. Aetiologic probability was estimated using Bayesian nested partial latent class analysis. Latent class analysis identified syndromic constellations of clinical characteristics.

RESULTS

hMPV was detected more frequently among cases (267/3887, 6.9%) than controls (115/4976, 2.3%), among cases with pneumonia chest X-ray findings (8.5%) than without (5.5%), and among controls with respiratory tract illness (3.8%) than without (1.8%; all p ≤ 0.001). HMPV-positive cases were negatively associated with the detection of other viruses (aOR, 0.18), especially RSV (aOR, 0.11; all p < 0.0001), and positively associated with the detection of bacteria (aORs, 1.77; p 0.03). No single clinical syndrome distinguished hMPV-positive from other cases. Among hMPV-positive cases, 65.2% were aged <1 year and 27.5% had pneumonia danger signs; positive predictive value for hMPV aetiology was 74.5%; mortality was 3.9%, similar to RSV-positive (2.4%) and lower than that among other cases (9.6%).

DISCUSSION

HMPV-associated severe paediatric pneumonia in high-burden settings was predominantly in young infants and clinically indistinguishable from RSV. HMPV-positives had low case fatality, similar to that in RSV-positives.

摘要

目的

在呼吸道合胞病毒（RSV）之后，人偏肺病毒（hMPV）是PERCH研究中导致重症肺炎的第二大致病原。我们试图通过与RSV阳性病例及其他病例进行比较，来描述高负担地区hMPV阳性病例的特征，目前该地区相关数据有限。

方法

在7个非洲和亚洲国家，对1至59个月大因疑似重症肺炎住院的儿童以及年龄/季节匹配的社区对照进行鼻咽/口咽拭子检测，采用多重PCR检测32种呼吸道病原体，并在入院时进行其他临床和实验室评估。使用逻辑回归计算年龄和地点调整后的比值比（调整后OR[aOR]）。采用贝叶斯嵌套部分潜在类别分析估计病因概率。潜在类别分析确定临床特征的症状组合。

结果

病例组（267/3887，6.9%）中hMPV的检出率高于对照组（115/4976，2.3%），有肺炎胸部X线表现的病例组（8.5%）高于无此表现的病例组（5.5%），有呼吸道疾病的对照组（3.8%）高于无呼吸道疾病的对照组（1.8%；所有p≤0.001）。hMPV阳性病例与其他病毒的检出呈负相关（aOR，0.18），尤其是RSV（aOR，0.11；所有p<0.0001），与细菌的检出呈正相关（aOR，1.77；p 0.03）。没有单一的临床综合征能够区分hMPV阳性病例与其他病例。在hMPV阳性病例中，65.2%年龄<1岁，27.5%有肺炎危险体征；hMPV病因的阳性预测值为74.5%；死亡率为3.9%，与RSV阳性病例（2.4%）相似，低于其他病例（9.6%）。