OBJECTIVES: To investigate the epidemiological characteristics of human metapneumovirus (hMPV) and the risk factors for severe pneumonia in hospitalized children. METHODS: The epidemiological characteristics of hMPV in hospitalized children at Hebei Children's Hospital from January 2019 to December 2023 were retrospectively analyzed. The clinical data of hospitalized children with hMPV infection from April to December 2023 were included, and independent risk factors for severe pneumonia were identified through logistic regression. RESULTS: A total of 44 092 children were tested, with an hMPV positive rate of 7.30% (3 220/44 092). Children aged 3-6 years constituted the largest proportion (40.93%, 1 318/3 220) among hMPV-positive cases. The detection rate varied significantly by year (P<0.001), peaking in 2022 (12.35%, 978/7 919). The peak season of the epidemic was winter and spring from 2019 to 2021, but shifted to spring and summer from 2022 to 2023. The proportion of co-infection was 38.70% (1 246/3 220), primarily with rhinovirus (600/1 246, 48.15%), Mycoplasma pneumoniae (217/1 246, 17.42%), and respiratory syncytial virus (182/1 246, 14.61%). The main manifestations of hMPV pneumonia were cough, expectoration, and fever. Children with severe pneumonia were significantly younger (P<0.05). Wheezing, underlying diseases, co-infection, and younger age were identified as independent risk factors for severe pneumonia (P<0.05). CONCLUSIONS There are significant annual and seasonal differences in the epidemiological characteristics of hMPV in hospitalized children. Young age, underlying diseases, wheezing, and co-infection are independent risk factors for severe pneumonia.
Humans ; Risk Factors ; Metapneumovirus ; Child, Preschool ; Child ; Male ; Female ; Paramyxoviridae Infections/complications* ; Pneumonia/epidemiology* ; Retrospective Studies ; Child, Hospitalized ; Infant ; Logistic Models ; Seasons ; Hospitalization

Objective: To investigate the clinical characteristics and the risk factors of severe human metapneumovirus (hMPV)-associated community acquired pneumonia (CAP) in children. Methods: A retrospective case summary was conducted. From December 2020 to March 2022, 721 children who were diagnosed with CAP and tested positive for hMPV nucleic acid by PCR-capillary electrophoresis fragment analysis of nasopharyngeal secretions at the Yuying Children's Hospital, the Second Affiliated Hospital of Wenzhou Medical University were selected as the research objects. The clinical characteristics, epidemiological characteristics and mixed pathogens of the two groups were analyzed. According to CAP diagnostic criteria, the children were divided into the severe group and the mild group. Chi-square test or Mann-Whitney rank and contrast analysis was used for comparison between groups, while multivariate Logistic regression was applied to analyze the risk factors of the severe hMPV-associated CAP. Results: A total of 721 children who were diagnosed with hMPV-associated CAP were included in this study, with 397 males and 324 females. There were 154 cases in the severe group. The age of onset was 1.0 (0.9, 3.0) years, <3 years old 104 cases (67.5%), and the length of hospital stay was 7 (6, 9) days. In the severe group, 67 children (43.5%) were complicated with underlying diseases. In the severe group, 154 cases (100.0%) had cough, 148 cases (96.1%) had shortness of breath and pulmonary moist rales, and 132 cases (85.7%) had fever, 23 cases (14.9%) were complicated with respiratory failure. C-reactive protein (CRP) was elevated in 86 children (55.8%), including CRP≥50 mg/L in 33 children (21.4%). Co-infection was detected in 77 cases (50.0%) and 102 strains of pathogen were detected, 25 strains of rhinovirus, 17 strains of Mycoplasma pneumoniae, 15 strains of Streptococcus pneumoniae, 12 strains of Haemophilus influenzae and 10 strains of respiratory syncytial virus were detected. Six cases (3.9%) received heated and humidified high flow nasal cannula oxygen therapy, 15 cases (9.7%) were admitted to intensive care unit, and 2 cases (1.3%) received mechanical ventilation. In the severe group, 108 children were cured, 42 children were improved, 4 chlidren were discharged automatically without recovery and no death occurred. There were 567 cases in the mild group. The age of onset was 2.7 (1.0, 4.0) years, and the length of hospital stay was 4 (4, 6) days.Compared with the mild group, the proportion of children who age of disease onset <6 months, CRP≥50 mg/L, the proportions of preterm birth, congenital heart disease, malnutrition, congenital airway malformation, neuromuscular disease, mixed respiratory syncytial viruses infection were higher (20 cases (13.0%) vs. 31 cases (5.5%), 32 cases (20.8%) vs. 64 cases (11.3%), 23 cases (14.9%) vs. 44 cases (7.8%), 11 cases (7.1%) vs. 18 cases (3.2%), 9 cases (5.8%) vs. 6 cases (1.1%), 11 cases (7.1%) vs. 12 cases (2.1%), 8 cases (5.2%) vs. 4 cases (0.7%), 10 cases (6.5%) vs. 13 cases (2.3%), χ²=0.42, 9.45, 7.40, 4.94, 11.40, 8.35, 3.52, 6.92, all P<0.05). Multivariate Logistic regression analysis showed that age<6 months (OR=2.51, 95%CI 1.29-4.89), CRP≥50 mg/L (OR=2.20, 95%CI 1.36-3.57), prematurity (OR=2.19, 95%CI 1.26-3.81), malnutrition (OR=6.05, 95%CI 1.89-19.39) were the independent risk factors for severe hMPV-associated CAP. Conclusions: Severe hMPV-associated CAP is most likely to occur in infants under 3 years old and has a higher proportion of underlying diseases and co-infection. The main clinical manifestations are cough, shortness of breath and pulmonary moist rales, fever. The overall prognosis is good. Age<6 months, CRP≥50 mg/L, preterm birth, malnutrition are the independent risk factors for severe hMPV-associated CAP.
Infant ; Male ; Female ; Humans ; Child ; Infant, Newborn ; Child, Preschool ; Retrospective Studies ; Cough ; Coinfection ; Premature Birth ; Respiratory Sounds ; Metapneumovirus ; Pneumonia, Viral/epidemiology* ; Respiratory Syncytial Virus, Human ; Community-Acquired Infections/epidemiology* ; Risk Factors ; Dyspnea ; Malnutrition

OBJECTIVE: To investigate the prevalence of respiratory viral infections in patients with primary immunodeficiency disease (PID) during hematopoietic stem cell transplantation. METHODS: 108 specimens of nasopharyngeal aspirate were collected from 22 PID patients before and after hematopoietic stem cell transplantation from July 2016 to July 2018 in the Department of Hematology. The TR-PCR was used to detect for respiratory viruses including respiratory syncytial virus(RSV)，human metapneumoviros(hMPV)，coronavirus(CoV) and parainfluenza 1-3 (PIV1-3). And the clinical characteristics and co-infection were analyzed. RESULTS: Among the total 108 specimens, viral pathogens were identified in 41 (37.96%) specimens. Among which the pathogens of highest detection rate was RSV (25.9%). Different types of PID showed different virus infection rates, among which the highest infection rate was severe combined immunodeficiency disease (SCID) patients, with the virus detection rate was 57.9%. The incidence of co-infection with two or more than two viruses was 19.5%. CONCLUSION Patients with PID who undergo hematopoietic stem cell transplantation are more susceptible to respiratory viruses. RSV is an important respiratory tract virus pathogen after hematopoietic stem cell transplantation.
Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Metapneumovirus ; Primary Immunodeficiency Diseases ; therapy ; Respiratory Syncytial Virus, Human ; Respiratory Tract Infections

BACKGROUND: This study investigated the effect of fine dust concentrations in the air on the incidence of viral respiratory infections in the Republic of Korea.METHODS: A time series analysis using R statistics was performed to determine the relationship between weekly concentrations of fine dust in the air and the incidences of acute respiratory tract infections caused by the respiratory syncytial virus (RSV), adenovirus (HAdV), rhinovirus (HRV), human metapneumovirus (HMPV), human coronavirus (HCoV), human bocavirus (HBoV), human parainfluenza virus (HPIV), and influenza virus (IFV), from the beginning of 2016 to the end of 2017. Correlations between various meteorological factors and the amount of fine dust were analyzed using the Spearman's rank correlation coefficient. To analyze the relationship between viral infections and fine dust, a quasi-poisson analysis was performed.RESULTS: The incidence of the HAdV was proportional to fine dust and air temperature. The IFV was proportional to fine dust and relative humidity and was inversely proportional to temperature. The HMPV was proportional to fine dust, wind speed, and inversely proportional to relative humidity. The HCoV was proportional to micro dust, relative humidity, and inversely proportional to temperature. Both the HBoV and HPIV were directly proportional to fine dust, temperature, wind speed, and inversely proportional to relative humidity. The RSV was inversely proportional to fine dust, temperature, wind speed. A lag effect was observed for the influenza virus, in that its incidence increased 2–3 weeks later on the cumulative lag model.CONCLUSION: As the weekly average concentration of fine dust increases, the incidence of HAdV, HMPV, HCoV, HBoV, HPIV, and influenza increase.
Adenoviridae ; Air Pollution ; Coronavirus ; Dust ; Human bocavirus ; Humans ; Humidity ; Incidence ; Influenza, Human ; Metapneumovirus ; Meteorological Concepts ; Orthomyxoviridae ; Paramyxoviridae Infections ; Particulate Matter ; Republic of Korea ; Respiration Disorders ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Rhinovirus ; Wind

PURPOSE: The most common cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is respiratory infection. Most studies of bacterial or viral cause in AECOPD have been conducted in Western countries. We investigated bacterial and viral identification rates in AECOPD in Korea. MATERIALS AND METHODS: We reviewed and analyzed medical records of 736 cases of AECOPD at the Korea University Guro Hospital. We analyzed bacterial and viral identification rates and classified infections according to epidemiological factors, such as Global Initiative for Chronic Obstructive Lung Disease stage, mortality, and seasonal variation. RESULTS: The numbers of AECOPD events involving only bacterial identification, only viral identification, bacterial-viral co-identification, and no identification were 200 (27.2%), 159 (21.6%), 107 (14.5%), and 270 (36.7%), respectively. The most common infectious bacteria identified were Pseudomonas aeruginosa (13.0%), Streptococcus pneumoniae (11.4%), and Haemophilus influenzae (5.3%); the most common viruses identified were influenza virus (12.4%), rhinovirus (9.4%), parainfluenza virus (5.2%), and metapneumovirus (4.9%). The bacterial identification rate tended to be higher at more advanced stages of chronic obstructive pulmonary disease (p=0.020 overall, p=0.011 for P. aeruginosa, p=0.048 for S. pneumoniae). Staphylococcus aureus and Klebsiella pneumoniae were identified more in mortality group (p=0.003 for S. aureus, p=0.009 for K. pneumoniae). All viruses were seasonal (i.e., greater prevalence in a particular season; p < 0.050). Influenza virus and rhinovirus were mainly identified in the winter, parainfluenza virus in the summer, and metapneumovirus in the spring. CONCLUSION: This information on the epidemiology of respiratory infections in AECOPD will improve the management of AECOPD using antibiotics and other treatments in Korea.
Anti-Bacterial Agents ; Bacteria ; Epidemiology ; Haemophilus influenzae ; Klebsiella pneumoniae ; Korea ; Medical Records ; Metapneumovirus ; Mortality ; Orthomyxoviridae ; Paramyxoviridae Infections ; Prevalence ; Pseudomonas aeruginosa ; Pulmonary Disease, Chronic Obstructive ; Respiratory Tract Infections ; Rhinovirus ; Seasons ; Staphylococcus aureus ; Streptococcus pneumoniae

Seasonal outbreaks of airsacculitis in China's poultry cause great economic losses annually. This study tried to unveil the potential role of Avian metapneumovirus (AMPV), Ornithobacterium rhinotracheale (ORT) and Chlamydia psittaci (CPS) in avian airsacculitis. A serological investigation of 673 breeder chickens and a case-controlled study of 430 birds were undertaken. Results showed that infection with AMPV, ORT, and CPS was highly associated with the disease. The correlation between AMPV and CPS were positively robust in both layers and broilers. Finally, we determined the co-infection with AMPV, ORT, and CPS was prevalent in the sampled poultry farms suffering from respiratory diseases and the outbreak of airsacculitis was closely related to simultaneous exposure to all three agents.
Air Sacs ; microbiology ; pathology ; Animals ; Antibodies, Bacterial ; blood ; Antibodies, Viral ; blood ; Case-Control Studies ; Chickens ; Chlamydia ; Chlamydia Infections ; microbiology ; pathology ; veterinary ; Coinfection ; Flavobacteriaceae Infections ; microbiology ; pathology ; veterinary ; Humans ; Metapneumovirus ; Ornithobacterium ; Paramyxoviridae Infections ; pathology ; veterinary ; virology ; Poultry Diseases ; microbiology ; pathology ; virology ; Respiratory Tract Diseases ; microbiology ; veterinary ; virology ; Seroepidemiologic Studies

PURPOSE: Despite the availability of molecular methods, identification of the causative virus in children with acute respiratory infections (ARIs) has proven difficult as the same viruses are often detected in asymptomatic children. METHODS: Multiplex reverse transcription polymerase chain reaction assays were performed to detect 15 common respiratory viruses in children under 15 years of age who were hospitalized with ARI between January 2013 and December 2015. Viral epidemiology and clinical profiles of single virus infections were evaluated. RESULTS: Of 3,505 patients, viruses were identified in 2,424 (69.1%), with the assay revealing a single virus in 1,747 cases (49.8%). While major pathogens in single virus-positive cases differed according to age, human rhinovirus (hRV) was common in patients of all ages. Respiratory syncytial virus (RSV), influenza virus (IF), and human metapneumovirus (hMPV) were found to be seasonal pathogens, appearing from fall through winter and spring, whereas hRV and adenovirus (AdV) were detected in every season. Patients with ARIs caused by RSV and hRV were frequently afebrile and more commonly had wheezing compared with patients with other viral ARIs. Neutrophil-dominant inflammation was observed in ARIs caused by IF, AdV, and hRV, whereas lymphocyte-dominant inflammation was observed with RSV A, parainfluenza virus, and hMPV. Monocytosis was common with RSV and AdV, whereas eosinophilia was observed with hRV. CONCLUSION: In combination with viral identification, recognition of virus-specific clinical and laboratory patterns will expand our understanding of the epidemiology of viral ARIs and help us to establish more efficient therapeutic and preventive strategies.
Adenoviridae ; Child ; Child, Hospitalized* ; Eosinophilia ; Epidemiology ; Humans ; Inflammation ; Metapneumovirus ; Orthomyxoviridae ; Paramyxoviridae Infections ; Polymerase Chain Reaction ; Respiratory Sounds ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Reverse Transcription ; Rhinovirus ; Seasons

Respiratory infections, which are caused by airborne pathogens, are the most common disease of all ages worldwide. This study was conducted to characterize the airborne respiratory pathogens in the public facilities in Busan, South Korea. A total of 260 public facilities were investigated in 2017, 52 seasonal indoor air from 2 hospitals and 208 indoor air samples from 208 randomly selected daycare centers. Among respiratory pathogen, 8 viral pathogens including human adenovirus (HAdV), human bocavirus (HBoV), human rhinovirus (HRV), human parainfluenza virus (HPIV), human respiratory syncytial virus (HRSV), human metapneumovirus (HMPV), human coronavirus (HCoV) and influenza virus (IFV), and 3 bacterial pathogens including Mycoplasma pneumoniae, Bordetella pertussis, and Chlamydophila pneumoniae, were investigated by multiplex real-time reverse transcription polymerase chain reaction. Pathogens were detected in 9 cases (3.4%). Among 9 positive samples, 6 (2.3%) cases were positive for HBoV and 3 (1.2%) cases were positive for IFV. All the positive cases were detected in daycare centers. Additionally, the concentration of HBoV was determined. In HBoV-positive samples, the cycle threshold (Ct) values of HBoV were 29.73~36.84, which are corresponding to the viral concentration of 4.91 × 10⁰ ~ 9.57 × 10² copies/ml. Serotype distribution of isolated HBoV was analyzed by sequencing of VP1/VP2 gene. All of the HBoV isolates were identified as HBoV type 1 with a high similarity among the isolates (>97%). No bacterial pathogen was identified in indoor air samples. Although virus concentration was not high in public facilities (daycare center), the presence of respiratory viral pathogens has been identified. Effective ventilation and air purification strategies are needed to reduce the indoor concentration of respiratory pathogens. A long-term and ongoing surveillance plan for respiratory pathogen management should be established.
Adenoviruses, Human ; Bordetella pertussis ; Busan ; Chlamydial Pneumonia ; Chlamydophila pneumoniae ; Coronavirus ; Human bocavirus ; Humans ; Korea ; Metapneumovirus ; Mycoplasma pneumoniae ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pneumonia, Mycoplasma ; Polymerase Chain Reaction ; Public Facilities* ; Respiratory Syncytial Virus, Human ; Respiratory Tract Infections ; Reverse Transcription ; Rhinovirus ; Seasons ; Serogroup ; Ventilation

PURPOSE: The aim of this study was to evaluate the severity of disease in children with acute bronchiolitis according to the type of infected virus. METHODS: From November 2007 to May 2015, 768 patients under 2 years of age who underwent real time-polymerase chain reaction of nasopharyngeal aspirates admitted to the Department of Pediatrics of Dongguk University Ilsan Hospital for acute bronchiolitis were enrolled. Severe bronchiolitis was defined as presence of one or more kinds among tachypnea, chest retraction, needs of O2 inhalation or ventilator care. RESULTS: The severity of bronchiolitis was increased with shorter fever duration (P < 0.001) and previous wheezing episodes (P = 0.005). In the case of single infection, respiratory syncytial virus (RSV) A only increased the severity of acute bronchiolitis (P = 0.012). However, the severity of illness decreased when RSV A coinfected with adenovirus (P = 0.034), human rhinovirus (P = 0.038), or human coronavirus NL63 (P = 0.042). On the other hand, when human rhinovirus was coinfected with enterovirus (P = 0.013) or parainfluenza 3 (P = 0.019), the severity was increased. When human metapneumovirus coinfected with human bocavirus, the severity was increased (P = 0.038). CONCLUSION: Acute bronchiolitis was associated with increased severity only when RSV A infected solely, but several viruses increased or decreased the severity when coinfection occurred. Therefore, it may be helpful in predicting the course of the acute bronchiolitis according to the affected virus.
Adenoviridae ; Bronchiolitis ; Child ; Coinfection ; Coronavirus NL63, Human ; Enterovirus ; Fever ; Hand ; Human bocavirus ; Humans ; Infant ; Inhalation ; Metapneumovirus ; Paramyxoviridae Infections ; Pediatrics ; Respiratory Sounds ; Respiratory Syncytial Viruses ; Rhinovirus ; Tachypnea ; Thorax ; Ventilators, Mechanical

PURPOSE: This study was performed to investigate the epidemiologic and clinical features of human metapneumovirus (hMPV). METHODS: We performed real-time reverse transcription polymerase chain reaction with nasopharyngeal samples from 2,403 children who were hospitalized with acute respiratory infection. Then medical records of 120 children, who were diagnosed with hMPV respiratory infection between 2011 and 2014, were retrospectively analyzed retrospectively and compared to epidemiologic data on respiratory virus infection reported by Korea Centers for Disease Control and Prevention. RESULTS: We detected 120 hMPV-positive cases out of 1,723 virus-positive specimens (7.0%), which prevailed mostly in spring between March and May. Respiratory infection with hMPV was more common in female patients (55.0%) and hPMV infection was prevalent among children aged <5 years (80.8%). Coinfections with other respiratory viruses were observed in 34 patients of 120 hMPV-positive cases (28.3%), mostly with rhinovirus (52.9%). In addition, hPMV infection mostly presented with pneumonia (71.7%). Among 120 hMPV-positive patients during the recent 4 years, most (68.3%) were diagnosed in 2014. During 2011–2014, influenza virus infection was prevalent mainly from January to March, and hMPV infection started to appear just after the end of influenza virus outbreak. CONCLUSION: In Korean children, hMPV was a common causative organism of viral pneumonia during the spring season. The hMPV infection pandemic was observed in 2014 and the clinical importance of hMPV has recently been increasing. Therefore, additional studies are required to define the epidemiology, disease characteristics caused by hMPV, and the cause of recent outbreak.
Centers for Disease Control and Prevention (U.S.) ; Child* ; Coinfection ; Epidemiology* ; Female ; Humans* ; Korea ; Medical Records ; Metapneumovirus* ; Orthomyxoviridae ; Pandemics ; Pneumonia ; Pneumonia, Viral ; Polymerase Chain Reaction ; Respiratory Tract Infections ; Retrospective Studies ; Reverse Transcription ; Rhinovirus ; Seasons