Pneumococcal Coinfection with Human Metapneumovirus

• Published in: The Journal of infectious diseases 2006-05, Vol.193 (9), p.1236-1243
• Main Authors: Madhi, Shabir A., Ludewick, Herbert, Kuwanda, Locadiah, Niekerk, Nadia van, Cutland, Clare, Little, Tessa, Klugman, Keith P.
• Format: Article
• Language: English
• Subjects: Bacteriology; Biological and medical sciences; Child; Child, Preschool; Coinfection; Female; Fundamental and applied biological sciences. Psychology; Hospitalization; Human immunodeficiency virus; Human metapneumovirus; Humans; Infections; Infectious diseases; Male; Medical sciences; Metapneumovirus; Metapneumovirus - isolation & purification; Microbiology; Miscellaneous; Paramyxoviridae Infections - complications; Paramyxoviridae Infections - diagnosis; Paramyxoviridae Infections - epidemiology; Placebos; Pneumococcal Infections - complications; Pneumococcal Infections - prevention & control; Pneumococcal pneumonia; Pneumococcal Vaccines - therapeutic use; Pneumonia; Pneumonia, Viral - complications; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Streptococcus pneumoniae; Vaccination; Vaccines, Conjugate - therapeutic use; Viral pneumonia; Viruses
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/503053

BackgroundInfection with the newly discovered human metapneumovirus (hMPV) may lead to hospitalization of children with lower respiratory tract infection (LRTI), although the pathogenesis thereof remains to be elucidated MethodsThis hypothesis-generating study involved a cohort of children randomized to receive 9-valent conjugate pneumococcal vaccine or placebo and who were tested for hMPV infection when hospitalized for LRTI. By use of a nested reverse-transcription polymerase chain reaction assay targeted at amplifying a fragment of the hMPV fusion (F) protein gene, 202 such infections were identified among 2715 episodes of LRTI in children ResultsAmong human immunodeficiency virus (HIV)–uninfected children who had received 3 doses of conjugate pneumococcal vaccine, the incidence of hMPV-associated LRTI was reduced by 45% (95% confidence interval [CI], 19%–62%; P=.002), and the incidence of clinical pneumonia was reduced by 55% (95% CI, 22%–74%; P=.003). Similarly, in fully vaccinated HIV-infected children, the incidence of hMPV-associated LRTI was reduced by 53% (95% CI, 3%–77%; P=.035), and that of clinical pneumonia was reduced by 65% (95% CI, 19%–85%; P=.020) ConclusionsThe pathogenesis of hMPV-associated LRTI that results in hospitalization of both HIV-infected and -uninfected children involves bacterial coinfection with pneumococcus, and a significant proportion of these hospitalizations may be prevented by vaccination with pneumococcal conjugate vaccine