title: Newer respiratory virus infections: human metapneumovirus, avian influenza virus, and human coronaviruses.
abstract: OBJECTIVE
  Recently, several previously unrecognized respiratory viral pathogens have been identified and several influenza A virus subtypes, previously known to infect poultry and wild birds, were transmitted to humans. Here we review the recent literature on these respiratory viruses.
  
  
  RESULTS
  Human metapneumovirus has now been detected worldwide, causing severe respiratory tract illnesses primarily in very young, elderly and immunocompromised individuals. Animal models and reverse genetic techniques were designed for human metapneumovirus, and the first vaccine candidates have been developed. Considerable genetic and antigenic diversity was observed for human metapneumovirus, but the implication of this diversity for vaccine development and virus epidemiology requires further study. Two previously unrecognized human coronaviruses were discovered in 2004 in The Netherlands and Hong Kong. Their clinical impact and epidemiology are largely unknown and warrant further investigation. Several influenza A virus subtypes were transmitted from birds to humans, and these viruses continue to constitute a pandemic threat. The clinical symptoms associated with these zoonotic transmissions range from mild respiratory illnesses and conjunctivitis to pneumonia and acute respiratory distress syndrome, sometimes resulting in death. More basic research into virus ecology and evolution and development of effective vaccines and antiviral strategies are required to limit the impact of influenza A virus zoonoses and the threat of an influenza pandemic.
  
  
  CONCLUSIONS
  Previously unknown and emerging respiratory viruses are an important threat to human health. Development of virus diagnostic tests, antiviral strategies, and vaccines for each of these pathogens is crucial to limit their impact.
authors.affiliation: Department of Virology, Erasmus Medical Center, Rotterdam, The Netherlands. r.fouchier@erasmusmc.nl
authors.forename: Ron Am
authors.initials: RA
authors.lastname: Fouchier
authors.forename: Guus F
authors.initials: GF
authors.lastname: Rimmelzwaan
authors.forename: Thijs
authors.initials: T
authors.lastname: Kuiken
authors.forename: Albert Dme
authors.initials: AD
authors.lastname: Osterhaus
mesh_terms: D021821:Communicable Diseases, Emerging; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000821:virology; D004196:Disease Outbreaks; D006801:Humans; D009980:Influenza A virus; D007251:Influenza, Human / Q000453:epidemiology / Q000821:virology*; D029121:Metapneumovirus; D018184:Paramyxoviridae Infections / Q000453:epidemiology* / Q000821:virology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000821:virology*; D012307:Risk Factors