Pneumococcal coinfection with human metapneumovirus.
BACKGROUND
Infection 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.


METHODS
This 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.


RESULTS
Among 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).


CONCLUSIONS
The 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.
University of the Witwatersrand/Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Bertsham, South Africa. madhis@hivsa.com
Shabir A
SA
Madhi
Herbert
H
Ludewick
Locadiah
L
Kuwanda
Nadia van
Nv
Niekerk
Clare
C
Cutland
Tessa
T
Little
Keith P
KP
Klugman
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D029121:Metapneumovirus / Q000302:isolation & purification*; D018184:Paramyxoviridae Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D011008:Pneumococcal Infections / Q000150:complications / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D011024:Pneumonia, Viral / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D013296:Streptococcus pneumoniae; D018074:Vaccines, Conjugate / Q000627:therapeutic use
D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate