title: Co-circulation of human metapneumovirus and SARS-associated coronavirus during a major nosocomial SARS outbreak in Hong Kong.
abstract: BACKGROUND
  The clinico-epidemiological significance of human metapneumovirus (hMPV) detected during the SARS outbreak is unknown.
  
  
  OBJECTIVE
  To characterize a nosocomial hMPV outbreak during the 2003 SARS epidemic.
  
  
  METHODS
  All available nasopharyngeal aspirate (NPA) collected from confirmed patients during the first 8 weeks of the SARS outbreak in 2003 were tested for hMPV by a nested RT-PCR assay targeting the F-gene. Clinico-epidemiological information was used to analyze the relationship of hMPV co-infection to specific risk factors (demographics/symptoms/outcomes; status as health-care workers (HCWs)/patients; history of exposure/contact; ward location). Multivariate logistic regression analysis was performed to determine independent risk factors.
  
  
  RESULTS
  An hMPV outbreak occurred during 6-16 March 2003 (first week of the Hong Kong SARS epidemic). hMPV RNA was detected in 31 of 155 (20%) NPAs from SARS patients. HCW status (OR 2.72, 95% CI 1.11-6.68; p=0.029) or epidemiological linkage to the SARS outbreak ward (OR 3.59, 95% CI 1.42-9.05; p=0.007) were independent factors associated with hMPV infection. Symptoms of cough and coryza were more common in co-infected individuals (22.6% vs. 15.9%) but this was not statistically significant. Other clinical manifestations and outcomes were not different in co-infected patients.
  
  
  CONCLUSIONS
  A major nosocomial hMPV outbreak involving HCWs occurred during the early SARS epidemic. Patients with dual hMPV and SARS infection were not sicker than those with SARS infection only.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: N
authors.initials: N
authors.lastname: Lee
authors.forename: P K S
authors.initials: PK
authors.lastname: Chan
authors.forename: I T
authors.initials: IT
authors.lastname: Yu
authors.forename: K K
authors.initials: KK
authors.lastname: Tsoi
authors.forename: G
authors.initials: G
authors.lastname: Lui
authors.forename: J J Y
authors.initials: JJ
authors.lastname: Sung
authors.forename: C S
authors.initials: CS
authors.lastname: Cockram
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000453:epidemiology / Q000821:virology*; D004196:Disease Outbreaks; D006282:Health Personnel; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D017053:Infection Control; D029121:Metapneumovirus / Q000302:isolation & purification*; D009305:Nasopharynx / Q000821:virology; D018184:Paramyxoviridae Infections / Q000453:epidemiology / Q000821:virology*; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D045473:Severe acute respiratory syndrome-related coronavirus / Q000302:isolation & purification*; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology / Q000821:virology*