title: Epidemiology of human metapneumovirus in a pediatric long-term care facility.
abstract: BACKGROUND
  Viral respiratory pathogens cause outbreaks in pediatric long-term care facilities (LTCFs), but few studies have used viral diagnostic testing to identify the causative pathogens. We describe the use of such testing during a prolonged period of respiratory illness and elucidate the epidemiology of human metapneumovirus (hMPV) at our LTCF.
  
  
  METHODS
  Retrospective study of influenza-like illness (ILI).
  
  
  METHODS
  A 136-bed pediatric LTCF from January 1 through April 30, 2010.
  
  
  METHODS
  The ILI case definition included fever, cough, change in oropharyngeal secretions, increase in oxygen requirement, and/or wheezing.
  
  
  RESULTS
  During the study period, 69 episodes of ILI occurred in 61 (41%) of 150 residents. A viral pathogen was detected in 27 (39%) of the episodes, including respiratory syncytial virus (RSV) (n = 3), influenza A virus (not typed; n = 2), parainfluenza virus (n =2), adenovirus (n = 1), and hMPV (n = 19). Twenty-seven of the residents with ILI (44%) required transfer to acute care hospitals (mean length of hospitalization, 12 days; range, 3-47 days). Residents with tracheostomies were more likely to have ILI (adjusted odds ratio [OR], 3.99 [95% confidence interval {CI}, 1.87-8.53]; P = .0004). The mortality rate for residents with ILI was 1.6%. Residents with hMPV were younger (P = .03), more likely to be transferred to an acute care facility (OR, 3.73 [95% CI, 1.17-11.95]; P = .02), and less likely to have a tracheostomy (adjusted OR, 0.19 [95% CI, 0.047-0.757]; P = .02 ).
  
  
  CONCLUSIONS
  Diverse pathogens, most notably hMPV, caused ILI in our pediatric LTCF during a prolonged period of time. Viral testing was helpful in characterizing the epidemiology of ILI in this population.
authors.affiliation: Department of Pediatrics, Columbia University, New York, New York, USA. nn45@columbia.edu
authors.forename: Natalie
authors.initials: N
authors.lastname: Neu
authors.forename: Theresa
authors.initials: T
authors.lastname: Plaskett
authors.forename: Gordon
authors.initials: G
authors.lastname: Hutcheon
authors.forename: Meghan
authors.initials: M
authors.lastname: Murray
authors.forename: Karen L
authors.initials: KL
authors.lastname: Southwick
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
mesh_terms: D000257:Adenoviridae Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D017053:Infection Control; D009980:Influenza A virus / Q000302:isolation & purification; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D029121:Metapneumovirus / Q000302:isolation & purification*; D009519:New York City; D018184:Paramyxoviridae Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D010360:Patient Transfer / Q000706:statistics & numerical data; D012112:Residential Facilities; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D055815:Young Adult