Human metapneumovirus viral load is an important risk factor for disease severity in young children

Background: The role of viral load in human metapneumovirus (HMPV) disease severity has not yet been clearly determined. Objective: We evaluated the importance of viral load along with other factors in HMPV disease severity among children aged <3 years old. Study design: HMPV-positive cases were selected from a cohort of outpatients and hospitalized children with lower respiratory tract infections. HMPV groups (A or B) and viral loads were determined in their nasopharyngeal aspirates. Disease severity was defined by assessing risk for hospitalization and by using two validated clinical severity scores. Results: Of the 118 HMPV cases detected over 4 years for which viral load could be determined, 60 belonged to genotype A and 58 to genotype B. Baseline characteristics were similar in HMPV-A and HMPV-B mono-infected patients. In multivariate analysis, HMPV hospitalization was associated with viral load >= 1000 copies/10(4) cells (OR, 3.2; 95%CI, 1.4-7.4), age <6 months (OR, 3.1; 95%CI, 1.2-8.6) and presence of >= 3 children in the household (OR, 2.7; 95%CI, 1.04-6.9). A high HMPV viral load was also associated with pulmonary rales (p= 03), use of bronchodilators (p=.02) and inhaled corticosteroids (p=.01). Conclusion: HMPV viral load is associated with disease severity in young children along with young age and household crowding. (C) 2014 Elsevier B.V. All rights reserved.