A community study of clinical traits and risk factors for human metapneumovirus and respiratory syncytial virus infection during the first year of life

Human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) are important respiratory pathogens with similar symptomatology. The aim of this prospective birth cohort study was to identify risk factors for an hMPV or RSV infection during the first year of life in unselected healthy children. We followed 217 children from birth to 1 year of age. Nasal swabs and symptom diaries were collected monthly. Anti-hMPV and anti-RSV IgG antibodies by age 1 year were detected by ELISA, and nasal swabs were analysed for hMPV and RSV by RT-PCR. Logistic regression was used for risk factor analysis. Anti-hMPV IgG was found in 38 children (17.5%), and anti-RSV IgG in 172 children (79%). Risk factors for being anti-hMPV IgG-positive were: (1) being born in the spring (OR=2.36; 95% CI:1.06-5.27), and (2) having older siblings (OR=3.82; 95% CI:1.75-8.34). Risk factors for being anti-RSV IgG-positive were: (1) gestational age < 38 weeks (OR=3.39; 95% CI:1.42-8.05), (2) increasing paternal age (OR=1.85 per 5 yrs; 95% CI:1.28-2.68), and (3) wall-to-wall carpeting (OR=3.15; 95% CI:1.29-7.68). Being born in the spring was associated with decreased odds of being anti-RSV IgG-positive (OR=0.27, 95% CI:0.09-0.85). Risk factors for RSV hospitalisation (n=11) were: (1) older siblings (OR=4.49; 95% CI: 1.08-18.73) and (2) smoking in the household (OR=5.06; 95% CI: 1.36-18.76). Exclusive breastfeeding for the first 14 days of life protected against hospitalisation (OR=0.21; 95% CI:0.06-0.79). In conclusion, this study identifies risk factors for mild and asymptomatic hMPV infections in infancy.