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Introduction: In Brazil, few studies were performed regarding the co-detection of respiratory viruses in hospitalized patients. In this way, the study aimed to describe the epidemiological profile of hospitalized patients due to influenza virus infection that presented co-detection with another respiratory virus. Methods: The epidemiological analysis was made by collecting data from Open-Data-SUS. The study comprised patients infected by the influenza A or B virus with positive co-detection of another respiratory virus, such as adenovirus, bocavirus, metapneumovirus, parainfluenza virus (types 1, 2, 3, and 4), rhinovirus, and respiratory syncytial virus (RSV). The markers [gender, age, clinical signs and symptoms, comorbidities, need for intensive care unit (ICU) treatment, and need for ventilatory support] were associated with the chance of death. The data was collected during the first three years of the coronavirus disease (COVID)-19 pandemic--from December 19, 2019, to April 06, 2023. Results: A total of 477 patients were included, among them, the influenza A virus was detected in 400 (83.9%) cases. The co-detection occurred, respectively, for RSV (53.0%), rhinovirus (14.0%), adenovirus (13.4%), parainfluenza virus type 1 (10.7%), parainfluenza virus type 3 (5.2%), metapneumovirus (3.8%), parainfluenza virus type 2 (3.6%), bocavirus (3.4%), and parainfluenza virus type 4 (1.5%). The co-detection rate was higher in the male sex (50.7%), age between 0-12 years of age (65.8%), and white individuals (61.8%). The most common clinical symptoms were cough (90.6%), dyspnea (78.8%), and fever (78.6%). A total of 167 (35.0%) people had at least one comorbidity, mainly cardiopathy (14.3%), asthma (8.4%), and diabetes mellitus (7.3%). The need for ICU treatment occurred in 147 (30.8%) cases, with most of them needing ventilatory support (66.8%), mainly non-invasive ones (57.2%). A total of 33 (6.9%) patients died and the main predictors of death were bocavirus infection (OR = 14.78 [95%CI = 2.84-76.98]), metapneumovirus infection (OR = 8.50 [95%CI = 1.86-38.78]), race (other races vs. white people) (OR = 3.67 [95%CI = 1.39-9.74]), cardiopathy (OR = 3.48 [95%CI = 1.13-10.71]), and need for ICU treatment (OR = 7.64 [95%CI = 2.44-23.92]). Conclusion: Co-detection between the influenza virus and other respiratory viruses occurred, mainly with RSV, rhinovirus, and adenovirus being more common in men, white people, and in the juvenile phase. Co-detection of influenza virus with bocavirus and metapneumovirus was associated with an increased chance of death. Other factors such as race, cardiopathy, and the need for an ICU were also associated with a higher chance of death. [ABSTRACT FROM AUTHOR]

IntroductionIn Brazil, few studies were performed regarding the co-detection of respiratory viruses in hospitalized patients. In this way, the study aimed to describe the epidemiological profile of hospitalized patients due to influenza virus infection that presented co-detection with another respiratory virus.MethodsThe epidemiological analysis was made by collecting data from Open-Data-SUS. The study comprised patients infected by the influenza A or B virus with positive co-detection of another respiratory virus, such as adenovirus, bocavirus, metapneumovirus, parainfluenza virus (types 1, 2, 3, and 4), rhinovirus, and respiratory syncytial virus (RSV). The markers [gender, age, clinical signs and symptoms, comorbidities, need for intensive care unit (ICU) treatment, and need for ventilatory support] were associated with the chance of death. The data was collected during the first three years of the coronavirus disease (COVID)-19 pandemic—from December 19, 2019, to April 06, 2023.ResultsA total of 477 patients were included, among them, the influenza A virus was detected in 400 (83.9%) cases. The co-detection occurred, respectively, for RSV (53.0%), rhinovirus (14.0%), adenovirus (13.4%), parainfluenza virus type 1 (10.7%), parainfluenza virus type 3 (5.2%), metapneumovirus (3.8%), parainfluenza virus type 2 (3.6%), bocavirus (3.4%), and parainfluenza virus type 4 (1.5%). The co-detection rate was higher in the male sex (50.7%), age between 0–12 years of age (65.8%), and white individuals (61.8%). The most common clinical symptoms were cough (90.6%), dyspnea (78.8%), and fever (78.6%). A total of 167 (35.0%) people had at least one comorbidity, mainly cardiopathy (14.3%), asthma (8.4%), and diabetes mellitus (7.3%). The need for ICU treatment occurred in 147 (30.8%) cases, with most of them needing ventilatory support (66.8%), mainly non-invasive ones (57.2%). A total of 33 (6.9%) patients died and the main predictors of death were bocavirus infection (OR = 14.78 [95%CI = 2.84–76.98]), metapneumovirus infection (OR = 8.50 [95%CI = 1.86–38.78]), race (other races vs. white people) (OR = 3.67 [95%CI = 1.39–9.74]), cardiopathy (OR = 3.48 [95%CI = 1.13–10.71]), and need for ICU treatment (OR = 7.64 [95%CI = 2.44–23.92]).ConclusionCo-detection between the influenza virus and other respiratory viruses occurred, mainly with RSV, rhinovirus, and adenovirus being more common in men, white people, and in the juvenile phase. Co-detection of influenza virus with bocavirus and metapneumovirus was associated with an increased chance of death. Other factors such as race, cardiopathy, and the need for an ICU were also associated with a higher chance of death.

Although the omicron variant of SARS-CoV-2 circulated intensely during the 2021–2022 season, many patients with severe acute respiratory disease tested negative for COVID-19. The aim of this study was to assess the presence of different respiratory viruses in deceased persons. The proportion of deceased persons with respiratory viral infections in the 2021–2022 season in Navarre, Spain, was estimated considering all deaths caused by confirmed COVID-19 according to the epidemiological surveillance and the results of multiplex PCR tests for respiratory viruses performed in a sample of deceased persons with a cause of death other than COVID-19. Of 3578 deaths, 324 (9.1%) were initially reported as caused by pre-mortem confirmed COVID-19. A sample of 242 persons who died by causes other than COVID-19 were tested post-mortem; 64 (26.4%) of them were positive for any respiratory virus: 11.2% for SARS-CoV-2, 5.8% for rhinovirus, 3.7% for human coronavirus, 2.5% for metapneumovirus, 1.7% for respiratory syncytial virus, 1.7% for parainfluenza, 1.2% for influenza, and less than 1% each for adenovirus and bocavirus. Combining both approaches, we estimated that 34.4% of all deceased persons during the study period had a respiratory viral infection and 19.2% had SARS-CoV-2. Only 33.3% (9/27) of SARS-CoV-2 and 5.0% (2/40) of other viruses detected post-mortem had previously been confirmed pre-mortem. In a period with very intense circulation of SARS-CoV-2 during the pandemic, other respiratory viruses were also frequently present in deceased persons. Some SARS-CoV-2 infections and most other viral infections were not diagnosed pre-mortem. Several respiratory viruses may contribute to excess mortality in winter. [ABSTRACT FROM AUTHOR]

Background: While influenza virus and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) are recognised as a cause of severe illness and mortality, clinical interest for respiratory syncytial virus (RSV), rhinovirus and human metapneumovirus (hMPV) infections is still limited. Methods: We conducted a retrospective database study comparing baseline characteristics and 30‐day mortality in a large cohort of adult patients admitted for an overnight stay or longer with an influenza virus (A/B), rhinovirus, hMPV, RSV or SARS‐CoV‐2 infection. For non‐SARS‐CoV‐2 viruses, data were included for the period July 2017–February 2020. For SARS‐CoV‐2, data between March 2020 and March 2022 were included. Results: Covariate‐adjusted 30‐day mortality following RSV, hMPV or rhinovirus infections was substantial (crude mortality 8–10%) and comparable with mortality following hospitalisation with an influenza A virus infection. Mortality following a SARS‐CoV‐2 infection was consistently higher than for any other respiratory virus, at any point in time (crude mortality 14–25%). Odds of mortality for SARS‐CoV‐2 compared with influenza A declined from 4.9 to 1.7 over the course of the pandemic. Patients with SARS‐CoV‐2 infection had less comorbidity than patients with other respiratory virus infections and were more often male. In this cohort, age was related to mortality following hospitalisation, while an association with comorbidity was not apparent. Conclusions: With the exception of SARS‐CoV‐2 infections, we find the clinical outcome of common respiratory virus infections requiring hospitalisation more similar than often assumed. The observed mortality from SARS‐CoV‐2 was significantly higher, but the difference with other respiratory viruses became less distinct over time. [ABSTRACT FROM AUTHOR]

Human metapneumovirus (hMPV) is a major respiratory pathogen worldwide. Here, we report the crystal structure of a neutralizing antibody M8C10 isolated from human B cells that targets the viral fusion protein (hMPV-F) trimerization interface. This is a novel prefusion-specific epitope that is highly conserved across hMPV strains and other related viruses. The interactions between M8C10 and hMPV-F are largely driven by residues on the light chain with most hypermutated light chain residues on or near the interface. This highlights the immune recognition of a buried trimerization interface during the in vivo affinity maturation process. In addition, in vivo cotton rat challenge studies were performed that show M8C10 provides strong lung protection against hMPV A viral challenge. The hMPV-F:M8C10 Fab structure reported reveals a class of hMPV antibodies in the human immune repertoire with a novel neutralization mechanism, targeting the trimerization interface of hMPV-F antigen. [ABSTRACT FROM AUTHOR]

Among the respiratory pathogens of birds, the Avian Metapneumovirus (aMPV) is one of the most relevant, as it is responsible for causing infections of the upper respiratory tract and may induce respiratory syndromes. aMPV is capable of affecting the reproductive system of birds, directly impacting shell quality and decreasing egg production. Consequently, this infection can cause disorders related to animal welfare and zootechnical losses. The first cases of respiratory syndromes caused by aMPV were described in the 1970s, and today six subtypes (A, B, C, D, and two more new subtypes) have been identified and are widespread in all chicken and turkey-producing countries in the world, causing enormous economic losses for the poultry industry. Conventionally, immunological techniques are used to demonstrate aMPV infection in poultry, however, the identification of aMPV through molecular techniques helped in establishing the traceability of the virus. This review compiles data on the main aMPV subtypes present in different countries; aMPV and bacteria co-infection; vaccination against aMPV and viral selective pressure, highlighting the strategies used to prevent and control respiratory disease; and addresses tools for viral diagnosis and virus genome studies aiming at improving and streamlining pathogen detection and corroborating the development of new vaccines that can effectively protect herds, preventing viral escapes. [ABSTRACT FROM AUTHOR]

Among the respiratory pathogens of birds, the Avian Metapneumovirus (aMPV) is one of the most relevant, as it is responsible for causing infections of the upper respiratory tract and may induce respiratory syndromes. aMPV is capable of affecting the reproductive system of birds, directly impacting shell quality and decreasing egg production. Consequently, this infection can cause disorders related to animal welfare and zootechnical losses. The first cases of respiratory syndromes caused by aMPV were described in the 1970s, and today six subtypes (A, B, C, D, and two more new subtypes) have been identified and are widespread in all chicken and turkey-producing countries in the world, causing enormous economic losses for the poultry industry. Conventionally, immunological techniques are used to demonstrate aMPV infection in poultry, however, the identification of aMPV through molecular techniques helped in establishing the traceability of the virus. This review compiles data on the main aMPV subtypes present in different countries; aMPV and bacteria co-infection; vaccination against aMPV and viral selective pressure, highlighting the strategies used to prevent and control respiratory disease; and addresses tools for viral diagnosis and virus genome studies aiming at improving and streamlining pathogen detection and corroborating the development of new vaccines that can effectively protect herds, preventing viral escapes.

BackgroundThe non-pharmaceutical measures in the first Covid-19 winter season significantly impacted respiratory pathogens such as RSV, influenza, or metapneumovirus, which cause respiratory infections, especially in infants and young children. This longitudinal prospective study aimed to determine how less strict measures affect the pathogen profile in the second winter season.MethodsFrom September 2021 till the end of March 2022, 678 children (0–36 months) admitted to Vienna's largest pediatric center with an acute respiratory infection were enrolled in this study. The researchers performed nasal swabs and tested them by multiplex PCR for 23 respiratory pathogens, chronicled clinical features and treatment, and analyzed the effect of lockdown on the pathogen prevalence.ResultsThe 815 smears of 678 children revealed the most common pathogens to be rhino-/enterovirus (38.5%), RSV (26.7%), and metapneumovirus (7.2%). The lockdown interrupted the early RSV onset in September [RR 0.367, CI (0.184–0.767), p = 0.003], while no effects on the other pathogens were found. Metapneumovirus started circulating in January. Influenza was only sporadically detected. The hospitalization rate was significantly higher than last season due to RSV [OR 4.089, 95%CI (1.414–11.827), p-adj = 0.05].ConclusionWith more flexible non-pharmaceutical measures, children aged 0–36 months started presenting again with viral pathogens, such as RSV and metapneumovirus. RSV, associated with a high hospitalization rate, had a very early onset with an abrupt interruption due to the only lockdown.

Avian metapneumovirus (AMPV) represents a long‐term threat to the poultry industry due to its etiological role in the induction of acute respiratory disease and/or egg drop syndrome in domestic turkeys, chickens, and ducks. Although this disease is commonly referred to as turkey rhinotracheitis, the host range of AMPV encompasses many avian species. We have screened 1323 oropharyngeal‐ and cloacal swab samples obtained from wild mallards in the Netherlands from 2017 to 2019 by RT‐PCR using a degenerate primer pair to detect all members of the Paramyxoviridae and Pneumoviridae or an avian metapneumovirus subtype C (AMPV‐C)‐specific RT‐qPCR assay. We identified a total of seven cases of AMPV‐C infections in wild, healthy mallards (Anas platyrhynchos), of which two AMPV‐C positive samples were further processed using next‐generation sequencing. Phylogenetic analysis of the two complete genomes showed that the newly identified AMPV‐C strains share closest sequence identity (97%) with Eurasian lineage AMPV‐C strains identified in Muscovy ducks in China that presented with severe respiratory disease and egg production loss in 2011. Further analysis of G protein amino acid sequences showed a high degree of variability between the newly identified AMPV‐C variants. PONDR scoring of the G protein has revealed the ectodomain of AMPV‐C to be partitioned into a long intrinsically disordered and short ordered region, giving insights into AMPV G protein structural biology. In summary, we provide the first report of full‐length AMPV‐C genome sequences derived from wild birds in Europe. This emphasizes the need for further surveillance efforts to better characterize the host range, epidemiologic distribution, and pathogenicity of AMPV‐C to determine the risk posed by cross‐species jumps from wildfowl to domesticated avian species. [ABSTRACT FROM AUTHOR]

Avian metapneumovirus (aMPV) poses a significant global threat to the respiratory and reproductive systems of poultry, yet its prevalence and impact in specific regions, such as northern Thailand, remain understudied. This study is the first comprehensive assessment of aMPV seroprevalence among layer hens in the region. By the application of Enzyme-Linked Immunosorbent Assay (ELISA), our findings reveal a high overall seroprevalence of 60.78%, with significantly higher rates among post-laying hens (70.87%) compared to pre-laying hens (47.02%). Regional variations were noted, Uttaradit province showing the highest seroprevalence at 74%. Factors such as overcrowded conditions and poor farm hygiene were implied as contributors to increased seropositivity. Comparison with global studies highlights aMPV's endemicity and emphasizes the need for targeted surveillance and biosecurity measures. Migratory birds were inferred as potential vectors, contributing to the spread of aMPV across different regions. This study provides crucial epidemiological data essential for optimizing vaccination strategies and enhancing disease management practices to safeguard poultry health and sustainable production in northern Thailand., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Unlike influenza, information on the burden of human metapneumovirus (HMPV) as a cause of hospitalizations in adults with acute respiratory illness (ARI) is limited., Methods: We compared the population-based incidence, seasonality, and clinical characteristics of these 2 viral infections among adults aged ≥20 years with ARI hospitalizations in Auckland, New Zealand, during 2012-2015 through the Southern Hemisphere Influenza Vaccine Effectiveness Research and Surveillance (SHIVERS) project., Results: Of the 14 139 ARI hospitalizations, 276 of 6484 (4.3%) tested positive for HMPV and 1342 of 7027 (19.1%) tested positive for influenza. Crude rates of 9.8 (95% confidence interval [CI], 8.7-11.0) HMPV-associated and 47.6 (95% CI, 45.1-50.1) influenza-associated ARI hospitalizations were estimated for every 100 000 adult residents annually. The highest rates for both viruses were in those aged ≥80 years, of Māori or Pacific ethnicity, or living in low socioeconomic status (SES) areas. HMPV infections were more common than influenza in those with chronic medical conditions., Conclusions: Although HMPV infections accounted for fewer hospitalizations than influenza in adults aged ≥20 years, HMPV-associated ARI hospitalization rates were higher than influenza in older adults, Māori and Pacific people, and those of low SES. This highlights a need for vaccine/antiviral development., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Outbreaks cause significant morbidity and mortality in healthcare settings. Current testing methods can identify specific viral respiratory pathogens, yet the approach to outbreak management remains general. Objectives: Our aim was to examine pathogen-specific trends in respiratory outbreaks, including how attack rates, case fatality rates and outbreak duration differ by pathogen between hospitals and long-term care (LTC) and retirement homes (RH) in Ontario. Methods: Confirmed respiratory outbreaks in Ontario hospitals and LTC/RH reported between September 1, 2007, and August 31, 2017, were extracted from the integrated Public Health Information System (iPHIS). Median attack rates and outbreak duration and overall case fatality rates of pathogen-specific outbreaks were compared in both settings. Results: Over the 10-year surveillance period, 9,870 confirmed respiratory outbreaks were reported in Ontario hospitals and LTC/RH. Influenza was responsible for most outbreaks (32% in LTC/RH, 51% in hospitals), but these outbreaks were shorter and had lower attack rates than most non-influenza outbreaks in either setting. Human metapneumovirus, while uncommon (

Contexte : Les éclosions provoquent une morbidité et une mortalité importantes dans les établissements de soins de santé. Les méthodes de dépistage actuelles permettent de cerner des agents pathogènes respiratoires viraux spécifiques, mais l’approche de la gestion des éclosions reste générale. Objectifs : Notre objectif était d’examiner les tendances spécifiques aux agents pathogènes dans les éclosions respiratoires, y compris la façon dont le taux d’attaque, le taux de létalité et la durée de l’éclosion diffèrent par agent pathogène entre les hôpitaux, et les établissements de soins de longue durée et les maisons de retraite en Ontario. Méthodes : Les éclosions d’infections respiratoires confirmées dans les hôpitaux et les établissements de soins de longue durée ou les maisons de retraite de l’Ontario signalées entre le 1er septembre 2007 et le 31 août 2017 ont été extraites du Système intégré d’information sur la santé publique (SIISP). Les taux d’attaque médians, la durée des éclosions et les taux généraux de létalité des éclosions spécifiques à un pathogène ont été comparés dans les deux types d’établissements. Résultats : Au cours de la période de surveillance de 10 ans, 9 870 éclosions respiratoires confirmées ont été signalées dans les hôpitaux et les établissements de soins de longue durée ou les maisons de retraite de l’Ontario. La grippe était à l’origine de la plupart des éclosions (32 % dans les établissements de soins de longue durée et les maisons de retraite, 51 % dans les hôpitaux), mais ces éclosions étaient plus courtes et présentaient des taux d’attaque inférieurs à ceux de la plupart des éclosions non grippales dans les deux types d’établissements. Le métapneumovirus humain, bien que peu fréquent (moins de 4 % des éclosions), présentait des taux de létalité élevés dans les deux types d’établissements. Conclusion : Les taux d’attaque et les taux de létalité variaient selon l’agent pathogène, tout comme la durée de l’éclosion. L’élaboration de conseils propres à la gestion des éclosions, qui tiennent compte de l’agent pathogène et de l’établissement de soins de santé, pourrait être utile pour limiter la charge des éclosions respiratoires.

Abstract Background Human metapneumovirus (HMPV) is an important cause of acute respiratory illness in young children. Whole genome sequencing enables better identification of transmission events and outbreaks, which is not always possible with sub-genomic sequences. Results We report a 2-reaction amplicon-based next generation sequencing method to determine the complete genome sequences of five HMPV strains, representing three subgroups (A2, B1 and B2), directly from clinical samples. In addition to reporting five novel HMPV genomes from Africa we examined genetic diversity and sequence patterns of publicly available HMPV genomes. We found that the overall nucleotide sequence identity was 71.3 and 80% for HMPV group A and B, respectively, the diversity between HMPV groups was greater at amino acid level for SH and G surface protein genes, and multiple subgroups co-circulated in various countries. Comparison of sequences between HMPV groups revealed variability in G protein length (219 to 241 amino acids) due to changes in the stop codon position. Genome-wide phylogenetic analysis showed congruence with the individual gene sequence sets except for F and M2 genes. Conclusion This is the first genomic characterization of HMPV genomes from African patients.

Background: Human Metapneumovirus (HMPV) belongs to the Pneumoviridae family and is responsible for respiratory infections. Mild infections are well-recognized in children, while its precise impact in various categories of immunocompromised adults has not been well addressed., Research Question: We retrospectively studied HMPV infections in immunocompromised adults followed in two large French university medical centers., Study Design and Methods: We identified immunocompromised adults with positive HMPV Polymerase Chain Reaction (PCR) for 36 months and reviewed their medical charts. For lung transplant recipients (LTR), FEV1 was collected at baseline, during and after infection. Imaging was centralized and chest involvement was categorized by dominant CT patterns. We compared severe patients (requiring oxygen or ventilation) and non hypoxemic patients., Results: Seventy-two patients were included, 27 were LTR, 25 had a hematological malignancy or were hematopoietic stem cell recipients, 20 had another immunocompromised status. Twenty patients (28%) presented a hypoxemic infection, requiring hospitalization and intensive care units transfers in 50/72 (69.4%) and 9/72 (12.5%) respectively, with only one death. Hypoxemia was less pronounced in LTRs (p = 0.014). Finally, age and dyspnea remained independent factors associated with hypoxemia (p < 0.005). The most frequent radiological patterns were bronchopneumonia (34.2%) and bronchiolitis (39.5% and 64.3% in the overall population and in LTRs respectively, p = 0.045). FEV1 improved in LTRs at one month and 85% had recovered their baseline FEV1 within 6 months., Interpretations: In immunocompromised adults, HMPV infections required frequent hospitalizations and ICU transfers, while mortality is low. In LTRs, bronchiolitis pattern was predominant with short and long-term favorable outcome., Competing Interests: Declaration of competing interest V.A.-F. has received grants (to her institution) from the ANRS, ViiV Healthcare and the MSD AVENIR foundation and honoraria and travel grants from ViiV Healthcare and Gilead Sciences, for participation in educational programs and conferences; Others authors do not have conflict of interest related to the present article., (Copyright © 2024. Published by Elsevier Ltd.)

A 67-year-old man presented with a week of flu-like symptoms, hypoxia, and fever. Respiratory viral panel was positive for human metapneumovirus. Initial chest imaging showed left lower lobe opacification, suggesting a bacterial superimposed on viral pneumonia. Despite antibiotics, the patient became tachycardic and increasingly hypoxic, requiring 40 L high-flow nasal cannula. Repeat imaging demonstrated worsening of a left lower lobe process. Elective bronchoscopy with bronchoalveolar lavage revealed hemorrhage. Subsequent autoimmune, bacterial, and fungal workup was negative. The patient was diagnosed with diffuse alveolar hemorrhage (DAH) secondary to human metapneumovirus pneumonia. DAH is defined as bleeding into the alveolar spaces of the lungs, a process which carries high rates of morbidity and mortality.1 While dramatic in name and often associated with hemoptysis, DAH may only present with clinically subtle and nonspecific features with a variety of alternative etiologies to consider. We present this case of DAH secondary to human metapneumovirus (hMPV) to promote discussion of etiologies of DAH aside from systemic vasculitis. [ABSTRACT FROM AUTHOR]

Viruses cause a wide spectrum of clinical disease, the majority being acute respiratory infections (ARI). In most cases, ARI symptoms are similar for different viruses although severity can be variable. The objective of this study was to understand the shared and unique elements of the host transcriptional response to different viral pathogens. We identified 162 subjects in the US and Sri Lanka with infections due to influenza, enterovirus/rhinovirus, human metapneumovirus, dengue virus, cytomegalovirus, Epstein Barr Virus, or adenovirus. Our dataset allowed us to identify common pathways at the molecular level as well as virus-specific differences in the host immune response. Conserved elements of the host response to these viral infections highlighted the importance of interferon pathway activation. However, the magnitude of the responses varied between pathogens. We also identified virus-specific responses to influenza, enterovirus/rhinovirus, and dengue infections. Influenza-specific differentially expressed genes (DEG) revealed up-regulation of pathways related to viral defense and down-regulation of pathways related to T cell and neutrophil responses. Functional analysis of entero/rhinovirus-specific DEGs revealed up-regulation of pathways for neutrophil activation, negative regulation of immune response, and p38MAPK cascade and down-regulation of virus defenses and complement activation. Functional analysis of dengue-specific up-regulated DEGs showed enrichment of pathways for DNA replication and cell division whereas down-regulated DEGs were mainly associated with erythrocyte and myeloid cell homeostasis, reactive oxygen and peroxide metabolic processes. In conclusion, our study will contribute to a better understanding of molecular mechanisms to viral infections in humans and the identification of biomarkers to distinguish different types of viral infections. [ABSTRACT FROM AUTHOR]

We detected human metapneumovirus (HMPV) in 72 (7.1%) of 1,021 patients hospitalized with severe acute respiratory infection in Luohe, China, during 2017–2019. We detected HMPV most frequently in young children and less often in adults. HMPV genotype A2c variants 111 nt and 180 nt duplications predominated, demonstrating their continuing geographic spread.