key: cord-0002900-l7eq3oeb authors: Midgley, Claire M.; Baber, Jill K.; Biggs, Holly M.; Singh, Twila; Feist, Michelle; Miller, Tracy K.; Kruger, Kirby; Gerber, Susan I.; Watson, John T.; Howell, Molly A. title: Notes from the Field: Severe Human Metapneumovirus Infections — North Dakota, 2016 date: 2017-05-12 journal: MMWR Morb Mortal Wkly Rep DOI: 10.15585/mmwr.mm6618a7 sha: c8978a8074a9df4bf07e49393821886d0b80979f doc_id: 2900 cord_uid: l7eq3oeb nan Indian Health Service personnel did not describe a notable increase in respiratory illness during the investigation period, although testing for HMPV was not routinely done. Case finding was expanded to five additional large hospitals throughout North Dakota. A case was defined as a positive HMPV test in any pediatric or adult inpatient since June 1, 2015. In addition to the six cases initially reported, 11 pediatric cases from three hospitals and 27 adult patients from four hospitals were identified (Table) . Medical chart abstractions were performed. Among the 11 additional pediatric patients (median age = 10 months), none were American Indian. Nine had underlying medical conditions, including chronic lung disease (seven) and premature birth (four). One patient required mechanical ventilation; none died. Among the 27 adult patients (median age = 69 years), all were white, and all had underlying medical conditions, particularly chronic lung disease (19) or chronic heart disease (16). This finding is consistent with previous descriptions of HMPV infection in hospitalized adults, in which elderly patients and those with underlying medical conditions had a more complicated clinical course (4). Twenty-two patients were current or previous smokers. Ten patients required either mechanical ventilation (two) or noninvasive ventilation (eight); among these 10 patients, nine reported chronic lung disease. Three adult patients died. Although 10 patients resided in long-term care facilities before hospital admission, no HMPV clusters were identified. HMPV can cause severe respiratory illness in children and adults. Increased HMPV diagnostic testing could facilitate enhanced understanding of the clinical spectrum of illness, virus circulation, and populations at increased risk. Four of the six children in the hospital A cluster were American Indian. Although American Indian children are at increased risk for hospitalization with respiratory syncytial virus (5), whether HMPV disproportionately affects this population is unknown. Further study is needed to understand the epidemiology of HMPV in the American Indian population. * Some patients had multiple underlying conditions. † Chronic lung disease included asthma, reactive airway disease, bronchopulmonary dysplasia, chronic obstructive pulmonary disease, or emphysema, or the requirement for home oxygen combined with other lung conditions such as chronic respiratory failure or pulmonary hypertension. § Chronic heart disease included congestive heart failure, diastolic heart failure, coronary artery disease, aortic stenosis, and arrhythmias. Reports of isolated hypertension were not included. ¶ Immunocompromised patients included those with an immune deficiency, such as hypogammaglobulinemia, or those taking immunosuppressive medications. ** Includes continuous positive airway pressure or bilevel positive airway pressure. Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children Human metapneumovirus infection in adults with community-acquired pneumonia and exacerbation of chronic obstructive pulmonary disease Human metapneumovirus circulation in the United States Human metapneumovirus in adults Respiratory syncytial virus hospitalizations among American Indian and Alaska Native infants and the general United States infant population