Respiratory Diseases Roundup

Human Metapneumovirus Concerns, COVID-19 Impact on Kidney Health, Long COVID in Younger Adults, and More

Miranda Manier, BA

Human Metapneumovirus (HMPV) Cases Rising Amid Respiratory Illnesses in China1

Reports of respiratory illnesses in China have sparked concern, with human metapneumovirus (HMPV) emerging as a notable contributor alongside influenza. Official data from the Chinese CDC identifies influenza as the primary driver of these illnesses, with 30.2% of tests returning positive. However, HMPV accounts for 6.2% of respiratory illness cases and 5.4% of hospitalizations, surpassing rates linked to other respiratory viruses such as COVID-19 and rhinovirus. While some media outlets have speculated about a potential HMPV outbreak, experts note the virus has circulated for decades.

Discovered in 2001 and related to respiratory syncytial virus (RSV), HMPV spreads through respiratory droplets, close contact, and contaminated surfaces. It causes symptoms such as fever, cough, and congestion, with severe cases progressing to bronchitis or pneumonia, especially in children, older adults, and immunocompromised individuals.

Experts stress the importance of hygiene practices to curb transmission. Although HMPV is not expected to cause a pandemic due to widespread immunity, its recognition as a significant respiratory pathogen underscores the need for ongoing monitoring.

COVID-19 Linked to Accelerated Kidney Function Decline2

New research highlights the long-term impact of COVID-19 on kidney health, revealing an accelerated decline in kidney function compared with other respiratory infections such as pneumonia. In a cohort of over 134,000 individuals, the annual decline in kidney function, measured by estimated glomerular filtration rate (eGFR), was 3.4% following COVID-19, compared with 2.3% after pneumonia. The decline was even steeper—5.4% annually—among hospitalized patients with COVID-19, emphasizing the virus’s potential to exacerbate chronic kidney disease (CKD).

This decline raises significant concerns for patients recovering from severe COVID-19, as they may be at heightened risk of developing long-term kidney complications. While both COVID-19 and pneumonia were associated with faster eGFR decline, the magnitude was greater for COVID-19 survivors, especially those who experienced acute kidney injury during hospitalization. The study underscores the need for close post-infection monitoring of kidney function to ensure early intervention and management of CKD, which can help mitigate complications and improve patient outcomes.

Nirmatrelvir-Ritonavir Reduces Hospitalization and Mortality in CKD Patients with COVID-193

A cohort study has demonstrated the efficacy of nirmatrelvir-ritonavir in reducing severe outcomes in patients with COVID-19 and chronic kidney disease (CKD). Among 1095 patients treated with the protease inhibitor, the 30-day risk of hospitalization decreased by 56%, and the 1-year risk of major adverse cardiovascular events (MACE) fell by 51%. Additionally, the risk of death within one year dropped by 63% compared to a matched cohort of patients diagnosed with COVID-19 before nirmatrelvir-ritonavir was available.

However, the treatment did not slow CKD progression or improve eGFR decline over the year following infection, indicating the need for additional therapeutic strategies to address long-term kidney damage in this population. Despite this limitation, the findings suggest that nirmatrelvir-ritonavir offers substantial protection against acute and long-term complications of COVID-19 in high-risk patients with CKD, emphasizing its role as a critical intervention in this vulnerable group.

Adults Aged 18 to 64 Face Greater Burden of Neuro-PASC Symptoms4

Long COVID’s neurological effects appear to disproportionately impact adults aged 18 to 64, according to a study of patients with neurologic post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC). While adults aged 65 and older more frequently present with abnormal neurologic exam findings and pre-existing comorbidities, those aged 18 to 64 report greater burdens of fatigue, sleep disturbances, and cognitive dysfunction. These symptoms significantly impair quality of life, particularly among non-hospitalized patients with long COVID.

Objective cognitive testing revealed that individuals aged 18 to 44 demonstrated the worst executive function and working memory scores, followed by those aged 45 to 64, compared with those aged 65 and older. Interestingly, despite higher rates of comorbidities in the older population, they reported fewer neurologic symptoms overall. This suggests that the burden of Neuro-PASC extends beyond traditional risk factors like age or underlying health conditions.

References

  1. Willmoth H. HMPV: China's new virus outbreak explained. Newsweek. January 3, 2025. Updated January 6, 2025. Accessed January 16, 2025. https://www.newsweek.com/human-metapneumovirus-hmpv-china-outbreak-explainer-2009126
  2. Mahalingasivam V, Faucon AL, Sjölander A, et al. Kidney function decline after COVID-19 infection. JAMA Netw Open. 2024;7(12):e2450014. doi:10.1001/jamanetworkopen.2024.50014
  3. Ian A Strohbehn, Tianqi Ouyang, Meghan D Lee, Sophia Zhao, Destiny Harden, Sherley M Mejia, Andrew Cao, Roby P Bhattacharyya, Meghan E Sise, The effect of nirmatrelvir-ritonavir on short- and long-term adverse outcomes from COVID-19 among patients with kidney disease: A propensity-score matched study. Open Forum Infectious Diseases, 2024; ofae756. https://doi.org/10.1093/ofid/ofae756
  4. Choudhury NA, Mukherjee S, Singer T, et al. Neurologic manifestations of long COVID disproportionately affect young and middle-age adults. Ann Neurol. Published online November 22, 2024. doi: 10.1002/ana.27128