Human parainfluenza virus

Human parainfluenza virus: One in a group of four RNA viruses that rank second only to respiratory syncytial virus (RSV) as a common cause of lower respiratory tract disease in young children. Like RSV, human parainfluenza viruses (HPIVs) can cause repeated infections throughout life. These infections are usually manifested by an upper respiratory tract illness (such as a cold or sore throat). HPIVs can also cause serious lower respiratory tract disease with repeat infection (including pneumonia, bronchitis, and bronchiolitis), especially among the elderly, and among patients with compromised immune systems.

There are four serotypes types of HPIV (1 through 4). Each of the four HPIVs has different clinical and epidemiologic features. The most distinctive clinical feature of HPIV-1 and HPIV-2 is croup (laryngotracheobronchitis); HPIV-1 is the leading cause of croup in children, whereas HPIV-2 is less frequently detected. Both HPIV-1 and HPIV-2 can cause other upper and lower respiratory tract illnesses. HPIV-3 is more often associated with bronchiolitis and pneumonia. HPIV-4 is infrequently detected, possibly because it is less likely to cause severe disease.

The incubation period for HPIVs is generally from 1 to 7 days. HPIVs are spread from respiratory secretions through close contact with infected persons or contact with contaminated surfaces or objects. Infection can occur when infectious material contacts mucous membranes of the eyes, mouth, or nose, and possibly through the inhalation of droplets generated by a sneeze or cough. HPIVs can remain infectious in aerosols for over an hour.

HPIVs are ubiquitous and infect most people during childhood. The highest rates of serious HPIV illnesses occur among young children. Serologic surveys have shown that 90% to 100% of children aged 5 years and older have antibodies to HPIV-3, and about 75% have antibodies to HPIV-1 and HPIV-2. The different HPIV serotypes differ in their clinical features and seasonality. HPIV-1 causes biennial outbreaks of croup in the fall (presently in the United States during odd numbered years). HPIV-2 causes annual or biennial fall outbreaks. HPIV-3 peak activity occurs during the spring and early summer months each year, but the virus can be isolated throughout the year.

The diagnosis of HPIV can be confirmed in two ways: (1) by isolation and identification of the virus in cell culture or direct detection of the virus in respiratory secretions using immunofluorescence, enzyme immunoassay, or polymerase chain reaction (PCR) assay, and (2) by demonstration of a significant rise in specific IgG antibodies between appropriately collected paired serum specimens or specific IgM antibodies in a single serum specimen.

No vaccine is currently available to protect against infection caused by any of the HPIVs; however, researchers are developing vaccines against HPIV-1 and HPIV-3 infections. Passively acquired maternal antibodies may play a role in protection from HPIV types 1 and 2 in the first few months of life, highlighting the importance of breast-feeding.

Strict attention to infection-control practices should decrease or prevent spread of infection. Frequent handwashing and not sharing items such as cups, glasses, and utensils with an infected person should decrease the spread of virus to others. Excluding children with colds or other respiratory illnesses (without fever) who are well enough to attend child care or school settings will probably not decrease the spread of HPIVs, because the viruses are often spread in the early stages of illness. In a hospital setting, spread of HPIVs can and should be prevented by strict attention to contact precautions, such as handwashing and wearing of protective gowns and gloves.

The HPIVs are negative-sense, single-stranded RNA viruses that possess fusion and hemagglutinin-neuraminidase glycoprotein "spikes" on their surface. The virion varies in size (average diameter between 150 and 300 nm) and shape, is unstable in the environment (surviving a few hours on environmental surfaces), and is readily inactivated with soap and water. Hence, the value of handwashing in combating spread of HPIVs.

Also see: Parainfluenza.