Guidance

Human parainfluenza viruses: clinical and public health management

Information on the diagnosis, prevention and treatment of human parainfluenza viruses (HPIVs).

• From: Public Health England
• Published: 27 August 2008

Viruses

Human parainfluenza viruses (HPIVs) are a group of spherical, enveloped, negative-sense, single-stranded RNA viruses in the paramyxovirus family. There are 4 types of HPIV (Types 1 to 4) and 2 subtypes (4A and 4B). A fifth putative HPIV, PIV5, (formerly known as SV5) is commonly categorised as an ‘unknown haemabsorbing agent’ when clinical respiratory samples are propagated in laboratory cell culture. These viruses are unstable in the environment and are readily inactivated with soap and water.

Clinical features

HPIV1-4 infection is one of the common causes of upper and lower respiratory tract disease, especially in young children. Similar to respiratory syncytial virus (RSV), HPIVs 1 to 4 can cause repeated infections throughout life, and HPIV types 1 to 4 can cause a full spectrum of respiratory illness, including the common cold, croup, and severe lower respiratory tract illness, such as bronchitis, bronchiolitis and pneumonia.

Disease association with HPIV5 is not well established, although it has been implicated in a range of chronic diseases outside the respiratory tract among adults, most HPIV 1-4 infections cause mild disease showing as upper respiratory tract symptoms. However, HPIV infections may also cause more severe diseases especially among the elderly and among patients who are immunocompromised. HPIV infections are important causes of mortality among immunocompromised patients (1, 2, 3). The incubation period is from 1 to 7 days.

Epidemiological Features

HPIVs are spread from respiratory secretions through close contact with infected persons or contact with contaminated surfaces or objects. Health Protection Agency’s (now Public Health England) analysis of HPIV infections in England and Wales found that HPIV-3 was the major HPIV virus type causing most infections and outbreaks, followed by HPIV-1, HPIV-2 and HPIV-4 (4).

HPIV-3 infections had an annual epidemic cycle with a peak in late spring or summer, whereas peaks of HPIV-1 and HPIV-2 occurred at 1 or 2 year intervals in the late autumn or early winter. HPIV-4 has been detected in low levels and mainly appeared in the late autumn or early winter. Children under one year of age were the most commonly affected group, followed by those aged from 1 to 4 years . Other age groups were less affected. Males were slightly more affected than females.

Treatment and prevention

No specific antiviral is presently licensed for treatment of HPIV. There are currently no licensed vaccines available to protect against infection caused by any of the HPIVs (5,6,7). However, research is still on-going to try to develop vaccines against HPIV-1, HPIV-2 and HPIV-3 infections in laboratory and animal studies (6,8,9,10). A phase 2 study for the HPIV-3 vaccine found it safe and immunogenic in children 6 to 18 months old (10).

In outbreak and cluster settings, to prevent onward transmission, strict attention to infection control measures such as hand washing and wearing protective equipments should decrease or prevent spread of infection.

Surveillance

Public Health England (PHE) monitors HPIV activity in the UK. Laboratory surveillance data (by specimen week) for England and Wales, between 1 January 1975 and 26 August 2008 are shown on the ‘Epidemiological information: human parainfluenza viruses’ page of our archive website. Regular reports are published in the PHE’s weekly bulletin - the Health Protection Report (HPR) every 4 weeks throughout the year.

Reference

1. Zambon M, Bull T, Sadler CJ, Goldman JM, Ward KN. Molecular epidemiology of two consecutive outbreaks of parainfluenza 3 in a bone marrow transplant unit. J Clin Microbiol 1998 Aug;36(8):2289-93.
2. Couch RB, Englund JA, Whimbey E. Respiratory viral infections in immunocompetent and immunocompromised persons. Am J Med. 1997 Mar 17;102(3A):2-9; discussion 25-6. Review.
3. Englund JA. Diagnosis and epidemiology of community-acquired respiratory virus infections in the immunocompromised host.Biol Blood Marrow Transplant. 2001;7 Suppl:2S-4S. Review.
4. Laurichesse H, Dedman D, Watson JM, Zambon MC. Epidemiological features of parainfluenza virus infections: laboratory surveillance in England and Wales, 1975-1997. Eur J Epidemiol 1999;15(5):475-84.
5. Durbin AP and Karron RA. Progress in the development of respiratory syncytial virus and parainfluenza virus vaccines. Clin Infect Dis 2003;37(12):1668-77.
6. Bartlett EJ, Castaño A, Surman SR, Collins PL, Skiadopoulos MH, Murphy BR. Attenuation and efficacy of human parainfluenza virus type 1 (HPIV1) vaccine candidates containing stabilized mutations in the P/C and L genes. Virol J. 2007;4:67.
7. Hall CB. Respiratory syncytial virus and parainfluenza virus. N Engl J Med 2001;344(25):1917-28.
8. Nolan SM, Skiadopoulos MH, Bradley K, Kim OS, Bier S, Amaro-Carambot E, et al. Recombinant human parainfluenza virus type 2 vaccine candidates containing a 3’ genomic promoter mutation and L polymerase mutations are attenuated and protective in non-human primates. Vaccine. 2007;25(34):6409-22.
9. Zhan X, Slobod KS, Krishnamurthy S, Luque LE, Takimoto T, Jones B, et al. Sendai virus recombinant vaccine expressing hPIV-3 HN or F elicits protective immunity and combines with a second recombinant to prevent hPIV-1, hPIV-3 and RSV infections. Vaccine 2008;26(27-28):3480-8.
10. Belshe RB, Newman FK, Tsai TF, Karron RA, Reisinger K, Roberton D, et al. Phase 2 evaluation of parainfluenza type 3 cold passage mutant 45 live attenuated vaccine in healthy children 6-18 months old. J Infect Dis 2004;189(3):462-70.

Published 27 August 2008