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Parainfluenza viruses in children

Flor M Munoz, MD, MSc
Section Editors
Morven S Edwards, MD
George B Mallory, MD
Deputy Editor
Mary M Torchia, MD


Human parainfluenza viruses are important respiratory pathogens in children and adults. In infants and young children, parainfluenza viruses are the most common cause of lower respiratory tract infections after respiratory syncytial virus (RSV) [1-4]. Lower respiratory infections (eg, bronchiolitis, interstitial pneumonitis, pneumonia) are a leading cause of morbidity and mortality in infants during the first year of life in the United States and in children younger than the age of six years in developing countries [1]. In adults, parainfluenza viruses generally cause mild upper respiratory infections (URIs) but can induce more severe disease in the elderly [5]. Immunocompromised patients, particularly lung and hematopoietic cell transplant recipients can experience life-threatening lower respiratory tract infections with parainfluenza virus [6-8].

The virology, clinical manifestations, diagnosis, and treatment of parainfluenza viruses in children will be reviewed here. Infection with parainfluenza viruses in adults is discussed separately. (See "Parainfluenza viruses in adults".)


Virus — Parainfluenza viruses (PIV) are single-stranded, enveloped RNA viruses belonging to the genus paramyxovirus in the Paramyxoviridae family [9]. This family also includes human mumps, measles, and respiratory syncytial viruses and metapneumoviruses, as well as avian, bovine, and murine strains of these viruses.

The virions are pleomorphic and range in diameter from 150 to 200 nm. The single strand of negative-sense RNA is 15,462 nucleotides in length and encodes six common viral proteins: the nucleocapsid protein (NP), the phosphoprotein (P), the matrix protein (M), the fusion glycoprotein (F), the hemagglutinin-neuraminidase glycoprotein (HN), and the RNA polymerase (L) [10].

The HN and F proteins project through the lipid envelope and form the major antigenic targets for neutralizing antibody [11]. Their hydrophobic tails project into the virion, where they interact with the M protein to aid in virus assembly [12].

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Literature review current through: Nov 2017. | This topic last updated: Jul 06, 2016.
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  1. Denny FW Jr. The clinical impact of human respiratory virus infections. Am J Respir Crit Care Med 1995; 152:S4.
  2. Griffin MR, Walker FJ, Iwane MK, et al. Epidemiology of respiratory infections in young children: insights from the new vaccine surveillance network. Pediatr Infect Dis J 2004; 23:S188.
  3. Weinberg GA, Hall CB, Iwane MK, et al. Parainfluenza virus infection of young children: estimates of the population-based burden of hospitalization. J Pediatr 2009; 154:694.
  4. Shi T, McLean K, Campbell H, Nair H. Aetiological role of common respiratory viruses in acute lower respiratory infections in children under five years: A systematic review and meta-analysis. J Glob Health 2015; 5:010408.
  5. van Asten L, van den Wijngaard C, van Pelt W, et al. Mortality attributable to 9 common infections: significant effect of influenza A, respiratory syncytial virus, influenza B, norovirus, and parainfluenza in elderly persons. J Infect Dis 2012; 206:628.
  6. Kumar D, Husain S, Chen MH, et al. A prospective molecular surveillance study evaluating the clinical impact of community-acquired respiratory viruses in lung transplant recipients. Transplantation 2010; 89:1028.
  7. Maeng SH, Yoo HS, Choi SH, et al. Impact of parainfluenza virus infection in pediatric cancer patients. Pediatr Blood Cancer 2012; 59:708.
  8. Srinivasan A, Wang C, Yang J, et al. Symptomatic parainfluenza virus infections in children undergoing hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2011; 17:1520.
  9. Karron RA, Colling PL. Parainfluenza viruses. In: Fields Virology, Knipe DM, Howley PM (Eds), Lippincott Williams & Wilkins, Philadelphia 2007. p.1497.
  10. Murphy BR, Hall SL, Kulkarni AB, et al. An update on approaches to the development of respiratory syncytial virus (RSV) and parainfluenza virus type 3 (PIV3) vaccines. Virus Res 1994; 32:13.
  11. Tao T, Durbin AP, Whitehead SS, et al. Recovery of a fully viable chimeric human parainfluenza virus (PIV) type 3 in which the hemagglutinin-neuraminidase and fusion glycoproteins have been replaced by those of PIV type 1. J Virol 1998; 72:2955.
  12. Patterson S, Gross J, Oxford JS. The intracellular distribution of influenza virus matrix protein and nucleoprotein in infected cells and their relationship to haemagglutinin in the plasma membrane. J Gen Virol 1988; 69 ( Pt 8):1859.
  13. Hamaguchi M, Yoshida T, Nishikawa K, et al. Transcriptive complex of Newcastle disease virus. I. Both L and P proteins are required to constitute an active complex. Virology 1983; 128:105.
  14. Moscona A. Interaction of human parainfluenza virus type 3 with the host cell surface. Pediatr Infect Dis J 1997; 16:917.
  15. Huberman K, Peluso RW, Moscona A. Hemagglutinin-neuraminidase of human parainfluenza 3: role of the neuraminidase in the viral life cycle. Virology 1995; 214:294.
  16. Bartlett EJ, Cruz AM, Boonyaratanakornkit J, et al. A novel human parainfluenza virus type 1 (HPIV1) with separated P and C genes is useful for generating C gene mutants for evaluation as live-attenuated virus vaccine candidates. Vaccine 2010; 28:767.
  17. Boonyaratanakornkit J, Bartlett E, Schomacker H, et al. The C proteins of human parainfluenza virus type 1 limit double-stranded RNA accumulation that would otherwise trigger activation of MDA5 and protein kinase R. J Virol 2011; 85:1495.
  18. Wendt CH, Hertz MI. Respiratory syncytial virus and parainfluenza virus infections in the immunocompromised host. Semin Respir Infect 1995; 10:224.
  19. Zhang L, Collins PL, Lamb RA, Pickles RJ. Comparison of differing cytopathic effects in human airway epithelium of parainfluenza virus 5 (W3A), parainfluenza virus type 3, and respiratory syncytial virus. Virology 2011; 421:67.
  20. Walker TA, Khurana S, Tilden SJ. Viral respiratory infections. Pediatr Clin North Am 1994; 41:1365.
  21. Wright PF. Parainfluenza viruses. In: Principles and Practice of Infectious Diseases, 6th ed, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, New York 2005. p.1998.
  22. Rubin EE, Quennec P, McDonald JC. Infections due to parainfluenza virus type 4 in children. Clin Infect Dis 1993; 17:998.
  23. Slavin KA, Passaro DJ, Hacker JK, et al. Parainfluenza virus type 4: case report and review of the literature. Pediatr Infect Dis J 2000; 19:893.
  24. Lau SK, To WK, Tse PW, et al. Human parainfluenza virus 4 outbreak and the role of diagnostic tests. J Clin Microbiol 2005; 43:4515.
  25. Frost HM, Robinson CC, Dominguez SR. Epidemiology and clinical presentation of parainfluenza type 4 in children: a 3-year comparative study to parainfluenza types 1-3. J Infect Dis 2014; 209:695.
  26. Castleman WL, Brundage-Anguish LJ, Kreitzer L, Neuenschwander SB. Pathogenesis of bronchiolitis and pneumonia induced in neonatal and weanling rats by parainfluenza (Sendai) virus. Am J Pathol 1987; 129:277.
  27. Zhang L, Bukreyev A, Thompson CI, et al. Infection of ciliated cells by human parainfluenza virus type 3 in an in vitro model of human airway epithelium. J Virol 2005; 79:1113.
  28. Porter DD, Prince GA, Hemming VG, Porter HG. Pathogenesis of human parainfluenza virus 3 infection in two species of cotton rats: Sigmodon hispidus develops bronchiolitis, while Sigmodon fulviventer develops interstitial pneumonia. J Virol 1991; 65:103.
  29. Prince GA, Porter DD. Treatment of parainfluenza virus type 3 bronchiolitis and pneumonia in a cotton rat model using topical antibody and glucocorticosteroid. J Infect Dis 1996; 173:598.
  30. Welliver RC, Wong DT, Sun M, McCarthy N. Parainfluenza virus bronchiolitis. Epidemiology and pathogenesis. Am J Dis Child 1986; 140:34.
  31. Wilson J, Rowlands K, Rockett K, et al. Genetic variation at the IL10 gene locus is associated with severity of respiratory syncytial virus bronchiolitis. J Infect Dis 2005; 191:1705.
  32. Crowe JE Jr, Williams JV. Immunology of viral respiratory tract infection in infancy. Paediatr Respir Rev 2003; 4:112.
  33. Schaap-Nutt A, Scull MA, Schmidt AC, et al. Growth restriction of an experimental live attenuated human parainfluenza virus type 2 vaccine in human ciliated airway epithelium in vitro parallels attenuation in African green monkeys. Vaccine 2010; 28:2788.
  34. Schmidt AC, Schaap-Nutt A, Bartlett EJ, et al. Progress in the development of human parainfluenza virus vaccines. Expert Rev Respir Med 2011; 5:515.
  35. Welliver RC, Wong DT, Middleton E Jr, et al. Role of parainfluenza virus-specific IgE in pathogenesis of croup and wheezing subsequent to infection. J Pediatr 1982; 101:889.
  36. Einarsson O, Geba GP, Zhu Z, et al. Interleukin-11: stimulation in vivo and in vitro by respiratory viruses and induction of airways hyperresponsiveness. J Clin Invest 1996; 97:915.
  37. Jacoby DB, Xiao HQ, Lee NH, et al. Virus- and interferon-induced loss of inhibitory M2 muscarinic receptor function and gene expression in cultured airway parasympathetic neurons. J Clin Invest 1998; 102:242.
  38. Ottolini MG, Hemming VG, Piazza FM, et al. Topical immunoglobulin is an effective therapy for parainfluenza type 3 in a cotton rat model. J Infect Dis 1995; 172:243.
  39. Glezen WP, Frank AL, Taber LH, Kasel JA. Parainfluenza virus type 3: seasonality and risk of infection and reinfection in young children. J Infect Dis 1984; 150:851.
  40. Takamura S, Roberts AD, Jelley-Gibbs DM, et al. The route of priming influences the ability of respiratory virus-specific memory CD8+ T cells to be activated by residual antigen. J Exp Med 2010; 207:1153.
  41. American Academy of Pediatrics. Parainfluenza viral infections. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.586.
  42. Steffens A, Finelli L, Whitaker B, Fowlkes A. Population-based Surveillance for Medically Attended Human Parainfluenza Viruses From the Influenza Incidence Surveillance Project, 2010-2014. Pediatr Infect Dis J 2016; 35:717.
  43. PARROTT RH, VARGOSKO AJ, KIMHW, et al. Acute respiratory diseases of viral etiology. III. parainfluenza. Myxoviruses. Am J Public Health Nations Health 1962; 52:907.
  44. Reed G, Jewett PH, Thompson J, et al. Epidemiology and clinical impact of parainfluenza virus infections in otherwise healthy infants and young children < 5 years old. J Infect Dis 1997; 175:807.
  45. Hemming VG. Viral respiratory diseases in children: classification, etiology, epidemiology, and risk factors. J Pediatr 1994; 124:S13.
  46. Counihan ME, Shay DK, Holman RC, et al. Human parainfluenza virus-associated hospitalizations among children less than five years of age in the United States. Pediatr Infect Dis J 2001; 20:646.
  47. Abedi GR, Prill MM, Langley GE, et al. Estimates of Parainfluenza Virus-Associated Hospitalizations and Cost Among Children Aged Less Than 5 Years in the United States, 1998-2010. J Pediatric Infect Dis Soc 2016; 5:7.
  48. Fry AM, Curns AT, Harbour K, et al. Seasonal trends of human parainfluenza viral infections: United States, 1990-2004. Clin Infect Dis 2006; 43:1016.
  49. Marx A, Török TJ, Holman RC, et al. Pediatric hospitalizations for croup (laryngotracheobronchitis): biennial increases associated with human parainfluenza virus 1 epidemics. J Infect Dis 1997; 176:1423.
  50. Chew FT, Doraisingham S, Ling AE, et al. Seasonal trends of viral respiratory tract infections in the tropics. Epidemiol Infect 1998; 121:121.
  51. Ansari SA, Springthorpe VS, Sattar SA, et al. Potential role of hands in the spread of respiratory viral infections: studies with human parainfluenza virus 3 and rhinovirus 14. J Clin Microbiol 1991; 29:2115.
  52. Madhi SA, Klugman KP, Vaccine Trialist Group. A role for Streptococcus pneumoniae in virus-associated pneumonia. Nat Med 2004; 10:811.
  53. Vesa S, Kleemola M, Blomqvist S, et al. Epidemiology of documented viral respiratory infections and acute otitis media in a cohort of children followed from two to twenty-four months of age. Pediatr Infect Dis J 2001; 20:574.
  54. Arisoy ES, Demmler GJ, Thakar S, Doerr C. Meningitis due to parainfluenza virus type 3: report of two cases and review. Clin Infect Dis 1993; 17:995.
  55. Wilks D, Burns SM. Myopericarditis associated with parainfluenza virus type 3 infection. Eur J Clin Microbiol Infect Dis 1998; 17:363.
  56. Román G, Phillips CA, Poser CM. Parainfluenza virus type 3: isolation from CSF of a patient with Guillain-Barré syndrome. JAMA 1978; 240:1613.
  57. Olivares F, Salinas M, Soto A, et al. [Severe acute disseminated encephalomyelitis associated with parainfluenza 3 infection: Case report]. Rev Chilena Infectol 2015; 32:476.
  58. Shah DP, Shah PK, Azzi JM, Chemaly RF. Parainfluenza virus infections in hematopoietic cell transplant recipients and hematologic malignancy patients: A systematic review. Cancer Lett 2016; 370:358.
  59. Lehners N, Tabatabai J, Prifert C, et al. Long-Term Shedding of Influenza Virus, Parainfluenza Virus, Respiratory Syncytial Virus and Nosocomial Epidemiology in Patients with Hematological Disorders. PLoS One 2016; 11:e0148258.
  60. Richardson L, Brite J, Del Castillo M, et al. Comparison of respiratory virus shedding by conventional and molecular testing methods in patients with haematological malignancy. Clin Microbiol Infect 2016; 22:380.e1.
  61. Cohen AL, Sahr PK, Treurnicht F, et al. Parainfluenza Virus Infection Among Human Immunodeficiency Virus (HIV)-Infected and HIV-Uninfected Children and Adults Hospitalized for Severe Acute Respiratory Illness in South Africa, 2009-2014. Open Forum Infect Dis 2015; 2:ofv139.
  62. Taylor CE, Osman HK, Turner AJ, et al. Parainfluenza virus and respiratory syncytial virus infection in infants undergoing bone marrow transplantation for severe combined immunodeficiency. Commun Dis Public Health 1998; 1:202.
  63. Srinivasan A, Wang C, Yang J, et al. Parainfluenza virus infections in children with hematologic malignancies. Pediatr Infect Dis J 2011; 30:855.
  64. Wendt CH, Weisdorf DJ, Jordan MC, et al. Parainfluenza virus respiratory infection after bone marrow transplantation. N Engl J Med 1992; 326:921.
  65. Zambon M, Bull T, Sadler CJ, et al. Molecular epidemiology of two consecutive outbreaks of parainfluenza 3 in a bone marrow transplant unit. J Clin Microbiol 1998; 36:2289.
  66. Elizaga J, Olavarria E, Apperley J, et al. Parainfluenza virus 3 infection after stem cell transplant: relevance to outcome of rapid diagnosis and ribavirin treatment. Clin Infect Dis 2001; 32:413.
  67. Piralla A, Percivalle E, Di Cesare-Merlone A, et al. Multicluster nosocomial outbreak of parainfluenza virus type 3 infection in a pediatric oncohematology unit: a phylogenetic study. Haematologica 2009; 94:833.
  68. Maziarz RT, Sridharan P, Slater S, et al. Control of an outbreak of human parainfluenza virus 3 in hematopoietic stem cell transplant recipients. Biol Blood Marrow Transplant 2010; 16:192.
  69. Nichols WG, Erdman DD, Han A, et al. Prolonged outbreak of human parainfluenza virus 3 infection in a stem cell transplant outpatient department: insights from molecular epidemiologic analysis. Biol Blood Marrow Transplant 2004; 10:58.
  70. Campbell AP, Chien JW, Kuypers J, et al. Respiratory virus pneumonia after hematopoietic cell transplantation (HCT): associations between viral load in bronchoalveolar lavage samples, viral RNA detection in serum samples, and clinical outcomes of HCT. J Infect Dis 2010; 201:1404.
  71. Vu DL, Bridevaux PO, Aubert JD, et al. Respiratory viruses in lung transplant recipients: a critical review and pooled analysis of clinical studies. Am J Transplant 2011; 11:1071.
  72. Osiowy C. Direct detection of respiratory syncytial virus, parainfluenza virus, and adenovirus in clinical respiratory specimens by a multiplex reverse transcription-PCR assay. J Clin Microbiol 1998; 36:3149.
  73. Fan J, Henrickson KJ, Savatski LL. Rapid simultaneous diagnosis of infections with respiratory syncytial viruses A and B, influenza viruses A and B, and human parainfluenza virus types 1, 2, and 3 by multiplex quantitative reverse transcription-polymerase chain reaction-enzyme hybridization assay (Hexaplex). Clin Infect Dis 1998; 26:1397.
  74. Puppe W, Weigl JA, Aron G, et al. Evaluation of a multiplex reverse transcriptase PCR ELISA for the detection of nine respiratory tract pathogens. J Clin Virol 2004; 30:165.
  75. Selvaraju SB, Selvarangan R. Evaluation of xTAG Respiratory Viral Panel FAST and xTAG Human Parainfluenza Virus Analyte-Specific Reagents for detection of human parainfluenza viruses in respiratory specimens. Diagn Microbiol Infect Dis 2012; 72:278.
  76. Kim C, Ahmed JA, Eidex RB, et al. Comparison of nasopharyngeal and oropharyngeal swabs for the diagnosis of eight respiratory viruses by real-time reverse transcription-PCR assays. PLoS One 2011; 6:e21610.
  77. Hammitt LL, Kazungu S, Welch S, et al. Added value of an oropharyngeal swab in detection of viruses in children hospitalized with lower respiratory tract infection. J Clin Microbiol 2011; 49:2318.
  78. Weinberg GA, Erdman DD, Edwards KM, et al. Superiority of reverse-transcription polymerase chain reaction to conventional viral culture in the diagnosis of acute respiratory tract infections in children. J Infect Dis 2004; 189:706.
  79. Frank AL, Couch RB, Griffis CA, Baxter BD. Comparison of different tissue cultures for isolation and quantitation of influenza and parainfluenza viruses. J Clin Microbiol 1979; 10:32.
  80. Ray CG, Minnich LL. Efficiency of immunofluorescence for rapid detection of common respiratory viruses. J Clin Microbiol 1987; 25:355.
  81. Terlizzi ME, Massimiliano B, Francesca S, et al. Quantitative RT real time PCR and indirect immunofluorescence for the detection of human parainfluenza virus 1, 2, 3. J Virol Methods 2009; 160:172.
  82. Ivaska L, Niemelä J, Heikkinen T, et al. Identification of respiratory viruses with a novel point-of-care multianalyte antigen detection test in children with acute respiratory tract infection. J Clin Virol 2013; 57:136.
  83. Sadeghi CD, Aebi C, Gorgievski-Hrisoho M, et al. Twelve years' detection of respiratory viruses by immunofluorescence in hospitalised children: impact of the introduction of a new respiratory picornavirus assay. BMC Infect Dis 2011; 11:41.
  84. Hayden FG. Advances in antivirals for non-influenza respiratory virus infections. Influenza Other Respir Viruses 2013; 7 Suppl 3:36.
  85. Moss RB, Hansen C, Sanders RL, et al. A phase II study of DAS181, a novel host directed antiviral for the treatment of influenza infection. J Infect Dis 2012; 206:1844.
  86. Chen YB, Driscoll JP, McAfee SL, et al. Treatment of parainfluenza 3 infection with DAS181 in a patient after allogeneic stem cell transplantation. Clin Infect Dis 2011; 53:e77.
  87. Guzmán-Suarez BB, Buckley MW, Gilmore ET, et al. Clinical potential of DAS181 for treatment of parainfluenza-3 infections in transplant recipients. Transpl Infect Dis 2012; 14:427.
  88. Chalkias S, Mackenzie MR, Gay C, et al. DAS181 treatment of hematopoietic stem cell transplant patients with parainfluenza virus lung disease requiring mechanical ventilation. Transpl Infect Dis 2014; 16:141.
  89. Drozd DR, Limaye AP, Moss RB, et al. DAS181 treatment of severe parainfluenza type 3 pneumonia in a lung transplant recipient. Transpl Infect Dis 2013; 15:E28.
  90. Waghmare A, Wagner T, Andrews R, et al. Successful Treatment of Parainfluenza Virus Respiratory Tract Infection With DAS181 in 4 Immunocompromised Children. J Pediatric Infect Dis Soc 2015; 4:114.
  91. Dhakal B, D'Souza A, Pasquini M, et al. DAS181 Treatment of Severe Parainfluenza Virus 3 Pneumonia in Allogeneic Hematopoietic Stem Cell Transplant Recipients Requiring Mechanical Ventilation. Case Rep Med 2016; 2016:8503275.
  92. Walker JL, Brady MF, DiSilvestro PA, et al. A Phase III Clinical Trial of Bevacizumab with IV versus IP Chemotherapy in Ovarian, Fallopian Tube, and Primary Peritoneal Carcinoma (GOG 252). Annual Meeting on Women's Cancer. 2016.
  93. ClinicalTrials.gov. DAS181 in patients with parainfluenza. http://clinicaltrials.gov/show/NCT01441024 (Accessed on January 16, 2014).
  94. Schmidt AC. Progress in respiratory virus vaccine development. Semin Respir Crit Care Med 2007; 28:243.
  95. Durbin AP, Wyatt LS, Siew J, et al. The immunogenicity and efficacy of intranasally or parenterally administered replication-deficient vaccinia-parainfluenza virus type 3 recombinants in rhesus monkeys. Vaccine 1998; 16:1324.
  96. Lee MS, Greenberg DP, Yeh SH, et al. Antibody responses to bovine parainfluenza virus type 3 (PIV3) vaccination and human PIV3 infection in young infants. J Infect Dis 2001; 184:909.
  97. Greenberg DP, Walker RE, Lee MS, et al. A bovine parainfluenza virus type 3 vaccine is safe and immunogenic in early infancy. J Infect Dis 2005; 191:1116.
  98. Slobod KS, Shenep JL, Luján-Zilbermann J, et al. Safety and immunogenicity of intranasal murine parainfluenza virus type 1 (Sendai virus) in healthy human adults. Vaccine 2004; 22:3182.
  99. Karron RA, Wright PF, Hall SL, et al. A live attenuated bovine parainfluenza virus type 3 vaccine is safe, infectious, immunogenic, and phenotypically stable in infants and children. J Infect Dis 1995; 171:1107.
  100. Karron RA, Makhene M, Gay K, et al. Evaluation of a live attenuated bovine parainfluenza type 3 vaccine in two- to six-month-old infants. Pediatr Infect Dis J 1996; 15:650.
  101. Karron RA, Belshe RB, Wright PF, et al. A live human parainfluenza type 3 virus vaccine is attenuated and immunogenic in young infants. Pediatr Infect Dis J 2003; 22:394.
  102. Belshe RB, Newman FK, Tsai TF, 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; 189:462.
  103. Belshe RB, Newman FK, Anderson EL, et al. Evaluation of combined live, attenuated respiratory syncytial virus and parainfluenza 3 virus vaccines in infants and young children. J Infect Dis 2004; 190:2096.
  104. Bernstein DI, Falloon J, Yi T. A randomized, double-blind, placebo-controlled, phase 1/2a study of the safety and immunogenicity of a live, attenuated human parainfluenza virus type 3 vaccine in healthy infants. Vaccine 2011; 29:7042.
  105. Bernstein DI, Malkin E, Abughali N, et al. Phase 1 study of the safety and immunogenicity of a live, attenuated respiratory syncytial virus and parainfluenza virus type 3 vaccine in seronegative children. Pediatr Infect Dis J 2012; 31:109.
  106. Karron RA, Thumar B, Schappell E, et al. Evaluation of two chimeric bovine-human parainfluenza virus type 3 vaccines in infants and young children. Vaccine 2012; 30:3975.
  107. Bernstein D, Malkin E, Charenkavanich S, Dubovsky F. Safety profile, immunogenicity and viral shedding of MEDI-534, a live, attenuated respiratory syncytial virus (RSV) and parainfluenza virus 3 (PIV3) vaccine in RSV/PIV3 seronegative children. Presented at: International RSV symposium. GCO BV, Rotterdam, The Netherlands, December 2-5, 2010.
  108. Bartlett EJ, Amaro-Carambot E, Surman SR, et al. Human parainfluenza virus type I (HPIV1) vaccine candidates designed by reverse genetics are attenuated and efficacious in African green monkeys. Vaccine 2005; 23:4631.
  109. Nolan SM, Surman SR, Amaro-Carambot E, et al. Live-attenuated intranasal parainfluenza virus type 2 vaccine candidates developed by reverse genetics containing L polymerase protein mutations imported from heterologous paramyxoviruses. Vaccine 2005; 23:4765.
  110. Bartlett EJ, Castaño A, Surman SR, et al. 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.
  111. Karron RA, San Mateo J, Thumar B, et al. Evaluation of a Live-Attenuated Human Parainfluenza Type 1 Vaccine in Adults and Children. J Pediatric Infect Dis Soc 2015; 4:e143.
  112. Mackow N, Amaro-Carambot E, Liang B, et al. Attenuated Human Parainfluenza Virus Type 1 (HPIV1) Expressing the Fusion Glycoprotein of Human Respiratory Syncytial Virus (RSV) as a Bivalent HPIV1/RSV Vaccine. J Virol 2015; 89:10319.