Review Article: Exploring the Impact of Human Metapneumovirus: A Red Global Alarm for 2025
DOI:
https://doi.org/10.32792/utq/utjsci/v12i1.1336Keywords:
human metapneumovirus (hMPV)Abstract
Respiratory infections including Respiratory syncytial virus (RSV) and Human metapneumovirus (hMPV) are the most common worldwide infections, Respiratory syncytial virus’s (RSV) and hMPV considers a public health concern among all countries since they are sharing same clinical presentation, these viruses have the potential to unleash as the global pandemic has already laid a strong foundation. While the similarities with RSV are clear, patient needs to follow a concrete approach including continuous administration of antibiotics or antivirals to fight these viruses. Mild to severe complications with hMPV demand more research covering both hMPV and RSV concurrently. This review attempts to improve knowledge of the pathogen and frequency of hMPV as a possible transmission vector by aggregating present data. Examining its possible effects and clinical differences among the human population will also help us to better understand hMPV and suggest ways of prevention. In conclusion, we seek to emphasize findings from prior research while generating empirical evidence to support our claims. Moreover, it is anticipated that by 2025, hMPV may present a global health risk.
Received: 2025-01-09
Revised: 2025-02-19
Accepted:2025-03-19
References
A. Averin et al., “Cost-effectiveness of Bivalent Respiratory Syncytial Virus Prefusion F Vaccine for Prevention of Respiratory Syncytial Virus among Older Adults in Germany,” Expert Review of Vaccines, vol. 24, no. 1, pp. 1–10, Dec. 2024, doi: https://doi.org/10.1080/14760584.2024.2436183.
P. P., U. Shetty, P. Parida, P. Varamballi, C. Mukhopadhyay, and S. N, “Molecular Detection and Genotyping of HMPV in Patients with Severe Acute Respiratory Infection in India,” Annals of Medicine, vol. 56, no. 1, Sep. 2024, doi: https://doi.org/10.1080/07853890.2024.2398719.
A. J. W. te Velthuis, J. M. Grimes, and E. Fodor, “Structural Insights into RNA Polymerases of negative-sense RNA Viruses,” Nature Reviews Microbiology, vol. 19, no. 5, pp. 303–318, May 2021, doi: https://doi.org/10.1038/s41579-020-00501-8.
J. L. Piñana et al., “Upper and/or Lower Respiratory Tract Infection Caused by Human Metapneumovirus after Allogeneic Hematopoietic Stem Cell Transplantation,” The Journal of Infectious Diseases, vol. 229, no. 1, pp. 83–94, Jul. 2023, doi: https://doi.org/10.1093/infdis/jiad268.
D. Ogonczyk-Makowska et al., “Author Correction: Mucosal Bivalent Live Attenuated Vaccine Protects against Human Metapneumovirus and Respiratory Syncytial Virus in Mice,” npj Vaccines, vol. 9, no. 1, Jul. 2024, doi: https://doi.org/10.1038/s41541-024-00917-w.
G. A. Perchetti et al., “Human Metapneumovirus Infection and Genotyping of Infants in Rural Nepal,” Journal of the Pediatric Infectious Diseases Society, vol. 10, no. 4, pp. 408–416, Nov. 2020, doi: https://doi.org/10.1093/jpids/piaa118.
M. H. Moumbeket Yifomnjou, G. C. Monamele, A. F. Modiyinji, M. Njankouo-Ripa, B. Onana, and R. Njouom, “Genetic Diversity of Human Respiratory Syncytial Virus during COVID-19 Pandemic in Yaoundé, Cameroon, 2020–2021,” Microorganisms, vol. 12, no. 5, p. 952, May 2024, doi: https://doi.org/10.3390/microorganisms12050952.
J. D. Whitehead et al., “Structure of the N-RNA/P interface indicates mode of L/P recruitment to the nucleocapsid of human metapneumovirus,” Nature Communications, vol. 14, no. 1, Nov. 2023, doi: https://doi.org/10.1038/s41467-023-43434-5.
Kerri Beth Boggs et al., “Human Metapneumovirus Phosphoprotein Independently Drives Phase Separation and Recruits Nucleoprotein to Liquid-Like Bodies,” MBio, vol. 13, no. 3, Jun. 2022, doi: https://doi.org/10.1128/mbio.01099-22.
N. Cheemarla and A. Guerrero-Plata, “Immune Response to Human Metapneumovirus Infection: What We Have Learned from the Mouse Model,” Pathogens, vol. 4, no. 3, pp. 682–696, Sep. 2015, doi: https://doi.org/10.3390/pathogens4030682.
Preetiparna Parida, SUDHEESH N, Sanjay E.R, Anitha Jagadesh, Srilatha Marate, and Govindakarnavar Arunkumar, “The Emergence of Human Metapneumovirus G Gene Duplication in Hospitalized Patients with Respiratory Tract infection, India, 2016–2018,” Mol Biol Rep, vol. 50, no. 2, pp. 1109–1116, Nov. 2022, doi: https://doi.org/10.1007/s11033-022-08092-8.
N. Nao et al., “Recent Molecular Evolution of Human Metapneumovirus (HMPV): Subdivision of HMPV A2b Strains,” Microorganisms, vol. 8, no. 9, p. 1280, Aug. 2020, doi: https://doi.org/10.3390/microorganisms8091280.
M. Lavoignat et al., “Peptidomics Analysis of in Vitro Digested Wheat breads: Effect of Genotype and Environment on Protein Digestibility and Release of Celiac Disease and Wheat Allergy Related Epitopes,” Food Chemistry, vol. 448, no. food chemistry, p. 139148, Aug. 2024, doi: https://doi.org/10.1016/j.foodchem.2024.139148.
C. Oh et al., “Improved Performance of Nucleic acid-based Assays for Genetically Diverse Norovirus Surveillance,” Applied and Environmental Microbiology, vol. 89, no. 10, Mar. 2023, doi: https://doi.org/10.1101/2023.03.13.23286721.
A. Pierangeli et al., “Multicenter Epidemiological Investigation and Genetic Characterization of Respiratory Syncytial Virus and Metapneumovirus Infections in the pre-pandemic 2018–2019 Season in Northern and Central Italy,” Clinical and Experimental Medicine, vol. 23, no. 6, pp. 2725–2737, Dec. 2022, doi: https://doi.org/10.1007/s10238-022-00973-3.
W. Z. Chow et al., “Genetic diversity, Seasonality and Transmission Network of Human metapneumovirus: Identification of a Unique sub-lineage of the Fusion and Attachment Genes,” Scientific Reports, vol. 6, no. 1, Jun. 2016, doi: https://doi.org/10.1038/srep27730.
L. Gandhi, D. Maisnam, D. Rathore, P. Chauhan, A. Bonagiri, and M. Venkataramana, “Respiratory Illness Virus Infections with Special Emphasis on COVID-19,” European Journal of Medical Research, vol. 27, no. 1, Nov. 2022, doi: https://doi.org/10.1186/s40001-022-00874-x.
I. M. Batiha, S. Momani, A. Ouannas, Z. Momani, and S. B. Hadid, “Fractional-order COVID-19 Pandemic outbreak: Modeling and Stability Analysis,” International Journal of Biomathematics, vol. 15, no. 01, Nov. 2021, doi: https://doi.org/10.1142/s179352452150090x.
M. L. Schüz et al., “Global Prevalence of Respiratory Virus Infections in Adults and Adolescents during the COVID-19 pandemic: a Systematic Review and meta-analysis,” International Journal of Infectious Diseases, vol. 137, no. International Journal of Infectious Diseases, pp. 16–24, Dec. 2023, doi: https://doi.org/10.1016/j.ijid.2023.10.001.
M. Del Riccio et al., “Global analysis of respiratory viral circulation and timing of epidemics in the pre–COVID-19 and COVID-19 pandemic eras, based on data from the Global Influenza Surveillance and Response System (GISRS),” International Journal of Infectious Diseases, vol. 144, no. 144, p. 107052, Jul. 2024, doi: https://doi.org/10.1016/j.ijid.2024.107052.
Isıl Deniz Alıravcı, Taylan Çelik, Semiha Çelik-Ekinci, and A. A. Hamidi, “Bibliometric Analysis of Human Metapneumovirus Studies,” Infectious Diseases and Clinical Microbiology, vol. 5, no. 4, pp. 311–322, Dec. 2023, doi: https://doi.org/10.36519/idcm.2023.250.
S. Viazov, F. Ratjen, R. Scheidhauer, M. Fiedler, and M. Roggendorf, “High Prevalence of Human Metapneumovirus Infection in Young Children and Genetic Heterogeneity of the Viral Isolates,” Journal of Clinical Microbiology, vol. 41, no. 7, pp. 3043–3045, Jul. 2003, doi: https://doi.org/10.1128/jcm.41.7.3043-3045.2003.
J. Barenfanger, T. Mueller, J. O’Brien, C. Drake, and J. Lawhorn, “Prevalence of Human Metapneumovirus in Central Illinois in Patients Thought to Have Respiratory Viral Infection,” Journal of Clinical Microbiology, vol. 46, no. 4, pp. 1489–1490, Apr. 2008, doi: https://doi.org/10.1128/jcm.02283-07.
M. Camps et al., “Prevalence of human metapneumovirus among hospitalized children younger than 1 year in Catalonia, Spain,” Journal of Medical Virology, vol. 80, no. 8, pp. 1452–1460, Jun. 2008, doi: https://doi.org/10.1002/jmv.21209.
M. L. García‐García, C. Calvo, P. Pérez‐Breña, J. M. De Cea, B. Acosta, and I. Casas, “Prevalence and clinical characteristics of human metapneumovirus infections in hospitalized infants in Spain,” Pediatric Pulmonology, vol. 41, no. 9, pp. 863–871, Jul. 2006, doi: https://doi.org/10.1002/ppul.20456.
J. W. Oketch, E. Kamau, G. P. Otieno, J. R. Otieno, C. N. Agoti, and D. J. Nokes, “Human Metapneumovirus Prevalence and Patterns of Subgroup Persistence Identified through Surveillance of Pediatric Pneumonia Hospital Admissions in Coastal Kenya, 2007–2016,” BMC Infectious Diseases, vol. 19, no. 1, Aug. 2019, doi: https://doi.org/10.1186/s12879-019-4381-9.
Yong Kwan Lim, Oh Joo Kweon, Hye Ryoun Kim, T.-H. Kim, and M.-K. Lee, “Clinical Features, Epidemiology, and Climatic Impact of Genotype-specific Human Metapneumovirus Infections: Long-term Surveillance of Hospitalized Patients in South Korea,” Clinical Infectious Diseases, vol. 70, no. 12, pp. 2683–2694, Jul. 2019, doi: https://doi.org/10.1093/cid/ciz697.
J. P. McCracken et al., “Comparative epidemiology of human metapneumovirus- and respiratory syncytial virus-associated hospitalizations in Guatemala,” Influenza and Other Respiratory Viruses, vol. 8, no. 4, pp. 414–421, Apr. 2014, doi: https://doi.org/10.1111/irv.12251.
A. Emami, A. Moattari, and M. Moghadami, “899 Prevalence of Human Metapneumovirus (HMPV) in Children with Respiratory Disease Symptoms - Shiraz-Iran,” Pediatric Research, vol. 68, no. 9, pp. 450–451, Nov. 2010, doi: https://doi.org/10.1203/00006450-201011001-00899.
J. Li et al., “Prevalence of human metapneumovirus in adults with acute respiratory tract infection in Beijing, China,” Journal of Infection, vol. 64, no. 1, pp. 96–103, Jan. 2012, doi: https://doi.org/10.1016/j.jinf.2011.10.011.
X. Li et al., “Prevalence of human metapneumovirus in hospitalized children with respiratory tract infections in Tianjin, China,” Archives of Virology, vol. 154, no. 11, Sep. 2009, doi: https://doi.org/10.1007/s00705-009-0492-8.
M. Nidaira et al., “Molecular Epidemiology of Human Metapneumovirus from 2009 to 2011 in Okinawa, Japan,” Japanese Journal of Infectious Diseases, vol. 65, no. 4, pp. 337–340, 2012, doi: https://doi.org/10.7883/yoken.65.337.
A. Neemuchwala, V. R. Duvvuri, A. Marchand‐Austin, A. Li, and J. B. Gubbay, “Human metapneumovirus prevalence and molecular epidemiology in respiratory outbreaks in Ontario, Canada,” Journal of Medical Virology, vol. 87, no. 2, pp. 269–274, Aug. 2014, doi: https://doi.org/10.1002/jmv.24024.
J. E. Schuster et al., “Human Metapneumovirus Infection in Jordanian Children,” The Pediatric Infectious Disease Journal, vol. 34, no. 12, pp. 1335–1341, Dec. 2015, doi: https://doi.org/10.1097/inf.0000000000000892.
S. Essa, A. Owayed, H. Altawalah, M. Khadadah, N. Behbehani, and W. Al-Nakib, “The Prevalence of Human Bocavirus, Human Coronavirus-NL63, Human Metapneumovirus, Human Polyomavirus KI and WU in Respiratory Tract Infections in Kuwait,” Medical Principles and Practice, vol. 24, no. 4, pp. 382–387, 2015, doi: https://doi.org/10.1159/000381422.
H. Ye et al., “Epidemiology, genetic characteristics, and association with meteorological factors of human metapneumovirus infection in children in southern China: A 10-year retrospective study,” International Journal of Infectious Diseases, vol. 137, pp. 40–47, Dec. 2023, doi: https://doi.org/10.1016/j.ijid.2023.10.002.
N. Horthongkham, N. Athipanyasilp, R. Sirijatuphat, S. Assanasen, and R. Sutthent, “Prevalence and Molecular Characterization of Human Metapneumovirus in Influenza A Negative Sample in Thailand,” Journal of Clinical Laboratory Analysis, vol. 28, no. 5, pp. 398–404, Mar. 2014, doi: https://doi.org/10.1002/jcla.21700.
P. E. Rodriguez et al., “Human Metapneumovirus: Epidemiology and genotype diversity in children and adult patients with respiratory infection in Córdoba, Argentina,” PLOS ONE, vol. 15, no. 12, p. e0244093, Dec. 2020, doi: https://doi.org/10.1371/journal.pone.0244093.
Y. Liu et al., “Epidemiology, evolution and transmission of human metapneumovirus in Guangzhou China, 2013–2017,” Scientific Reports, vol. 9, no. 1, Oct. 2019, doi: https://doi.org/10.1038/s41598-019-50340-8.
S.-L. Yang et al., “Epidemiology of Human Metapneumovirus in Taiwan from 2013 to 2023,” Archives of Virology, vol. 169, no. 11, Oct. 2024, doi: https://doi.org/10.1007/s00705-024-06147-8.
O. Evelyn, F.-S. Jaime, M. David, A. Lorena, A. Jenifer, and G. Oscar, “Prevalence, Clinical Outcomes and Rainfall Association of Acute Respiratory Infection by Human Metapneumovirus in Children in Bogotá, Colombia,” BMC Pediatrics, vol. 19, no. 1, Oct. 2019, doi: https://doi.org/10.1186/s12887-019-1734-x.
L. Ji, L. Chen, D. Xu, and X. Wu, “Molecular Typing and Epidemiologic Profiles of Human Metapneumovirus Infection among Children with Severe Acute Respiratory Infection in Huzhou, China,” Molecular Biology Reports, vol. 48, no. 12, Oct. 2021, doi: https://doi.org/10.1007/s11033-021-06776-1.
N. S. Korsun et al., “The Prevalence and Genetic Characterization of Human Metapneumovirus in Bulgaria, 2016–2019,” Intervirology, vol. 64, no. 4, pp. 194–202, 2021, doi: https://doi.org/10.1159/000516821.
Preetiparna Parida, SUDHEESH N, Sanjay E.R, Anitha Jagadesh, Srilatha Marate, and Govindakarnavar Arunkumar, “The Emergence of Human Metapneumovirus G Gene Duplication in Hospitalized Patients with Respiratory Tract infection, India, 2016–2018,” 50, vol. 50, no. 2, pp. 1109–1116, Nov. 2022, doi: https://doi.org/10.1007/s11033-022-08092-8.
C. Wang et al., “Epidemiology and genotypic diversity of human metapneumovirus in paediatric patients with acute respiratory infection in Beijing, China,” Virology Journal, vol. 18, no. 1, Feb. 2021, doi: https://doi.org/10.1186/s12985-021-01508-0.
X. Tang et al., “Comparison of the Clinical Features of Human Bocavirus and Metapneumovirus Lower Respiratory Tract Infections in Hospitalized Children in Suzhou, China,” Frontiers in Pediatrics, vol. 10, no. 10, Jan. 2023, doi: https://doi.org/10.3389/fped.2022.1074484.
Z. Xie et al., “Seasonal and Genetic Characteristics of Human Metapneumovirus Circulating — Henan Province, China, 2017–2023,” Deleted Journal, vol. 6, no. 20, pp. 450–456, Jan. 2024, doi: https://doi.org/10.46234/ccdcw2024.087.
C. G. Jones et al., “Outbreaks of Human Metapneumovirus in Western Sydney Aged-Care Facilities in 2018,” Communicable Diseases Intelligence, vol. 46, no. 46, Aug. 2022, doi: https://doi.org/10.33321/cdi.2022.46.54.
N. Devanathan et al., “Emerging Lineages A2.2.1 and A2.2.2 of Human Metapneumovirus (hMPV) in Pediatric Respiratory infections: Insights from India,” IJID Regions, vol. 14, no. 14, p. 100486, Mar. 2025, doi: https://doi.org/10.1016/j.ijregi.2024.100486.
H. Deval et al., “Human metapneumovirus (hMPV): an associated etiology of severe acute respiratory infection in children of Eastern Uttar Pradesh, India,” Access Microbiology, vol. 6, no. 9, Sep. 2024, doi: https://doi.org/10.1099/acmi.0.000829.v4.
A. Veronese, T. Uršič, S. B. Vojinovič, and Jasna Rodman Berlot, “Exploring Clinical Predictors of Severe Human Metapneumovirus Respiratory Tract Infections in Children: Insights from a Recent Outbreak,” Microorganisms, vol. 12, no. 4, pp. 641–641, Mar. 2024, doi: https://doi.org/10.3390/microorganisms12040641.
W. Ji et al., “Clinical and epidemiological characteristics of 96 pediatric human metapneumovirus infections in Henan, China after COVID-19 pandemic: a retrospective analysis,” Virology Journal, vol. 21, no. 1, Apr. 2024, doi: https://doi.org/10.1186/s12985-024-02376-0.
A. R. Falsey et al., “Assessment of Illness Severity in Adults Hospitalized with Acute Respiratory Tract Infection Due to Influenza, Respiratory Syncytial Virus, or Human Metapneumovirus: Influenza and Other Respiratory Viruses,” Influenza and other respiratory viruses, vol. 18, no. 5, p. e13275, May 2024, doi: https://doi.org/10.1111/irv.13275.
L. K. Dallmeyer et al., “Epidemiology of Respiratory Viruses among Children during the SARS-CoV-2 pandemic: a Systematic Review and meta-analysis,” International Journal of Infectious Diseases, vol. 138, no. 138, pp. 10–18, Jan. 2024, doi: https://doi.org/10.1016/j.ijid.2023.10.023.
N. S. Crowcroft, “Pertussis Vaccine Is Only Modestly Effective in Adults: Another Piece in the Pertussis Puzzle,” Clinical Infectious Diseases, vol. 71, no. 2, pp. 351–352, Aug. 2019, doi: https://doi.org/10.1093/cid/ciz822.
N. Madi, H. A. Safar, A. Al-Adwani, M. Sadeq, and M. Al-Turab, “Genomic Characterization of Circulating Human Respiratory Syncytial Viruses a and B in Kuwait Using whole-genome Sequencing,” Microbiology Spectrum, vol. 12, no. 7, Jul. 2024, doi: https://doi.org/10.1128/spectrum.00159-24.
M. H. Wali, H. M. Naif, N. A. Abdul Rahim, and M. A. Yunus, “Phylogenetic and Sequence Analyses of the Variable Region in the Glycoprotein Gene of the Respiratory Syncytial Virus Isolated from Iraqi Patients,” Malaysian Journal of Medical Sciences, vol. 31, no. 6, pp. 133–147, Dec. 2024, doi: https://doi.org/10.21315/mjms2024.31.6.11.
L. E. M. Haas, S. F. T. Thijsen, L. van Elden, and K. A. Heemstra, “Human Metapneumovirus in Adults,” Viruses, vol. 5, no. 1, pp. 87–110, Jan. 2013, doi: https://doi.org/10.3390/v5010087.
J. Choi and G. L. Lee, “Common Pediatric Respiratory Emergencies,” Emergency Medicine Clinics of North America, vol. 30, no. 2, pp. 529–563, May 2012, doi: https://doi.org/10.1016/j.emc.2011.10.009.
S. Esposito and Maria Vincenza Mastrolia, “Metapneumovirus Infections and Respiratory Complications,” Seminars in Respiratory and Critical Care Medicine, vol. 37, no. 04, pp. 512–521, Aug. 2016, doi: https://doi.org/10.1055/s-0036-1584800.
F. Kodama, D. A. Nace, and R. L. P. Jump, “Respiratory Syncytial Virus and Other Noninfluenza Respiratory Viruses in Older Adults,” Infectious Disease Clinics of North America, vol. 31, no. 4, pp. 767–790, Dec. 2017, doi: https://doi.org/10.1016/j.idc.2017.07.006.
T. Heikkinen, R. Österback, V. Peltola, T. Jartti, and R. Vainionpää, “Human Metapneumovirus Infections in Children,” Emerging Infectious Diseases, vol. 14, no. 1, pp. 101–106, Jan. 2008, doi: https://doi.org/10.3201/eid1401.070251.
Rubens Carmo Costa-Filho, F. Saddy, J. Luiz, L. R. Tavares, and H. Caire, “The Silent Threat of Human Metapneumovirus: Clinical Challenges and Diagnostic Insights from a Severe Pneumonia Case,” Microorganisms, vol. 13, no. 1, pp. 73–73, Jan. 2025, doi: https://doi.org/10.3390/microorganisms13010073.
G. Boivin, “Human Metapneumovirus Infections in Hospitalized Children,” Emerging Infectious Diseases, vol. 9, no. 6, Sep. 2003, doi: https://doi.org/10.3201/eid0906.0300017.
N. Principi and S. Esposito, “Paediatric Human Metapneumovirus infection: Epidemiology, Prevention and Therapy,” Journal of Clinical Virology, vol. 59, no. 3, pp. 141–147, Mar. 2014, doi: https://doi.org/10.1016/j.jcv.2014.01.003.
M. Bouscambert-Duchamp, B. Lina, Aurélien Trompette, H. Moret, J. Motte, and Laurent Andreoletti, “Detection of Human Metapneumovirus RNA Sequences in Nasopharyngeal Aspirates of Young French Children with Acute Bronchiolitis by Real-Time Reverse Transcriptase PCR and Phylogenetic Analysis,” Journal of Clinical Microbiology, vol. 43, no. 3, pp. 1411–1414, Mar. 2005, doi: https://doi.org/10.1128/jcm.43.3.1411-1414.2005.
T. Jefferson et al., “Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses,” Cochrane Database of Systematic Reviews, vol. 11, no. 11, Nov. 2020, doi: https://doi.org/10.1002/14651858.cd006207.pub5.
S. Ma et al., “Development of a Novel multi-epitope mRNA Vaccine Candidate to Combat HMPV Virus,” Human Vaccines & Immunotherapeutics, vol. 20, no. 1, Jan. 2024, doi: https://doi.org/10.1080/21645515.2023.2293300.
V. Schildgen et al., “Human Metapneumovirus: Lessons Learned over the First Decade,” Clinical Microbiology Reviews, vol. 24, no. 4, pp. 734–754, Oct. 2011, doi: https://doi.org/10.1128/cmr.00015-11.
J. Hasvold, M. Sjoding, K. Pohl, C. R. Cooke, and R. C. Hyzy, “The Role of Human Metapneumovirus in the Critically Ill Adult Patient,” Journal of Critical Care, vol. 31, no. 1, pp. 233–237, Feb. 2016, doi: https://doi.org/10.1016/j.jcrc.2015.09.035.
J. Burns et al., “Travel-related Control Measures to Contain the COVID-19 pandemic: a Rapid Review,” Cochrane Database of Systematic Reviews, Sep. 2020, doi: https://doi.org/10.1002/14651858.cd013717.
J. V. Williams, “Human metapneumovirus: an Important Cause of Respiratory Disease in Children and Adults,” Current Infectious Disease Reports, vol. 7, no. 3, pp. 204–210, Jun. 2005, doi: https://doi.org/10.1007/s11908-005-0036-7.
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