Human Metapneumovirus (hMPV) Information Hub
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Respiratory viruses—including influenza, respiratory syncytial virus (RSV) and human Metapneumovirus (hMPV)—can place older adults and those with chronic conditions like cardiovascular, renal and respiratory diseases at an increased risk of severe respiratory disease and hospitalisations.1
hMPV is an important cause of respiratory virus hospitalisation.2,3 However, while influenza and RSV are relatively well understood, less is known about hMPV infections.4 Similar to RSV in terms of clinical symptoms and outcomes, hMPV is a viral infection that can cause upper and lower respiratory tract disease.3,5 As part of our ongoing efforts to protect the most vulnerable populations, we recognise the need for ongoing research that may lead to solutions for those most at risk for viruses like hMPV.
Understanding hMPV
hMPV is a common respiratory virus spread through the mucus and saliva of an infected person when they cough or sneeze, among other ways, much like RSV. 6
For otherwise healthy adults, hMPV can cause cough, runny nose, sore throat, headache, fever and fatigue.5-7 However, for young children, older adults and people with chronic conditions such as cardiovascular, renal and respiratory diseases, the virus may cause more severe illness requiring hospitalisation.1,3,8 Severe health outcomes resulting from hMPV have included heart failure, worsened quality of life measures and nervous system-related symptoms such as encephalitis, or inflammation of the brain, and the need for mechanical ventilation.1,5,9 In adults, hMPV is responsible for up to 11% of hospitalisations for acute respiratory illness, particularly in adults with underlying heart or lung disease.10
hMPV and RSV are considered “viral cousins” that belong to the same virus family and are associated with similar symptoms and clinical outcomes.11,12 The two viruses also have overlapping seasonality, with RSV cases often spiking in the early winter months and hMPV spiking mid-winter through early spring.3,14 This extends the active transmission period of these viruses and may result in severe respiratory disease, increasing infections and healthcare system burden.14-16
Like RSV, hMPV is a viral infection that can cause upper
and lower respiratory tract disease.5
About two-thirds of older adults have a health condition that makes respiratory viral infections like hMPV more severe.1,17,18
The Impact of hMPV on Older Adults
About two-thirds of older adults have a health condition that makes respiratory viral infections more severe.1,17 As an hMPV infection progresses, it can lead to bronchiolitis or viral pneumonia.5 For people living with respiratory illnesses such as asthma or COPD, it can contribute to worsening of their condition and often spreads easily in assisted living facilities.1
Lower respiratory tract infections caused by hMPV—along with other viruses like influenza, COVID-19 and RSV—are common causes of hospitalisation in older adults with infectious disease.2,19 As with many conditions, older age is a major risk factor for serious hMPV and RSV infections.1,20 With the number of people aged 60 years and older expected to double globally by 2050, experts anticipate that the incidence of infectious diseases, and related hospitalisations will increase, contributing to a significant threat to public health.1,20
Among adults 65 years and older, there are approximately 177,000 hospitalisations due to RSV and approximately 123,000 hospitalisations due to hMPV in the United States each year.3,21-23 Of this population, there are approximately 14,000 deaths from RSV annually.3,21-23 In additional studies in adults 50 years and older, mortality for hMPV has been observed to be similar to RSV.3,21-23
Prevention & Treatment of hMPV
There are currently no approved prevention or treatment options for hMPV.6
Despite being largely unknown to healthcare professionals and the general public, hMPV is a serious virus that represents a significant public health concern particularly as the world’s population of older adults continues to increase. The collective burden of viral respiratory infections, including hMPV and RSV, puts a strain on the healthcare system and profoundly impacts quality of life for older adults, especially for those with a weakened immune system or chronic conditions such as cardiovascular, renal and respiratory disease. Even for those who are otherwise healthy, viral infections like hMPV can lead to severe symptoms and hospitalisation, increasing the need for rehabilitation and driving worsened long-term health outcomes in older adults.
hMPV FAQs
Q&A with Ajoke Sobanjo-ter Meulen, M.D., M.Sc., Vice President of Medical Affairs & Policy, Vaccines & Immune Therapies, AstraZeneca
I’ve heard so much about COVID-19, RSV and the flu. Why haven't I heard more about hMPV?
\While hMPV has been circulating for around 70 years, it was discovered relatively recently in the early 2000s—primarily in children.5 Several years later, initial studies showed that hMPV can cause potentially serious disease in older adults. One of the biggest reasons why people—including physicians—aren’t aware of hMPV is because it is not included in routine testing.6 Furthermore, since there are no treatment or prevention options available for hMPV, there is limited surveillance of the virus. Because of this, the incidence of hMPV may be underestimated.24,25
Why is hMPV a concern for older adults?
Similar to other respiratory viruses like the flu or RSV, hMPV causes upper and lower respiratory tract infections that can be more severe in older adults and people with weakened immune systems.1,6 As you get older, your immune system ages, which can make you more susceptible to infection and severe disease, and lead to hospitalisation.26 In fact, there are approximately 123,000 hMPV-related hospitalisations among older adults in the United States each year.22,23
Additionally, as your lungs age, they lose the ability to ward off infection of the lower respiratory tract.26 This means the virus doesn’t just stay in the nose and upper respiratory tract, but it progresses down into the lungs and lower respiratory tract, causing a lower respiratory tract infection, which is when respiratory disease often becomes more severe.1,27 More severe cases can lead to bronchiolitis or viral pneumonia, and contribute to longer-term health impacts, including exacerbating conditions like heart failure and increasing the risk of stroke and heart attack.5,28
What are some of the similarities between hMPV and RSV?
Human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) belong to the same “virus family” and they may also severely impact the same populations (i.e., infants, older adults, those who are immunocompromised) with similar clinical symptoms, leading to potentially more serious complications.11,12
Additionally, they are both “winter viruses,” which means they typically circulate in the colder months. Unlike influenza and COVID-19, neither hMPV nor RSV have seasonal variants, which means they do not change from year to year due to their stable nature and makes them good candidates for potential prevention strategies like vaccines.29,30
What is the most important thing for older adults to keep in mind about hMPV?
The most important thing for older adults to know about hMPV is that it’s not just a common cold.
Although the burden of hMPV has not been fully characterized, older patients with chronic heart or respiratory conditions who get an hMPV are at an increased risk for severe disease and hospitalisation.1,2 Severe health outcomes resulting from hMPV have included heart failure, worsened quality of life measures and nervous system-related symptoms such as encephalitis, or inflammation of the brain, and the need for mechanical ventilation.1,5,9 There are currently no prevention or treatment options for hMPV.6
References:
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11. Crowe JE Jr, Williams JV. Paramyxoviruses: Respiratory Syncytial Virus and Human Metapneumovirus. Viral Infections of Humans. 2014 Feb 27:601–27. .[Accessed 09 October 2024] Available from: <doi: 10.1007/978-1-4899-7448-8_26>
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15. Lazar I, Weibel C, Dziura J, Ferguson D, Landry ML, Kahn JS. Human Metapneumovirus and Severity of Respiratory Syncytial Virus Disease. [Internet] Emerg Infect Dis. 2004 Jul; 10(7): 1318–1320.[Accessed 09 October 2024] Available from: <doi: 10.3201/eid1007.030983>
16. Bhasin A, Nguyen DC, Briggs BJ, Nam HH. The burden of RSV, hMPV, and PIV amongst hospitalized adults in the United States from 2016 to 2019. [Internet] J Hosp Med. 2024 Jul;19(7):581-588.[Accessed 09 October 2024] Available from: <doi: 10.1002/jhm.13320.>
17. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med [Internet]. 2002 [Accessed 09 October 2024];162(20):2269. Available from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/213908
18. Haas LE, Thijsen SF, van Elden L, Heemstra KA. Human metapneumovirus in adults. Viruses. 2013 Jan 8;5(1):87-110. [Accessed 09 October 2024] Available from: <doi: 10.3390/v5010087>
19. Sieling WD, Goldman CR, Oberhardt M, Phillips M, Finelli L, Saiman L. Comparative incidence and burden of respiratory viruses associated with hospitalization in adults in New York City. [Internet]. Influenza Other Respi Viruses 2021 Sep;15(5):670-677. [Accessed 29 August 2024Accessed 09 October 2024] Available from: <doi: 10.1111/irv.12842>
20. World Health Organization. Ageing and health [Internet]. WHO. 2022. [Accessed 09 October 2024]. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
21. Falsey AR, Walsh EE, House S, Vnneandenijck Y, Ren X, Keim S, et al. Risk factors and medical resource utilization of respiratory syncytial virus, human metapneumovirus and influenza related hospitalizations in adults – A global study during the 2017-2019 epidemic seasons (hospitalized acute respiratory tract infection [HARTI] study). Open Forum Infect Dis [Internet]. 2021 [Accessed 09 October 2024];8(11). Available from: http://dx.doi.org/10.1093/ofid/ofab491
22. Widmer K, Zhu Y, Griffin MR, Edwards KM, Talbot HK. Rates of Hospitalizations for Respiratory Syncytial Virus, Human Metapneumovirus, and Influenza Virus in Older Adults. [Internet] J Infect Dis. 2012 Jul 1; 206(1): 56–62. [Accessed 09 October 2024] Available from<doi: 10.1093/infdis/jis309>
23. U.S. Census Bureau. The Older Population: 2020. [Internet] 2013 [Accessed 09 October 2024]. Available from: https://www2.census.gov/library/publications/decennial/2020/census-briefs/c2020br-07.pdf
24. Hamelin M-È, Abed Y, Boivin G. Human metapneumovirus: A new player among respiratory viruses. Clin Infect Dis [Internet]. 2004 [Accessed 09 October 2024];38(7):983–90. Available from: http://dx.doi.org/10.1086/382536
25. Falsey AR, Erdman D, Anderson LJ, Walsh EE. Human metapneumovirus infections in young and elderly adults. [Internet]. J Infect Dis. 2003 Mar 1;187(5):785-90. [Accessed 09 October 2024] Available from: <doi: 10.1086/367901>
26. Medlineplus. Aging changes in the lungs [Internet]. [Accessed 09 October 2024]. Available from: https://medlineplus.gov/ency/article/004011.htm
27. CDC. Respiratory Infections. CDC Yellow Book 2024. [Internet]. [Accessed 09 October 2024]. Available from: https://wwwnc.cdc.gov/travel/yellowbook/2024/posttravel-evaluation/respiratory-infectionshttps://wwwnc.cdc.gov/travel/yellowbook/2024/posttravel-evaluation/respiratory-infection
28. Blackburn R, Zhao H, Pebody R, Hayward A, Warren-Gash C. Laboratory-Confirmed Respiratory Infections as Predictors of Hospital Admission for Myocardial Infarction and Stroke: Time-Series Analysis of English Data for 2004–2015. [Internet]. Clin Infect Dis. 2018 Jul 1; 67(1): 8–17. [Accessed 09 October 2024]. Available from: <doi: 10.1093/cid/cix1144>
29. Uche IK, Guerrero-Plata A. Interferon-mediated response to human metapneumovirus infection. [Internet]. Viruses, 10(9), 505. [Accessed 09 October 2024] Available from: <doi: 10.3390/v10090505>
30. McLellan JS, Ray WC, Peeples ME. Structure and function of respiratory syncytial virus surface glycoproteins. Curr Top Microbiol Immunol. 2013;372:83-104. [Accessed 09 October 2024] Available from: <doi: 10.1007/978-3-642-38919-1_4>
Veeva ID: Z4-68692
Date of preparation: October 2024