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Reviewed by

Dr. Tapas Kumar Koley

HOD & Consultant – Internal Medicine

Manipal Hospitals, Delhi

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Battling the Invisible Enemy: Human Metapneumovirus Insights

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Human Metapneumovirus (HMPV) is a significant respiratory pathogen, particularly affecting young children, the elderly, and those with compromised immune systems. As the first human member of the Metapneumovirus genus in the Pneumovirinae subfamily within the Paramyxoviridae family, HMPV is an enveloped negative-sense single-stranded RNA virus.

Recently, HMPV has been making headlines due to a notable surge in cases, especially in China, raising global concerns about its spread and potential public health impact.

Surge in China

Recent reports indicate a significant surge in HMPV cases in China, with an alarming increase in hospitalizations. The outbreak is raising fears that the virus, which causes symptoms similar to the flu or common cold, may overwhelm the healthcare system, especially during the winter season when respiratory viruses tend to spread more rapidly. This surge has prompted increased monitoring and responses from both national and international health bodies.

Symptoms of Human Metapneumovirus (HMPV)

Fever: A common initial symptom, often accompanied by chills.
Cough: Persistent and can be either dry or productive.
Nasal Congestion: Blocked or runny nose, often leading to difficulty breathing through the nose.
Sore Throat: Pain or irritation in the throat, especially when swallowing.
Wheezing: A high-pitched whistling sound during breathing, indicating respiratory distress.
Bronchiolitis: Inflammation of the small airways in the lungs, more common in infants.
Pneumonia: Infection that inflames the air sacs in one or both lungs, which can fill with fluid.
Respiratory Distress: Severe difficulty in breathing, requiring immediate medical attention.

HMPV is highly contagious and spreads through respiratory droplets, making it easily transmissible in close-contact environments like schools, hospitals, and crowded public spaces. Given its similarities with other respiratory viruses, it can sometimes be mistaken for the flu or a common cold, making timely diagnosis critical.

Consult our internal medicine specialist in Delhi if you are experiencing symptoms of HMPV and need treatment.

Prevention and Treatment

Currently, there is no specific antiviral treatment for HMPV infections. The focus remains on supportive care, such as fluid management, fever control, and ensuring adequate oxygen levels for patients who experience severe respiratory symptoms. In some cases, patients may require mechanical ventilation if respiratory distress occurs.

Prevention of HMPV is similar to measures taken for other respiratory viruses. These include regular hand washing, using tissues when coughing or sneezing, wearing masks in high-risk areas, and avoiding close contact with infected individuals. Maintaining good hygiene and disinfecting surfaces in high-traffic areas can help reduce transmission. Additionally, protecting vulnerable populations such as infants, the elderly, and immunocompromised individuals from exposure is key to controlling the spread of HMPV.

Consult our internal medicine specialist in Delhi if you need treatment of HMPV

Vaccine Development and WHO Response

As of now, no specific vaccine exists for human metapneumovirus. However, researchers are actively investigating the development of vaccines and antiviral treatments to reduce the burden of the disease. The World Health Organization (WHO) is closely monitoring the outbreak and continues to work with countries like China to understand the virus's behaviour and mitigate its spread[4]. WHO has recommended that national health authorities enhance surveillance and reporting of HMPV cases to better assess the situation and allocate resources for response.

According to WHO, “China’s reported levels of acute respiratory infections, including HMPV, are within the expected range for the winter season with no unusual outbreak patterns reported. Chinese authorities confirmed that the healthcare system is not overwhelmed, hospital utilization is currently lower than this time last year, and there have been no emergency declarations or responses triggered”[4]. However, the WHO has issued advisories emphasizing the importance of timely diagnosis, effective treatment protocols, and enhancing public health awareness campaigns. Additionally, WHO has urged governments to strengthen health systems to ensure they are prepared to handle potential surges in cases, especially during peak respiratory virus seasons.

Cases in India

India, too, has reported sporadic cases of HMPV, with a few localized outbreaks occurring in recent years. Given the country's dense population and high prevalence of respiratory diseases, HMPV poses a significant public health concern. As health authorities continue to monitor the situation, India has implemented measures similar to those in other countries, including enhanced surveillance and public health advisories.

While the immediate risk of a widespread outbreak in India remains low, the government and health experts emphasize the importance of preventive measures, particularly in areas with high levels of respiratory illnesses. Increased awareness and vigilance among healthcare providers are crucial for early detection and treatment.

Here's a table comparing Human Metapneumovirus (HMPV) with other common respiratory viruses:

Feature	HMPV	Influenza (Flu)	Respiratory Syncytial Virus	Common Cold (Rhinovirus)
Virus Family	Paramyxoviridae	Orthomyxoviridae	Paramyxoviridae	Picornaviridae
Genus	Metapneumovirus	Influenzavirus	Orthopneumovirus	Enterovirus
Genome Type	RNA, negative-sense	RNA, negative-sense	RNA, negative-sense	RNA, positive-sense
Transmission	Respiratory droplets, direct contact	Respiratory droplets, direct contact	Respiratory droplets, direct contact	Respiratory droplets, direct contact
Common Symptoms	Fever, cough, nasal congestion, sore throat, wheezing	Fever, chills, muscle aches, cough, sore throat	Runny nose, decrease in appetite, coughing, sneezing, fever	Runny nose, sore throat, cough, sneezing
Severe Complications	Bronchiolitis, pneumonia, respiratory distress	Pneumonia, bronchitis, sinus infections, worsening of chronic conditions	Bronchiolitis, pneumonia, respiratory distress	Rare, but can lead to sinus infections or ear infections
Affected Populations	Young children, elderly, immunocompromised	All age groups, especially young children, the elderly, and those with chronic conditions	Infants, young children, elderly, immunocompromised	All age groups, particularly children
Seasonality	Winter and early spring	Fall and winter	Fall, winter, and early spring	Year-round, with peaks in fall and spring
Prevention	Hand washing, masks, avoiding close contact with infected individuals	Annual vaccination, hand washing, masks	Hand washing, masks, avoiding close contact with infected individual	Hand washing, masks, avoiding close contact with infected individuals
Treatment	Supportive care, no specific antiviral	Antiviral medications (e.g., oseltamivir), supportive care	Supportive care, no specific antiviral	Supportive care, no specific antiviral

Conclusion

In conclusion, while HMPV continues to pose a public health challenge, its management relies heavily on early detection, supportive treatment, and preventive strategies. The surge in China has heightened global attention, and the ongoing efforts of health organizations, such as the WHO, remain vital in controlling its spread