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Review
. 2025 Jun 27;13(7):1508.
doi: 10.3390/microorganisms13071508.

hMPV Outbreaks: Worldwide Implications of a Re-Emerging Respiratory Pathogen

Alexandra Lianou  1 , Andreas G Tsantes  2   3 , Petros Ioannou  4 , Efstathia-Danai Bikouli  5 , Anastasia Batsiou  1 , Aggeliki Kokkinou  1 , Kostantina A Tsante  3 , Dionysios Tsilidis  6 , Maria Lampridou  1 , Nicoletta Iacovidou  7 , Rozeta Sokou  7
Affiliations
Review

hMPV Outbreaks: Worldwide Implications of a Re-Emerging Respiratory Pathogen

Alexandra Lianou et al. Microorganisms. .

Abstract

Human metapneumovirus (hMPV), a member of the Pneumoviridae subfamily, has emerged as a significant etiological agent of acute respiratory tract infections across diverse age groups, particularly affecting infants, the elderly, and immunocompromised individuals. Since its initial identification in 2001, hMPV has been recognized globally for its seasonal circulation pattern, predominantly in late winter and spring. hMPV is a leading etiological agent, accounting for approximately 5% to 10% of hospitalizations among pediatric patients with acute respiratory tract infections. hMPV infection can result in severe bronchiolitis and pneumonia, particularly in young children, with clinical manifestations often indistinguishable from those caused by human RSV. Primary hMPV infection typically occurs during early childhood; however, re-infections are frequent and may occur throughout an individual's lifetime. hMPV is an enveloped, negative-sense RNA virus transmitted through respiratory droplets and aerosols, with a 3-5-day incubation period. The host immune response is marked by elevated pro-inflammatory cytokines, which contribute to disease severity. Advances in molecular diagnostics, particularly reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and metagenomic next-generation sequencing (mNGS), have improved detection accuracy and efficiency. Despite these advancements, treatment remains largely supportive, as no specific antiviral therapy has yet been approved. Promising developments in vaccine research, including mRNA-based candidates, are currently undergoing clinical evaluation. This review synthesizes current knowledge on hMPV, highlighting its virological, epidemiological, and clinical characteristics, along with diagnostic advancements and emerging therapeutic strategies, while underscoring the critical role of continued research and sustained preventive measures-including vaccines, monoclonal antibodies, and non-pharmaceutical interventions-in mitigating the global burden of hMPV-related disease.

Keywords: global health; human metapneumovirus; neonates; pediatric; perinatal; pregnancy; public health surveillance; respiratory infections; vaccines.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Overview of hMPV proteins: structure and functional characteristics. hMPV: human metapneumovirus; RNA: ribonucleic acid; SH: small hydrophobic protein. Created in BioRender. L., A. (accessed on 30 April 2025) https://BioRender.com/zj1pa3c.
Figure 2
Figure 2
Positivity rates and seasonality of hMPV virus. US: United States; UK: United Kingdom; LRTIs: Lower respiratory tract infections; ARI: acute respiratory infection. Created in BioRender. L., A. (accessed 30 April 2025) https://BioRender.com/39vha56.
Figure 3
Figure 3
Numbers of hMPV-positive tests per surveillance year. Data collected from Jobe NB, Rose E, Winn AK, Goldstein L, Schneider ZD, Silk BJ. Human Metapneumovirus Seasonality and Co-Circulation with Respiratory Syncytial Virus—United States, 2014–2024 [5].
Figure 4
Figure 4
Weekly hMPV-positive tests during 2024–2025 in the United States. Labels on the chart represent positivity rates [50].
See this image and copyright information in PMC

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