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Background <p>Human metapneumovirus (hMPV) is an under-recognized cause of severe respiratory illness in high-risk adults. We conducted a systematic review and meta-analysis to quantify hMPV prevalence and clinical outcomes in adults with chronic underlying conditions predisposing them to severe respiratory illness, including the immunocompromised.</p> Methods <p>We searched MEDLINE, Embase, and BioRelate (January 2010 to February 2025) for studies of laboratory-confirmed hMPV in adults (≥ 18 years) with high-risk chronic or immunocompromising conditions. We extracted data on hMPV positivity and key outcomes (hospitalization, intensive care unit [ICU] admission, respiratory support, length of stay, and mortality). We performed random-effects meta-analyses for outcomes reported in ≥ 3 studies and assessed study quality using an adapted Joanna Briggs Institute checklist.</p> Results <p>We included 72 studies. Among immunocompromised adults with hMPV infection, 55.2% (95% confidence interval [CI], 42.0–67.7%) required hospital admission. Among immunocompromised patients hospitalized with respiratory illness, hMPV was detected in 5.4% (95% CI, 2.7–10.8%). Among patients with cardiovascular disease, 11.4% (95% CI, 8.0–16.1%) tested positive for hMPV. Regarding patients with chronic respiratory conditions, 3.4% (95% CI, 2.4–5.0%) of patients with chronic obstructive pulmonary disease exacerbations and 7.6% (95% CI, 2.5–20.5%) of patients with asthma exacerbations were hMPV-positive. Among hospitalized hMPV-positive high-risk patients, 13.0% (95% CI, 8.8–18.9%) required ICU admission, 43.6% (95% CI, 34.9–52.7%) required supplemental oxygen, and 7.3% (95% CI, 1.2–33.8%) required mechanical ventilation. The mean length of hospital stay was 10.4 days (95% CI, 3.4–17.4%). The pooled case fatality ratio among hospitalized adults with hMPV infection was 2.4% (95% CI, 0.1–35.1%).</p> Conclusions <p>hMPV is a substantial cause of severe respiratory illness in high-risk adults. Enhanced detection, surveillance, and preventive strategies are needed to reduce hMPV-associated morbidity in vulnerable populations.</p>

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The Global Burden of Human Metapneumovirus in High-Risk Adults: A Systematic Literature Review and Meta-Analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月13日

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  • Kashmira Date,
  • Evangelia Antoniou,
  • Aleksandra Polkowska-Kramek,
  • Philip Zachariah,
  • Anna Dorste,
  • Jennifer Granda Acaro,
  • Lauren Mason,
  • Laura Mora,
  • Jennifer Eeuwijk,
  • Pimnara Peerawaranun,
  • Kyla Hayford,
  • Bradford D. Gessner,
  • Harish Nair,
  • Elizabeth Begier

摘要

Background

Human metapneumovirus (hMPV) is an under-recognized cause of severe respiratory illness in high-risk adults. We conducted a systematic review and meta-analysis to quantify hMPV prevalence and clinical outcomes in adults with chronic underlying conditions predisposing them to severe respiratory illness, including the immunocompromised.

Methods

We searched MEDLINE, Embase, and BioRelate (January 2010 to February 2025) for studies of laboratory-confirmed hMPV in adults (≥ 18 years) with high-risk chronic or immunocompromising conditions. We extracted data on hMPV positivity and key outcomes (hospitalization, intensive care unit [ICU] admission, respiratory support, length of stay, and mortality). We performed random-effects meta-analyses for outcomes reported in ≥ 3 studies and assessed study quality using an adapted Joanna Briggs Institute checklist.

Results

We included 72 studies. Among immunocompromised adults with hMPV infection, 55.2% (95% confidence interval [CI], 42.0–67.7%) required hospital admission. Among immunocompromised patients hospitalized with respiratory illness, hMPV was detected in 5.4% (95% CI, 2.7–10.8%). Among patients with cardiovascular disease, 11.4% (95% CI, 8.0–16.1%) tested positive for hMPV. Regarding patients with chronic respiratory conditions, 3.4% (95% CI, 2.4–5.0%) of patients with chronic obstructive pulmonary disease exacerbations and 7.6% (95% CI, 2.5–20.5%) of patients with asthma exacerbations were hMPV-positive. Among hospitalized hMPV-positive high-risk patients, 13.0% (95% CI, 8.8–18.9%) required ICU admission, 43.6% (95% CI, 34.9–52.7%) required supplemental oxygen, and 7.3% (95% CI, 1.2–33.8%) required mechanical ventilation. The mean length of hospital stay was 10.4 days (95% CI, 3.4–17.4%). The pooled case fatality ratio among hospitalized adults with hMPV infection was 2.4% (95% CI, 0.1–35.1%).

Conclusions

hMPV is a substantial cause of severe respiratory illness in high-risk adults. Enhanced detection, surveillance, and preventive strategies are needed to reduce hMPV-associated morbidity in vulnerable populations.