The prevalence and role of human metapneumovirus in respiratory tract infections: a systematic review and meta-analysis of global data.

BACKGROUND

Human metapneumovirus (hMPV) is a significant respiratory pathogen, yet its global prevalence and epidemiological patterns remain poorly characterized. This study presents the first comprehensive systematic review and meta-analysis of hMPV prevalence among patients with respiratory tract infections (RTIs), addressing a critical gap in the literature, and clarifying the association between hMPV infection and RTIs.

METHODS

We conducted a systematic search across PubMed, Scopus, and Web of Science, from 2002 to 2024. Studies reporting hMPV prevalence detected by Polymerase chain reaction-based methods in respiratory samples were included. Data was analyzed using random-effects models, with subgroup analyses by age, region, diagnostic methods, and patient's demographic. The main outcome was hMPV prevalence among patients with RTIs.

FINDINGS

The global pooled prevalence of hMPV among 2,236,820 patients with RTIs was 5.3% (95% CI: 5.0%-5.6%). Prevalence was highest in children under 5 years (6.7%) and lowest in adults (2.5%). Lower respiratory infections showed the highest prevalence (8.2%), with bronchiolitis (7.0%) and pneumonia (5.5%) being prominent. Inpatients exhibited a significantly higher prevalence of hMPV (6.1%) compared to outpatients (3.3%). Among hMPV-positive samples, type A was more prevalent than type B. A meta-analysis of 41 case-control datasets revealed a significant association between hMPV infection and respiratory infections (pooled odds ratio [OR] = 4.6; 95% CI: 3.7-5.6; I = 14.4%).

INTERPRETATION

This first-of-its-kind meta-analysis highlights hMPV as a major contributor to RTIs, particularly in young children and severe respiratory conditions. The findings show the need for improved diagnostic strategies, targeted surveillance, and vaccine development to mitigate hMPV's global burden.

FUNDING

This study was financially supported by the Iran University of Medical Sciences (Grant Number: 1402-2-75-25881).