The human metapneumovirus (hMPV), a longstanding respiratory virus, finds its way into the limelight in a post-pandemic world, casting suspicions over a possible large-scale outbreak
Image Source: Getty
As winter looms over the Northern Hemisphere, attention has shifted to a respiratory infection that made headlines in China and now, India as well. The current spotlight is on the human metapneumovirus (hMPV), a virus that predominantly causes a mild upper-respiratory tract infection in infants, the elderly, and the immunocompromised. Heightened attention in the media has caused speculation of a COVID-like response, with chances of another lockdown and social distancing measures. Experts highlight that hMPV is a seasonal occurrence (peaks between January and March) that is typically self-limiting, or treated with over-the-counter medications for a majority of the susceptible population. Infection generates partial immunity, thus making populations experience re-infections when they are reintroduced to the virus. Authorities state that vigilance must be maintained through personal protective measures.
Experts highlight that hMPV is a seasonal occurrence (peaks between January and March) that is typically self-limiting, or treated with over-the-counter medications for a majority of the susceptible population.
The Indian Council of Medical Research (ICMR) has reported seven cases of hMPV in the country, all affecting children. According to the Ministry of Health and Family Welfare (MoHFW), the diagnoses were made as a part of the country’s ongoing surveillance of respiratory illnesses. The affected individuals have no history of international travel and thus acquired hMPV through transmission within the country.
hMPV has quietly circulated among humans for at least five decades, even though it was only formally identified in the respiratory secretions of children with Respiratory Tract Infections (RTIs) by Dutch scientists in the early 2000s. Some studies suggest that hMPV may account for around 5-10 percent of hospitalised children suffering from acute respiratory tract infections globally. Much like its close cousin, the Respiratory Syncytial Virus (RSV), hMPV tends to hit the very young, the elderly, and immunocompromised individuals the hardest, occasionally leading to severe lower respiratory infections such as bronchiolitis, pneumonia, and acute asthma exacerbations.
For context, India’s population demographics show that more than 10 percent of the population is 60 years or older, and approximately 13 percent are under the age of six. While precise data on immunocompromised individuals is not tracked, it could be estimated as roughly around 2-3 percent, comprising those suffering from malnourishment, cancers, HIV/AIDS or those on transplants and immuno-suppressant medications. Various studies in India detected hMPV in approximately 3-10 percent of the paediatric acute respiratory tract infections they tested, and the average prevalence varies between 4-12 percent. hMPV as a cause for RTIs is underestimated in India due to a paucity of research, and also because the available prevalence data on this topic is highly localised to small-scale settings while mostly being more than a decade old.
According to recent government official interviews and statements, there has been no noticeable spike or unusual pattern in winter respiratory illnesses—hMPV included—despite headlines about positive test results.
Clinically, hMPV can present like any other common respiratory virus and cause symptoms that include a fever, cough, runny nose, sore throat, and wheezing—much like the common cold. The incubation period is around 3 to 6 days and the virus peaks in circulation around late winter and early spring. It is detected through Real-Time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) testing of respiratory specimens such as swabs or aspirates, although viral culture and antigen testing methods can also be used. Retrospective seroprevalence studies and surveillance efforts in the Netherlands indicate that many children (virtually all by age five) develop transient antibodies against hMPV. This broad underlying immunity probably accounts for the low fatality rates reported in hMPV cases. Indeed, according to recent government official interviews and statements, there has been no noticeable spike or unusual pattern in winter respiratory illnesses—hMPV included—despite headlines about positive test results.
Public health advisories include simple preventive measures like not sending symptomatic children to school, practising hand hygiene, and wearing masks in crowded settings—although on-ground observations would suggest that the Indian public has largely regressed from learnt preventive behaviours from the COVID era. In addition, healthy individuals are typically affected with only mild and self-limiting symptoms, reinforcing the fact that hMPV remains one of many routine respiratory pathogens circulating in India because of its low fatality rate and broad pre-existing immunity.
The current outbreak centres around social media reports of China’s health system struggling to manage hospitalisations caused by hMPV, which has sparked concerns of a COVID-like situation.
The Joint Monitoring Group—under the Chairmanship of the Directorate General of Health Services (DGHS), MoHFW—has confirmed that it is monitoring the situation in China closely and is ensuring surveillance is vigilant in India. The current upsurge in respiratory illnesses in China is typical of the current flu season and includes not only hMPV but also RSV, influenza A, COVID-19, measles, and mumps.
The current upsurge in respiratory illnesses in China is typical of the current flu season and includes not only hMPV but also RSV, influenza A, COVID-19, measles, and mumps.
This outbreak comes at a time when five years prior, China downplayed the emergence of COVID-19 by delaying the animal-human transmission nature of the virus, and through its hesitance to share vital information on genetic analyses and patient information with the World Health Organisation (WHO). Just last week, the WHO again urged China to share all available data pertinent to determining the origin of COVID-19. Social media reports suggesting that China is embroiled in a health frenzy have alarmed the public. This comes at a time after Indian media panicked over a mysterious “Dinga Dinga” illness that reportedly caused uncontrollable shaking in some women in Uganda. Timely sharing of information and transparency on disease outbreaks between countries is essential to global health security and is of utmost priority to surveillance and pandemic preparedness. Nevertheless, the current situation is not akin to the COVID-19 outbreak, which was a novel infectious virus whose transmission dynamics, molecular biology, and viral characteristics were largely unknown at that time. Hype through sensationalist reporting creates panic and anxiety amongst the public.
In a recent WHO bulletin, rising cases of respiratory infections were noted last year, and in response, China’s National Disease Control and Prevention Administration (NCDPA)—a ministerial agency under the National Health Commission of China—began surveillance and monitoring of the situation in a coordinated manner. The current hMPV status is described by a spokesperson from China’s foreign ministry as “less severe” compared to last year, while Dr Atul Goel—the Director of India’s National Centre for Disease Control (NCDC)—stated that there is “nothing to be alarmed about the present situation”, but general precautions concerning respiratory illnesses must be adhered to.
As there are currently no specific antiviral therapies or vaccines, prevention is through personal protective hygiene. High-risk environments, including paediatric wards, day-care centres, and nursing homes can maintain simple habits such as stricter enforcement of handwashing, regular disinfection of common surface areas, and the avoidance of overcrowding to prevent infection and spread.
From a public health perspective, India can carry out extensive research on hMPV to determine its prevalence, genetic diversity, and association with other respiratory illnesses.
Various vaccine candidates, using mRNA technology and virus-like particles (VLPs), are in differing stages of preclinical and clinical development.
Global hMPV vaccine development has been challenging owing to difficulties in obtaining adequate immunity and ensuring safety. Nevertheless, various vaccine candidates, using mRNA technology and virus-like particles (VLPs), are in differing stages of preclinical and clinical development. Notably, London-based Vicebio and AstraZeneca have candidates in clinical trials that target both hMPV and RSV, while the University of Oxford, in partnership with Moderna, has recently launched a phase I trial for another candidate.
In our COVID-fatigued world, excessive panic and hype through social media have alarmed the public over a potential public health emergency akin to COVID-19. India is exercising vigil over the recent spike in hMPV cases amidst an increase in the number of respiratory cases reported in China. ICMR’s recently boosted surveillance demonstrates that India is strengthening its detection mechanisms. The current flu season serves as a reminder that a robust health security agenda requires constant surveillance, the sharing of biological information in a timely fashion, and the judicious application of public health interventions.
Lakshmy Ramakrishnan is an Associate Fellow with the Health Initiative at the Observer Research Foundation.
K.S. Uplabdh Gopal is an Associate Fellow with the Health Initiative at the Observer Research Foundation.
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.
Lakshmy is an Associate Fellow with ORF’s Centre for New Economic Diplomacy. Her work focuses on the intersection of biotechnology, health, and international relations, with a ...
Read More +
Dr. K. S. Uplabdh Gopal is an Associate Fellow within the Health Initiative at ORF. His focus lies in researching and advocating for policies that ...
Read More +
PREV
