Metapneumovirus in Ukraine: 13 cases confirmed, but no need to panic

6 January 2025 11:27

OPINION

Olga Golubovska, Ukrainian infectious disease specialist, MD, PhD, Professor

A few words about the metapneumovirus outbreak

Human metapneumovirus (HMPV) can cause upper and lower respiratory tract infections in people of all ages, especially young children, the elderly, and people with weakened immune systems. Discovered in 2001, HMPV is a member of the Pneumoviridae family along with respiratory syncytial virus (RSV).

IgG antibodies against HMPV were detected in 100% of people with repeated infection, and in children under 10 years of age, the seropositivity is almost 100%.

Currently, according to the CDC, 13 officially confirmed cases have been registered in Ukraine since the beginning of the season, of course, there are more cases in reality.

Infection occurs through droplets, and episodes can recur throughout life. The disease is often mild (runny nose, cough), but can be severe with the development of fulminant (rapidly progressing) respiratory failure. The latter has been previously observed in immunocompromised patients, after lung transplantation, etc.

The approximate incubation period is 3 to 6 days, and the average duration of the disease may vary depending on the severity, averaging 7-10 days. HMPV is most active in temperate climates during late winter and spring.

Radiographic changes are nonspecific: “frosted glass”, atelectasis, hyperinflated lungs, sometimes consolidation. Bilateral lesions are more common.

Inhaled ribavirin is used in the world for seriously ill patients (note – empirically, since there is no evidence for obvious reasons). In our country, this form of ribavirin is not registered, and the tablet form is unlikely to be effective, based on our experience.

Why is this situation with this disease?

In my opinion, this is a reflection of the evolution and adaptation of microorganisms that take advantage of the changed immune landscape due to the 2019 coronavirus pandemic, which is essentially a systemic immune disease. Our tolerance to infection with many widespread pathogens was also negatively affected by prolonged mass lockdowns, we did not come into contact with each other, and immune responses begin with local defense factors. The first wave of retribution for this began the year before last with the tragic outbreak of RSV infection in the world, and we have repeatedly talked about this at our events. For example, emergency departments in the United States in the 2023-2024 season were overcrowded with sick children under 1 year of age with this disease, and we also saw its growth in the elderly. Since HMPV is the “brother” of RSV, it is its turn. By the way, domestic experts, such as Professor Volyansky (Andriy Volyansky), predicted outbreaks of common respiratory diseases after the restrictive measures were completed. This is what we are seeing now.

What should we do?

First, do not panic. Once again, the time factor is crucial for the tactics of patient management. In the event of a respiratory illness, especially in risk groups, it is advisable to confirm it. Among all SARS, influenza and COVID-19 were the most dangerous, and now metapneumovirus should be added to the testing, especially in hospitalized patients, as there is a resource. If you are sick, measure your blood saturation correctly with a pulse oximeter.

Secondly, the usual prevention of infection is to avoid/reduce the risks of airborne transmission (limiting contact with patients with respiratory diseases, especially those at risk, washing hands, ventilating rooms, wet cleaning). All of this, of course, does not guarantee infection, but we remember that it’s all about the dose of the pathogen that “attacks” you: the lower the dose, the more likely you are to have a minor illness.

Third, a general recommendation. Take care of your health, diagnose pathology in a timely manner (for example, insulin resistance syndrome, thyroid disease), take vitamins, especially D (as prescribed by your doctor), as many people have its insufficiency or deficiency, and it is also a hormone of the immune system.

Please do not delay hospitalization if the patient is progressing daily. Remember that the severity of the course is assessed not only and not so much by temperature indicators as by the general condition of the patient, especially in risk groups. It is believed that concomitant infections with other viruses or bacteria may be a trigger for severe disease, so the use of empirical antiviral therapy with broad-spectrum drugs may be justified.