Respiratory syncytial virus and human metapneumovirus infections cause seasonal lower respiratory tract disease, particularly in infants and young children. Disease may be asymptomatic, mild, or severe, including bronchiolitis and pneumonia. Although diagnosis is usually clinical, laboratory diagnosis is available. Treatment is supportive.
Respiratory syncytial virus (RSV)
RSV is an RNA virus, classified as a pneumovirus. Subgroups A and B have been identified.
RSV is the most common cause of lower respiratory tract illness in young infants and is responsible for > 50,000 hospitalizations annually in the United States in children under the age of 5 years.
RSV is ubiquitous; almost all children are infected by age 4 years. Outbreaks typically occur annually in winter or early spring in temperate climates. However, RSV and other respiratory virus circulation patterns were disrupted during the COVID-19 pandemic (1 Reference Respiratory syncytial virus and human metapneumovirus infections cause seasonal lower respiratory tract disease, particularly in infants and young children. Disease may be asymptomatic, mild... read more ).
Because the immune response to RSV does not protect against reinfection, the attack rate is approximately 40% for all exposed people. However, antibody to RSV decreases illness severity.
Human metapneumovirus (hMPV)
hMPV is a similar but separate virus.
The seasonal epidemiology of hMPV appears to be similar to that of RSV, but the incidence of infection and illness appears to be substantially lower.
Reference
1. Olsen SJ, Winn AK, Budd AP, et al: Changes in influenza and other respiratory virus activity during the COVID-19 pandemic–United States, 2020-2021. MMWR Morb Mortal Wkly Rep 70(29):1013–1019, 2021. doi: 10.15585/mmwr.mm7029a1
Symptoms and Signs of RSV and hMPV
RSV and hMPV illnesses manifest similarly. The most recognizable clinical syndromes are bronchiolitis Bronchiolitis Bronchiolitis is an acute viral infection of the lower respiratory tract affecting infants < 24 months and is characterized by respiratory distress, wheezing, and/or crackles. Diagnosis is... read more and pneumonia Overview of Pneumonia Pneumonia is acute inflammation of the lungs caused by infection. Initial diagnosis is usually based on chest x-ray and clinical findings. Causes, symptoms, treatment, preventive measures, and... read more .
These illnesses typically begin with upper respiratory symptoms and fever, then progress over several days to dyspnea, cough, wheezing, and/or crackles on chest auscultation. Apnea may be the initial symptom of RSV in infants < 6 months.
In healthy adults and older children, illness is usually mild and may be inapparent or manifested only as an afebrile common cold. However, severe disease may develop in the following:
Patients who are < 6 months old, older adults, or patients who are immunocompromised
Patients who have underlying cardiopulmonary or neuromuscular disorders
Diagnosis of RSV and hMPV
Characteristic symptoms and signs, particularly during the usual season or a known outbreak
Sometimes rapid antigen tests, reverse-transcription–polymerase chain reaction (RT-PCR), or viral culture (all done on nasal washings or swabs)
RSV (and possibly hMPV) infection is suspected in infants and young children with bronchiolitis or pneumonia during RSV season. Because antiviral treatment is not typically recommended, a specific laboratory diagnosis is unnecessary for patient management. However, a laboratory diagnosis may facilitate hospital infection control by allowing segregation of children infected with the same virus.
Rapid antigen tests with a high sensitivity for RSV and other respiratory viruses are available for use in children; nasal washings or swabs are used. These tests are less sensitive in adults. Viral culture may be performed. Molecular diagnostic assays such as RT-PCR have improved sensitivity and are generally available as single or multiplex assays.
Treatment of RSV and hMPV
Supportive care
Treatment of RSV and hMPV infections is supportive and includes supplemental oxygen and hydration as needed (see treatment of bronchiolitis Treatment Bronchiolitis is an acute viral infection of the lower respiratory tract affecting infants < 24 months and is characterized by respiratory distress, wheezing, and/or crackles. Diagnosis is... read more ).
Corticosteroids and bronchodilators are generally not helpful and are currently not recommended.
Antibiotics are reserved for patients with fever, evidence of pneumonia on chest x-ray, and clinical suspicion of a bacterial coinfection.
Palivizumab (monoclonal antibody to RSV) is not effective for treatment.
Inhaled ribavirin, an antiviral medication with activity against RSV, has marginal efficacy, is potentially toxic to health care professionals, and is no longer recommended except for infection in patients who are severely immunocompromised.
Numerous medications targeting viral fusion, entry, and replication for adults and infants are currently in development and in clinical trials (1 Treatment reference Respiratory syncytial virus and human metapneumovirus infections cause seasonal lower respiratory tract disease, particularly in infants and young children. Disease may be asymptomatic, mild... read more ).
Treatment reference
1. Domachowske JB, Anderson EJ, Goldstein M: The future of respiratory syncytial virus disease prevention and treatment. Infect Dis Ther 10(Suppl 1):47–60, 2021. doi: 10.1007/s40121-020-00383-6
Prevention of RSV and hMPV
Contact precautions (eg, hand washing, gloves, isolation) are important, particularly in hospitals.
Passive prophylaxis with palivizumab decreases the frequency of hospitalization for RSV in high-risk infants. It is cost-effective only for infants at high risk of hospitalization, including those with the following characteristics:
< 1 year old with hemodynamically significant congenital heart disease
< 1 year old with chronic lung disease of prematurity (gestational age < 32 weeks and 0 days with the need for oxygen therapy for at least 28 days after birth)
Born at < 29 weeks gestation and are < 1 year old at the start of RSV season
Chronic lung disease of prematurity in the second year of life and have received within 6 months of RSV season treatment with chronic corticosteroids or diuretics or have had a continued need for oxygen therapy
Prophylaxis may also be considered for
Infants in the first year of life who have anatomic pulmonary abnormalities that impair the ability to effectively clear the upper airways
Infants who have neuromuscular disorders
Children < 24 months old who have profound immunocompromise
The dose of palivizumab is 15 mg/kg IM. The first dose is given just before the usual onset of the RSV season (early November in North America). Subsequent doses are given at 1-month intervals for the duration of the RSV season (usually a total of 5 doses). Additional doses may be recommended during a prolonged RSV season or significant interseason RSV activity. (See also the American Academy of Pediatrics' updated 2014 updated guidance for palivizumab prophylaxis for infants and young children who are at increased risk of hospitalization for RSV and 2022 updated guidance on the use of palivizumab prophylaxis to prevent hospitalization from severe RSV infection during the 2022–2023 RSV season.)
In May 2023, the U.S. Food and Drug Administration approved a respiratory syncytial virus vaccine for the prevention of lower respiratory tract disease caused by RSV in people ≥ 60 years of age.
Nirsevimab, a fusion protein monoclonal antibody, and several other maternal, pediatric, and adult RSV vaccines are in development in clinical trials (1 Prevention references Respiratory syncytial virus and human metapneumovirus infections cause seasonal lower respiratory tract disease, particularly in infants and young children. Disease may be asymptomatic, mild... read more , 2 Prevention references Respiratory syncytial virus and human metapneumovirus infections cause seasonal lower respiratory tract disease, particularly in infants and young children. Disease may be asymptomatic, mild... read more ).
Prevention references
1. Hammitt LL, Dagan R, Yuan Y, et al: Nirsevimab for prevention of RSV in healthy late-preterm and term infants. N Engl J Med 386(9):837–846, 2022. doi: 10.1056/NEJMoa2110275
2. Domachowske JB, Anderson EJ, Goldstein M: The future of respiratory syncytial virus disease prevention and treatment. Infect Dis Ther 10(Suppl 1):47–60, 2021. doi: 10.1007/s40121-020-00383-6
Key Points
Respiratory syncytial virus (RSV) and human metapneumovirus usually cause a syndrome of bronchiolitis, but pneumonia may occur.
Diagnosis is usually clinical, but testing, including rapid antigen tests and molecular assays (eg, reverse-transcription–polymerase chain reaction), is available.
Give supportive treatment; corticosteroids, bronchodilators, and palivizumab are not recommended.
Inhaled ribavirin may be useful for RSV but is potentially toxic to health care professionals and is now used only in patients with severe immunocompromise.
Passive prophylaxis with palivizumab just before and during RSV season decreases the frequency of hospitalization in specific high-risk infants.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
American Academy of Pediatrics (AAP): Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection (2014)
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FAQs
What is the difference between RSV and hMPV? ›
Human metapneumovirus (hMPV)
hMPV is a similar but separate virus. The seasonal epidemiology of hMPV appears to be similar to that of RSV, but the incidence of infection and illness appears to be substantially lower.
hPMV is spread by close contact with an infected individual or by coming in contact with a contaminated area. hMPV usually causes symptoms similar to the common cold that last roughly 2-5 days and go away on their own. Most children who get infected with hMPV are age 5 or younger.
How serious is human metapneumovirus? ›In general, hMPV is not serious. Most people have few symptoms. Symptoms they do have get better on their own without treatment, usually within a few days. People with asthma may have asthma flare-ups after infection.
What are the symptoms of human metapneumovirus in children? ›Symptoms commonly associated with HMPV include cough, fever, nasal congestion, and shortness of breath. Clinical symptoms of HMPV infection may progress to bronchitis or pneumonia and are similar to other viruses that cause upper and lower respiratory infections.
Is RSV deadlier than COVID? ›Coronavirus and respiratory syncytial virus (RSV) are two kinds of respiratory illnesses that have some similar symptoms. So far, the new coronavirus appears to be more dangerous for adults, especially older ones.
Is hMPV just a cold? ›Human metapneumovirus (hMPV) is a common respiratory virus that causes an upper respiratory infection (like a cold). It is a seasonal disease that usually occurs in the winter and early spring, similar to RSV and the flu.
How long does human metapneumovirus last in kids? ›Most people recover within about seven to 10 days. However, people with weakened immune systems, asthma, or respiratory conditions may develop serious illness, such as bronchitis or pneumonia.
What is the isolation period for human metapneumovirus? ›Respiratory syncytial virus (RSV) Human metapneumovirus (hMPV) Isolate until 24 hours after resolution of fever without the use of fever-reducing medications and without respiratory symptoms. Scabies Isolate until 24 hours after initiation of appropriate therapy. Avoid using of shared patient equipment.
Is human metapneumovirus bad in babies? ›The human Matapneumovirus (hMPV) virus usually causes mild, cold-like symptoms – or no symptoms at all. However, in some people, such as babies under a year old and older people with heart or lung disease, hMPV can lead to serious problems like bronchiolitis or pneumonia.
What are the long term effects of metapneumovirus? ›In vivo, HMPV infection is associated with long-term pulmonary inflammation, which leads to significant obstructive disease of the airways [15,16].
Can human metapneumovirus be treated with antibiotics? ›
Nonetheless, the prescription rate of antibiotics for respiratory infections is exceedingly high. In particular, human metapneumovirus (hMPV) infections frequently cause antibiotic treatment.
Is metapneumovirus a type of pneumonia? ›Human metapneumovirus (hMPV) is a virus that often spreads during the winter and spring. hMPV produces symptoms similar to the common cold. Most people have mild cases of hMPV, but some may have complications such as bronchiolitis, bronchitis and pneumonia.
How do you get rid of metapneumovirus? ›Can human metapneumovirus be treated? Supportive treatment for patients varies with the severity of the illness but generally treatment consists of fever reducers, antihistamines, breathing treatments and other means of providing comfort to the patient until the illness resolves.
What is metapneumovirus in kids? ›Human metapneumovirus (hMPV) is a respiratory viral pathogen that causes a spectrum of illnesses that range from asymptomatic infection to severe bronchiolitis.
Is metapneumovirus a croup? ›It is marked by a harsh cough often sounding like a seal bark and can be caused by a variety of organisms, including parainfluenza, human metapneumovirus, adenovirus and even influenza.
Is RSV a form of Covid? ›The flu, COVID-19, and respiratory syncytial virus (RSV) are all highly contagious respiratory infections caused by viruses: The flu by influenza virus, COVID-19 by SARS-CoV-2 virus, and RSV by respiratory syncytial virus. It is possible for a person to be infected with multiple viruses at the same time.
How long will RSV show positive? ›People infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks.
Why is RSV scary? ›Babies are born with the tiniest of airways. Viruses like RSV inflame those airways, making it difficult to breathe. The smaller the airway, the less inflammation it takes to close it off. What's more, viruses are usually more severe the first time they infect people.
What is the new coughing virus in 2023? ›HMPV rates have spiked in early 2023, much like RSV and influenza during the fall and winter (positive cases of HMPV from rapid tests and PCR tests shown here).
Does hMPV infection often require hospitalization? ›LRTIs associated with hMPV infection frequently require hospitalization.
What are the home remedies for human metapneumovirus? ›
Home Remedies and Lifestyle
While metapneumovirus doesn't cause complications in most people, it still requires rest to get over the illness. Things you can do at home that may help ease symptoms include: Using a humidifier to prevent dry skin and cough. Drinking lots of fluids to remain hydrated.
The Disease and Risk Factors
LRT disease can be severe, particularly when an individual is exposed to virus for the first time. Outcomes can include bronchiolitis and pneumonia and can result in death [37].
Especially in cold season, the Human metapneumovirus causes respiratory infections and bronchilitis. Apart from that, the virus can cause nosocomial respiratory infections. The transmission of the Human metapneumovirus is still unknown, but airborne transmission is assumed to be the major transmission path.
What does RSV mean? ›Respiratory Syncytial Virus (RSV) Infection
Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms.
Rhinovirus is more likely to lead to headaches and all-over body aches, along with the symptoms it shares with RSV, such as sneezing and a sore throat. RSV is more likely to have symptoms such as loss of appetite and fever.
When does human metapneumovirus peak? ›Rates of hospitalization of children for HMPV infection are highest in the first year of life but occur throughout early childhood. Many studies report that the peak age of hospitalization for HMPV is between 6 and 12 months of age, which is later than the peak age of hospitalization for RSV (2–3 months) 44, 51– 56.
Does albuterol help with human metapneumovirus? ›Both studies suggest a role for albuterol in improvement of clinical outcomes in asthma; however, our results would not support a similar expectation in HMPV bronchiolitis. This demonstrates a difference between asthma and lower respiratory tract infection caused by HMPV.
What is the antiviral for metapneumovirus? ›Ribavirin, which has broad antiviral activity, has been shown to have activity against hMPV in vitro.
Can you get reinfected with metapneumovirus? ›Like RSV, HMPV induces incomplete immunity, and reinfection later in life is well documented among adults of all ages. Infection has been associated with febrile respiratory illnesses in young and older adults, asthma and COPD exacerbations, and fatal diffuse pneumonia in immunocompromised patients.
How long does a fever last with metapneumovirus? ›The average duration of fever during hMPV infection is 10 days. Hospitalization, supplemental oxygen, and mechanical ventilation may be necessary in severe hMPV infections.
Is there a test for human metapneumovirus? ›
The most sensitive means of hMPV infection diagnosis is by quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) of respiratory secretions, which is currently the most commonly used method. In research settings, this technique is also being used to quantify viral load.
Can you get human metapneumovirus twice? ›People of all ages can get hMPV, but children under 5 years of age, older adults, or those with a compromised immune system are at higher risk of serious complications. You can get sick with hMPV more than once.
Is human metapneumovirus more severe than RSV infection in hospitalized children? ›We concluded that hMPV is a major pathogen associated with hospitalization of children and with the same severity of illness as RSV but in a slightly older population. Because of the apparent prevalence and severity of illness, routine screening should be implemented.
Does hMPV require isolation? ›Respiratory syncytial virus (RSV) Human metapneumovirus (hMPV) Isolate until 24 hours after resolution of fever without the use of fever-reducing medications and without respiratory symptoms. Scabies Isolate until 24 hours after initiation of appropriate therapy. Avoid using of shared patient equipment.
What is another name for RSV? ›Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms.
What are the two types of RSV? ›There are two major antigenic subtypes of human RSV (A and B) determined largely by antigenic drift and duplications in RSV-G sequences, but accompanied by genome-wide sequence divergence, including within RSV-F. Human RSV is a globally prevalent cause of lower respiratory tract infection in all age groups.
How long does it take to recover from human metapneumovirus? ›Most people recover within about seven to 10 days. However, people with weakened immune systems, asthma, or respiratory conditions may develop serious illness, such as bronchitis or pneumonia.
How many kids have died from RSV virus? ›60,000-160,000 hospitalizations among adults 65 years and older. 6,000-10,000 deaths among adults 65 years and older. 100–300 deaths in children younger than 5 years old.
How long are you contagious with RSV? ›People infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks.
How do you catch human metapneumovirus? ›Human metapneumovirus (hMPV) is a disease that spreads from person to person through close contact. hMPV usually causes symptoms similar to the common cold, but symptoms can be more serious for some groups of people.
Is RSV a type of Covid? ›
What is the difference between the flu, COVID-19, and RSV? The flu, COVID-19, and respiratory syncytial virus (RSV) are all highly contagious respiratory infections caused by viruses: The flu by influenza virus, COVID-19 by SARS-CoV-2 virus, and RSV by respiratory syncytial virus.
How long does RSV last in kids? ›Most RSV infections go away on their own in a week or two. There is no specific treatment for RSV infection, though researchers are working to develop vaccines and antivirals (medicines that fight viruses).
What does RSV cough sound like? ›Children with RSV typically have two to four days of upper respiratory tract symptoms, such as fever and runny nose/congestion. These are then followed by lower respiratory tract symptoms, like increasing wheezing cough that sounds wet and forceful with increased work breathing.
What does RSV turn into? ›RSV infection can spread to the lower respiratory tract, causing pneumonia or bronchiolitis — inflammation of the small airway passages entering the lungs. Signs and symptoms may include: Fever. Severe cough.
What's the treatment for RSV? ›How RSV Is Treated. Mild RSV infections will go away in a week or two without treatment. You can use over-the-counter fever reducers and pain relievers to manage your symptoms. Check with your doctor if you are not sure if an over-the-counter product is safe to give to your child.
Is RSV the same as whooping cough? ›Respiratory syncytial virus, or RSV, and pertussis, commonly called whooping cough, are not likely to cause serious health issues for otherwise healthy adults, but it's still very important for everyone to take precautions against both.