Treatment of Human Metapneumovirus (HMPV) Infection
For immunocompetent adults with HMPV infection, provide supportive care only, as no antiviral agent has established efficacy for HMPV treatment. 1, 2
Immunocompetent Patients
Supportive care remains the sole evidence-based approach for otherwise healthy individuals with HMPV infection. 2 The management consists of:
- Rest, hydration, and symptomatic management as the mainstays of therapy 2
- Oxygen therapy titrated to maintain adequate saturation 2
- Monitoring of vital signs, oxygen saturation, and respiratory status 2
- Fluid and electrolyte management 2
- Treatment of bacterial superinfection if suspected or documented 2
The 2003 IDSA/ATS guidelines explicitly state there is no antiviral agent with established efficacy for treatment of adults with pulmonary infections involving metapneumovirus. 1
Immunocompromised Patients and Severe Disease
For immunocompromised patients with HMPV lower respiratory tract disease (LRTD), consider treatment with ribavirin and/or intravenous immunoglobulin (IVIG), despite the absence of randomized controlled trial data supporting this approach. 1, 2
When to Consider Antiviral Therapy
Treatment consideration is specifically recommended for:
- Hematopoietic stem cell transplant (HSCT) recipients with HMPV LRTD 1, 2
- Leukemia patients with pneumonia or lower respiratory tract involvement 2
- Patients with documented severe disease requiring hospitalization 2
Upper respiratory tract infection alone in immunocompromised patients does not typically warrant antiviral therapy. 2
Important Caveats
The evidence supporting ribavirin and/or IVIG treatment is weak:
- No general recommendation for treatment can currently be made based on available evidence 1, 2
- Single cases of severe disease and fatal outcomes have been reported even with treatment attempts 1, 2
- HMPV is frequently codetected with other pathogens (bacteria, fungi, other respiratory viruses, cytomegalovirus) in pneumonia cases, which obscures the true attributable morbidity and complicates treatment decisions 1, 2
Infection Control Considerations
Implement standard and droplet precautions to prevent nosocomial transmission, as HMPV demonstrates asymptomatic and prolonged shedding, particularly in HSCT patients. 2
- Asymptomatic shedding has been documented in immunocompromised populations 1, 2
- Prolonged viral shedding occurs especially in HSCT recipients 2
Current Research Status
No licensed vaccines or antiviral therapies are currently available for HMPV. 3 While several monoclonal antibodies, vaccine candidates, and antiviral agents (including fusion inhibitors and repurposed drugs like probenecid) are under investigation, none have reached clinical approval. 3