Spatiotemporal Dynamics of Human Metapneumovirus and Potential Impact of Respiratory Syncytial Virus Interventions in the United States
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Human metapneumovirus (HMPV) causes acute lower respiratory infections, primarily affecting young children and older adults, with seasonal outbreaks peaking annually in March or April in the United States and other temperate regions in the Northern hemisphere. However, the factors driving HMPV seasonality in the United States remain poorly understood. We analyzed laboratory-confirmed HMPV cases and age-specific emergency department visits across 10 US regions, fitting an age-stratified dynamic transmission model to assess spatiotemporal patterns and investigate the influence of environmental variables and viral interference from RSV on HMPV transmission rates. We found that models incorporating climate variables into the transmission rate, including vapor pressure, precipitation, potential evapotranspiration, and minimum temperature, could not capture the timing of HMPV activity across all regions. Instead, HMPV timing was associated with RSV activity, with the HMPV transmission rate reduced in the presence of RSV. We showed that, unlike RSV, only models incorporating viral interference could reproduce the biennial pattern of HMPV observed in some regions, characterized by alternating “late-small” and “early-large” epidemics. Furthermore, our model successfully reproduced post-COVID-19 HMPV and RSV epidemics and predicted that RSV interventions are not likely to lead to a substantial increase in HMPV activity despite decreasing competition from RSV. Our work unravels the spatiotemporal dynamics of HMPV and its interaction with RSV, informing future seasonal forecasting and intervention strategies for HMPV.
Author Summary
Human metapneumovirus (HMPV) circulates each year in the United States and contributes to respiratory illness, particularly among young children and older adults. Although HMPV epidemics show clear seasonal patterns, the mechanisms underlying these patterns are not well understood. In this study, we combined surveillance data from multiple regions in the United States with mathematical modeling to investigate the drivers of HMPV transmission. We evaluated whether environmental factors or interactions with respiratory syncytial virus (RSV) better explained differences in epidemic timing and intensity. Our findings indicate that interactions between HMPV and RSV play an important role in shaping HMPV epidemics. In particular, RSV circulation appeared to suppress HMPV transmission, helping explain the alternating epidemic patterns observed in some regions. Our model also suggested that expanded RSV prevention programs are unlikely to substantially increase HMPV burden. This work provides new insights into respiratory virus interactions and highlights the importance of considering pathogen interactions when predicting seasonal outbreaks and evaluating intervention strategies.
