A Comparative Profile of the Burden of Human Metapneumovirus, Respiratory Syncytial Virus, and Influenza in the HIVE Cohort, 2010-2022

Background Human metapneumovirus (HMPV) was initially identified as a cause of lower respiratory illness in young children; its characteristics are well documented in this group. However, when compared with other major respiratory viruses, less is known about its impact on adults, especially in community settings.Methods Since 2010, the HIVE (Household Influenza Vaccine Evaluation) study has followed a cohort of households in Ann Arbor, Michigan, for acute respiratory illness (ARI) of viral etiology. Relative frequency of HMPV, respiratory syncytial virus (RSV), and influenza A and B virus (IAV/IBV) detection and associated reported symptoms was calculated; linear and Poisson mixed-effects models assessed measures of ARI burden. Additionally, a self-controlled case series analysis was conducted to characterize HMPV symptoms and burden.Results Throughout 2010-2011 to 2021-2022, 11 714 specimens were collected. HMPV was identified in 3.4% of all specimens, RSV in 4.4%, and IAV and IBV in 6.7% and 2.5%, respectively. HMPV and RSV occurrence was comparable between adults aged 18 to 39 and >= 40 years. Mean HMPV symptom burden and severity fell between that of RSV and influenza ARIs, with HMPV associated with a rate of moderate to severe symptoms 11% below that of influenza ARI (rate ratio, 0.89; 95% CI, .79-.99). HMPV-associated disruptions in work attendance and productivity were comparable to those of RSV. No significant differences in symptom frequencies during HMPV ARIs were observed when compared with RSV, IAV, and IBV by self-controlled case series analysis.Conclusions HMPV was comparable to RSV but not influenza in its overall occurrence, symptom frequency, and ARI burden among younger and older adults.