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“Three of a kind?” Unmasking the clinical burden of human metapneumovirus and parainfluenza virus compared to respiratory syncytial virus in hospitalized adults: A pre-COVID-19 multicenter cohort study

Year: 2025

Type: article

Abstract: OBJECTIVES: Respiratory syncytial virus (RSV) is recognized as a leading cause of severe respiratory tract infections (RTIs) in older adults. However, the clinical burden of other paramyxoviruses-parainfluenza virus (PIV) and human metapneumovirus (hMPV)-remains under-investigated in this population. We aimed to compare morbidity and mortality associated with RSV, PIV, and hMPV infections in hospitalized adults. METHODS: Multicenter retrospective cohort study (2016-2018) in three hospitals of the Paris-Saclay network, including adults with RT-PCR confirmed RSV, PIV (1-3), or hMPV infection. Outcomes included hospital and ICU admission, short-term favorable outcome (defined as stability criteria within 5 days) and 90-day mortality. RESULTS: Of 242 patients (mean age 72.8 ± 16.2 years), 45.0% (n = 109) had RSV, 18.2% (n = 44) PIV and 36.8% (n = 89) hMPV. Overall, 88.4% were hospitalized. Median length of stay was similar across viruses (P = 0.59). In multivariable analysis, hMPV infection was independently associated with higher odds of short-term favorable outcome (adjusted OR 4.22, 95% CI [1.42-12.6]; P = 0.01), whereas eosinophil count >50/mm³ was also associated with lower ICU admission risk and better short-term outcomes. Ninety-day mortality was low and comparable (RSV 6.5%, PIV 2.4%, hMPV 5.1%; P = 0.62). CONCLUSION: RSV, PIV, and hMPV infections cause similar morbidity and mortality in hospitalized adults, yet PIV and hMPV remain markedly under-estimated causes of severe respiratory disease in this population. The unexpectedly better stability criteria observed with hMPV warrants further investigation. These findings highlight the importance of including hMPV and PIV in respiratory virus surveillance and future vaccine strategies.

Source: International Journal of Infectious Diseases

DOI: 10.1016/j.ijid.2025.108353