HMPV virus – its not the pandemic

HMPV can be prevented by following the usual precautions of the flu season. These include wearing masks, avoiding touching the face, frequently washing hands, avoiding crowded places, especially by the very young and the elderly. In fact, routinely wearing masks could help reduce many high-burden diseases in India including seasonal flu, pneumonia, and tuberculosis.

The health system in India is fully equipped to deal with HMPV. The virus can be detected through a routine RT-PCR test of the kind used for detecting the Covid19 virus, though this is not needed for most cases. Management of HMPV is similar to that of other respiratory viruses and principally revolves around symptomatic management including hydrating, taking warm fluids, resting, and taking paracetamol for managing high fever. It is important to keep an eye out for warning signs, particularly in infants and the elderly. These include breathing fast, difficulty in breathing, persistent high fever, incessant coughing, vomiting, and infants being unable to feed. One should seek medical attention from a doctor if these symptoms appear.

We can say with a high degree of confidence that the handful of cases of HMPV that have been detected so far in India originate not from outside the country but from within, as is expected during the winter months.

Using its country-wide lab-based surveillance network, the Indian Council of Medical Research (ICMR) has found that HMPV has caused approximately 3 per cent of the cases of Influenza Like Illness (ILI) and Severe Acute Respiratory Illness (SARI) in the current season. The vast majority of cases have been caused by SARS-CoV-2 (that caused the Covid19 pandemic and is still circulating in the country), Influenza A, Influenza B, RSV and other pathogens. This distribution typically changes month-on-month. Of course, the more we test the more we will detect. For an infection like HMPV, the absolute numbers of cases are not important and need not be counted — only overall trends in virus circulation in the country are useful to know.

Further, there is no data to suggest that the circulating HMPV has mutated in any way that is of public health concern. ICMR and its institutes continue to track this aspect as well.

Anxieties about respiratory disease outbreaks are understandable in the wake of the Covid19 pandemic. Hence, science-based communication and response become even more critical for all sections of society.

When SARS-CoV-2 was first detected in 2019, it was a truly novel virus for the world. At the time, no one in the world had been exposed to SARS-CoV-2 or had specific immunity against it. In contrast, people across the world have been exposed to HMPV for decades and the virus is well studied. HMPV and SARS-CoV-2 belong to two very different virus families with fundamentally different characteristics and epidemiology, with strong seasonality seen for HMPV unlike SARS-CoV-2. Both viruses cause different severity of symptoms particularly over the long-term and the affected population segments do not fully overlap. HMPV in general causes milder illness with deaths being very rare and no long-term post-viral symptoms.

India’s Ministry of Health & Family Welfare has taken prompt action during this flu season, keeping in mind the sensitivities around HMPV. Learning from the Covid19 pandemic, ICMR and the National Centre for Disease Control (NCDC) are closely monitoring surveillance data across the country. The national and state governments are also communicating proactively. We should use this period to test our surveillance and risk communication systems, to learn and refine processes in anticipation of an actually virulent outbreak in the future.

The Niti Aayog published its framework report on future pandemic preparedness and emergency response in August 2024. The recommendations of this report should be implemented on priority along with increased investments in R&D for vaccines and counter measures against pathogens of concern, which have been identified by the World Health Organisation. This will help India to be fully prepared for future outbreaks, epidemics from known and emerging infections.

Finally, air pollution significantly exacerbates respiratory illnesses, including ILI and SARI, and is one of the leading drivers of mortality globally. It’s time we swiftly and effectively act on air pollution across the country through a multi-sectoral and all-of-government approach.

Swaminathan is chairperson, M S Swaminathan Research Foundation, Chennai, and principal advisor, MOHFW. Jandu is an independent consultant