{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T21:30:30Z","timestamp":1777584630321,"version":"3.51.4"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014091","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014091","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012264","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1UL1 TR001857"],"award-info":[{"award-number":["1UL1 TR001857"]}],"id":[{"id":"10.13039\/501100012264","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Most studies of human metapneumovirus (HMPV) epidemiology have been among inpatients. This study examined the epidemiology of HMPV compared with other common viruses among outpatients seeking care for an acute respiratory illness (ARI) during 5 influenza seasons (2016\u20132017 to 2019\u20132020, before the coronavirus disease 2019 pandemic, and in 2021\u20132022, during the pandemic).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Outpatients \u22656 months old seeking care for ARI and presenting with cough of \u22647 days\u2019 duration provided nasal and pharyngeal swab samples, demographic data, and access to electronic medical record data. Samples were tested with reverse-transcription polymerase chain reaction assays for HMPV, influenza, parainfluenza virus (PIV) 1\u20134, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Student\u2032s t and \u03c72 tests were used to compare HMPV cases with other ARIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After exclusion of 68 coinfections, 7143 patients remained; 2017 had influenza, 762 had RSV, 423 had HMPV, 83 had PIV, 352 had SARS-CoV-2, and 3506 tested polymerase chain reaction negative for all of these viruses. Of all patients with ARI each influenza season, 30.2%\u201337.1% tested positive for influenza, 11.3%\u201313.6% for RSV, 4.7%\u20137.3% for HMPV, and 0.1%\u20131.9% for PIV. Compared with patients with RSV, those with HMPV less often had congestion, dyspnea, and sore throat. Compared with patients with influenza, those with HMPV were less likely to have fever but more often had congestion or dyspnea and felt worse at 7\u201314-day follow-up. Children recovered from HMPV faster than adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HMPV is an important cause of outpatient ARI during influenza season. Patients with HMPV had slightly different demographic characteristics and symptoms from those with other ARIs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag081","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T12:40:44Z","timestamp":1771418444000},"source":"Crossref","is-referenced-by-count":1,"title":["Epidemiology of HMPV and Other Respiratory Viral Infections Among Outpatients, 2016\u20132022"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1702-2690","authenticated-orcid":false,"given":"Mary Patricia","family":"Nowalk","sequence":"first","affiliation":[{"name":"Department of Family Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"D\u2019Agostino","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Pittsburgh School of Public Health , Pittsburgh, Pennsylvania ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1512-9600","authenticated-orcid":false,"given":"Gabriella","family":"Alicea","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Pittsburgh School of Public Health , Pittsburgh, Pennsylvania ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Susick","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lora L","family":"Pless","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard K","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G K","family":"Balasubramani","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Pittsburgh School of Public Health , Pittsburgh, Pennsylvania ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John V","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Wisconsin\u2014Madison School of Medicine and Public Health , Madison, Wisconsin ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"2026031216115506900_ofag081-B1","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S2213-2600(24)00367-9","article-title":"Burden of RSV infections among young children in primary care: a prospective cohort study in five European countries (2021\u201323)","volume":"13","author":"Hak","year":"2025","journal-title":"Lancet Respir Med"},{"key":"2026031216115506900_ofag081-B2","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3390\/diseases13020035","article-title":"Burden and economic impact of respiratory viral infections in adults aged 60 and older: a focus on RSV","volume":"13","author":"Pel\u00e1ez","year":"2025","journal-title":"Diseases"},{"key":"2026031216115506900_ofag081-B3","doi-asserted-by":"crossref","first-page":"020416","DOI":"10.7189\/jogh.05.020416","article-title":"Risk factors for respiratory syncytial virus associated with acute lower respiratory infection in children under five years: systematic review and meta\u2013analysis","volume":"5","author":"Shi","year":"2015","journal-title":"J Glob Health"},{"key":"2026031216115506900_ofag081-B4","doi-asserted-by":"crossref","first-page":"S577","DOI":"10.1093\/infdis\/jiz059","article-title":"Global disease burden estimates of respiratory syncytial virus\u2013associated acute respiratory infection in older adults in 2015: a systematic review and meta-analysis","volume":"222","author":"Shi","year":"2019","journal-title":"J Infect Dis"},{"key":"2026031216115506900_ofag081-B5","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1055\/s-0031-1283284","article-title":"Human metapneumovirus","volume":"32","author":"Kroll","year":"2011","journal-title":"Semin Respir Critical Care Med"},{"key":"2026031216115506900_ofag081-B6","doi-asserted-by":"crossref","first-page":"469","DOI":"10.3390\/microorganisms13030469","article-title":"Epidemiological transitions in influenza dynamics in the United States: insights from recent pandemic challenges","volume":"13","author":"Giovanetti","year":"2025","journal-title":"Microorganisms"},{"key":"2026031216115506900_ofag081-B7","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.3390\/jcm14041387","article-title":"Changes in respiratory viruses\u2019 activity in children during the COVID-19 pandemic: a systematic review","volume":"14","author":"Maglione","year":"2025","journal-title":"J Clin Med"},{"key":"2026031216115506900_ofag081-B8","doi-asserted-by":"crossref","first-page":"182","DOI":"10.15585\/mmwr.mm7411a1","article-title":"Human metapneumovirus seasonality and co-circulation with respiratory syncytial virus\u2014United States, 2014\u20132024","volume":"74","author":"Jobe","year":"2025","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026031216115506900_ofag081-B9","author":"Centers for Disease Control and Prevention"},{"key":"2026031216115506900_ofag081-B10","author":"Centers for Disease Control and Prevention"},{"key":"2026031216115506900_ofag081-B11","doi-asserted-by":"crossref","first-page":"920","DOI":"10.15585\/mmwr.mm7234a4","article-title":"Use of nirsevimab for the prevention of respiratory syncytial virus disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices\u2014United States, 2023","volume":"72","author":"Jones","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026031216115506900_ofag081-B12","doi-asserted-by":"crossref","first-page":"3875","DOI":"10.1111\/jgs.19176","article-title":"Protection against influenza hospitalizations from enhanced influenza vaccines among older adults: a systematic review and network meta-analysis","volume":"72","author":"Ferdinands","year":"2024","journal-title":"J Am Geriatr Soc"},{"key":"2026031216115506900_ofag081-B13","author":"Centers for Disease Control and Prevention"},{"key":"2026031216115506900_ofag081-B14","author":"United Nations News"},{"key":"2026031216115506900_ofag081-B15","doi-asserted-by":"crossref","first-page":"2531","DOI":"10.1056\/NEJMc2204560","article-title":"Association between COVID-19 vaccination and influenza vaccination rates","volume":"386","author":"Leuchter","year":"2022","journal-title":"N Engl J Med"},{"key":"2026031216115506900_ofag081-B16","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1111\/irv.13029","article-title":"Effectiveness of two and three mRNA COVID-19 vaccine doses against Omicron- and Delta-related outpatient illness among adults, October 2021-February 2022","volume":"16","author":"Kim","year":"2022","journal-title":"Influenza Other Respir Viruses"},{"key":"2026031216115506900_ofag081-B17","doi-asserted-by":"crossref","first-page":"3880","DOI":"10.1128\/JCM.01873-13","article-title":"Consistency of influenza A virus detection test results across respiratory specimen collection methods using real-time reverse transcription-PCR","volume":"51","author":"Spencer","year":"2013","journal-title":"J Clin Microbiol"},{"key":"2026031216115506900_ofag081-B18","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1186\/1743-422X-8-332","article-title":"Real-world comparison of two molecular methods for detection of respiratory viruses","volume":"8","author":"Ali","year":"2011","journal-title":"Virol J"},{"key":"2026031216115506900_ofag081-B19","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1038\/89098","article-title":"A newly discovered human pneumovirus isolated from young children with respiratory tract disease","volume":"7","author":"Van den Hoogen","year":"2001","journal-title":"Nat Med"},{"key":"2026031216115506900_ofag081-B20","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1111\/irv.13040","article-title":"Population-based hospitalization burden estimates for respiratory viruses, 2015\u20132019","volume":"16","author":"Zimmerman","year":"2022","journal-title":"Influenza Other Respir Viruses"},{"key":"2026031216115506900_ofag081-B21","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1086\/367901","article-title":"Human metapneumovirus infections in young and elderly adults","volume":"187","author":"Falsey","year":"2003","journal-title":"J Infect Dis"},{"key":"2026031216115506900_ofag081-B22","doi-asserted-by":"crossref","first-page":"e70017","DOI":"10.1111\/irv.70017","article-title":"Seasonality and co-detection of respiratory viral infections among hospitalised patients admitted with acute respiratory illness\u2014Valencia Region, Spain, 2010\u20132021","volume":"18","author":"Shirreff","year":"2024","journal-title":"Influenza Other Respir Viruses"},{"key":"2026031216115506900_ofag081-B23","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1093\/infdis\/jiae064","article-title":"The burden of human metapneumovirus-and influenza-associated hospitalizations in adults in New Zealand, 2012\u20132015","volume":"230","author":"Aminisani","year":"2024","journal-title":"J Infect Dis"},{"key":"2026031216115506900_ofag081-B24","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.resinv.2024.05.015","article-title":"Burden of respiratory syncytial virus, human metapneumovirus and influenza virus infections in Japanese adults in the Hospitalized Acute Respiratory Tract Infection Study","volume":"62","author":"Shinkai","year":"2024","journal-title":"Respir Investig"},{"key":"2026031216115506900_ofag081-B25","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s12879-023-08750-7","article-title":"Epidemiological trends of respiratory tract pathogens detected via mPCR in Australian adult patients before COVID-19","volume":"24","author":"Grech","year":"2024","journal-title":"BMC Infect Dis"},{"key":"2026031216115506900_ofag081-B26","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1002\/jhm.13320","article-title":"The burden of RSV, hMPV, and PIV amongst hospitalized adults in the United States from 2016 to 2019","volume":"19","author":"Bhasin","year":"2024","journal-title":"J Hosp Med"},{"key":"2026031216115506900_ofag081-B27","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1111\/irv.12247","article-title":"Influenza and other respiratory virus infections in outpatients with medically attended acute respiratory infection during the 2011\u201312 influenza season","volume":"8","author":"Zimmerman","year":"2014","journal-title":"Influenza Other Respir Viruses"},{"key":"2026031216115506900_ofag081-B28","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s12879-015-0806-2","article-title":"Viral infections in outpatients with medically attended acute respiratory illness during the 2012\u20132013 influenza season","volume":"15","author":"Zimmerman","year":"2015","journal-title":"BMC Infect Dis"},{"key":"2026031216115506900_ofag081-B29","doi-asserted-by":"crossref","first-page":"2489","DOI":"10.1001\/archinte.168.22.2489","article-title":"Another piece of the puzzle: human metapneumovirus infections in adults","volume":"168","author":"Walsh","year":"2008","journal-title":"Arch Intern Med"},{"key":"2026031216115506900_ofag081-B30","doi-asserted-by":"crossref","first-page":"e1031","DOI":"10.1016\/S2214-109X(19)30264-5","article-title":"Global patterns in monthly activity of influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus: a systematic analysis","volume":"7","author":"Li","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2026031216115506900_ofag081-B31","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1056\/NEJMoa1204630","article-title":"Burden of human metapneumovirus infection in young children","volume":"368","author":"Edwards","year":"2013","journal-title":"N Engl J Med"},{"key":"2026031216115506900_ofag081-B32","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1086\/499274","article-title":"The role of human metapneumovirus in upper respiratory tract infections in children: a 20-year experience","volume":"193","author":"Williams","year":"2006","journal-title":"J Infect Dis"},{"key":"2026031216115506900_ofag081-B33","doi-asserted-by":"crossref","first-page":"135","DOI":"10.12688\/f1000research.12625.1","article-title":"Human metapneumovirus\u2014what we know now","volume":"7","author":"Shafagati","year":"2018","journal-title":"F1000Res"},{"key":"2026031216115506900_ofag081-B34","doi-asserted-by":"crossref","first-page":"piaf026","DOI":"10.1093\/jpids\/piaf026","article-title":"The epidemiology and burden of human parainfluenza virus hospitalizations in US children","volume":"14","author":"Weinberg","year":"2025","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2026031216115506900_ofag081-B35","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1093\/jpids\/piu047","article-title":"Estimates of parainfluenza virus-associated hospitalizations and cost among children aged less than 5 years in the United States, 1998\u20132010","volume":"5","author":"Abedi","year":"2016","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2026031216115506900_ofag081-B36","first-page":"72090","article-title":"Principles and guidelines for recipients of NIH research grants and contracts on obtaining and disseminating biomedical research resources","volume":"64","author":"National Institutes of Health","year":"1999","journal-title":"Federal Register."}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofag081\/66989136\/ofag081.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/3\/ofag081\/66989136\/ofag081.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/3\/ofag081\/66989136\/ofag081.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T20:12:06Z","timestamp":1773346326000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofag081\/8490265"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,3]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofag081","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2026,2,19]]},"article-number":"ofag081"}}