Multicenter Cross-sectional Study on the Epidemiology of Human Metapneumovirus in Italy, 2022-2024, With a Focus on Adults Over 50 Years of Age.

Background. Human metapneumovirus (hMPV) infections have a significant impact on public health. However, the extent of this burden in Italy remains poorly defined due to a lack of comprehensive data. The aim of this cross-sectional multicenter study was to understand the epidemiology of hMPV in Italy, particularly in older adults. Methods. We analyzed laboratory data from molecular respiratory viral diagnostic tests conducted at 17 centers across Italy from September 2022 to August 2024. Respiratory viruses were tested from outpatients for epidemiologic surveillance and from patients presenting to tertiary hospitals for diagnostic purpose. G gene sequencing was performed on a limited number of circulating strains. Results. Data from 96 460 tests yielded an overall hMPV positivity rate of 3.4%; the hMPV positivity rate was 2.6% in adults aged 50 years and older, a third of whom were aged >80 years. In north-west Italy, hMPV was detected more frequently in outpatients than in hospitalized patients. The temporal distribution of cases showed seasonal peaks in February 2023 and April 2024, which exhibited some geographic variation but overlapped in the general population and in the elderly. Phylogenetic analysis suggested an even distribution of hMPV-A and -B, with a predominance of clades A2c with a 111-nucleotide duplication and B2b, and the possible extinction of previously circulating clades A2c with a 180-nucleotide duplication and B2a. Conclusions. hMPV was shown to be a relevant respiratory pathogen in older adults, who could be more likely to have severe outcomes. These findings may inform hMPV surveillance and the development of prevention strategies.