In Reply: In their recent study, Borgmann et al1 highlighted the underestimated clinical spectrum of human metapneumovirus (hMPV) infection in infants and young children, as well as its substantial direct and indirect costs. Nevertheless, hMPV continues to receive comparatively limited attention from medical professionals, particularly when contrasted with respiratory syncytial virus (RSV) and seasonal influenza.2 To explore this gap, we conducted a questionnaire-based survey among 255 healthcare professionals attending the International Conference of Clinical Neonatology and Respiratory Viruses (September 2025; Turin, Italy). The instrument, adapted from previously validated RSV surveys,3,4 assessed knowledge, risk perception and attitudes toward potential preventive strategies, including monoclonal antibodies (mAbs) and candidate vaccination approaches (maternal, infant and adult). Knowledge scores (KS) and risk perception scores (RPS) were expressed as percentages. Preliminary findings, summarized later, appear highly consistent with and complementary to the study by Borgmann et al,1 as they underscore the substantial knowledge gaps among healthcare professionals regarding hMPV. Eighty-six participants completed the survey (response rate, 33.7%). Respondents were predominantly female (54.7%), with a mean age of 47.7 ± 12.1 years; 79.1% were of European origin (Table 1; see Supplemental Digital Content 1–14, https://links.lww.com/INF/G598, for details). Overall, KS were suboptimal, with particularly low correct response rates regarding complications of hMPV in adults (14.0%), case fatality ratio in children younger than 5 years (22.1%) and seasonality relative to RSV (36.0%). Risk perception was highest for adults aged ≥65 years (mean RPS, 74.3% ± 24.1), followed by infants (<1 year; 68.0% ± 22.3), adults (39.4% ± 26.5) and children (36.5% ± 21.2). Prior diagnosis of hMPV (68.6%) was associated with higher KS (59.7% ± 20.7 vs. 48.1% ± 24.6; P = 0.039), without significant differences in RPS. Perceived impact of hMPV was rated lower than that of influenza (P = 0.047) and RSV (P < 0.001). Notably, RPS for adults and children was inversely correlated with KS (P = 0.019 and P = 0.007, respectively). TABLE 1. - Characteristics of Professionals Participating into the Survey on Knowledge, Attitudes, Practices, on Human Metapneumovirus (hMPV), in General and by Having Had or Not Previously Diagnosed Any Case of hMPV Total, N./86, % Previous Diagnosis of Cases Affected by hMPV P Value N./59, % N./27, % Gender 0.413 Male 39, 45.3% 25, 42.4% 14, 51.9% Female 47, 54.7% 34, 57.6% 13, 48.1% Any background in pediatric infectious diseases 58, 67.4% 41, 69.5% 17, 63.0% 0.363 Age (mean, SD) 47.7 ± 12.1 47.8 ± 11.1 47.5 ± 14.4 0.934 Seniority (mean, SD) 20.7 ± 12.2 21.4 ± 10.9 19.3 ± 14.6 0.503 Country 0.090 Italy 27, 31.4% 18, 30.5% 9, 33.3% European country 41, 47.7% 31, 52.5% 10, 37.0% North America 13, 15.1% 6, 10.2% 7, 25.9% Other 5, 5.8% 4, 6.8% 1, 3.7% Practices Previously diagnosed a case of hMPV 59, 68.6% - - - Previously required hospitalization of cases affected by hMPV 44, 51.2% 44, 74.6% 0, - < 0.001 Knowledge status Knowledge score (mean, SD) 56.1 ± 22.5 59.7 ± 20.7 48.1 ± 24.6 0.039 Risk perception Risk perception score (mean, DS) Infants (<1 yr old) 68.0 ± 22.3 69.2 ± 23.5 65.6 ± 19.4 0.499 Children (1–17 yr) 36.5 ± 21.2 36.3 ± 18.2 36.7 ± 26.9 0.944 Adults (18–64 yr) 39.4 ± 26.5 38.6 ± 24.2 41.2 ± 31.5 0.705 Older adults (65+ yr) 74.3 ± 24.1 74.7 ± 25.8 73.5 ± 20.1 0.811 Perceived impact on daily practice (1–10) hMPV 6.8 ± 2.1 6.8 ± 2.2 6.9 ± 2.0 0.830 Seasonal flu 7.7 ± 1.9 8.1 ± 1.5 6.7 ± 2.3 0.005 COVID-19 6.4 ± 2.5 6.3 ± 2.4 6.4 ± 2.6 0.860 Respiratory syncytial virus 8.4 ± 2.1 8.6 ± 2.3 8.0 ± 1.7 0.273 Adenovirus 7.4 ± 1.9 7.8 ± 1.5 6.4 ± 2.2 0.004 Mycoplasma 6.0 ± 2.3 6.2 ± 2.1 5.5 ± 2.6 0.203 Pneumococcus 6.1 ± 2.6 6.5 ± 2.3 5.2 ± 3.0 0.044 Preferred preventative intervention (somewhat agree vs. somewhat disagree) Infant mAb, short acting 34 (39.5%) 22 (37.3%) 12 (44.4%) 0.695 Infant mAb, long acting 53 (61.6%) 41 (69.5%) 12 (44.4%) 0.048 Maternal vaccination 43 (50.0%) 31 (52.5%) 12 (44.4%) 0.642 Infant vaccination 47 (54.7%) 30 (50.8%) 17 (63.0%) 0.416 Preferred qualities for a putative hMPV vaccine (somewhat agree vs. somewhat disagree) Avoiding natural infection 43 (50.0%) 31 (52.5%) 12 (44.4%) 0.642 Avoiding complications 70 (81.4%) 54 (91.5%) 16 (59.3%) 0.001 Avoiding hospitalizations 74 (86.0%) 55 (93.2%) 19 (70.4%) 0.012 Retaining effectiveness in ≥65 years old 72 (83.7%) 52 (88.1%) 20 (74.1%) 0.185 P Values were calculated by means of chi-squared test for categorical variables, and Mann–Whitney test for continuous variables.COVID-19 indicates coronavirus disease 2019; SD, standard deviation. Among potential preventive options, extended half-life mAbs were most frequently endorsed (61.6%), followed by infant (54.7%) and maternal vaccination (50.0%). Desired benefits included prevention of hospitalizations (86.0%), effectiveness in older adults (83.7%) and avoidance of complications (81.4%). In multivariable analysis, a background in pediatric infectious diseases was independently associated with acceptance of mAb prophylaxis (adjusted odds ratio aOR, 6.85; 95% confidence interval CI, 1.59–29.46). Higher KS predicted acceptance of infant vaccination (aOR, 1.03; 95% CI, 1.01–1.06), long-acting mAbs (aOR, 1.10; 95% CI, 1.03–1.17) and maternal vaccination (aOR, 1.03; 95% CI, 1.00–1.06). Despite the limited sample size, our findings reveal substantial knowledge gaps and inconsistent risk perception regarding hMPV among healthcare professionals, underscoring the need for targeted educational initiatives. In anticipation of emerging preventive strategies,5 enhanced professional training may facilitate informed and confident adoption of innovative interventions, including vaccines and monoclonal antibodies.
Riccò et al. (Mon,) studied this question.