Epidemiological characteristics and clinical correlations of human metapneumovirus (HMPV) infection in children aged 0–14 years in China: a systematic review and meta-analysis

OBJECTIVE: To systematically evaluate the human metapneumovirus (HMPV) detection status in Chinese children (0-14 years) via meta-analysis, clarify its epidemiological and clinical correlations, and support childhood respiratory infection prevention. METHODS: Following PRISMA guidelines, we searched CNKI, Wanfang, VIP, PubMed, and Web of Science for studies (January 2015-July 2025) on childhood HMPV infection in China. Statistical analysis was performed with R 4.5.1's Meta package. RESULTS: Seventy-eight eligible studies (334,901 participants; 15,612 HMPV-positive) were included. The overall HMPV detection rate was 4.56% (95% CI: 3.83%-5.43%). Subgroup analysis revealed the highest rate in 1-year-olds (6.02%), no significant sex difference (boys: 4.93%, girls: 4.86%), epidemic peaks in spring (4.48%) and winter (4.12%), a higher rate of acute lower respiratory tract infection (4.58%) than upper respiratory tract infection (2.92%), with bronchiolitis having the highest rate (14.11%, 95% CI: 7.73%-24.37%), similar rates in outpatients (4.70%) and inpatients (4.59%), and higher rates in Northeast China (10.84%) and Southwest China (10.16%). The overall HMPV-other respiratory virus coinfection rate was 28.72% (95% CI: 20.17%-39.13%), most commonly with RSV (21.87%) and HRV (21.44%).​ CONCLUSION: The overall HMPV detection rate in Chinese children (0-14 years) is 4.56%. The high-risk groups included 1-year-olds; the epidemic seasons were spring/winter; and the high-incidence regions were Northeast China/Southwest China. The HMPV coinfection rate was 28.72% (mainly RSV/HRV), and its strong association with bronchiolitis (14.11%) provides a reference for targeted prevention.