Prevalence of human metapneumovirus infection among children suffering from acute respiratory illness in India: a systematic review and meta-analysis.

Acute respiratory infections (ARI) are a leading cause of pediatric morbidity and mortality worldwide, with India bearing a significant burden. Human metapneumovirus (HMPV), an under-recognized respiratory pathogen, has been implicated in ARI, yet its prevalence in India remains inadequately characterized. The objective of this study was to estimate the prevalence of HMPV among children with ARI in India and assess regional, temporal, and demographic trends to guide public health interventions. This systematic review and meta-analysis was conducted following PRISMA guidelines. Data were extracted from 30 studies encompassing 12,534 children with ARI across India from 2004 to 2024. A random-effects model was used to calculate pooled prevalence, with subgroup and sensitivity analyses to explore heterogeneity. Publication bias was assessed using Egger's test and funnel plots. The pooled prevalence of HMPV was 5% (95% confidence interval: 4-6%), with significant heterogeneity (I²=95%). Subgroup analyses revealed higher prevalence in the northeast region (7%) and among children under 5 years (6%), compared to older age groups (2%). No significant differences were observed in prevalence pre- and post-COVID-19. Sensitivity analyses confirmed the robustness of findings, with minimal impact of publication bias. HMPV is a significant contributor to pediatric ARI in India, particularly among children under 5 years, highlighting its public health importance. The lack of a post-COVID-19 surge in prevalence suggests sustained circulation and widespread immunity. These findings underscore the need for enhanced diagnostic capacities, routine surveillance, and targeted interventions to mitigate the burden of HMPV-related ARI in vulnerable populations.