HMPV in Bangladesh: Tackling respiratory risks in a crowded nation

As the world grapples with the persistent impact of respiratory illnesses, a new threat has quietly emerged in Bangladesh: human metapneumovirus (HMPV). This year, a person infected with HMPV was identified in Narshingdi, marking the first case of the virus in the country for 2025. The infected individual, who had been undergoing medical treatment at a hospital in the city, was diagnosed on 9 January. 

This case serves as a stark reminder of the rising potential for HMPV to spread in Bangladesh, a country already grappling with a heavy burden of respiratory diseases.

Why should Bangladesh pay attention?

With a population of over 170 million, Bangladesh is densely populated, particularly in urban slums where crowded living conditions facilitate the rapid spread of airborne diseases. Children under five, who account for a significant portion of the population, already face high rates of respiratory infections and malnutrition, increasing their susceptibility to severe HMPV cases. 

Respiratory diseases are already a top public health concern in Bangladesh, with pneumonia being the leading infectious cause of death in children under five, as reported by the World Health Organisation (WHO). 

Given the rising burden of air pollution, malnutrition, and inadequate healthcare infrastructure, the introduction of HMPV into this complex health landscape could exacerbate the already dire situation. This underreporting could lead to unrecognised outbreaks, straining an already fragile healthcare system.

Recent studies from neighbouring countries such as India and Nepal highlight the growing prevalence of HMPV. For instance, in India, HMPV has been implicated in a substantial percentage of hospitalisations for severe respiratory illnesses, especially among children under five years of age. 

In Nepal, a study conducted in 2020 revealed that HMPV contributed to a significant number of respiratory-related hospital admissions. These neighbouring countries have already recognised HMPV's role in the respiratory illness burden, and Bangladesh, with its similar socio-economic and environmental conditions, faces a parallel risk.

Learning from neighbouring countries

Bangladesh can look to its neighbouring countries to learn how to effectively address HMPV. Countries like India and Nepal have already recognised the significance of HMPV in the respiratory illness burden. In early January 2025, India reported its first confirmed cases of HMPV, with infections identified in Mumbai, Bengaluru, Nagpur, and Tamil Nadu. 

In response, the Indian government intensified surveillance for respiratory illnesses, including Influenza-Like Illness (ILI) and Severe Acute Respiratory Infection (SARI). Health authorities advised states to enhance public awareness regarding preventive measures, such as frequent handwashing, covering mouth and nose while coughing or sneezing, and avoiding close contact with symptomatic individuals. 

Nepal has proactively addressed respiratory illnesses by planning to test patients for HMPV to assess its spread during the winter season. Additionally, Nepal has focused on strengthening healthcare systems in remote and flood-prone areas to address emerging respiratory threats, including HMPV. 

The use of mobile health units and community healthcare workers has been particularly effective in Nepal's rural areas, where access to healthcare is limited. By ensuring early detection and treatment, these measures have significantly reduced morbidity and mortality caused by respiratory infections, including those associated with HMPV.

The path forward

To address the potential threat of HMPV effectively, Bangladesh must adopt a comprehensive and context-specific strategy. Here are actionable steps tailored to the country's unique challenges and opportunities:

Integrating HMPV into National Health Policies: Incorporating HMPV into the national health agenda and disease surveillance programs is critical. It should be recognised as a priority pathogen under existing frameworks like the National Plan for Action on Pneumonia and Diarrhoea.

Community-based surveillance: Bangladesh's vibrant network of community health workers, such as family welfare assistants and community health care providers, can play a vital role in detecting respiratory illnesses early. Training these frontline workers to identify and report potential cases of HMPV will enhance grassroots-level surveillance.

Enhancing laboratory networks: Public hospitals and community health centres across the country must be equipped with affordable and user-friendly diagnostic tools, such as rapid antigen tests or affordable alternatives to PCR testing. Establishing regional diagnostic hubs in divisional cities can reduce the time and costs associated with testing.

Expanding school health programs: School-going children are often the first to contract and spread respiratory viruses. Incorporating respiratory hygiene education into school health programs, promoting hand hygiene, and ensuring adequate ventilation in classrooms can significantly reduce transmission rates.

Establishing mobile health units: In remote and vulnerable regions, mobile health units equipped with diagnostic and treatment tools can provide timely healthcare access. These units can also serve as vehicles for public awareness campaigns, especially in hard-to-reach areas.

Climate-resilient healthcare facilities: Given the frequent displacement caused by natural disasters, healthcare facilities in vulnerable areas must be built or upgraded to withstand climatic shocks. Ensuring these facilities remain operational during crises will help address spikes in respiratory infections, including HMPV.

Scaling up oxygen availability: Since HMPV often leads to severe respiratory distress in vulnerable populations, ensuring the availability of medical oxygen at all healthcare levels is essential. Partnerships with the private sector can be explored to expand oxygen production and distribution.

Engaging religious and community leaders: Religious and community leaders hold significant influence in rural Bangladesh. Involving them in public health campaigns can help disseminate critical information on respiratory hygiene and encourage early healthcare-seeking behaviour.

Targeted health interventions for high-risk groups: Special initiatives are needed to address the needs of high-risk groups, such as malnourished children, the elderly, and people with chronic illnesses. Nutritional support, vaccination campaigns for other respiratory illnesses, and tailored health services for these groups can reduce overall vulnerability.

Encouraging local research and innovation: Local universities and research institutions should be incentivised to study HMPV's epidemiology and socio-economic impact in Bangladesh. Collaborative grants and funding opportunities can encourage multidisciplinary research. Innovation in cost-effective diagnostics and telemedicine services can also enhance the healthcare system's capacity to deal with HMPV.

The identification of HMPV in Bangladesh this year is a wake-up call for the country. With its fragile healthcare system, overcrowded urban centres, and ongoing public health challenges, Bangladesh cannot afford to ignore the threat posed by HMPV. 

By learning from the experiences of neighbouring countries, strengthening surveillance and diagnostic capacities, and implementing proactive public health measures, Bangladesh can mitigate the risks associated with this emerging virus. Taking action now will ensure that the country is better prepared to protect its population from the looming threat of human metapneumovirus.

Md Al-Mamun is a researcher and social scientist at BIGD, an applied social science research and teaching institute at BRAC University. 

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.