Human Metapneumovirus: A Neglected Contributor to Acute Respiratory Infections in Bangladesh: A Public Health Perspective.

Background and Aims: Acute respiratory tract infections (ARTIs) are a primary cause of mortality in Bangladesh, yet the Human Metapneumovirus (hMPV) remains critically underdiagnosed. This perspective aims to evaluate the current diagnostic landscape, identify specific surveillance gaps, and propose a prioritized strategic framework for integrating hMPV into national health priorities. Search Strategy: We conducted a targeted narrative synthesis of existing regional and local literature, utilizing databases such as PubMed, Google Scholar, and Banglajol, focusing on epidemiological data from the PERCH study and IEDCR reports. Results: Preliminary evidence suggests that hMPV may account for up to 7.4% of pediatric ARTI hospitalizations in urban centers like Dhaka. However, a critical lack of RT-PCR access in rural areas and a narrow surveillance focus on Influenza and SARS-CoV-2 result in a likely underestimation of the hMPV burden. Systemic hurdles include high diagnostic costs (approximately 3000-5000 BDT per test) and limited clinician awareness. Conclusion: To mitigate this critical gap, Bangladesh must transition from research-based detection to integrated sentinel surveillance. We recommend a tiered approach involving laboratory modernization, clinician training, and the adoption of affordable point-of-care testing to protect vulnerable populations.