Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study
Por:
Wang X, Li Y, O'Brien KL, Madhi SA, Widdowson MA, Byass P, Omer SB, Abbas Q, Ali A, Amu A, Azziz-Baumgartner E, Bassat Q, Abdullah Brooks W, Chaves SS, Chung A, Cohen C, Echavarria M, Fasce RA, Gentile A, Gordon A, Groome M, Heikkinen T, Hirve S, Jara JH, Katz MA, Khuri-Bulos N, Krishnan A, de Leon O, Lucero MG, McCracken JP, Mira-Iglesias A, Moïsi JC, Munywoki PK, Ourohiré M, Polack FP, Rahi M, Rasmussen ZA, Rath BA, Saha SK, Simões EA, Sotomayor V, Thamthitiwat S, Treurnicht FK, Wamukoya M, Yoshida LM, Zar HJ, Campbell H, Nair H and Respiratory Virus Global Epidemiology Network
Publicada:
1 abr 2020
Ahead of Print:
20 feb 2020
Categoría:
Medicine (miscellaneous)
Resumen:
Background Seasonal influenza virus is a common cause of acute lower respiratory infection (ALRI) in young children. In 2008, we estimated that 20 million influenza-virus-associated ALRI and 1 million influenza-virus-associated severe ALRI occurred in children under 5 years globally. Despite this substantial burden, only a few low-income and middle-income countries have adopted routine influenza vaccination policies for children and, where present, these have achieved only low or unknown levels of vaccine uptake. Moreover, the influenza burden might have changed due to the emergence and circulation of influenza A/H1N1pdm09. We aimed to incorporate new data to update estimates of the global number of cases, hospital admissions, and mortality from influenza-virus-associated respiratory infections in children under 5 years in 2018.
Methods We estimated the regional and global burden of influenza-associated respiratory infections in children under 5 years from a systematic review of 100 studies published between Jan 1, 1995, and Dec 31, 2018, and a further 57 high-quality unpublished studies. We adapted the Newcastle-Ottawa Scale to assess the risk of bias. We estimated incidence and hospitalisation rates of influenza-virus-associated respiratory infections by severity, case ascertainment, region, and age. We estimated in-hospital deaths from influenza virus ALRI by combining hospital admissions and in-hospital case-fatality ratios of influenza virus ALRI. We estimated the upper bound of influenza virus-associated ALRI deaths based on the number of in-hospital deaths, US paediatric influenza-associated death data, and population-based childhood all-cause pneumonia mortality data in six sites in low-income and lower-middle-income countries.
Findings In 2018, among children under 5 years globally, there were an estimated 109.5 million influenza virus episodes (uncertainty range [UR] 63.1-190.6), 10.1 million influenza-virus-associated ALRI cases (6.8-15.1); 870 000 influenza-virus-associated ALRI hospital admissions (543 000-1 415 000), 15 300 in-hospital deaths (5800-43 800), and up to 34 800 (13 200-97 200) overall influenza-virus-associated ALRI deaths. Influenza virus accounted for 7% of ALRI cases, 5% of ALRI hospital admissions, and 4% of ALRI deaths in children under 5 years. About 23% of the hospital admissions and 36% of the in-hospital deaths were in infants under 6 months. About 82% of the in-hospital deaths occurred in low-income and lower-middle-income countries.
Interpretation A large proportion of the influenza-associated burden occurs among young infants and in low-income and lower middle-income countries. Our findings provide new and important evidence for maternal and paediatric influenza immunisation, and should inform future immunisation policy particularly in low-income and middle-income countries. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Filiaciones:
Wang X:
Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
Li Y:
Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
O'Brien KL:
Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Madhi SA:
Medical Research Council: Respiratory and Meningeal Pathogens Research Unit
Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Widdowson MA:
Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
Institute of Tropical Medicine, Antwerp, Belgium
Byass P:
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
Omer SB:
Yale Institute for Global Health
Section of Infectious Diseases, Department of Medicine, Yale School of Medicine
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
Abbas Q:
Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
Ali A:
Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
Amu A:
Dodowa Health Research Centre, Dodowa, Ghana
Azziz-Baumgartner E:
Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
Bassat Q:
Barcelona Global Health Institute, Hospital Clínic-University of Barcelona, Barcelona, Spain
Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
Abdullah Brooks W:
Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Chaves SS:
Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
Chung A:
Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
Cohen C:
Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Echavarria M:
Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas, Argentina
Fasce RA:
Public Health Institute of Chile, Región Metropolitana, Chile
Gentile A:
Ricardo Gutierrez Children Hospital, Buenos Aires, Argentina
Gordon A:
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
Groome M:
Medical Research Council: Respiratory and Meningeal Pathogens Research Unit
Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Heikkinen T:
Department of Pediatrics, University of Turku and Turku University Hospital, Finland
Hirve S:
Vadu Rural Health program, KEM Hospital Research Centre, Pune, Maharashtra, India
Jara JH:
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
Katz MA:
Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
Ben Gurion University of the Negev, School of Public Health and Medical School for International Health, Beer-Sheva, Israel
University of Michigan School of Public Health, Ann Arbor, MI, USA
Khuri-Bulos N:
Department of Pediatrics, University of Jordan School of Medicine, Amman, Jordan
Krishnan A:
Centre for Community Medicine, All India institute of Medical Sciences, New Delhi, India
de Leon O:
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
Lucero MG:
ARI Study Group, Research Institute for Tropical Medicine, Muntinlupa, Philippines
McCracken JP:
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
:
Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Salud Pública), Valencia, Spain
Moïsi JC:
Agence de Médecine Préventive, Paris, France
Munywoki PK:
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
Ourohiré M:
Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
Polack FP:
Fundacion INFANT, Buenos Aires, Argentina
Rahi M:
Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
Rasmussen ZA:
Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
Rath BA:
Vienna Vaccine Safety Initiative, Berlin, Germany
Saha SK:
Department of Microbiology, Child Health Research Foundation, Dhaka, Bangladesh
Simões EA:
Department of Pediatrics, Section of Infectious Diseases, University of Colorado, School of Medicine, Aurora, CO, USA
Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora CO, USA
Sotomayor V:
Epidemiology Department, Ministry of Health, Santiago, Chile
Thamthitiwat S:
Division of Global Health Protection, Thailand Ministry of Public Health
US CDC Collaboration, Nonthaburi, Thailand
Treurnicht FK:
Department of Medical Virology, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Wamukoya M:
African Population & Health Research Center, Nairobi, Kenya
Yoshida LM:
Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
Zar HJ:
Department of Paediatrics & Child Health and Medical Research Council unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
Campbell H:
Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
Nair H:
Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
Green Submitted, Green Published, Green Accepted, gold
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