Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study.,The Lancet Global Health

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Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study.
The Lancet Global Health ( IF 19.9 ) Pub Date : 2020-02-20 , DOI: 10.1016/s2214-109x(19)30545-5
Xin Wang ₁ , You Li ₁ , Katherine L O'Brien ₂ , Shabir A Madhi ₃ , Marc-Alain Widdowson ₄ , Peter Byass ₅ , Saad B Omer ₆ , Qalab Abbas ₇ , Asad Ali ₇ , Alberta Amu ₈ , Eduardo Azziz-Baumgartner ₉ , Quique Bassat ₁₀ , W Abdullah Brooks ₂ , Sandra S Chaves ₁₁ , Alexandria Chung ₁ , Cheryl Cohen ₁₂ , Marcela Echavarria ₁₃ , Rodrigo A Fasce ₁₄ , Angela Gentile ₁₅ , Aubree Gordon ₁₆ , Michelle Groome ₃ , Terho Heikkinen ₁₇ , Siddhivinayak Hirve ₁₈ , Jorge H Jara ₁₉ , Mark A Katz ₂₀ , Najwa Khuri-Bulos ₂₁ , Anand Krishnan ₂₂ , Oscar de Leon ₁₉ , Marilla G Lucero ₂₃ , John P McCracken ₁₉ , Ainara Mira-Iglesias ₂₄ , Jennifer C Moïsi ₂₅ , Patrick K Munywoki ₂₆ , Millogo Ourohiré ₂₇ , Fernando P Polack ₂₈ , Manveer Rahi ₁ , Zeba A Rasmussen ₂₉ , Barbara A Rath ₃₀ , Samir K Saha ₃₁ , Eric Af Simões ₃₂ , Viviana Sotomayor ₃₃ , Somsak Thamthitiwat ₃₄ , Florette K Treurnicht ₃₅ , Marylene Wamukoya ₃₆ , Lay-Myint Yoshida ₃₇ , Heather J Zar ₃₈ , Harry Campbell ₁ , Harish Nair ₁ ,

Affiliation

Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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.
Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya; Institute of Tropical Medicine, Antwerp, Belgium.
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
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.
Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Dodowa Health Research Centre, Dodowa, Ghana.
Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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.
Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya.
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.
Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas, Argentina.
Public Health Institute of Chile, Región Metropolitana, Chile.
Ricardo Gutierrez Children Hospital, Buenos Aires, Argentina.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Department of Pediatrics, University of Turku and Turku University Hospital, Finland.
Vadu Rural Health program, KEM Hospital Research Centre, Pune, Maharashtra, India.
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
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.
Department of Pediatrics, University of Jordan School of Medicine, Amman, Jordan.
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
ARI Study Group, Research Institute for Tropical Medicine, Muntinlupa, Philippines.
Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Salud Pública), Valencia, Spain.
Agence de Médecine Préventive, Paris, France.
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
Fundacion INFANT, Buenos Aires, Argentina.
Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
Vienna Vaccine Safety Initiative, Berlin, Germany.
Department of Microbiology, Child Health Research Foundation, Dhaka, Bangladesh.
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.
Epidemiology Department, Ministry of Health, Santiago, Chile.
Division of Global Health Protection, Thailand Ministry of Public Health; US CDC Collaboration, Nonthaburi, Thailand.
Department of Medical Virology, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
African Population & Health Research Center, Nairobi, Kenya.
Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
Department of Paediatrics & Child Health and Medical Research Council unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.

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.

Funding

WHO; Bill & Melinda Gates Foundation.

中文翻译：

2018 年 5 岁以下儿童季节性流感相关呼吸道感染的全球负担：系统回顾和建模研究。

背景

季节性流感病毒是幼儿急性下呼吸道感染 (ALRI) 的常见原因。 2008年，我们估计全球5岁以下儿童中发生了2000万例与流感病毒相关的ALRI和100万例与流感病毒相关的严重ALRI。尽管负担沉重，但只有少数低收入和中等收入国家采取了针对儿童的常规流感疫苗接种政策，而且即使有这些政策，疫苗接种率也很低或未知。此外，由于甲型H1N1pdm09流感的出现和传播，流感负担可能发生变化。我们的目标是纳入新数据，更新 2018 年全球 5 岁以下儿童流感病毒相关呼吸道感染病例数、住院人数和死亡率的估计值。

方法

我们通过对 1995 年 1 月 1 日至 2018 年 12 月 31 日期间发表的 100 项研究以及另外 57 项高质量未发表研究的系统回顾，估计了 5 岁以下儿童流感相关呼吸道感染的区域和全球负担。我们采用纽卡斯尔-渥太华量表来评估偏倚风险。我们根据严重程度、病例确定、地区和年龄估算了流感病毒相关呼吸道感染的发病率和住院率。我们通过结合流感病毒 ALRI 的入院情况和院内病死率来估计流感病毒 ALRI 的院内死亡人数。我们根据低收入及以下地区六个地点的院内死亡人数、美国儿童流感相关死亡数据以及基于人口的儿童全因肺炎死亡率数据，估计了流感病毒相关 ALRI 死亡上限。 - 中等收入国家。

发现

2018 年，全球 5 岁以下儿童中估计有 1.09·5 亿流感病毒发作（不确定性范围 [UR] 63·1–190·6），10·100 万流感病毒相关 ALRI 病例（6· 8–15·1); 870 000 例与流感病毒相关的 ALRI 入院 (543 000–1 415 000)，15 300 例院内死亡 (5800–43 800)，总共有 34 800 例 (13 200–97 200) 例与流感病毒相关的死亡ALRI 死亡。 5 岁以下儿童中，流感病毒占 ALRI 病例的 7%、ALRI 住院人数的 5% 和 ALRI 死亡的 4%。大约 23% 的入院病例和 36% 的院内死亡病例是 6 个月以下的婴儿。约 82% 的院内死亡发生在低收入和中低收入国家。