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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  

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from a systematic review of 100 studies published between Jan 1, 1995, and Dec 31, 2018, and a further 57 high-quality unpublished studies.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。

 解释


很大一部分与流感相关的负担发生在幼儿以及低收入和中低收入国家。我们的研究结果为孕产妇和儿童流感免疫提供了新的重要证据,并应为未来的免疫政策,特别是低收入和中等收入国家的免疫政策提供信息。

 资金


WHO;比尔及梅琳达·盖茨基金会。

更新日期:2020-02-20
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