Background

Respiratory viruses are increasingly detected in children with community-acquired pneumonia but prevalence estimates vary substantially. We aimed to systematically review and pool estimates for 22 viruses commonly associated with community-acquired pneumonia.

Methods

We conducted a systematic review and meta-analysis to determine the prevalence of each of the common respiratory viruses detected by any diagnostic method in children aged up to 18 years with community-acquired pneumonia. We searched MEDLINE, PubMed, Embase, Web of Science, and Scopus databases with no language restrictions for relevant published articles and reports published between Jan 1, 1995, and Dec 31, 2019, restricting the review to pre-COVID-19 pandemic years. Three independent reviewers screened articles and extracted data using a predefined protocol. We calculated the pooled prevalence for each virus in childhood pneumonia using DerSimonian–Laird random-effects models. We assessed bias using the Newcastle–Ottawa Scale. The review protocol was registered in PROSPERO (CRD42016034047).

Findings

We identified 186 eligible articles that represented 152 209 children up to age 18 years with community-acquired pneumonia. One or more respiratory viruses were detected in 55·0% (95% CI 50·4–59·7) of paediatric patients with a diagnosis of community-acquired pneumonia; heterogeneity was high (I²=99·4%). Respiratory syncytial virus (22·7%, 20·9–24·5) and rhinovirus (22·1%, 19·5–24·7) were the most commonly detected causes of paediatric pneumonia globally, with other viruses detected in 1–9% of cases. There was non-significant variation in prevalence by the country's national income, under-5 mortality rate, or WHO region.

Interpretation

Respiratory viruses are frequently detected in community-acquired pneumonia among children of all ages and geographical regions, with non-significant variation by country's national income or region. Further strategies to limit antibiotic use in children with viral pneumonia and develop treatment and prevention approaches targeting common respiratory viruses are expected to have a substantial effect on the residual burden of childhood pneumonia.

Funding

None.

中文翻译：

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儿童社区获得性肺炎中呼吸道病毒的流行：系统评价和荟萃分析

背景

在患有社区获得性肺炎的儿童中越来越多地检测到呼吸道病毒，但对流行率的估计差异很大。我们旨在系统地回顾和汇总 22 种通常与社区获得性肺炎相关的病毒的估计值。

方法

我们进行了系统回顾和荟萃分析，以确定通过任何诊断方法检测到的每种常见呼吸道病毒在 18 岁以下患有社区获得性肺炎的儿童中的流行率。我们对 1995 年 1 月 1 日至 2019 年 12 月 31 日期间发表的相关已发表文章和报告无语言限制地搜索了 MEDLINE、PubMed、Embase、Web of Science 和 Scopus 数据库，将审查限制在 COVID-19 大流行之前的年份。三位独立评审员使用预定义的协议筛选文章并提取数据。我们使用 DerSimonian-Laird 随机效应模型计算了儿童肺炎中每种病毒的汇总流行率。我们使用纽卡斯尔-渥太华量表评估偏差。审查方案已在 PROSPERO (CRD42016034047) 中注册。

发现

我们确定了 186 篇符合条件的文章，这些文章代表了 152209 名 18 岁以下的社区获得性肺炎儿童。在 55·0% (95% CI 50·4–59·7) 诊断为社区获得性肺炎的儿科患者中检测到一种或多种呼吸道病毒；异质性高（I ² =99·4%）。呼吸道合胞病毒 (22·7%, 20·9–24·5) 和鼻病毒 (22·1%, 19·5–24·7) 是全球最常见的儿童肺炎病因，其他病毒在 1 –9% 的案例。该国的国民收入、5 岁以下儿童死亡率或世卫组织区域的流行率没有显着差异。

解释

在所有年龄和地理区域的儿童的社区获得性肺炎中经常检测到呼吸道病毒，不同国家的国民收入或地区差异不显着。进一步限制在病毒性肺炎患儿中使用抗生素和开发针对常见呼吸道病毒的治疗和预防方法的进一步策略预计将对儿童肺炎的残余负担产生重大影响。

资金

没有任何。