Global burden of acute lower respiratory infection associated with human parainfluenza virus in children younger than 5 years for 2018: A systematic review and meta-analysis

• Autores: Wang, Xin; Li, You; Deloria Knoll, Maria; Madhi, Shabir A.; Cohen, Cheryl; Arguelles, Vina Lea; Basnet, Sudha; Bassat, Quique; Brooks, W Abdullah; Echavarria, Marcela; Fasce, Rodrigo A; Gentile, Angela; Goswami, Doli; Homaira, Nusrat; Howie, Stephen R C; Kotloff, Karen L; Khuri Bulos, Najwa; Krishnan, Anand; Lucero, Marilla G; Lupisan, Socorro; Mathisen, Maria; McLean, Kenneth A; Mira-Iglesias, Ainara; Moraleda, Cinta; Okamoto, Michiko; Oshitani, Histoshi; O'Brien, Katherine L; Owor, Betty E; Rasmussen, Zeba A; Rath, Barbara A; Caballero, Mauricio Tomás
• Año de publicación: 2021
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: Influenza; Global burden; Mortality
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

Background: Human parainfluenza virus (hPIV) is a common virus in childhood acute lower respiratory infections (ALRI). However, no estimates have been made to quantify the global burden of hPIV in childhood ALRI. We aimed to estimate the global and regional hPIV-associated and hPIV-attributable ALRI incidence, hospital admissions, and mortality for children younger than 5 years and stratified by 0–5 months, 6–11 months, and 12–59 months of age. Methods: We did a systematic review of hPIV-associated ALRI burden studies published between Jan 1, 1995, and Dec 31, 2020, found in MEDLINE, Embase, Global Health, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Global Health Library, three Chinese databases, and Google search, and also identified a further 41 high-quality unpublished studies through an international research network. We included studies reporting community incidence of ALRI with laboratory-confirmed hPIV; hospital admission rates of ALRI or ALRI with hypoxaemia in children with laboratory-confirmed hPIV; proportions of patients with ALRI admitted to hospital with laboratory-confirmed hPIV; or in-hospital case–fatality ratios (hCFRs) of ALRI with laboratory-confirmed hPIV. We used a modified Newcastle-Ottawa Scale to assess risk of bias. We analysed incidence, hospital admission rates, and hCFRs of hPIV-associated ALRI using a generalised linear mixed model. Adjustment was made to account for the non-detection of hPIV-4. We estimated hPIV-associated ALRI cases, hospital admissions, and in-hospital deaths using adjusted incidence, hospital admission rates, and hCFRs. We estimated the overall hPIV-associated ALRI mortality (both in-hospital and out-hospital mortality) on the basis of the number of in-hospital deaths and care-seeking for child pneumonia. We estimated hPIV-attributable ALRI burden by accounting for attributable fractions for hPIV in laboratory-confirmed hPIV cases and deaths. Sensitivity analyses were done to validate the estimates of overall hPIV-associated ALRI mortality and hPIV-attributable ALRI mortality. The systematic review protocol was registered on PROSPERO (CRD42019148570). Findings: 203 studies were identified, including 162 hPIV-associated ALRI burden studies and a further 41 high-quality unpublished studies. Globally in 2018, an estimated 18·8 million (uncertainty range 12·8–28·9) ALRI cases, 725 000 (433 000–1 260 000) ALRI hospital admissions, and 34 400 (16 400–73 800) ALRI deaths were attributable to hPIVs among children younger than 5 years. The age-stratified and region-stratified analyses suggested that about 61% (35% for infants aged 0–5 months and 26% for 6–11 months) of the hospital admissions and 66% (42% for infants aged 0–5 months and 24% for 6–11 months) of the in-hospital deaths were in infants, and 70% of the in-hospital deaths were in low-income and lower-middle-income countries. Between 73% and 100% (varying by outcome) of the data had a low risk in study design; the proportion was 46–65% for the adjustment for health-care use, 59–77% for patient groups excluded, 54–93% for case definition, 42–93% for sampling strategy, and 67–77% for test methods. Heterogeneity in estimates was found between studies for each outcome. Interpretation: We report the first global burden estimates of hPIV-associated and hPIV-attributable ALRI in young children. Globally, approximately 13% of ALRI cases, 4–14% of ALRI hospital admissions, and 4% of childhood ALRI mortality were attributable to hPIV. These numbers indicate a potentially notable burden of hPIV in ALRI morbidity and mortality in young children. These estimates should encourage and inform investment to accelerate the development of targeted interventions. Funding: Bill & Melinda Gates Foundation.
Fil: Wang, Xin. University of Edinburgh; Reino Unido
Fil: Li, You. University of Edinburgh; Reino Unido
Fil: Deloria Knoll, Maria. University Johns Hopkins; Estados Unidos
Fil: Madhi, Shabir A.. University of the Witwatersrand; Sudáfrica
Fil: Cohen, Cheryl. University of the Witwatersrand; Sudáfrica. National Institute For Communicable Diseases; Sudáfrica
Fil: Arguelles, Vina Lea. Research Institute for Tropical Medicine; Filipinas
Fil: Basnet, Sudha. The Aga Khan University; Pakistán. University of Bergen; Noruega
Fil: Bassat, Quique. Tribhuvan University; Nepal
Fil: Brooks, W Abdullah. University of Bergen; Noruega
Fil: Echavarria, Marcela. Universidad de Barcelona; España
Fil: Fasce, Rodrigo A. Public Health Institute of Chile; Chile
Fil: Gentile, Angela. Universidad Austral; Argentina. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez". Departamento de Medicina; Argentina
Fil: Goswami, Doli. International Centre for Diarrhoeal Disease Research; Bangladesh
Fil: Homaira, Nusrat. University Johns Hopkins; Estados Unidos
Fil: Howie, Stephen R C. University of Auckland; Nueva Zelanda. London School of Hygiene & Tropical Medicine; Reino Unido
Fil: Kotloff, Karen L. University of Maryland; Estados Unidos
Fil: Khuri Bulos, Najwa. University of Jordan; Jordania
Fil: Krishnan, Anand. All India Institute of Medical Sciences; India
Fil: Lucero, Marilla G. Research Institute for Tropical Medicine; Filipinas
Fil: Lupisan, Socorro. Research Institute for Tropical Medicine; Filipinas
Fil: Mathisen, Maria. International Centre For Diarrhoeal Disease Research Bangladesh; Bangladesh
Fil: McLean, Kenneth A. University of Edinburgh; Reino Unido
Fil: Mira-Iglesias, Ainara. University of Auckland; Nueva Zelanda
Fil: Moraleda, Cinta. University of Maryland; Estados Unidos
Fil: Okamoto, Michiko. Tohoku University Graduate School of Medicine; Japón
Fil: Oshitani, Histoshi. All India Institute Of Medical Sciences; India
Fil: O'Brien, Katherine L. Trust Research Programme; Kenia
Fil: Owor, Betty E. Trust Research Programme; Kenia
Fil: Rasmussen, Zeba A. Fundacion Para El Fomento de la Investigacion Sanitaria y Biomedica de la Comunitat Valenciana; España
Fil: Rath, Barbara A. University of the Witwatersrand; Sudáfrica
Fil: Caballero, Mauricio Tomás. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina