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

• Autores: Wang, Xin; Li, You; O'Brien, Katherine L.; Madhi, Shabir A.; Widdowson, Marc Alain; Byass, Peter; Omer, Saad B.; Abbas, Qalab; Ali, Asad; Amu, Alberta; Azziz-Baumgartner, Eduardo; Bassat, Quique; Abdullah Brooks, W.; Chaves, Sandra S.; Chung, Alexandria; Cohen, Cheryl; Echavarría, Marcela Silvia; Fasce, Rodrigo A.; Gentile, Angela; Gordon, Aubree; Groome, Michelle; Heikkinen, Terho; Hirve, Siddhivinayak; Jara, Jorge H.; Katz, Mark A.; Khuri Bulos, Najwa; Krishnan, Anand; de Leon, Oscar; Lucero, Marilla G.; McCracken, John P.; Mira-Iglesias, Ainara; Moïsi, Jennifer C.; Munywoki, Patrick K.; Ourohiré, Millogo; Polack, Fernando Pedro; Rahi, Manveer; Rasmussen, Zeba A.; Rath, Barbara A.; Saha, Samir K.; Simões, Eric A.F.; Sotomayor, Viviana; Thamthitiwat, Somsak; Treurnicht, Florette K.; Wamukoya, Marylene; Lay-Myint, Yoshida; Zar, Heather J.; Campbell, Harry; Nair, Harish
• Año de publicación: 2020
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: RESPIRATORY SYNCYTIAL VIRUS
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

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from a systematic review of 100 studies published between Jan 1, 1995, and Dec 31, 2018, and a further 57 high-quality unpublished studies.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.
Fil: Wang, Xin. University of Edinburgh; Reino Unido
Fil: Li, You. University of Edinburgh; Reino Unido
Fil: O'Brien, Katherine L.. University Johns Hopkins; Estados Unidos
Fil: Madhi, Shabir A.. University of the Witwatersrand; Sudáfrica
Fil: Widdowson, Marc Alain. Centers for Disease Control and Prevention; Estados Unidos
Fil: Byass, Peter. Umea University; Suecia
Fil: Omer, Saad B.. Yale School Of Public Health; Estados Unidos
Fil: Abbas, Qalab. Aga Khan University; Pakistán
Fil: Ali, Asad. Aga Khan University; Pakistán
Fil: Amu, Alberta. Dodowa Health Research Centre; Ghana
Fil: Azziz-Baumgartner, Eduardo. Centers for Disease Control and Prevention; Estados Unidos
Fil: Bassat, Quique. University Of Barcelona; España
Fil: Abdullah Brooks, W.. University Johns Hopkins; Estados Unidos
Fil: Chaves, Sandra S.. Centers for Disease Control and Prevention; Estados Unidos
Fil: Chung, Alexandria. University of Edinburgh; Reino Unido
Fil: Cohen, Cheryl. National Institute For Communicable Diseases; Sudáfrica
Fil: Echavarría, Marcela Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina
Fil: Fasce, Rodrigo A.. Public Health Institute; Chile
Fil: Gentile, Angela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina
Fil: Gordon, Aubree. University of Michigan; Estados Unidos
Fil: Groome, Michelle. University of the Witwatersrand; Sudáfrica
Fil: Heikkinen, Terho. University Of Turku; Finlandia
Fil: Hirve, Siddhivinayak. Kem Hospital Research Centre; India
Fil: Jara, Jorge H.. Universidad del Valle de Guatemala; Guatemala
Fil: Katz, Mark A.. Clalit Research Institute; Israel
Fil: Khuri Bulos, Najwa. University Of Jordan School Of Medicine; Jordania
Fil: Krishnan, Anand. All India Institute Of Medical Sciences; India
Fil: de Leon, Oscar. Universidad del Valle de Guatemala; Guatemala
Fil: Lucero, Marilla G.. Research Institute For Tropical Medicine; Filipinas
Fil: McCracken, John P.. Universidad del Valle de Guatemala; Guatemala
Fil: Mira-Iglesias, Ainara. Fundación Para El Fomento de la Investigación Sanitaria; España
Fil: Moïsi, Jennifer C.. Agence de Médecine Préventive; Francia
Fil: Munywoki, Patrick K.. No especifíca;
Fil: Ourohiré, Millogo. No especifíca;
Fil: Polack, Fernando Pedro. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Rahi, Manveer. University of Edinburgh; Reino Unido
Fil: Rasmussen, Zeba A.. National Institutes Of Health; Estados Unidos
Fil: Rath, Barbara A.. Vienna Vaccine Safety Initiative; Alemania
Fil: Saha, Samir K.. Child Health Research Foundation; Bangladesh
Fil: Simões, Eric A.F.. University of Colorado; Estados Unidos
Fil: Sotomayor, Viviana. Ministerio de Salud de Santiago de Chile; Chile
Fil: Thamthitiwat, Somsak. Thailand Ministry Of Public Health; Tailandia
Fil: Treurnicht, Florette K.. University of the Witwatersrand; Sudáfrica
Fil: Wamukoya, Marylene. African Population & Health Research Center; Kenia
Fil: Lay-Myint, Yoshida. Nagasaki University; Japón
Fil: Zar, Heather J.. University of Cape Town; Sudáfrica
Fil: Campbell, Harry. University of Edinburgh; Reino Unido
Fil: Nair, Harish. University of Edinburgh; Reino Unido