Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study

Ting Shi, David A McAllister, Katherine L O'Brien, Eric A F Simoes, Shabir A Madhi, Bradford D Gessner, Fernando P Polack, Evelyn Balsells, Sozinho Acacio, Claudia Aguayo, Issifou Alassani, Asad Ali, Martin Antonio, Shally Awasthi, Juliet O Awori, Eduardo Azziz-Baumgartner, Henry C Baggett, Vicky L Baillie, Angel Balmaseda, Alfredo BarahonaSudha Basnet, Quique Bassat, Wilma Basualdo, Godfrey Bigogo, Louis Bont, Robert F Breiman, W Abdullah Brooks, Shobha Broor, Nigel Bruce, Dana Bruden, Philippe Buchy, Stuart Campbell, Phyllis Carosone-Link, Mandeep Chadha, James Chipeta, Monidarin Chou, Wilfrido Clara, Cheryl Cohen, Elizabeth de Cuellar, Duc-Anh Dang, Budragchaagiin Dash-Yandag, Maria Deloria-Knoll, Mukesh Dherani, Tekchheng Eap, Bernard E Ebruke, Marcela Echavarria, Carla Cecília de Freitas Lázaro Emediato, Rodrigo A Fasce, Harry Campbell, Harish Nair

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: We have previously estimated that respiratory syncytial virus (RSV) was associated with 22% of all episodes of (severe) acute lower respiratory infection (ALRI) resulting in 55 000 to 199 000 deaths in children younger than 5 years in 2005. In the past 5 years, major research activity on RSV has yielded substantial new data from developing countries. With a considerably expanded dataset from a large international collaboration, we aimed to estimate the global incidence, hospital admission rate, and mortality from RSV-ALRI episodes in young children in 2015.

METHODS: We estimated the incidence and hospital admission rate of RSV-associated ALRI (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies. We estimated the RSV-ALRI incidence for 132 developing countries using a risk factor-based model and 2015 population estimates. We estimated the in-hospital RSV-ALRI mortality by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies. We also estimated overall RSV-ALRI mortality by identifying studies reporting monthly data for ALRI mortality in the community and RSV activity.

FINDINGS: We estimated that globally in 2015, 33·1 million (uncertainty range [UR] 21·6-50·3) episodes of RSV-ALRI, resulted in about 3·2 million (2·7-3·8) hospital admissions, and 59 600 (48 000-74 500) in-hospital deaths in children younger than 5 years. In children younger than 6 months, 1·4 million (UR 1·2-1·7) hospital admissions, and 27 300 (UR 20 700-36 200) in-hospital deaths were due to RSV-ALRI. We also estimated that the overall RSV-ALRI mortality could be as high as 118 200 (UR 94 600-149 400). Incidence and mortality varied substantially from year to year in any given population.

INTERPRETATION: Globally, RSV is a common cause of childhood ALRI and a major cause of hospital admissions in young children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine or monoclonal antibody could have a substantial effect on disease burden in this age group.

FUNDING: The Bill & Melinda Gates Foundation.

Original languageEnglish
Pages (from-to)946-958
Number of pages13
JournalThe Lancet
Volume390
Issue number10098
Early online date6 Jul 2017
DOIs
Publication statusPublished - 6 Jul 2017

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