Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2019: a systematic analysis

You Li, Xin Wang, Dianna Blau, Mauricio Caballero, Daniel R. Feikin, Christopher Gill, Shabir A. Madhi, Saad B Omer, Eric A. F. Simoes, Harry Campbell, Ana Bermejo Pariente, Darmaa Bardach, Quique Bassat, Jean-Sebastien Casalegno, Giorgi Chakhunashvili, NIgel Crawford, Daria Danilenko, Anh N. Do, Marcela Echavarria, Angela GentileAubree Gordon, Terho Heikkinen, Sue Huang, Sophie Jullien, Anand Krishnan, E. Lopez, JOsko Markic, Ainara Mira-Iglesias , Hannah Moore, Jocelyn Moyes, Lawrence Mwananyanda, D. James Nokes, Faseeha Noordeen, Evangeline Obodai, Nandhini Palani, Candice Romero, Vahid Salimi, Ashish Satav, Euri Seo, Zakhar Shchomak, Rosalyn Singleton, Kirill Stolyarov, Sonia Stoszek, Anne von Gottberg, Danielle Wurzel, Lay-Myint Yoshida, Chee Fu Yung, Heather Zar, Harish Nair

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Respiratory syncytial virus (RSV) is the predominant cause of acute lower respiratory infection (ALRI) in young children. We previously estimated that globally in 2015, 33·1 million episodes of RSV-associated ALRI occurred in children aged 0–<60 months, resulting in a total of 118 200 overall deaths (i.e., in-hospital and out-of-hospital / community). Since then, several community surveillance studies have been conducted to obtain a more precise estimation of RSV associated community deaths. We aimed to update RSV-associated ALRI morbidity and mortality at global, regional and national levels in children aged 0–<60 months for 2019, with a focus on narrower infant age groups that are targeted by RSV prophylactics under development and on overall mortality.
Methods
We expanded our global RSV disease burden dataset by obtaining new data from an updated systematic literature review (including papers published between 1st January 2017 and 31st December 2020) as well as unpublished data from 51 studies. Generalised linear mixed-effects model (GLMM) was applied to estimate RSV-associated ALRI incidence, hospital admission and in-hospital mortality both globally and regionally (by country development status and by World Bank Income Classification) in 2019. Country-level RSV-associated ALRI incidence was estimated through a risk-factor based model. We developed new models (through GLMM) that incorporated the latest RSV community mortality data for estimating overall RSV mortality.
Findings
We estimated that globally in 2019, there were 33·0 million (uncertainty range, UR: 25·4–44·6) RSV-associated ALRI episodes, 3·6 million (2·9–4·6) RSV-associated ALRI hospital admissions, 26 300 (15 100–49 100) RSV-associated ALRI in-hospital deaths, and 101 400 (84 500–125 200) RSV-attributable overall deaths in 0–<60 months. In infants aged 0–<6 months, there were 6·6 million (4·6–9·7) RSV-associated ALRI episodes, 1·4 million (1·0–2·0) RSV-associated ALRI hospital admissions, 13 300 (6 800–28 100) RSV-associated ALRI in-hospital deaths, and 45 700 (38 400–55 900) RSV-attributable overall deaths. 2·0% (1·6–2·4) of overall deaths in 0–<60 months and 3·6% (3·0–4·4) of overall deaths in 28 days–<6 months were attributable to RSV. Low- and middle-income countries (LMICs) accounted for more than 95% of RSV-associated ALRI episodes and more than 97% of RSV-attributable deaths across all age bands.
Interpretation
RSV contributes substantially to morbidity and mortality burden globally in 0–<60 months, especially during the first six months of life and in LMICs. We highlight the striking overall mortality burden of RSV disease, with one in every 50 deaths in 0–<60 months and one in every 28 deaths in 28 days–<6 months being attributable to RSV globally; for every RSV-associated ALRI in-hospital death, there are approximately three more deaths attributable to RSV in community. RSV passive immunisation programmes targeting protection during the first six months of life could have a substantial effect on reducing RSV disease burden although more data are needed to understand the implications of the potential age-shifts in peak RSV burden to older age when these are implemented.
Original languageEnglish
Pages (from-to)2047-2064
JournalThe Lancet
Volume399
Issue number10340
Early online date19 May 2022
DOIs
Publication statusPublished - 28 May 2022

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