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The Lancet. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis
[Source: The Lancet, full text: (LINK). Abstract, edited.]
The Lancet, Early Online Publication, 11 November 2011 - doi:10.1016/S0140-6736(11)61051-9
Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis
Original Text
Dr Harish Nair DNB, W Abdullah Brooks MD, Mark Katz MD, Anna Roca PhD, James A Berkley FRCPCH, Prof Shabir A Madhi MD, James Mark Simmerman PhD, Aubree Gordon PhD, Masatoki Sato MD, Stephen Howie FRACP, Anand Krishnan MD , Maurice Ope MD, Kim A Lindblade PhD, Phyllis Carosone-Link MSPH, Marilla Lucero MD, Walter Ochieng MD, Laurie Kamimoto MD, Erica Dueger PhD, Niranjan Bhat MD, Sirenda Vong MD, Evropi Theodoratou PhD, Malinee Chittaganpitch MSc, Osaretin Chimah FWACP, Angel Balmaseda MD, Philippe Buchy MD, Prof Eva Harris MD, Valerie Evans MSc, Masahiko Katayose MD, Bharti Gaur MSc, Cristina O'Callaghan-Gordo BSc, Doli Goswami MPH, Wences Arvelo MD, Marietjie Venter PhD, Thomas Briese PhD, Rafal Tokarz PhD, Marc-Alain Widdowson VetMB, Anthony W Mounts MD, Robert F Breiman MD, Daniel R Feikin MD, Prof Keith P Klugman MD, Sonja J Olsen PhD, Bradford D Gessner MD, Prof Peter F Wright MD, Prof Igor Rudan MD, Prof Shobha Broor MD, Prof Eric AF Sim?es MD, Prof Harry Campbell MD
Summary
Background
The global burden of disease attributable to seasonal influenza virus in children is unknown. We aimed to estimate the global incidence of and mortality from lower respiratory infections associated with influenza in children younger than 5 years.
Methods
We estimated the incidence of influenza episodes, influenza-associated acute lower respiratory infections (ALRI), and influenza-associated severe ALRI in children younger than 5 years, stratified by age, with data from a systematic review of studies published between Jan 1, 1995, and Oct 31, 2010, and 16 unpublished population-based studies. We applied these incidence estimates to global population estimates for 2008 to calculate estimates for that year. We estimated possible bounds for influenza-associated ALRI mortality by combining incidence estimates with case fatality ratios from hospital-based reports and identifying studies with population-based data for influenza seasonality and monthly ALRI mortality.
Findings
We identified 43 suitable studies, with data for around 8 million children. We estimated that, in 2008, 90 million (95% CI 49?162 million) new cases of influenza (data from nine studies), 20 million (13?32 million) cases of influenza-associated ALRI (13% of all cases of paediatric ALRI; data from six studies), and 1 million (1?2 million) cases of influenza-associated severe ALRI (7% of cases of all severe paediatric ALRI; data from 39 studies) occurred worldwide in children younger than 5 years. We estimated there were 28 000?111 500 deaths in children younger than 5 years attributable to influenza-associated ALRI in 2008, with 99% of these deaths occurring in developing countries. Incidence and mortality varied substantially from year to year in any one setting.
Interpretation
Influenza is a common pathogen identified in children with ALRI and results in a substantial burden on health services worldwide. Sufficient data to precisely estimate the role of influenza in childhood mortality from ALRI are not available.
Funding
WHO; Bill & Melinda Gates Foundation.
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The Lancet, Early Online Publication, 11 November 2011 - doi:10.1016/S0140-6736(11)61051-9
Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis
Original Text
Dr Harish Nair DNB, W Abdullah Brooks MD, Mark Katz MD, Anna Roca PhD, James A Berkley FRCPCH, Prof Shabir A Madhi MD, James Mark Simmerman PhD, Aubree Gordon PhD, Masatoki Sato MD, Stephen Howie FRACP, Anand Krishnan MD , Maurice Ope MD, Kim A Lindblade PhD, Phyllis Carosone-Link MSPH, Marilla Lucero MD, Walter Ochieng MD, Laurie Kamimoto MD, Erica Dueger PhD, Niranjan Bhat MD, Sirenda Vong MD, Evropi Theodoratou PhD, Malinee Chittaganpitch MSc, Osaretin Chimah FWACP, Angel Balmaseda MD, Philippe Buchy MD, Prof Eva Harris MD, Valerie Evans MSc, Masahiko Katayose MD, Bharti Gaur MSc, Cristina O'Callaghan-Gordo BSc, Doli Goswami MPH, Wences Arvelo MD, Marietjie Venter PhD, Thomas Briese PhD, Rafal Tokarz PhD, Marc-Alain Widdowson VetMB, Anthony W Mounts MD, Robert F Breiman MD, Daniel R Feikin MD, Prof Keith P Klugman MD, Sonja J Olsen PhD, Bradford D Gessner MD, Prof Peter F Wright MD, Prof Igor Rudan MD, Prof Shobha Broor MD, Prof Eric AF Sim?es MD, Prof Harry Campbell MD
Summary
Background
The global burden of disease attributable to seasonal influenza virus in children is unknown. We aimed to estimate the global incidence of and mortality from lower respiratory infections associated with influenza in children younger than 5 years.
Methods
We estimated the incidence of influenza episodes, influenza-associated acute lower respiratory infections (ALRI), and influenza-associated severe ALRI in children younger than 5 years, stratified by age, with data from a systematic review of studies published between Jan 1, 1995, and Oct 31, 2010, and 16 unpublished population-based studies. We applied these incidence estimates to global population estimates for 2008 to calculate estimates for that year. We estimated possible bounds for influenza-associated ALRI mortality by combining incidence estimates with case fatality ratios from hospital-based reports and identifying studies with population-based data for influenza seasonality and monthly ALRI mortality.
Findings
We identified 43 suitable studies, with data for around 8 million children. We estimated that, in 2008, 90 million (95% CI 49?162 million) new cases of influenza (data from nine studies), 20 million (13?32 million) cases of influenza-associated ALRI (13% of all cases of paediatric ALRI; data from six studies), and 1 million (1?2 million) cases of influenza-associated severe ALRI (7% of cases of all severe paediatric ALRI; data from 39 studies) occurred worldwide in children younger than 5 years. We estimated there were 28 000?111 500 deaths in children younger than 5 years attributable to influenza-associated ALRI in 2008, with 99% of these deaths occurring in developing countries. Incidence and mortality varied substantially from year to year in any one setting.
Interpretation
Influenza is a common pathogen identified in children with ALRI and results in a substantial burden on health services worldwide. Sufficient data to precisely estimate the role of influenza in childhood mortality from ALRI are not available.
Funding
WHO; Bill & Melinda Gates Foundation.
Comment