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Lancet. 2017 Sep 2;390(10098):946-958. doi: 10.1016/S0140-6736(17)30938-8. Epub 2017 Jul 7.

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.

Shi T1, McAllister DA2, O'Brien KL3, Simoes EAF4, Madhi SA5, Gessner BD6, Polack FP7, Balsells E1, Acacio S8, Aguayo C9, Alassani I10, Ali A11, Antonio M12, Awasthi S13, Awori JO14, Azziz-Baumgartner E15, Baggett HC16, Baillie VL17, Balmaseda A18, Barahona A19, Basnet S20, Bassat Q21, Basualdo W22, Bigogo G23, Bont L24, Breiman RF25, Brooks WA26, Broor S27, Bruce N28, Bruden D29, Buchy P30, Campbell S1, Carosone-Link P31, Chadha M32, Chipeta J33, Chou M34, Clara W35, Cohen C36, de Cuellar E37, Dang DA38, Dash-Yandag B39, Deloria-Knoll M3, Dherani M28, Eap T40, Ebruke BE12, Echavarria M41, de Freitas Lázaro Emediato CC42, Fasce RA43, Feikin DR44, Feng L45, Gentile A46, Gordon A47, Goswami D26, Goyet S48, Groome M5, Halasa N49, Hirve S50, Homaira N51, Howie SRC52, Jara J53, Jroundi I54, Kartasasmita CB55, Khuri-Bulos N56, Kotloff KL57, Krishnan A27, Libster R58, Lopez O59, Lucero MG60, Lucion F46, Lupisan SP61, Marcone DN41, McCracken JP53, Mejia M62, Moisi JC6, Montgomery JM63, Moore DP5, Moraleda C64, Moyes J36, Munywoki P65, Mutyara K55, Nicol MP66, Nokes DJ67, Nymadawa P68, da Costa Oliveira MT42, Oshitani H69, Pandey N13, Paranhos-Baccalà G70, Phillips LN71, Picot VS70, Rahman M72, Rakoto-Andrianarivelo M73, Rasmussen ZA74, Rath BA75, Robinson A76, Romero C77, Russomando G78, Salimi V79, Sawatwong P80, Scheltema N24, Schweiger B81, Scott JAG82, Seidenberg P83, Shen K84, Singleton R85, Sotomayor V9, Strand TA86, Sutanto A87, Sylla M88, Tapia MD57, Thamthitiwat S80, Thomas ED74, Tokarz R89, Turner C90, Venter M91, Waicharoen S92, Wang J93, Watthanaworawit W90, Yoshida LM94, Yu H45, Zar HJ95, Campbell H1, Nair H96; RSV Global Epidemiology Network.

Author information

1
Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.
2
Institute of Health and Wellbeing, University of Glasgow, Scotland, UK.
3
Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MS, USA.
4
University of Colorado, Aurora, CO, USA.
5
Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
6
Agence de Medecine Preventive, Paris, France.
7
Fundacion INFANT, Buenos Aires, Argentina.
8
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
9
Epidemiology Department, Ministry of Health, Chile.
10
Ministry of Health, Togo.
11
Department of Pediatrics and Child Health, Aga Khan University, Pakistan.
12
Medical Research Council Unit The Gambia, Basse, The Gambia.
13
Department of Pediatrics, King George's Medical University, Lucknow (UP), India.
14
Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.
15
International Centre for Diarrhoeal Disease Research, Bangladesh; Centers for Disease Control and Prevention, Atlanta, GA, USA.
16
Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA.
17
Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
18
Ministry of Health, Nicaragua.
19
Hospital Materno Infantil Jose Domingo de Obaldia, Ciudad De David, Chiriqui, Panama.
20
Center for International Health, University of Bergen, Norway; Department of Child Health, Tribhuvan University Institute of Medicine, Nepal.
21
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Barcelona Ctr Int Health Res (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; ICREA, Pg Lluís Companys 23, 08010 Barcelona, Spain.
22
Hospital General Pediátrico Niños de Acosta Ñu, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay.
23
Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.
24
Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
25
Emory Global Health Institute, Emory University, AT, USA.
26
Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MS, USA; International Centre for Diarrhoeal Disease Research, Bangladesh.
27
All India Institute of Medical Sciences, New Delhi, India.
28
Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
29
Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centres for Disease Control and Prevention, Anchorage, AK, USA.
30
Institute Pasteur Cambodia, Children's Hospital Colorado, Aurora, CO, USA; GSK Vaccines Singapore, Children's Hospital Colorado, Aurora, CO, USA.
31
Department of Pediatric Infectious Diseases, Children's Hospital Colorado, Aurora, CO, USA.
32
National Institute of Virology, Pune, India.
33
University Teaching Hospital, Lusaka, Zambia.
34
Rodolphe Merieux Laboratory, Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia.
35
Centers for Disease Control and Prevention, Central American Region, Guatemala City, Guatemala.
36
Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
37
Hospital San Juan de Dios, Santa Ana, Ministry of Health, El Salvador.
38
National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
39
Bayanzurkh District General Hospital, Ulaanbaatar, Mongolia.
40
Department of Pneumology, National Pediatric Hospital, Phnom Penh, Cambodia.
41
Centro de Educación Médica envestigaciones Clínicas "CEMIC", Argentina.
42
Health Secretariat of the City of Belo Horizonte, Brazil.
43
Public Health Institute, Chile.
44
Centers for Disease Control and Prevention, Atlanta, GA, USA.
45
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
46
Epidemiology Department, Austral University and Ricardo Gutiérrez Children Hospital, Argentina.
47
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
48
Institute Pasteur Cambodia, Children's Hospital Colorado, Aurora, CO, USA.
49
Vanderbilt University, Nashville, TN, USA.
50
KEM Hospital Research Center, Pune, India.
51
International Centre for Diarrhoeal Disease Research, Bangladesh; School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, NSW, Australia.
52
Medical Research Council Unit The Gambia, Basse, The Gambia; Department of Paediatrics, University of Auckland, Auckland, New Zealand; Centre for International Health, University of Otago, Dunedin, New Zealand.
53
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala.
54
ISGlobal, Barcelona Ctr Int Health Res (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Unit of Training and Research in Public Health, School of Medicine and Pharmacy of Rabat, University Mohamed V, Rabat, Morocco.
55
University of Padjdjaran, Bandung, Indonesia.
56
University of Jordan, Amman, Jordan.
57
Department of Pediatrics and Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA.
58
Fundacion INFANT, Buenos Aires, Argentina; Vanderbilt University, Nashville, TN, USA; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
59
Hospital Dr Ernesto Torres Galdames, Iquique, Chile.
60
Research Institute for Tropical Medicine, Muntinlupa, Philippines.
61
Research Institute for Tropical Medicine-Department of Health, Philippines.
62
Ministry of Public Health and Social Welfare, Guatemala.
63
Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya.
64
ISGlobal, Barcelona Ctr Int Health Res (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
65
Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Pwani University, Kilifi, Kenya.
66
Division of Medical Microbiology, University of Cape Town and National Health Laboratory Services, South Africa.
67
Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; School of Life Sciences, University of Warwick, Coventry, UK.
68
Mongolian Academy of Medical Sciences, Ulaanbaatar, Mongolia.
69
Tohoku University Graduate School of Medicine, Department of Virology, Miyagi Prefecture, Japan.
70
Emerging Pathofens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France.
71
Emory University, Rollins School of Public Health, AT, USA.
72
International Centre for Diarrhoeal Disease Research, Bangladesh.
73
Centre d'Infectiologie Charles Mérieux (CICM), Antananarivo, Madagascar.
74
Fogarty International Center Division of International Epidemiology and Population Studies, NIH, Bethesda, MD, USA.
75
Department of Pediatrics, Charité University Medical Center, Berlin, Germany.
76
Hôpital Femme-Mère-Enfant, Antananarivo, Madagascar.
77
United States Naval Medical Research Unit No. 6, Callao, Peru.
78
Departamento de Biología Molecular y Genética, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asuncion, Paraguay.
79
School of Public Health, Virology Department, Tehran University of Medical Sciences, Iran.
80
Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
81
Robert Koch Institute (RKI), Berlin, Germany.
82
Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; London School of Hygiene & Tropical Medicine, London, UK.
83
Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA.
84
Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Beijing, China.
85
Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centres for Disease Control and Prevention, Anchorage, AK, USA; Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
86
Center for International Health, University of Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway.
87
Ministry of Health, Indonesia.
88
CHU Gabriel Touré, Bamako, Mali.
89
Centre for Infection and Immunity, Mailman School of Public Health, Columbia University, NY, USA.
90
Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
91
Centre for Viral Zoonosis, Department of Medical Virology, University of Pretoria, Pretoria, South Africa.
92
National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Thailand.
93
MOH Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China.
94
Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
95
Department of Paediatrics and Child Heath, Red Cross War Memorial Children's Hospital and MRC Unit on Child & Adolescent Health, University of Cape Town, South Africa.
96
Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK; Public Health Foundation of India, New Delhi, India. Electronic address: harish.nair@ed.ac.uk.

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.

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