Dataset Information

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.

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and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies.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by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies.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.

SUBMITTER: Shi T

PROVIDER: S-EPMC5592248 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Publications

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 Ting T McAllister David A DA O'Brien Katherine L KL Simoes Eric A F EAF Madhi Shabir A SA Gessner Bradford D BD Polack Fernando P FP Balsells Evelyn E Acacio Sozinho S Aguayo Claudia C Alassani Issifou I Ali Asad A Antonio Martin M Awasthi Shally S Awori Juliet O JO Azziz-Baumgartner Eduardo E Baggett Henry C HC Baillie Vicky L VL Balmaseda Angel A Barahona Alfredo A Basnet Sudha S Bassat Quique Q Basualdo Wilma W Bigogo Godfrey G Bont Louis L Breiman Robert F RF Brooks W Abdullah WA Broor Shobha S Bruce Nigel N Bruden Dana D Buchy Philippe P Campbell Stuart S Carosone-Link Phyllis P Chadha Mandeep M Chipeta James J Chou Monidarin M Clara Wilfrido W Cohen Cheryl C de Cuellar Elizabeth E Dang Duc-Anh DA Dash-Yandag Budragchaagiin B Deloria-Knoll Maria M Dherani Mukesh M Eap Tekchheng T Ebruke Bernard E BE Echavarria Marcela M de Freitas Lázaro Emediato Carla Cecília CC Fasce Rodrigo A RA Feikin Daniel R DR Feng Luzhao L Gentile Angela A Gordon Aubree A Goswami Doli D Goyet Sophie S Groome Michelle M Halasa Natasha N Hirve Siddhivinayak S Homaira Nusrat N Howie Stephen R C SRC Jara Jorge J Jroundi Imane I Kartasasmita Cissy B CB Khuri-Bulos Najwa N Kotloff Karen L KL Krishnan Anand A Libster Romina R Lopez Olga O Lucero Marilla G MG Lucion Florencia F Lupisan Socorro P SP Marcone Debora N DN McCracken John P JP Mejia Mario M Moisi Jennifer C JC Montgomery Joel M JM Moore David P DP Moraleda Cinta C Moyes Jocelyn J Munywoki Patrick P Mutyara Kuswandewi K Nicol Mark P MP Nokes D James DJ Nymadawa Pagbajabyn P da Costa Oliveira Maria Tereza MT Oshitani Histoshi H Pandey Nitin N Paranhos-Baccalà Gláucia G Phillips Lia N LN Picot Valentina Sanchez VS Rahman Mustafizur M Rakoto-Andrianarivelo Mala M Rasmussen Zeba A ZA Rath Barbara A BA Robinson Annick A Romero Candice C Russomando Graciela G Salimi Vahid V Sawatwong Pongpun P Scheltema Nienke N Schweiger Brunhilde B Scott J Anthony G JAG Seidenberg Phil P Shen Kunling K Singleton Rosalyn R Sotomayor Viviana V Strand Tor A TA Sutanto Agustinus A Sylla Mariam M Tapia Milagritos D MD Thamthitiwat Somsak S Thomas Elizabeth D ED Tokarz Rafal R Turner Claudia C Venter Marietjie M Waicharoen Sunthareeya S Wang Jianwei J Watthanaworawit Wanitda W Yoshida Lay-Myint LM Yu Hongjie H Zar Heather J HJ Campbell Harry H Nair Harish H

Lancet (London, England) 20170707 10098

<h4>Background</h4>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, hospit ...[more]

PMID: 28689664

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Project description:BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2015 provides an up-to-date analysis of the burden of lower respiratory tract infections (LRIs) in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 25 years and shows how the burden of LRI has changed in people of all ages.MethodsWe estimated LRI mortality by age, sex, geography, and year using a modelling platform shared across most causes of death in the GBD 2015 study called the Cause of Death Ensemble model. We modelled LRI morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for LRI using two different counterfactual approaches, the first for viral pathogens, which incorporates the aetiology-specific risk of LRI and the prevalence of the aetiology in LRI episodes, and the second for bacterial pathogens, which uses a vaccine-probe approach. We used the Socio-demographic Index, which is a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in LRI-related mortality. The two leading risk factors for LRI disability-adjusted life-years (DALYs), childhood undernutrition and air pollution, were used in a decomposition analysis to establish the relative contribution of changes in LRI DALYs.FindingsIn 2015, we estimated that LRIs caused 2·74 million deaths (95% uncertainty interval [UI] 2·50 million to 2·86 million) and 103·0 million DALYs (95% UI 96·1 million to 109·1 million). LRIs have a disproportionate effect on children younger than 5 years, responsible for 704 000 deaths (95% UI 651 000-763 000) and 60.6 million DALYs (95ÙI 56·0-65·6). Between 2005 and 2015, the number of deaths due to LRI decreased by 36·9% (95% UI 31·6 to 42·0) in children younger than 5 years, and by 3·2% (95% UI -0·4 to 6·9) in all ages. Pneumococcal pneumonia caused 55·4% of LRI deaths in all ages, totalling 1 517 388 deaths (95% UI 857 940-2 183 791). Between 2005 and 2015, improvements in air pollution exposure were responsible for a 4·3% reduction in LRI DALYs and improvements in childhood undernutrition were responsible for an 8·9% reduction.InterpretationLRIs are the leading infectious cause of death and the fifth-leading cause of death overall; they are the second-leading cause of DALYs. At the global level, the burden of LRIs has decreased dramatically in the last 10 years in children younger than 5 years, although the burden in people older than 70 years has increased in many regions. LRI remains a largely preventable disease and cause of death, and continued efforts to decrease indoor and ambient air pollution, improve childhood nutrition, and scale up the use of the pneumococcal conjugate vaccine in children and adults will be essential in reducing the global burden of LRI.FundingBill & Melinda Gates Foundation.

Project description:Growing evidence suggests respiratory syncytial virus (RSV) is an important cause of respiratory disease in adults. However, the adult burden remains largely uncharacterized as most RSV studies focus on children, and population-based studies with laboratory-confirmation of infection are difficult to implement. Indirect modelling methods, long used for influenza, can further our understanding of RSV burden by circumventing some limitations of traditional surveillance studies that rely on direct linkage of individual-level exposure and outcome data.Multiple linear time-series regression was used to estimate RSV burden in the United Kingdom (UK) between 1995 and 2009 among the total population and adults in terms of general practice (GP) episodes (counted as first consultation ?28 days following any previous consultation for same diagnosis/diagnostic group), hospitalisations, and deaths for respiratory disease, using data from Public Health England weekly influenza/RSV surveillance, Clinical Practice Research Datalink, Hospital Episode Statistics, and Office of National Statistics. The main outcome considered all ICD-listed respiratory diseases and, for GP episodes, related symptoms. Estimates were adjusted for non-specific seasonal drivers of disease using secular cyclical terms and stratified by age and risk group (according to chronic conditions indicating severe influenza risk as per UK recommendations for influenza vaccination). Trial registration NCT01706302 . Registered 11 October 2012.Among adults aged 18+ years an estimated 487,247 GP episodes, 17,799 hospitalisations, and 8,482 deaths were attributable to RSV per average season. Of these, 175,070 GP episodes (36 %), 14,039 hospitalisations (79 %) and 7,915 deaths (93 %) were in persons aged 65+ years. High- versus low-risk elderly were two-fold more likely to have a RSV-related GP episode or death and four-fold more likely be hospitalised for RSV. In most seasons since 2001, more GP episodes, hospitalisations and deaths were attributable to RSV in adults than to influenza.RSV is associated with a substantial disease burden in adults comparable to influenza, with most of the hospitalisation and mortality burden in the elderly. Treatment options and measures to prevent RSV could have a major impact on the burden of RSV respiratory disease in adults, especially the elderly.

Dataset Information

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.

Background

Methods

Findings

Interpretation

Funding

Publications

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.

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