Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis

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. We estimated the incidence of influenza episodes, inf...

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Published inThe Lancet (British edition) Vol. 378; no. 9807; pp. 1917 - 1930
Main Authors Nair, Harish, Brooks, W Abdullah, Katz, Mark, Roca, Anna, Berkley, James A, Madhi, Shabir A, Simmerman, James Mark, Gordon, Aubree, Sato, Masatoki, Howie, Stephen, Krishnan, Anand, Ope, Maurice, Lindblade, Kim A, Carosone-Link, Phyllis, Lucero, Marilla, Ochieng, Walter, Kamimoto, Laurie, Dueger, Erica, Bhat, Niranjan, Vong, Sirenda, Theodoratou, Evropi, Chittaganpitch, Malinee, Chimah, Osaretin, Balmaseda, Angel, Buchy, Philippe, Harris, Eva, Evans, Valerie, Katayose, Masahiko, Gaur, Bharti, O'Callaghan-Gordo, Cristina, Goswami, Doli, Arvelo, Wences, Venter, Marietjie, Briese, Thomas, Tokarz, Rafal, Widdowson, Marc-Alain, Mounts, Anthony W, Breiman, Robert F, Feikin, Daniel R, Klugman, Keith P, Olsen, Sonja J, Gessner, Bradford D, Wright, Peter F, Rudan, Igor, Broor, Shobha, Simões, Eric AF, Campbell, Harry
Format Journal Article
LanguageEnglish
Published Kidlington Elsevier Ltd 03.12.2011
Elsevier
Elsevier Limited
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Abstract 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. 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by age, with data from a systematic review of studies published between Jan 1, 1995, and Oct 31, 2010, and 16 unpublished population-based studies.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. 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. 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. WHO; Bill & Melinda Gates Foundation.
AbstractList 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 28a} 00-111a one fourth 00 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.
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. 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. 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. 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. WHO; Bill & Melinda Gates Foundation.
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. 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. 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. 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.
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.
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.BACKGROUNDThe 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.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.METHODSWe 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.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.FINDINGSWe 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.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.INTERPRETATIONInfluenza 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.WHO; Bill & Melinda Gates Foundation.FUNDINGWHO; Bill & Melinda Gates Foundation.
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.
Author Lucero, Marilla
Ochieng, Walter
Tokarz, Rafal
Carosone-Link, Phyllis
Olsen, Sonja J
Campbell, Harry
Madhi, Shabir A
Breiman, Robert F
Berkley, James A
Ope, Maurice
Katayose, Masahiko
Gessner, Bradford D
Nair, Harish
Vong, Sirenda
Chimah, Osaretin
Mounts, Anthony W
Roca, Anna
Harris, Eva
Gordon, Aubree
Wright, Peter F
Dueger, Erica
O'Callaghan-Gordo, Cristina
Sato, Masatoki
Goswami, Doli
Krishnan, Anand
Bhat, Niranjan
Rudan, Igor
Brooks, W Abdullah
Evans, Valerie
Arvelo, Wences
Simmerman, James Mark
Howie, Stephen
Simões, Eric AF
Buchy, Philippe
Briese, Thomas
Gaur, Bharti
Katz, Mark
Kamimoto, Laurie
Klugman, Keith P
Theodoratou, Evropi
Venter, Marietjie
Widdowson, Marc-Alain
Balmaseda, Angel
Feikin, Daniel R
Lindblade, Kim A
Chittaganpitch, Malinee
Broor, Shobha
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  organization: Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK
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  organization: International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
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  fullname: Katz, Mark
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  organization: Division of Disease Surveillance and Response, Ministry of Public Health and Sanitation, Kenya
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  surname: Lindblade
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  organization: University of Colorado Denver and Children's Hospital Colorado, Denver, CO, USA
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  organization: Research Institute for Tropical Medicine, Department of Health, Alabang, Muntinlupa, Philippines
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  organization: Kenya Medical Research Institute, Center for Virus Research, Nairobi, Kenya
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  surname: Kamimoto
  fullname: Kamimoto, Laurie
  organization: Influenza Division, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
– sequence: 18
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  surname: Dueger
  fullname: Dueger, Erica
  organization: Global Disease Detection and Response Center, Naval Medical Research Unit 3, Cairo, Egypt
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  fullname: Vong, Sirenda
  organization: Institut Pasteur du Cambodge, Phnom Penh, Cambodia
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  organization: Thai National Institutes of Health, Ministry of Public Health, Nonthaburi, Thailand
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  organization: Medical Research Council (UK) Laboratories, Banjul, The Gambia
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  givenname: Angel
  surname: Balmaseda
  fullname: Balmaseda, Angel
  organization: Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
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  givenname: Philippe
  surname: Buchy
  fullname: Buchy, Philippe
  organization: Institut Pasteur du Cambodge, Phnom Penh, Cambodia
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  surname: Harris
  fullname: Harris, Eva
  organization: Division of Infectious Diseases and Vaccinology, University of California, Berkeley, CA, USA
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  organization: Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK
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  organization: Department of Paediatrics, Soma General Hospital, Soma, Japan
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  fullname: Gaur, Bharti
  organization: All India Institute of Medical Sciences, New Delhi, India
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– sequence: 34
  givenname: Thomas
  surname: Briese
  fullname: Briese, Thomas
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  surname: Tokarz
  fullname: Tokarz, Rafal
  organization: Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA
– sequence: 36
  givenname: Marc-Alain
  surname: Widdowson
  fullname: Widdowson, Marc-Alain
  organization: Influenza Division, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
– sequence: 37
  givenname: Anthony W
  surname: Mounts
  fullname: Mounts, Anthony W
  organization: Global Influenza Program, World Health Organization, Geneva, Switzerland
– sequence: 38
  givenname: Robert F
  surname: Breiman
  fullname: Breiman, Robert F
  organization: Kenya Medical Research Institute and Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
– sequence: 39
  givenname: Daniel R
  surname: Feikin
  fullname: Feikin, Daniel R
  organization: Kenya Medical Research Institute and Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
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  givenname: Keith P
  surname: Klugman
  fullname: Klugman, Keith P
  organization: Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology, and National Research Foundation: Vaccine Preventable Diseases; University of the Witwatersrand, South Africa
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  givenname: Sonja J
  surname: Olsen
  fullname: Olsen, Sonja J
  organization: Influenza Division and International Emerging Infections Program, US Centers for Disease Control and Prevention—Thailand MOPH Collaboration, Nonthaburi, Thailand
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  givenname: Bradford D
  surname: Gessner
  fullname: Gessner, Bradford D
  organization: Agence de Médecine Préventive, Paris, France
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  givenname: Peter F
  surname: Wright
  fullname: Wright, Peter F
  organization: Division of Infectious Disease and International Health, Dartmouth Medical School, Lebanon, NH, USA
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  surname: Rudan
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  fullname: Broor, Shobha
  organization: All India Institute of Medical Sciences, New Delhi, India
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  surname: Simões
  fullname: Simões, Eric AF
  organization: University of Colorado Denver and Children's Hospital Colorado, Denver, CO, USA
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  givenname: Harry
  surname: Campbell
  fullname: Campbell, Harry
  email: harry.campbell@ed.ac.uk
  organization: Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK
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IsPeerReviewed true
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Issue 9807
Keywords Human
Infection
Preschool age
Medicine
Respiratory disease
Seasonal variation
Viral disease
Influenza A
Systematic review
Respiratory system infection
Child
Metaanalysis
Language English
License CC BY 4.0
Copyright © 2011 Elsevier Ltd. All rights reserved.
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Snippet 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...
Summary Background The global burden of disease attributable to seasonal influenza virus in children is unknown. We aimed to estimate the global incidence of...
BACKGROUND: The global burden of disease attributable to seasonal influenza virus in children is unknown. We aimed to estimate the global incidence of and...
Background: The global burden of disease attributable to seasonal influenza virus in children is unknown. We aimed to estimate the global incidence of and...
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StartPage 1917
SubjectTerms Age
Biological and medical sciences
burden of disease
Child, Preschool
childhood
Children
Children & youth
Data processing
Developing countries
Disease control
General aspects
Global Health
health services
Human viral diseases
Humans
Incidence
Infant
Infection
Infectious diseases
Influenza
Influenza virus
Influenza, Human - complications
Influenza, Human - epidemiology
Internal Medicine
LDCs
Medical research
Medical sciences
meta-analysis
Mortality
Orthomyxoviridae
Pathogens
Pediatrics
Population studies
Respiratory Tract Infections - complications
Respiratory Tract Infections - epidemiology
Reviews
Seasonal variations
Seasons
Streptococcus infections
Studies
Systematic review
Viral diseases
Viral diseases of the respiratory system and ent viral diseases
World Health Organization
Title Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis
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