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

Ting Shi,Issifou Alassani,Nitin Pandey,Mustafizur Rahman,Cinta Moraleda,Vahid Salimi,Sunthareeya Waicharoen,Imane Jroundi,Aubree Gordon,Shobha Broor,Philippe Buchy,Wilma Basualdo,Siddhivinayak Hirve,Michelle Groome,Alfredo Barahona,Marietjie Venter,Agustinus Sutanto,Stuart Campbell,Mukesh Dherani,Hongjie Yu,Somsak Thamthitiwat,Monidarin Chou,Evelyn Balsells,Cheryl Cohen,Harish Nair,Claudia Turner,Jianwei Wang,Dana Bruden,Budragchaagiin Dash-Yandag,Rosalyn Singleton,Viviana Sotomayor,Candice Romero,Jorge Jara,Brunhilde Schweiger,Gláucia Paranhos-Baccalà,Claudia Aguayo,Nigel Bruce,Quique Bassat,Godfrey Bigogo,Natasha Halasa,Mala Rakoto-Andrianarivelo,Pongpun Sawatwong,Jocelyn Moyes,Romina Libster,Louis Bont,Pagbajabyn Nymadawa,Annick Robinson,Doli Goswami,Sudha Basnet,Sophie Goyet,Kuswandewi Mutyara,Tekchheng Eap,Asad Ali,Rafal Tokarz,Phil Seidenberg,Wanitda Watthanaworawit,Phyllis Carosone-Link,Mariam Sylla,Kunling Shen,Nusrat Homaira,Histoshi Oshitani,Harry Campbell,James Chipeta,Luzhao Feng,Anand Krishnan,Carla Cecília De Freitas Lázaro Emediato,Graciela Russomando,Maria Tereza Da Costa Oliveira,Maria Deloria Knoll ,Vicky L Baillie ,W Abdullah Brooks ,Eduardo Azziz‐Baumgartner ,Débora Natalia Marcone ,Fernando P Polack ,Karen L Kotloff ,Shabir А Madhi ,John P Mccracken ,David Mcallister ,Olga López ,Henry C Baggett ,Bradford D Gessner ,Elizabeth Cuellar ,Elizabeth Thomas ,Joel M Montgomery ,Bernard E Ebruke ,Robert F Breiman ,Ángela Gentile ,Jennifer C Moïsi ,Cissy B Kartasasmita ,Sozinho Acácio ,Lay‐Myint Yoshida ,Barbara Rath ,Martín Antonio ,Daniel R Feikin ,Katherine L O'brien ,J Anthony G Scott ,Juliet O Awori ,Lia Phillips ,D James Nokes ,Tor A Strand ,Najwa Khuri‐Bulos ,Florencia Lución ,Socorro Lupisan ,Valentina Picot ,Mark P Nicol ,Zeba Rasmussen ,Ángel Balmaseda ,Eric A F Simões ,Rodrigo Fasce ,Sanjay Awasthi ,Stephen R C Howie ,Marcela Echavarría ,David P Moore ,Wilfrido Clará ,Duc Anh Dang ,Nienke M Scheltema ,Mandeep S Chadha ,Milagritos D Tapia ,Marilla Lucero ,Heather J Zar ,Mario Mejía ,Patrick K Munywoki

doi:10.1016/s0140-6736(17)30938-8

Abstract

SummaryBackgroundWe 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.MethodsWe 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.FindingsWe 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.InterpretationGlobally, 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.FundingThe Bill & Melinda Gates Foundation.

Highlights

Acute lower respiratory infection (ALRI) remains one of the leading causes of morbidity and mortality in children younger than 5 years.[1,2] Human respiratory syncytial virus (RSV) is the most common viral pathogen identified in children with acute lower respiratory infection (ALRI)
We have previously estimated that respiratory syncytial virus (RSV) was associated with 22% of all episodes of acute lower respiratory infection (ALRI) resulting in 55 000 to 199 000 deaths in children younger than 5 years in 2005
We previously reported that about 80% of ALRI deaths in young children occur outside hospital.[10]

Summary

Introduction

Acute lower respiratory infection (ALRI) remains one of the leading causes of morbidity and mortality in children younger than 5 years.[1,2] Human respiratory syncytial virus (RSV) is the most common viral pathogen identified in children with ALRI. We have previously estimated (from few data) that in 2005, about 33·8 million new episodes of RSV-ALRI occurred worldwide in young children, 10% severe enough to necessitate hospital admission.[3] We estimated that 55 000 to 199 000 child deaths could be attributed to RSV. Updated RSV disease burden estimates incorporating latest data are of great relevance for vaccine policy formulation and to prioritise research funding. We established the RSV Global Epidemiology Network (RSV GEN)—a collaboration of more than 70 investigator groups primarily in low-income and middle-income countries to estimate RSV-ALRI disease burden (at global, regional, and national levels) in young children for 2015; and highlight gaps in knowledge for future action

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