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; MCALLISTER, DAVID A; POLACK, FERNANDO P; BALSELLS, EVELYN; AWORI, JULIET O; AZZIZ-BAUMGARTNER, EDUARDO; BAGGETT, HENRY C; ECHAVARRIA, MARCELA; FEIKIN, DANIEL R; GENTILE, ANGELA; LIBSTER, ROMINA; MARCONE, DEBORA N; MUNYWOKI, PATRICK; NOKES, D JAMES; SCOTT, J ANTHONY G; CAMPBELL, HARRY; NAIR, HARISH

LANCET

ELSEVIER SCIENCE INC

Año: 2017 vol. 390 p. 946 - 958

0140-6736

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 55000 to 199000 deaths in children younger than5 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 theglobal 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and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies.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 populationestimates. 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by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies.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 overallRSV-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 59600 (48000?74500) in-hospital deaths in childrenyounger than 5 years. In children younger than 6 months, 1·4 million (UR 1·2?1·7) hospital admissions, and 27300 (UR 20700?36200) in-hospital deaths were due to RSV-ALRI. We also estimated that the overall RSV-ALRI mortality could be as high as 118200 (UR 94600?149400). 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 inyoung children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and inhospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine ormonoclonal antibody could have a substantial effect on disease burden in this age group.