Global hospital admissions and in-hospital mortality associated with all-cause and virus-specific acute lower respiratory infections in children and adolescents aged 5–19 years between 1995 and 2019: a systematic review and modelling study

Abstract

IntroductionThe burden of acute lower respiratory infections (ALRI), and common viral ALRI aetiologies among 5–19 years are less well understood. We conducted a systematic review to estimate global burden of all-cause and virus-specific ALRI in 5–19 years.MethodsWe searched eight databases and Google for studies published between 1995 and 2019 and reporting data on burden of all-cause ALRI or ALRI associated with influenza virus, respiratory syncytial virus, human metapneumovirus and human parainfluenza virus. We assessed risk of bias using a modified Newcastle-Ottawa Scale. We developed an analytical framework to report burden by age, country and region when there were sufficient data (all-cause and influenza-associated ALRI hospital admissions). We estimated all-cause ALRI in-hospital deaths and hospital admissions for ALRI associated with respiratory syncytial virus, human metapneumovirus and human parainfluenza virus by region.ResultsGlobally, an estimated 5.5 million (UR 4.0–7.8) all-cause ALRI hospital admissions occurred annually between 1995 and 2019 in 5–19 year olds, causing 87 900 (UR 40 300–180 600) in-hospital deaths annually. Influenza virus and respiratory syncytial virus were associated with 1 078 600 (UR 4 56 500–2 650 200) and 231 800 (UR 142 700–3 73 200) ALRI hospital admissions in 5–19 years. Human metapneumovirus and human parainfluenza virus were associated with 105 500 (UR 57 200–181 700) and 124 800 (UR 67 300–228 500) ALRI hospital admissions in 5–14 years. About 55% of all-cause ALRI hospital admissions and 63% of influenza-associated ALRI hospital admissions occurred in those 5–9 years globally. All-cause and influenza-associated ALRI hospital admission rates were highest in upper-middle income countries, Asia-Pacific region and the Latin America and Caribbean region.ConclusionIncidence and mortality data for all-cause and virus-specific ALRI in 5–19 year olds are scarce. The lack of data in low-income countries and Eastern Europe and Central Asia, South Asia, and West and Central Africa warrants efforts to improve the development and access to healthcare services, diagnostic capacity, and data reporting.

Comorbidities in Children with COVID-19 and MIS-C/PIMS-TS and Risk Factors for Hospitalization, Severe Disease, Intensive Care and Death

“…Hospital admission rates in children and adolescents with influenza were assessed in a meta-analysis of 48 studies in children 5–19 years of age with 0–8% (95%CI 4.5–14.5) whereby older children are less common hospitalized. In comparison with other viruses admission for influenza account for 19% of all admission in children aged 5–19 years for lower respiratory tract infection 29 . In this meta-analysis a slightly lower mortality for influenza compared to SARS-CoV-2-associated disease is reported.…”

Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis

“…Since our previous estimates for 2015 3 , we have improved our methods to develop more robust estimates in our subsequent global disease burden studies for other viral infections. 9 – 11 , 22 One important change is the use of GLMM framework in place of the conventional random-effects model (REM); compared with REM, GLMM has advantages when handling sparse data (ie, when case or denominator counts are small). 23 This helps explain the differences in the RSV-associated acute lower respiratory infection in-hospital deaths between our present and previous estimates, as REM tends to bias CFR estimates upwards, towards 0·5, 23 which inflated the CFR estimate for older children in particular.…”

Curative efficacy and safety of peramivir in the treatment of children suspected with influenza

“…3,4 A recent systematic review estimated that 99% of influenza-related deaths among children under the age of 5 years occurred in resource-limited settings, and that the incidence of severe acute lower respiratory tract infections among infants aged 0–11 months appeared to be greater in low-resource setting. 5 During 2010–2014, influenza resulted in approximately 279,047 illnesses, 36,276 medical visits, 1,612 hospitalizations, and 755 deaths in infants aged 0 – 5 months in Kenya. 6 In China, 195,723 patients were reportedly infected with the flu virus and there were 8 deaths in 2015; 306,682 patients were infected with the flu virus and there were 56 deaths in 2016; 456,718 patients were infected with the flu virus and there were 41 deaths in 2017; and 768,291 patients were infected with the flu virus and there were 144 deaths in 2018.…”