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

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and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies.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by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies.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

Reduced Nasal Viral Load and IFN Responses in Infants with Respiratory Syncytial Virus Bronchiolitis and Respiratory Failure

“…Respiratory failure, and requirement for supportive mechanical ventilation, is a feature of the most severe cases of bronchiolitis. Such cases reflect those most likely to be life-threatening in low and middle income countries and represent a major healthcare economic burden in developed nations (3,30). Despite the particular importance of this group, such infants have been relatively understudied in attempts to establish correlates of disease severity.…”

“…Respiratory syncytial virus (RSV) is the single commonest cause of moderate to severe acute respiratory infection during infancy, resulting in over 3 million hospital admissions globally per annum (3). Most infants have been infected with RSV by 2 years of age, the majority of cases being mild (1).…”

Delivery of ALX-0171 by inhalation greatly reduces respiratory syncytial virus disease in newborn lambs

“…This lower respiratory tract infection results in hospitalization in about 3% of RSV-infected infants less than 1 year old, and in about 0.5% of RSV-infected children aged between 1 and 2 years 3 . Each year, it is estimated that RSV causes at least 3.2 million lower respiratory tract infections requiring hospitalization and between 48,000-74,500 in-hospital deaths worldwide in infants less than 5 years of age, 4 and ∼ 177,000 hospital admissions and 14,000 deaths per year in the United States in the elderly 5 …”

A Mismatch-Tolerant RT-Quantitative PCR: Application to Broad-Spectrum Detection of Respiratory Syncytial Virus

“…RSV infection is associated with bronchiolitis, pneumonia, otitis media, rhinitis and other reactive airway diseases [16]. It has been estimated that there are approximately 33.1 million RSV-related cases worldwide per year in children younger than 5 years, and the mortality was 118,200 [17,18]. Early diagnosis and monitoring of RSV infection play a crucial role in the treatment and management of RSV patients.…”