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.
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.
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DOI：
10.1016/s0140-6736(22)00478-0
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发表时间：
2022-05-28
期刊：
影响因子：
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通讯作者：
RESCEU investigators
中科院分区：
文献类型：
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作者：
Li Y;Wang X;Blau DM;Caballero MT;Feikin DR;Gill CJ;Madhi SA;Omer SB;Simões EAF;Campbell H;Pariente AB;Bardach D;Bassat Q;Casalegno JS;Chakhunashvili G;Crawford N;Danilenko D;Do LAH;Echavarria M;Gentile A;Gordon A;Heikkinen T;Huang QS;Jullien S;Krishnan A;Lopez EL;Markić J;Mira-Iglesias A;Moore HC;Moyes J;Mwananyanda L;Nokes DJ;Noordeen F;Obodai E;Palani N;Romero C;Salimi V;Satav A;Seo E;Shchomak Z;Singleton R;Stolyarov K;Stoszek SK;von Gottberg A;Wurzel D;Yoshida LM;Yung CF;Zar HJ;Respiratory Virus Global Epidemiology Network;Nair H;RESCEU investigators
呼吸道合胞病毒（RSV）是幼儿急性下呼吸道感染的最常见原因。我们之前估计，2015年，0-60个月的儿童中发生了3310万例RSV相关急性下呼吸道感染，导致全球共118200例死亡。从那时起，已经进行了几项社区监测研究，以获得RSV相关社区死亡的更精确估计。我们的目标是更新2019年全球、区域和国家层面0-60个月儿童的RSV相关急性下呼吸道感染发病率和死亡率，重点关注总体死亡率和正在开发的RSV抗感染药物所针对的较窄婴儿年龄组。在这项系统性分析中，我们通过从MEDLINE、Embase、Global Health、CINAHL、Web of Science、LILACS、OpenGrey、CNKI、Wanfang和ChongqingVIP更新检索2017年1月1日至2020年12月31日期间发表的论文获得新数据，扩展了我们的全球RSV疾病负担数据集。我们还纳入了来自RSV GEN合作者的未发表数据。符合条件的研究报告了0-60个月儿童的数据，这些儿童的RSV为社区环境中急性下呼吸道感染的原发感染，或需要住院的急性下呼吸道感染;报告了至少连续12个月的数据，但住院病死率（CFR）或RSV季节性明确的情况除外;报告发病率、住院率、急性下呼吸道感染住院患者中RSV阳性比例、院内病死率。如果病例定义不明确或应用不一致，RSV感染未经实验室确认或仅基于血清学，或如果报告包括少于50例急性下呼吸道感染病例，则排除研究。我们应用广义线性混合效应模型（GLMM）估计2019年全球和区域（按国家发展状况和世界银行收入分类）RSV相关急性下呼吸道感染发病率、住院率和住院死亡率。我们通过基于风险因素的模型估计了国家水平的RSV相关急性下呼吸道感染发病率。我们开发了新的模型（通过GLMM），该模型纳入了最新的RSV社区死亡率数据，用于估计总体RSV死亡率。该综述已在PROSPERO（CRD 42021252400）中注册。除了我们之前的综述中纳入的317项研究外，我们还确定并纳入了113项新的合格研究和51项研究的未发表数据，共计481项研究。我们估计，2019年全球有3300万例RSV相关急性下呼吸道感染发作（不确定性范围[UR] 25.4 - 44.6百万），3.6百万RSV相关急性下呼吸道感染住院（2.9 - 4.6百万），26300例RSV相关急性下呼吸道感染住院死亡（15 100-49 100）和101 400例RSV可归因的0-60个月儿童总死亡（84 500-125 200）。在0-6个月的婴儿中，我们估计有660万例RSV相关的急性下呼吸道感染发作（4.6 - 9.7万），1.4万RSV相关急性下呼吸道感染住院RSV相关急性下呼吸道感染住院死亡13300例（6800 ~ 28100例），RSV相关总死亡45700例（38400 ~ 55900例）。0-60月龄儿童（UR 1.6 - 2.4）中2.0%的死亡和28天至6月龄儿童（UR 3.0 - 4.4）中3.6%的死亡可归因于RSV。在所有年龄段中，超过95%的RSV相关急性下呼吸道感染发作和超过97%的RSV可归因死亡发生在低收入和中等收入国家。RSV对全球0-60个月儿童的发病率和死亡率负担有很大贡献，特别是在出生后的前6个月和中低收入国家。我们强调了RSV疾病在全球范围内惊人的总体死亡率负担，0-60个月儿童中每50例死亡中就有一例，28天至6个月儿童中每28例死亡中就有一例可归因于RSV。对于每一例RSV相关急性下呼吸道感染住院死亡，我们估计社区中约有三例可归因于RSV的死亡。针对出生后前6个月的保护性RSV被动免疫接种计划可能对降低RSV疾病负担产生实质性影响，尽管需要更多数据来了解实施这些计划时RSV峰值负担向老年转移的潜在年龄变化的影响。欧洲呼吸道合胞病毒联盟（RESCEU）。
Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory infection in young children. We previously estimated that in 2015, 33·1 million episodes of RSV-associated acute lower respiratory infection occurred in children aged 0–60 months, resulting in a total of 118 200 deaths worldwide. Since then, several community surveillance studies have been done to obtain a more precise estimation of RSV associated community deaths. We aimed to update RSV-associated acute lower respiratory infection morbidity and mortality at global, regional, and national levels in children aged 0–60 months for 2019, with focus on overall mortality and narrower infant age groups that are targeted by RSV prophylactics in development. In this systematic analysis, we expanded our global RSV disease burden dataset by obtaining new data from an updated search for papers published between Jan 1, 2017, and Dec 31, 2020, from MEDLINE, Embase, Global Health, CINAHL, Web of Science, LILACS, OpenGrey, CNKI, Wanfang, and ChongqingVIP. We also included unpublished data from RSV GEN collaborators. Eligible studies reported data for children aged 0–60 months with RSV as primary infection with acute lower respiratory infection in community settings, or acute lower respiratory infection necessitating hospital admission; reported data for at least 12 consecutive months, except for in-hospital case fatality ratio (CFR) or for where RSV seasonality is well-defined; and reported incidence rate, hospital admission rate, RSV positive proportion in acute lower respiratory infection hospital admission, or in-hospital CFR. Studies were excluded if case definition was not clearly defined or not consistently applied, RSV infection was not laboratory confirmed or based on serology alone, or if the report included fewer than 50 cases of acute lower respiratory infection. We applied a generalised linear mixed-effects model (GLMM) to estimate RSV-associated acute lower respiratory infection incidence, hospital admission, and in-hospital mortality both globally and regionally (by country development status and by World Bank Income Classification) in 2019. We estimated country-level RSV-associated acute lower respiratory infection incidence through a risk-factor based model. We developed new models (through GLMM) that incorporated the latest RSV community mortality data for estimating overall RSV mortality. This review was registered in PROSPERO (CRD42021252400). In addition to 317 studies included in our previous review, we identified and included 113 new eligible studies and unpublished data from 51 studies, for a total of 481 studies. We estimated that globally in 2019, there were 33·0 million RSV-associated acute lower respiratory infection episodes (uncertainty range [UR] 25·4–44·6 million), 3·6 million RSV-associated acute lower respiratory infection hospital admissions (2·9–4·6 million), 26 300 RSV-associated acute lower respiratory infection in-hospital deaths (15 100–49 100), and 101 400 RSV-attributable overall deaths (84 500–125 200) in children aged 0–60 months. In infants aged 0–6 months, we estimated that there were 6·6 million RSV-associated acute lower respiratory infection episodes (4·6–9·7 million), 1·4 million RSV-associated acute lower respiratory infection hospital admissions (1·0–2·0 million), 13 300 RSV-associated acute lower respiratory infection inhospital deaths (6800–28 100), and 45700 RSV-attributable overall deaths (38 400–55 900). 2·0% of deaths in children aged 0–60 months (UR 1·6–2·4) and 3·6% of deaths in children aged 28 days to 6 months (3·0–4·4) were attributable to RSV. More than 95% of RSV-associated acute lower respiratory infection episodes and more than 97% of RSV-attributable deaths across all age bands were in low-income and middle-income countries (LMICs). RSV contributes substantially to morbidity and mortality burden globally in children aged 0–60 months, especially during the first 6 months of life and in LMICs. We highlight the striking overall mortality burden of RSV disease worldwide, with one in every 50 deaths in children aged 0–60 months and one in every 28 deaths in children aged 28 days to 6 months attributable to RSV. For every RSV-associated acute lower respiratory infection in-hospital death, we estimate approximately three more deaths attributable to RSV in the community. RSV passive immunisation programmes targeting protection during the first 6 months of life could have a substantial effect on reducing RSV disease burden, although more data are needed to understand the implications of the potential age-shifts in peak RSV burden to older age when these are implemented. EU Innovative Medicines Initiative Respiratory Syncytial Virus Consortium in Europe (RESCEU).