Global burden of acute lower respiratory infection associated with human metapneumovirus in children under 5 years in 2018: a systematic review and modelling study.
Global burden of acute lower respiratory infection associated with human metapneumovirus in children under 5 years in 2018: a systematic review and modelling study.
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DOI：
10.1016/s2214-109x(20)30393-4
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发表时间：
2021-01
期刊：
影响因子：
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通讯作者：
Respiratory Virus Global Epidemiology Network
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作者：
Wang X;Li Y;Deloria-Knoll M;Madhi SA;Cohen C;Ali A;Basnet S;Bassat Q;Brooks WA;Chittaganpitch M;Echavarria M;Fasce RA;Goswami D;Hirve S;Homaira N;Howie SRC;Kotloff KL;Khuri-Bulos N;Krishnan A;Lucero MG;Lupisan S;Mira-Iglesias A;Moore DP;Moraleda C;Nunes M;Oshitani H;Owor BE;Polack FP;O'Brien KL;Rasmussen ZA;Rath BA;Salimi V;Scott JAG;Simões EAF;Strand TA;Thea DM;Treurnicht FK;Vaccari LC;Yoshida LM;Zar HJ;Campbell H;Nair H;Respiratory Virus Global Epidemiology Network
人偏肺病毒是一种常见的与儿童急性下呼吸道感染（ALRI）相关的病毒。目前尚无与儿童人偏肺病毒相关的ALRI的全球负担估计值，也没有获得许可的用于人偏肺病毒感染的疫苗或药物。我们的目的是估计年龄分层的人偏肺病毒相关ALRI的全球发病率，住院率和死亡率负担小于5岁的儿童。我们通过对2001年1月1日至2019年12月31日期间发表的119项研究以及另外40项高质量未发表研究的系统性综述，估计了5岁以下儿童中人类偏肺病毒相关ALRI的全球负担。我们使用改良的Newcastle-Ottawa量表评估偏倚风险。我们使用广义线性混合模型估计了人偏肺病毒相关ALRI的发病率、住院率和住院病死率（hCFR）。我们将人偏肺病毒相关ALRI的发病率和住院率应用于人口估计，以获得按年龄段和世界银行收入水平的发病率负担估计。我们还估计了人偏肺病毒相关的ALRI住院死亡和总体人偏肺病毒相关的ALRI死亡（住院和非住院死亡）。此外，我们通过结合实验室确认的人偏肺病毒病例和死亡中人偏肺病毒相关负担估计值和人偏肺病毒的可归因分数，估计了人偏肺病毒可归因的ALRI病例、住院和死亡。2018年，在全球5岁以下儿童中，估计有1420万例人偏肺病毒相关ALRI病例（不确定性范围[UR] 1020万至2010万），643000例人偏肺病毒相关住院（UR 425000至977000），7700例人偏肺病毒相关院内死亡（2600至48800）和16100例总体（医院和社区）人偏肺病毒相关ALRI死亡（5700至88000）。 2018年，估计有1110万例ALRI病例（800万至1570万UR）、502000例ALRI住院（332000至762000 UR）和11300例ALRI死亡（4000至61600 UR）可归因于人类偏肺病毒。 约58%的住院婴儿年龄在12个月以下，64%的住院死亡婴儿年龄在6个月以下，其中79%发生在低收入和中低收入国家。在世界银行所有收入区域和所有儿童死亡率环境中，1岁以下婴儿患严重人类偏肺病毒感染的风险不成比例地高，类似于呼吸道合胞病毒和流感病毒。低收入和中低收入国家6个月以下的婴儿死于人偏肺病毒相关ALRI的风险高于年龄较大的儿童以及中高收入和高收入国家的儿童。我们的死亡率估计表明了干预策略对所有环境中婴儿的重要性，并保证继续努力改善低收入和中低收入国家幼儿中人类偏肺病毒相关ALRI的结局。比尔和梅林达·盖茨基金会。
Human metapneumovirus is a common virus associated with acute lower respiratory infections (ALRIs) in children. No global burden estimates are available for ALRIs associated with human metapneumovirus in children, and no licensed vaccines or drugs exist for human metapneumovirus infections. We aimed to estimate the age-stratified human metapneumovirus-associated ALRI global incidence, hospital admissions, and mortality burden in children younger than 5 years. We estimated the global burden of human metapneumovirus-associated ALRIs in children younger than 5 years from a systematic review of 119 studies published between Jan 1, 2001, and Dec 31, 2019, and a further 40 high quality unpublished studies. We assessed risk of bias using a modified Newcastle-Ottawa Scale. We estimated incidence, hospital admission rates, and in-hospital case-fatality ratios (hCFRs) of human metapneumovirus-associated ALRI using a generalised linear mixed model. We applied incidence and hospital admission rates of human metapneumovirus–associated ALRI to population estimates to yield the morbidity burden estimates by age bands and World Bank income levels. We also estimated human metapneumovirus-associated ALRI in-hospital deaths and overall human metapneumovirus-associated ALRI deaths (both in-hospital and non-hospital deaths). Additionally, we estimated human metapneumovirus-attributable ALRI cases, hospital admissions, and deaths by combining human metapneumovirus-associated burden estimates and attributable fractions of human metapneumovirus in laboratory-confirmed human metapneumovirus cases and deaths. In 2018, among children younger than 5 years globally, there were an estimated 14·2 million human metapneumovirus-associated ALRI cases (uncertainty range [UR] 10·2 million to 20·1 million), 643 000 human metapneumovirus-associated hospital admissions (UR 425 000 to 977 000), 7700 human metapneumovirus-associated in-hospital deaths (2600 to 48 800), and 16 100 overall (hospital and community) human metapneumovirus-associated ALRI deaths (5700 to 88 000). An estimated 11·1 million ALRI cases (UR 8·0 million to 15·7 million), 502 000 ALRI hospital admissions (UR 332 000 to 762 000), and 11 300 ALRI deaths (4000 to 61 600) could be causally attributed to human metapneumovirus in 2018. Around 58% of the hospital admissions were in infants under 12 months, and 64% of in-hospital deaths occurred in infants younger than 6 months, of which 79% occurred in low-income and lower-middle-income countries. Infants younger than 1 year have disproportionately high risks of severe human metapneumovirus infections across all World Bank income regions and all child mortality settings, similar to respiratory syncytial virus and influenza virus. Infants younger than 6 months in low-income and lower-middle-income countries are at greater risk of death from human metapneumovirus-associated ALRI than older children and those in upper-middle-income and high-income countries. Our mortality estimates demonstrate the importance of intervention strategies for infants across all settings, and warrant continued efforts to improve the outcome of human metapneumovirus-associated ALRI among young infants in low-income and lower-middle-income countries. Bill & Melinda Gates Foundation.