Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries.
Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries.
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DOI：
10.7189/jogh.03.010401
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发表时间：
2013-06
影响因子：
7.2
通讯作者：
Child Health Epidemiology Reference Group (CHERG)
中科院分区：
文献类型：
--
作者：
Rudan I;O'Brien KL;Nair H;Liu L;Theodoratou E;Qazi S;Lukšić I;Fischer Walker CL;Black RE;Campbell H;Child Health Epidemiology Reference Group (CHERG)
最近在《肺炎和腹泻全球行动计划》范围内进行的一系列审查涉及这两种致命疾病在全球和区域一级的流行病学;审查还估计了干预措施的有效性、实现高覆盖率的障碍以及对卫生政策的主要影响。本文的目的是提供国家一级儿童肺炎的估计数。这将使国家决策者和利益有关者能够在世界卫生组织（卫生组织）和儿童基金会成员国执行拟议的政策。我们进行了一系列系统性评价，以更新先前对儿童肺炎发病率、严重发病率、死亡率、风险因素和最常见病原体（肺炎链球菌（SP）、流感嗜血杆菌B型（HiB）、呼吸道合胞病毒（RSV）和流感病毒（流感））的具体贡献的全球、地区和国家负担的估计。我们使用流行病学模型，分发了2010-2011年全球和区域一级儿童肺炎病例、重症病例和死亡人数的估计数。该模型的依据是各国儿童肺炎的五个主要风险因素（营养不良、出生体重低、头四个月非纯母乳喂养、固体燃料使用和拥挤）的流行率以及使用荟萃分析估计的风险效应大小。根据世界卫生组织的定义，2010年低收入和中等收入国家（LMIC）社区获得性儿童肺炎的发病率约为0.22（四分位距（IQR）0.11-0.51）次/儿童年（e/cy），其中11.5%（IQR 8.0-33.0%）的病例进展为严重发作。这在过去十年中减少了近25%，这与观察到的整个LMIC肺炎风险因素患病率的降低一致。在肺炎发病率水平上，RSV是最常见的病原体，约占所有病例的29%，其次是流感（17%）。不同病原体的贡献因肺炎严重程度分层而异，病毒病因变得相对不那么重要，2010年大多数死亡是由主要细菌因子- SP（33%）和Hib（16%）引起的，占针对这两种病原体的疫苗使用。与2000年相比，有助于儿童肺炎负担模型的主要流行病学证据仅略有改善;所有估计数都有很大的不确定性范围。不过，有证据表明，2000-2010年期间，所有负担指标都呈下降趋势。肺炎发病率、严重发病率、死亡率和病因的估计数，虽然各自来自不同和独立的数据，但在内部是一致的-这使新的一套估计数具有可信度。肺炎仍然是新生儿期以后幼儿发病和死亡的主要原因，需要持续的战略和进展来进一步减轻负担。
The recent series of reviews conducted within the Global Action Plan for Pneumonia and Diarrhoea (GAPPD) addressed epidemiology of the two deadly diseases at the global and regional level; it also estimated the effectiveness of interventions, barriers to achieving high coverage and the main implications for health policy. The aim of this paper is to provide the estimates of childhood pneumonia at the country level. This should allow national policy–makers and stakeholders to implement proposed policies in the World Health Organization (WHO) and UNICEF member countries. We conducted a series of systematic reviews to update previous estimates of the global, regional and national burden of childhood pneumonia incidence, severe morbidity, mortality, risk factors and specific contributions of the most common pathogens: Streptococcus pneumoniae (SP), Haemophilus influenzae type B (Hib), respiratory syncytial virus (RSV) and influenza virus (flu). We distributed the global and regional–level estimates of the number of cases, severe cases and deaths from childhood pneumonia in 2010–2011 by specific countries using an epidemiological model. The model was based on the prevalence of the five main risk factors for childhood pneumonia within countries (malnutrition, low birth weight, non–exclusive breastfeeding in the first four months, solid fuel use and crowding) and risk effect sizes estimated using meta–analysis. The incidence of community–acquired childhood pneumonia in low– and middle–income countries (LMIC) in the year 2010, using World Health Organization's definition, was about 0.22 (interquartile range (IQR) 0.11–0.51) episodes per child–year (e/cy), with 11.5% (IQR 8.0–33.0%) of cases progressing to severe episodes. This is a reduction of nearly 25% over the past decade, which is consistent with observed reductions in the prevalence of risk factors for pneumonia throughout LMIC. At the level of pneumonia incidence, RSV is the most common pathogen, present in about 29% of all episodes, followed by influenza (17%). The contribution of different pathogens varies by pneumonia severity strata, with viral etiologies becoming relatively less important and most deaths in 2010 caused by the main bacterial agents – SP (33%) and Hib (16%), accounting for vaccine use against these two pathogens. In comparison to 2000, the primary epidemiological evidence contributing to the models of childhood pneumonia burden has improved only slightly; all estimates have wide uncertainty bounds. Still, there is evidence of a decreasing trend for all measures of the burden over the period 2000–2010. The estimates of pneumonia incidence, severe morbidity, mortality and etiology, although each derived from different and independent data, are internally consistent – lending credibility to the new set of estimates. Pneumonia continues to be the leading cause of both morbidity and mortality for young children beyond the neonatal period and requires ongoing strategies and progress to reduce the burden further.
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