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      Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis


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          The global burden of disease attributable to respiratory syncytial virus (RSV) remains unknown. We aimed to estimate the global incidence of and mortality from episodes of acute lower respiratory infection (ALRI) due to RSV in children younger than 5 years in 2005.


          We estimated the incidence of RSV-associated ALRI in children younger than 5 years, stratified by age, using data from a systematic review of studies published between January, 1995, and June, 2009, and ten unpublished population-based studies. We estimated possible boundaries for RSV-associated ALRI mortality by combining case fatality ratios with incidence estimates from hospital-based reports from published and unpublished studies and identifying studies with population-based data for RSV seasonality and monthly ALRI mortality.


          In 2005, an estimated 33·8 (95% CI 19·3–46·2) million new episodes of RSV-associated ALRI occurred worldwide in children younger than 5 years (22% of ALRI episodes), with at least 3·4 (2·8–4·3) million episodes representing severe RSV-associated ALRI necessitating hospital admission. We estimated that 66 000–199 000 children younger than 5 years died from RSV-associated ALRI in 2005, with 99% of these deaths occurring in developing countries. Incidence and mortality can vary substantially from year to year in any one setting.


          Globally, RSV is the most common cause of childhood ALRI and a major cause of admission to hospital as a result of severe ALRI. Mortality data suggest that RSV is an important cause of death in childhood from ALRI, after pneumococcal pneumonia and Haemophilus influenzae type b. The development of novel prevention and treatment strategies should be accelerated as a priority.


          WHO; Bill & Melinda Gates Foundation.

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          WHO estimates of the causes of death in children.

          Child survival efforts can be effective only if they are based on accurate information about causes of deaths. Here, we report on a 4-year effort by WHO to improve the accuracy of this information. WHO established the external Child Health Epidemiology Reference Group (CHERG) in 2001 to develop estimates of the proportion of deaths in children younger than age 5 years attributable to pneumonia, diarrhoea, malaria, measles, and the major causes of death in the first 28 days of life. Various methods, including single-cause and multi-cause proportionate mortality models, were used. The role of undernutrition as an underlying cause of death was estimated in collaboration with CHERG. In 2000-03, six causes accounted for 73% of the 10.6 million yearly deaths in children younger than age 5 years: pneumonia (19%), diarrhoea (18%), malaria (8%), neonatal pneumonia or sepsis (10%), preterm delivery (10%), and asphyxia at birth (8%). The four communicable disease categories account for more than half (54%) of all child deaths. The greatest communicable disease killers are similar in all WHO regions with the exception of malaria; 94% of global deaths attributable to this disease occur in the Africa region. Undernutrition is an underlying cause of 53% of all deaths in children younger than age 5 years. Achievement of the millennium development goal of reducing child mortality by two-thirds from the 1990 rate will depend on renewed efforts to prevent and control pneumonia, diarrhoea, and undernutrition in all WHO regions, and malaria in the Africa region. In all regions, deaths in the neonatal period, primarily due to preterm delivery, sepsis or pneumonia, and birth asphyxia should also be addressed. These estimates of the causes of child deaths should be used to guide public-health policies and programmes.
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            Epidemiology and etiology of childhood pneumonia.

            Childhood pneumonia is the leading single cause of mortality in children aged less than 5 years. The incidence in this age group is estimated to be 0.29 episodes per child-year in developing and 0.05 episodes per child-year in developed countries. This translates into about 156 million new episodes each year worldwide, of which 151 million episodes are in the developing world. Most cases occur in India (43 million), China (21 million) and Pakistan (10 million), with additional high numbers in Bangladesh, Indonesia and Nigeria (6 million each). Of all community cases, 7-13% are severe enough to be life-threatening and require hospitalization. Substantial evidence revealed that the leading risk factors contributing to pneumonia incidence are lack of exclusive breastfeeding, undernutrition, indoor air pollution, low birth weight, crowding and lack of measles immunization. Pneumonia is responsible for about 19% of all deaths in children aged less than 5 years, of which more than 70% take place in sub-Saharan Africa and south-east Asia. Although based on limited available evidence, recent studies have identified Streptococcus pneumoniae, Haemophilus influenzae and respiratory syncytial virus as the main pathogens associated with childhood pneumonia.
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              Rates of hospitalization for respiratory syncytial virus infection among children in medicaid.

              To determine rates of hospitalization associated with respiratory syncytial virus (RSV) infection among children with and without specific medical conditions. Retrospective cohort study of all children <3 years old enrolled in the Tennessee Medicaid program from July 1989 through June 1993 (248,652 child-years). During the first year of life, the estimated number of RSV hospitalizations per 1000 children was 388 for those with bronchopulmonary dysplasia, 92 for those with congenital heart disease, 70 for children born at < or = 28 weeks' gestation, 66 for those born at 29 to <33 weeks, 57 for those born at 33 to <36 weeks, and 30 for children born at term with no underlying medical condition. In the second year of life, children with bronchopulmonary dysplasia had an estimated 73 RSV hospitalizations per 1000 children, whereas those with congenital heart disease had 18 and those with prematurity 16 per 1000. Overall, 53% of RSV hospitalizations occurred in healthy children born at term. Children with bronchopulmonary dysplasia have high rates of RSV hospitalization until 24 months of age. In contrast, after the first year of life, children with congenital heart disease or prematurity have rates no higher than that of children at low risk who are <12 months old.

                Author and article information

                Lancet Publishing Group
                1 May 2010
                1 May 2010
                : 375
                : 9725
                : 1545-1555
                [a ]Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK
                [b ]Public Health Foundation of India, New Delhi, India
                [c ]Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
                [d ]Department of Biological Sciences, University of Warwick, Coventry, UK
                [e ]Agence de Médecine Préventive, Paris, France
                [f ]Division of Public Health, University of Liverpool, Liverpool, UK
                [g ]Medical Research Council Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
                [h ]Alaska Native Tribal Health Consortium, Anchorage, AK, USA
                [i ]Arctic Investigations Program, National Center for Preparedness, Detection and Control of Infectious Disease, CDC, Anchorage, AK, USA
                [j ]Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
                [k ]Barcelona Centre for International Health Research (CRESIB), Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
                [l ]Centro de Investigação em Saúde da Manhiça (CISM), Ministerio de Saúde, Maputo, Mozambique
                [m ]Division of Infectious Disease and International Health, Dartmouth Medical School, Lebanon, NH, USA
                [n ]West Nusa Tenggara Provincial Government, Lombok, Indonesia
                [o ]Indonesian Ministry of Health, Jakarta, Indonesia
                [p ]Medical Faculty, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
                [q ]University of Colorado Denver and The Children's Hospital, Denver, CO, USA
                [r ]Croatian Centre for Global Health, Faculty of Medicine, University of Split, Split, Croatia
                [s ]WHO, Indonesia Country Office, Jakarta, Indonesia
                Author notes
                [* ]Correspondence to: Prof Harry Campbell, Professor of Public Health and Genetic Epidemiology, Centre for Population Health Sciences, Public Health Sciences, Medical School, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK Harry.Campbell@ 123456ed.ac.uk
                © 2010 Elsevier Ltd. All rights reserved.

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