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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Author
Wang, XinLi, You
Deloria-Knoll, Maria
Madhi, Shabir A.
Cohen, Cheryl
Ali, Asad
Basnet, Sudha
Bassat, Quique
Brooks, W. Abdullah
Chittaganpitch, Malinee
Echavarria, Marcela
Fasce, Rodrigo A.
Goswami, Doli
Hirve, Siddhivinayak
Homaira, Nusrat
Howie, Stephen R.C.
Kotloff, Karen L.
Khuri-Bulos, Najwa
Krishnan, Anand
Lucero, Marilla G.
Lupisan, Socorro
Mira-Iglesias, Ainara
Moore, David P.
Moraleda, Cinta
Nunes, Marta
Oshitani, Histoshi
Owor, Betty E.
Polack, Fernando P.
O'Brien, Katherine L.
Rasmussen, Zeba A.
Rath, Barbara A.
Salimi, Vahid
Scott, J. Anthony G.
Simões, Eric A.F.
Strand, Tor A.
Thea, Donald M.
Treurnicht, Florette K.
Vaccari, Linda C.
Yoshida, Lay Myint
Zar, Heather J.
Campbell, Harry
Nair, Harish
Libster, Romina
Otieno, Grieven
Joundi, Imane
Broor, Shobha
Nicol, Mark
Amarchand, Ritvik
Shi, Ting
López-Labrador, F. Xavier
Baker, Julia M.
Jamison, Alexandra
Choudekar, Avinash
Juvekar, Sanjay
Obermeier, Patrick
Schweiger, Brunhilde
Madrid, Lola
Thomas, Elizabeth
Lanaspa, Miguel
Nohynek, Hanna
Nokes, James
Werner, Marta
Danhg, Anh
Chadha, Mandeep
Puig-Barberà, Joan
Caballero, Mauricio T.
Mathisen, Maria
Walaza, Sibongile
Hellferscee, Orienka
Laubscher, Matt
Higdon, Melissa M.
Haddix, Meredith
Sawatwong, Pongpun
Baggett, Henry C.
Seidenberg, Phil
Mwanayanda, Lawrence
Antonio, Martin
Ebruke, Bernard E.
Adams, Tanja
Rahman, Mustafizur
Rahman, Mohammed Ziaur
Sow, Samboa O.
Baillie, Vicky L.
Workman, Lesley
Toizumi, Michiko
Tapia, Milagritos D.
Nguyen, Thi hien anh
Morpeth, Susan
Date
2020-11-26Journal
Lancet Global HealthPublisher
Elsevier Ltd.Type
Article
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Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: Bill & Melinda Gates Foundation. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseSponsors
Bill & Melinda Gates Foundation Innovative Medicines Initiative.Keyword
Global Burden of DiseaseMetapneumovirus
Respiratory Tract Infections
Child
Infant
Infant, Newborn
Identifier to cite or link to this item
http://hdl.handle.net/10713/14287ae974a485f413a2113503eed53cd6c53
10.1016/S2214-109X(20)30393-4