Xin Wang1, You Li1, Maria Deloria-Knoll2, Shabir A Madhi3, Cheryl Cohen4, Asad Ali5, Sudha Basnet6, Quique Bassat7, W Abdullah Brooks2, Malinee Chittaganpitch8, Marcela Echavarria9, Rodrigo A Fasce10, Doli Goswami11, Siddhivinayak Hirve12, Nusrat Homaira13, Stephen R C Howie14, Karen L Kotloff15, Najwa Khuri-Bulos16, Anand Krishnan17, Marilla G Lucero18, Socorro Lupisan18, Ainara Mira-Iglesias19, David P Moore20, Cinta Moraleda21, Marta Nunes3, Histoshi Oshitani22, Betty E Owor23, Fernando P Polack24, Katherine L O'Brien2, Zeba A Rasmussen25, Barbara A Rath26, Vahid Salimi27, J Anthony G Scott28, Eric A F Simões29, Tor A Strand30, Donald M Thea31, Florette K Treurnicht4, Linda C Vaccari1, Lay-Myint Yoshida32, Heather J Zar33, Harry Campbell1, Harish Nair34. 1. Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK. 2. Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 3. Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 4. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa. 5. Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. 6. Department of Child Health, Tribhuvan University, Kathmandu, Nepal; Centre for International Health, University of Bergen, Bergen, Norway. 7. Barcelona Global Health Institute, Hospital Clínic-University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain. 8. Medical Sciences Technical Office, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand. 9. Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina. 10. Public Health Institute of Chile, Santiago, Chile. 11. International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh. 12. KEM Hospital Research Centre, Pune, India. 13. International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh; Discipline of Paediatrics, School of Women's and Children's Health, The University of New South Wales, Sydney, NSW, Australia. 14. Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand. 15. Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA. 16. Department of Pediatrics, University of Jordan School of Medicine, Amman, Jordan. 17. Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India. 18. Research Institute for Tropical Medicine, Muntinlupa, Philippines. 19. Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Salud Pública), Valencia, Spain. 20. Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 21. Barcelona Global Health Institute, Hospital Clínic-University of Barcelona, Barcelona, Spain; Infectious Pediatric Diseases Section, Hospital Universitario de Octubre, Universidad Complutense, Research Institute Hospital de Octubre, Madrid, Spain. 22. Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan. 23. KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. 24. Fundacion INFANT, Buenos Aires, Argentina. 25. Fogarty International Center, National Institutes of Health, Bethesda, MD, USA. 26. Vienna Vaccine Safety Initiative, Berlin, Germany. 27. Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 28. KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Nuffield Department of Tropical Medicine, Oxford University, Oxford, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. 29. Department of Pediatrics, School of Medicine, and Department of Epidemiology and Center for Global Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA. 30. Centre for International Health, University of Bergen, Bergen, Norway; Innland Hosptial Trust, Lillehammer, Norway. 31. Department of Global Health and Development, Boston University School of Public Health, Boston, MA, USA. 32. Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan. 33. Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. 34. Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK. Electronic address: harish.nair@ed.ac.uk.
Abstract
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.
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 humanmetapneumovirus-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) humanmetapneumovirus-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 childmortality 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.
Authors: You Li; Xin Wang; Dianna M Blau; Mauricio T Caballero; Daniel R Feikin; Christopher J Gill; Shabir A Madhi; Saad B Omer; Eric A F Simões; Harry Campbell; Ana Bermejo Pariente; Darmaa Bardach; Quique Bassat; Jean-Sebastien Casalegno; Giorgi Chakhunashvili; Nigel Crawford; Daria Danilenko; Lien Anh Ha Do; Marcela Echavarria; Angela Gentile; Aubree Gordon; Terho Heikkinen; Q Sue Huang; Sophie Jullien; Anand Krishnan; Eduardo Luis Lopez; Joško Markić; Ainara Mira-Iglesias; Hannah C Moore; Jocelyn Moyes; Lawrence Mwananyanda; D James Nokes; Faseeha Noordeen; Evangeline Obodai; Nandhini Palani; Candice Romero; Vahid Salimi; Ashish Satav; Euri Seo; Zakhar Shchomak; Rosalyn Singleton; Kirill Stolyarov; Sonia K Stoszek; Anne von Gottberg; Danielle Wurzel; Lay-Myint Yoshida; Chee Fu Yung; Heather J Zar; Harish Nair Journal: Lancet Date: 2022-05-19 Impact factor: 202.731
Authors: Patrick E Obermeier; Albert Heim; Barbara Biere; Elias Hage; Maren Alchikh; Tim Conrad; Brunhilde Schweiger; Barbara A Rath Journal: iScience Date: 2022-04-21
Authors: Allison August; Christine A Shaw; Heather Lee; Conor Knightly; Shiva Kalidindia; Laurence Chu; Brandon J Essink; William Seger; Tal Zaks; Igor Smolenov; Lori Panther Journal: Open Forum Infect Dis Date: 2022-05-01 Impact factor: 4.423
Authors: Xin Wang; You Li; Maria Deloria-Knoll; Shabir A Madhi; Cheryl Cohen; Vina Lea Arguelles; Sudha Basnet; Quique Bassat; W Abdullah Brooks; Marcela Echavarria; Rodrigo A Fasce; Angela Gentile; Doli Goswami; Nusrat Homaira; Stephen R C Howie; Karen L Kotloff; Najwa Khuri-Bulos; Anand Krishnan; Marilla G Lucero; Socorro Lupisan; Maria Mathisen; Kenneth A McLean; Ainara Mira-Iglesias; Cinta Moraleda; Michiko Okamoto; Histoshi Oshitani; Katherine L O'Brien; Betty E Owor; Zeba A Rasmussen; Barbara A Rath; Vahid Salimi; Pongpun Sawatwong; J Anthony G Scott; Eric A F Simões; Viviana Sotomayor; Donald M Thea; Florette K Treurnicht; Lay-Myint Yoshida; Heather J Zar; Harry Campbell; Harish Nair Journal: Lancet Glob Health Date: 2021-06-21 Impact factor: 38.927