학술논문
Global burden of influenza-associated lower respiratory tract infections and hospitalizations among adults: A systematic review and meta-analysis.
Document Type
article
Author
Kathryn E Lafond; Rachael M Porter; Melissa J Whaley; Zhou Suizan; Zhang Ran; Mohammad Abdul Aleem; Binay Thapa; Borann Sar; Viviana Sotomayor Proschle; Zhibin Peng; Luzhao Feng; Daouda Coulibaly; Edith Nkwembe; Alfredo Olmedo; William Ampofo; Siddhartha Saha; Mandeep Chadha; Amalya Mangiri; Vivi Setiawaty; Sami Sheikh Ali; Sandra S Chaves; Dinagul Otorbaeva; Onechanh Keosavanh; Majd Saleh; Antonia Ho; Burmaa Alexander; Hicham Oumzil; Kedar Prasad Baral; Q Sue Huang; Adedeji A Adebayo; Idris Al-Abaidani; Marta von Horoch; Cheryl Cohen; Stefano Tempia; Vida Mmbaga; Malinee Chittaganpitch; Mariana Casal; Duc Anh Dang; Paula Couto; Harish Nair; Joseph S Bresee; Sonja J Olsen; Eduardo Azziz-Baumgartner; J Pekka Nuorti; Marc-Alain Widdowson; Global Respiratory Hospitalizations–Influenza Proportion Positive (GRIPP) Working Group
Source
PLoS Medicine, Vol 18, Iss 3, p e1003550 (2021)
Subject
Language
English
ISSN
1549-1277
1549-1676
1549-1676
Abstract
BackgroundInfluenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings.Methods and findingsWe aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996-31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcastle-Ottawa scale for observational data. We applied meta-analytic proportions to global estimates of lower respiratory infections (LRIs) and hospitalizations from the Global Burden of Disease study in adults ≥20 years and by age groups (20-64 years and ≥65 years) to obtain the number of influenza-associated LRI episodes and hospitalizations for 2016. Data from 63 sources showed that influenza was associated with 14.1% (95% CI 12.1%-16.5%) of acute respiratory hospitalizations among all adults, with no significant differences by age group. The 63 data sources represent published observational studies (n = 28) and unpublished surveillance data (n = 35), from all World Health Organization regions (Africa, n = 8; Americas, n = 11; Eastern Mediterranean, n = 7; Europe, n = 8; Southeast Asia, n = 11; Western Pacific, n = 18). Data quality for published data sources was predominantly moderate or high (75%, n = 56/75). We estimate 32,126,000 (95% CI 20,484,000-46,129,000) influenza-associated LRI episodes and 5,678,000 (95% CI 3,205,000-9,432,000) LRI hospitalizations occur each year among adults. While adults ConclusionsIn this meta-analysis, we estimated that influenza viruses are associated with over 5 million hospitalizations worldwide per year. Inclusion of both published and unpublished findings allowed for increased power to generate stratified estimates, and improved representation from lower-income countries. Together, the available data demonstrate the importance of influenza viruses as a cause of severe disease and hospitalizations in younger and older adults worldwide.