{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T06:00:54Z","timestamp":1793944854502,"version":"4.8.0"},"reference-count":26,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T00:00:00Z","timestamp":1626220800000},"content-version":"unspecified","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP 1172551"],"award-info":[{"award-number":["OPP 1172551"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2021,5,12]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The burden of acute lower respiratory infections (ALRI), and common viral ALRI aetiologies among 5\u201319 years are less well understood. We conducted a systematic review to estimate global burden of all-cause and virus-specific ALRI in 5\u201319 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched eight databases and Google for studies published between 1995 and 2019 and reporting data on burden of all-cause ALRI or ALRI associated with influenza virus, respiratory syncytial virus, human metapneumovirus and human parainfluenza virus. We assessed risk of bias using a modified Newcastle-Ottawa Scale. We developed an analytical framework to report burden by age, country and region when there were sufficient data (all-cause and influenza-associated ALRI hospital admissions). We estimated all-cause ALRI in-hospital deaths and hospital admissions for ALRI associated with respiratory syncytial virus, human metapneumovirus and human parainfluenza virus by region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Globally, an estimated 5.5\u2009million (UR 4.0\u20137.8) all-cause ALRI hospital admissions occurred annually between 1995 and 2019 in 5\u201319\u2009year olds, causing 87\u2009900 (UR 40\u2009300\u2013180\u2009600) in-hospital deaths annually. Influenza virus and respiratory syncytial virus were associated with 1\u2009078\u2009600 (UR 4\u200956\u2009500\u20132 650 200) and 231\u2009800 (UR 142\u2009700\u20133\u200973\u2009200) ALRI hospital admissions in 5\u201319 years. Human metapneumovirus and human parainfluenza virus were associated with 105\u2009500 (UR 57\u2009200\u2013181\u2009700) and 124\u2009800 (UR 67\u2009300\u2013228\u2009500) ALRI hospital admissions in 5\u201314 years. About 55% of all-cause ALRI hospital admissions and 63% of influenza-associated ALRI hospital admissions occurred in those 5\u20139 years globally. All-cause and influenza-associated ALRI hospital admission rates were highest in upper-middle income countries, Asia-Pacific region and the Latin America and Caribbean region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Incidence and mortality data for all-cause and virus-specific ALRI in 5\u201319\u2009year olds are scarce. The lack of data in low-income countries and Eastern Europe and Central Asia, South Asia, and West and Central Africa warrants efforts to improve the development and access to healthcare services, diagnostic capacity, and data reporting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2021-006014","type":"journal-article","created":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T12:10:14Z","timestamp":1626264614000},"page":"e006014","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Global hospital admissions and in-hospital mortality associated with all-cause and virus-specific acute lower respiratory infections in children and adolescents aged 5\u201319 years between 1995 and 2019: a systematic review and modelling study"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8762-2421","authenticated-orcid":false,"given":"Xin","family":"Wang","sequence":"first","affiliation":[{"name":"Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Edinburgh, UK"},{"name":"School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You","family":"Li","sequence":"additional","affiliation":[{"name":"Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Edinburgh, UK"},{"name":"School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Mei","sequence":"additional","affiliation":[{"name":"Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Bushe","sequence":"additional","affiliation":[{"name":"Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Campbell","sequence":"additional","affiliation":[{"name":"Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harish","family":"Nair","sequence":"additional","affiliation":[{"name":"Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,7,14]]},"reference":[{"key":"2025072913431731000_6.7.e006014.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"2025072913431731000_6.7.e006014.2","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S2213-2600(18)30496-X","article-title":"Mortality, morbidity, and hospitalisations due to influenza lower respiratory tract infections, 2017: an analysis for the global burden of disease study 2017","volume":"7","year":"2019","journal-title":"Lancet Respir Med"},{"key":"2025072913431731000_6.7.e006014.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30721-4"},{"key":"2025072913431731000_6.7.e006014.4","unstructured":"Peterson J , Welch V , Losos M . The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses, 2011."},{"key":"2025072913431731000_6.7.e006014.5","doi-asserted-by":"crossref","first-page":"e497","DOI":"10.1016\/S2214-109X(19)30545-5","article-title":"Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study","volume":"8","author":"Wang","year":"2020","journal-title":"Lancet Glob Health"},{"key":"2025072913431731000_6.7.e006014.6","unstructured":"United Nations Department of Economic and Social Affairs Population Division . World population prospects, 2019."},{"key":"2025072913431731000_6.7.e006014.7","unstructured":"R\u00fccker G , Krahn U , K\u00f6nig J , et al . Network Meta-Analysis using Frequentist Methods. In: R package version 1.2-1, 2020."},{"key":"2025072913431731000_6.7.e006014.8","unstructured":"The World Bank . 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