{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:52:17Z","timestamp":1792788737415,"version":"4.5.0"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Yunnan Science and Technology Department; Kunming Medical University","award":["202101AY070001-217"],"award-info":[{"award-number":["202101AY070001-217"]}],"id":[{"id":"https:\/\/ror.org\/038c3w259","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Kunming Health Science and Technology Personnel Training Project","award":["2020 (Province)-21"],"award-info":[{"award-number":["2020 (Province)-21"]}]},{"name":"Key Science and Technology Program of Yunnan Province","award":["202102AA100019"],"award-info":[{"award-number":["202102AA100019"]}]},{"name":"Medical Science and Technology Leading Talent","award":["2025-SW(Leading)-03"],"award-info":[{"award-number":["2025-SW(Leading)-03"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"\n Background<\/jats:title>\n Infectious diseases remain a major public health threat to child survival and health, with particularly substantial burdens attributable to lower respiratory infections, diarrheal diseases, and CNS infections. Although the Global Burden of Disease (GBD) studies have previously evaluated specific pathogens or individual clinical syndromes, a descriptive assessment of the burden attributable to major pathogens across multiple infectious syndromes in children within G20 countries remains limited. Using the most recent GBD 2023 dataset, this study aimed to systematically evaluate the burden and temporal trends of 46 key pathogens among children aged 0\u201314 years in G20 countries from 1990 to 2023.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Data were obtained from the Global Burden of Disease Study 2023 (GBD 2023). We extracted estimates of deaths and disability-adjusted life years (DALYs) attributable to 46 pathogens among children aged 0\u201314 years in G20 countries between 1990 and 2023, and calculated corresponding death and DALY rates. Temporal trends were assessed using the estimated annual percentage change (EAPC). Regional disparities were examined through stratified analyses based on the Socio-demographic Index (SDI). The principal infectious syndromes analyzed included lower respiratory infections, diarrheal diseases, and meningitis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In 2023,\n Streptococcus pneumoniae<\/jats:italic>\n was the leading pathogen contributing to death and DALY loss among children in G20 countries, accounting for approximately 66,400 deaths (95% UI: 56,400\u201377,000) and 5.90 million DALYs (95% UI: 5.01\u20136.85 million). It also represented the predominant pathogen responsible for meningitis-related burden.\n Klebsiella pneumoniae<\/jats:italic>\n ranked second, causing approximately 21,500 deaths (95% UI: 17,900\u201324,700), followed closely by Adenovirus (approximately 16,700 deaths; 95% UI: 9,300\u201326,200) and Rotavirus (approximately 16,100 deaths; 95% UI: 11,100\u201322,900). In terms of temporal trends, death from\n Haemophilus influenzae<\/jats:italic>\n meningitis exhibited the most pronounced decline, with an average annual reduction of 9.06% (95% CI: \u22129.98 to \u22128.14). Regional analyses indicated that India, South Africa, and Indonesia bore the greatest burden within the G20. Age-stratified analyses revealed that infants younger than one year experienced substantially higher disease burdens than other pediatric age groups. Correlation analyses further demonstrated a significant inverse relationship between SDI and pathogen-attributable death rates (r\u2009= \u22120.8456, p\u2009<\u20090.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Although the overall burden of pediatric infectious diseases in G20 countries has declined markedly since 1990, substantial burdens attributable to pathogens such as\n Streptococcus pneumoniae<\/jats:italic>\n , rotavirus, and\n Klebsiella pneumoniae<\/jats:italic>\n persist in lower-SDI member states. Moving forward, priority should be given to increasing coverage of pneumococcal conjugate vaccines and rotavirus vaccines in resource-limited G20 settings, strengthening pathogen surveillance, and improving access to timely diagnosis and treatment for severe infections in order to further reduce health inequalities.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014723","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:27:09Z","timestamp":1789666029000},"page":"e0014723","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Burden of 46 key pathogens among children in G20 countries, 2023: A systematic analysis and regional comparison"],"prefix":"10.1371","volume":"20","author":[{"given":"Yonghan","family":"Luo","sequence":"first","affiliation":[{"name":"Children\u2019s Hospital Affiliated to Kunming Medical University (Kunming Children\u2019s Hospital)","place":["Kunming, Yunnan, China"],"department":["Second Department of Infectious Disease"]},{"name":"Kunming University of Science and Technology","place":["Kunming, Yunnan, China"],"department":["Faculty of Life Science and Technology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zhu","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Affiliated to Kunming Medical University (Kunming Children\u2019s Hospital)","place":["Kunming, Yunnan, China"],"department":["Second Department of Infectious Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haifeng","family":"Jin","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Affiliated to Kunming Medical University (Kunming Children\u2019s Hospital)","place":["Kunming, Yunnan, China"],"department":["Second Department of Infectious Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penghao","family":"Cui","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Affiliated to Kunming Medical University (Kunming Children\u2019s Hospital)","place":["Kunming, Yunnan, China"],"department":["Second Department of Infectious Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruonan","family":"Li","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Affiliated to Kunming Medical University (Kunming Children\u2019s Hospital)","place":["Kunming, Yunnan, China"],"department":["Second Department of Infectious Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingping","family":"Tang","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Affiliated to Kunming Medical University (Kunming Children\u2019s Hospital)","place":["Kunming, Yunnan, China"],"department":["Second Department of Infectious Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Li","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Affiliated to Kunming Medical University (Kunming Children\u2019s Hospital)","place":["Kunming, Yunnan, China"],"department":["Second Department of Infectious Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8216-6533","authenticated-orcid":true,"given":"Yanchun","family":"Wang","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Affiliated to Kunming Medical University (Kunming Children\u2019s Hospital)","place":["Kunming, Yunnan, China"],"department":["Second Department of Infectious Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"pntd.0014723.ref001","doi-asserted-by":"crossref","first-page":"1541751","DOI":"10.3389\/fpubh.2025.1541751","article-title":"The burden and trends of infectious diseases among children aged 14 and below in China from 1990 to 2021: a systematic analysis from the 2021 global burden of disease study","volume":"13","author":"CG Miao","year":"2025","journal-title":"Front Public Health"},{"key":"pntd.0014723.ref002","doi-asserted-by":"crossref","first-page":"1675854","DOI":"10.3389\/fpubh.2025.1675854","article-title":"Global, regional, and national burden of pneumococcal disease among children and adolescents aged <20 years from 1990 to 2021: a predictive analysis","volume":"13","author":"G-M Wang","year":"2025","journal-title":"Front Public Health"},{"issue":"1","key":"pntd.0014723.ref003","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s12889-025-25757-8","article-title":"Global to local burden and inequality of low respiratory infections among children and adolescents across 953 locations","volume":"26","author":"B Yi","year":"2026","journal-title":"BMC Public Health"},{"key":"pntd.0014723.ref004","doi-asserted-by":"crossref","first-page":"1679081","DOI":"10.3389\/fnut.2025.1679081","article-title":"Global trends, inequalities, and pathogen shifts in infectious diarrhea among children under five: a comprehensive analysis of the global burden of disease study 1990-2021","volume":"12","author":"Q Tian","year":"2025","journal-title":"Front Nutr"},{"issue":"6","key":"pntd.0014723.ref005","article-title":"Global, regional, and national burden of meningitis among children, 1990-2021: an analysis of the global burden of disease study 2021","volume":"20","author":"J Li","year":"2025","journal-title":"PLoS One"},{"issue":"10440","key":"pntd.0014723.ref006","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1016\/S0140-6736(24)00933-4","article-title":"Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"issue":"10469","key":"pntd.0014723.ref007","doi-asserted-by":"crossref","first-page":"2314","DOI":"10.1016\/S0140-6736(24)01446-6","article-title":"The burden of diseases, injuries, and risk factors by state in the USA, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"404","year":"2024","journal-title":"Lancet"},{"key":"pntd.0014723.ref008","doi-asserted-by":"crossref","first-page":"1675854","DOI":"10.3389\/fpubh.2025.1675854","article-title":"Global, regional, and national burden of pneumococcal disease among children and adolescents aged <20 years from 1990 to 2021: a predictive analysis","volume":"13","author":"G-M Wang","year":"2025","journal-title":"Front Public Health"},{"issue":"1","key":"pntd.0014723.ref009","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s12889-025-25757-8","article-title":"Global to local burden and inequalty of low respiratory infections among children and adolescents across 953 locations","volume":"26","author":"B Yi","year":"2025","journal-title":"BMC Public Health"},{"key":"pntd.0014723.ref010","doi-asserted-by":"crossref","first-page":"1679081","DOI":"10.3389\/fnut.2025.1679081","article-title":"Global trends, inequalities, and pathogen shifts in infectious diarrhea among children under five: a comprehensive analysis of the global burden of disease study 1990-2021","volume":"12","author":"Q Tian","year":"2025","journal-title":"Front Nutr"},{"key":"pntd.0014723.ref011","doi-asserted-by":"crossref","first-page":"1676249","DOI":"10.3389\/fmed.2025.1676249","article-title":"Regional and age-specific global trends associated with infectious diarrhea in children under 14 years old caused by pathogenic microorganisms in 2021","volume":"12","author":"T Wang","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"pntd.0014723.ref012","first-page":"8830738251399249","article-title":"Global, regional, and national burden of meningitis in children aged 0-14 years from 1990 to 2021: trends and disparities based on the global burden of disease study","volume":"2025","author":"S Yang","year":"2025","journal-title":"J Child Neurol"},{"key":"pntd.0014723.ref013","doi-asserted-by":"crossref","first-page":"1682224","DOI":"10.3389\/fcimb.2025.1682224","article-title":"The burden of infective encephalitis in children in Asian countries (1990-2021): systematic analysis and projection of the burden of disease","volume":"15","author":"Y Luo","year":"2025","journal-title":"Front Cell Infect Microbiol"},{"key":"pntd.0014723.ref014","doi-asserted-by":"crossref","first-page":"102944","DOI":"10.1016\/j.arr.2025.102944","article-title":"Global and regional burden of 34 key pathogens in the elderly population in 2021: A systematic analysis of the global burden of disease study 2021","volume":"113","author":"L Chen","year":"2026","journal-title":"Ageing Res Rev"},{"issue":"10513","key":"pntd.0014723.ref015","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1016\/S0140-6736(25)01637-X","article-title":"Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023","volume":"406","year":"2025","journal-title":"Lancet"},{"issue":"1","key":"pntd.0014723.ref016","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1186\/s12887-025-05476-0","article-title":"Clinical features and long-term outcomes of children with pneumococcal meningitis in China: a 10-year single-centre retrospective analysis","volume":"25","author":"Y Li","year":"2025","journal-title":"BMC Pediatr"},{"issue":"2","key":"pntd.0014723.ref017","first-page":"131","article-title":"A multi-center epidemiological study on pneumococcal meningitis in children from 2019 to 2020","volume":"26","author":"C-Y Wang","year":"2024","journal-title":"Zhongguo Dang Dai Er Ke Za Zhi"},{"issue":"1","key":"pntd.0014723.ref018","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1186\/s12879-024-10075-y","article-title":"Effect of 10-valent pneumococcal conjugate vaccine on trends of pneumococcal meningitis in children under five years, Uganda, 2003-2022","volume":"24","author":"Y Nuwamanya","year":"2024","journal-title":"BMC Infect Dis"},{"issue":"4","key":"pntd.0014723.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0250010","article-title":"Impact of 13-valent pneumococcal conjugate vaccine on laboratory-confirmed pneumococcal meningitis and purulent meningitis among children <5 years in Cameroon, 2011-2018","volume":"16","author":"J Njuma Libwea","year":"2021","journal-title":"PLoS One"},{"issue":"4","key":"pntd.0014723.ref020","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.jiac.2020.11.019","article-title":"Drastic reduction in pneumococcal meningitis in children owing to the introduction of pneumococcal conjugate vaccines: Longitudinal analysis from 2002 to 2016 in Japan","volume":"27","author":"S Iwata","year":"2021","journal-title":"J Infect Chemother"},{"issue":"44","key":"pntd.0014723.ref021","doi-asserted-by":"crossref","first-page":"6422","DOI":"10.1016\/j.vaccine.2022.09.050","article-title":"Impact of rotavirus vaccination on diarrheal hospitalizations in children younger than 5 years of age in a rural southern Mozambique","volume":"40","author":"F Manjate","year":"2022","journal-title":"Vaccine"},{"issue":"1","key":"pntd.0014723.ref022","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1080\/14760584.2024.2360212","article-title":"Impact of rotavirus vaccination on diarrheal disease burden of children in South America","volume":"23","author":"T Bose","year":"2024","journal-title":"Expert Rev Vaccines"},{"issue":"4","key":"pntd.0014723.ref023","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/jpids\/piab114","article-title":"Global Estimates of Rotavirus Hospitalizations Among Children Below 5 Years in 2019 and Current and Projected Impacts of Rotavirus Vaccination","volume":"11","author":"BD Hallowell","year":"2022","journal-title":"J Pediatric Infect Dis Soc"},{"issue":"1","key":"pntd.0014723.ref024","doi-asserted-by":"crossref","first-page":"15973","DOI":"10.1038\/s41598-025-00778-w","article-title":"Disease burden of rotavirus related diarrhea in children under 5 years in China: a meta-analysis","volume":"15","author":"L Cai","year":"2025","journal-title":"Sci Rep"}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014723","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:27:14Z","timestamp":1789666034000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014723"}},"subtitle":[],"editor":[{"given":"Marwan","family":"Osman","sequence":"first","affiliation":[{"name":"Yale University School of Medicine","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":24,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0014723","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]}}}