The morbidity spectrum of influenza, respiratory syncytial virus, human metapneumovirus and human parainfluenza virus in young children by age and country income level: A systematic review and meta-analysis
Background: Influenza virus (IFV), respiratory syncytial virus (RSV), human metapneumovirus (hMPV) and parainfluenza virus (hPIV) cause substantial disease burden in children under 5 years, but the infection spectrum remains unclear. Methods: We systematically reviewed studies published between 1995...
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Elsevier
2025-08-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971225001626 |
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| author | Lian He Jitian Weng Fuyu Zhu Yuhe Zhang Junru Chen Shuting Chen Miaojia Lu Harish Nair You Li Xin Wang |
| author_facet | Lian He Jitian Weng Fuyu Zhu Yuhe Zhang Junru Chen Shuting Chen Miaojia Lu Harish Nair You Li Xin Wang |
| author_sort | Lian He |
| collection | DOAJ |
| description | Background: Influenza virus (IFV), respiratory syncytial virus (RSV), human metapneumovirus (hMPV) and parainfluenza virus (hPIV) cause substantial disease burden in children under 5 years, but the infection spectrum remains unclear. Methods: We systematically reviewed studies published between 1995 and 2023 to estimate probabilities between viral test positivity, symptomatic infections, acute lower respiratory infections (ALRI), ALRI with chest-wall indrawing (CWI), ALRI hospitalization, and very severe ALRI – p(symptomatic | test positive), p(ALRI | symptomatic), p(CWI | ALRI), p(hosp | ALRI) and p(very severe | hosp). (PROSPERO CRD42024584039; CRD42023439269). Results: Based on 129 studies, we estimated that 67.7% of IFV test-positives were symptomatic and 16.2% of symptomatic IFV infections developed ALRI. In children under 2 years, 71.8% of RSV test-positives were symptomatic. Across the viruses, the estimated p(CWI | ALRI) and p(hosp | ALRI) were higher in infants than older children; between 2.6% and 41.2% of hospitalized children with ALRI were very severe, with higher estimates in low and lower-middle income countries. Conclusions: Infants and children under 5 years in low and lower-middle income countries are important risk groups for immunization due to their high vulnerability to severe outcomes. These findings provide critical data to support immunization assessment and development of immunization strategies. |
| format | Article |
| id | doaj-art-dd41add702b34e7b9fe8541e4dfbea72 |
| institution | DOAJ |
| issn | 1201-9712 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj-art-dd41add702b34e7b9fe8541e4dfbea722025-08-20T03:11:26ZengElsevierInternational Journal of Infectious Diseases1201-97122025-08-0115710793810.1016/j.ijid.2025.107938The morbidity spectrum of influenza, respiratory syncytial virus, human metapneumovirus and human parainfluenza virus in young children by age and country income level: A systematic review and meta-analysisLian He0Jitian Weng1Fuyu Zhu2Yuhe Zhang3Junru Chen4Shuting Chen5Miaojia Lu6Harish Nair7You Li8Xin Wang9Department of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, ChinaDepartment of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, ChinaDepartment of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, ChinaDepartment of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, ChinaDepartment of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, ChinaDepartment of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, ChinaDepartment of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, ChinaChangzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, ChinaDepartment of Epidemiology, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China; Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China; Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, United KingdomDepartment of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China; Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom; Corresponding author. Xin Wang, Department of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.Background: Influenza virus (IFV), respiratory syncytial virus (RSV), human metapneumovirus (hMPV) and parainfluenza virus (hPIV) cause substantial disease burden in children under 5 years, but the infection spectrum remains unclear. Methods: We systematically reviewed studies published between 1995 and 2023 to estimate probabilities between viral test positivity, symptomatic infections, acute lower respiratory infections (ALRI), ALRI with chest-wall indrawing (CWI), ALRI hospitalization, and very severe ALRI – p(symptomatic | test positive), p(ALRI | symptomatic), p(CWI | ALRI), p(hosp | ALRI) and p(very severe | hosp). (PROSPERO CRD42024584039; CRD42023439269). Results: Based on 129 studies, we estimated that 67.7% of IFV test-positives were symptomatic and 16.2% of symptomatic IFV infections developed ALRI. In children under 2 years, 71.8% of RSV test-positives were symptomatic. Across the viruses, the estimated p(CWI | ALRI) and p(hosp | ALRI) were higher in infants than older children; between 2.6% and 41.2% of hospitalized children with ALRI were very severe, with higher estimates in low and lower-middle income countries. Conclusions: Infants and children under 5 years in low and lower-middle income countries are important risk groups for immunization due to their high vulnerability to severe outcomes. These findings provide critical data to support immunization assessment and development of immunization strategies.http://www.sciencedirect.com/science/article/pii/S1201971225001626InfluenzaRespiratory syncytial virusMetapneumovirusParainfluenza virusInfection spectrumChildren |
| spellingShingle | Lian He Jitian Weng Fuyu Zhu Yuhe Zhang Junru Chen Shuting Chen Miaojia Lu Harish Nair You Li Xin Wang The morbidity spectrum of influenza, respiratory syncytial virus, human metapneumovirus and human parainfluenza virus in young children by age and country income level: A systematic review and meta-analysis International Journal of Infectious Diseases Influenza Respiratory syncytial virus Metapneumovirus Parainfluenza virus Infection spectrum Children |
| title | The morbidity spectrum of influenza, respiratory syncytial virus, human metapneumovirus and human parainfluenza virus in young children by age and country income level: A systematic review and meta-analysis |
| title_full | The morbidity spectrum of influenza, respiratory syncytial virus, human metapneumovirus and human parainfluenza virus in young children by age and country income level: A systematic review and meta-analysis |
| title_fullStr | The morbidity spectrum of influenza, respiratory syncytial virus, human metapneumovirus and human parainfluenza virus in young children by age and country income level: A systematic review and meta-analysis |
| title_full_unstemmed | The morbidity spectrum of influenza, respiratory syncytial virus, human metapneumovirus and human parainfluenza virus in young children by age and country income level: A systematic review and meta-analysis |
| title_short | The morbidity spectrum of influenza, respiratory syncytial virus, human metapneumovirus and human parainfluenza virus in young children by age and country income level: A systematic review and meta-analysis |
| title_sort | morbidity spectrum of influenza respiratory syncytial virus human metapneumovirus and human parainfluenza virus in young children by age and country income level a systematic review and meta analysis |
| topic | Influenza Respiratory syncytial virus Metapneumovirus Parainfluenza virus Infection spectrum Children |
| url | http://www.sciencedirect.com/science/article/pii/S1201971225001626 |
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