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Meta-Analysis
. 2013 Apr;54(2):122-34.
doi: 10.3325/cmj.2013.54.122.

Viral etiology of hospitalized acute lower respiratory infections in children under 5 years of age -- a systematic review and meta-analysis

Ivana Lukšić  1 , Patrick K Kearns, Fiona Scott, Igor Rudan, Harry Campbell, Harish Nair
Affiliations
Meta-Analysis

Viral etiology of hospitalized acute lower respiratory infections in children under 5 years of age -- a systematic review and meta-analysis

Ivana Lukšić et al. Croat Med J. 2013 Apr.

Abstract

Aim: To estimate the proportional contribution of influenza viruses (IV), parainfluenza viruses (PIV), adenoviruses (AV), and coronaviruses (CV) to the burden of severe acute lower respiratory infections (ALRI).

Methods: The review of the literature followed PRISMA guidelines. We included studies of hospitalized children aged 0-4 years with confirmed ALRI published between 1995 and 2011. A total of 51 studies were included in the final review, comprising 56091 hospitalized ALRI episodes.

Results: IV was detected in 3.0% (2.2%-4.0%) of all hospitalized ALRI cases, PIV in 2.7% (1.9%-3.7%), and AV in 5.8% (3.4%-9.1%). CV are technically difficult to culture, and they were detected in 4.8% of all hospitalized ALRI patients in one study. When respiratory syncytial virus (RSV) and less common viruses were included, at least one virus was detected in 50.4% (40.0%-60.7%) of all hospitalized severe ALRI episodes. Moreover, 21.9% (17.7%-26.4%) of these viral ALRI were mixed, including more than one viral pathogen. Among all severe ALRI with confirmed viral etiology, IV accounted for 7.0% (5.5%-8.7%), PIV for 5.8% (4.1%-7.7%), and AV for 8.8% (5.3%-13.0%). CV was found in 10.6% of virus-positive pneumonia patients in one study.

Conclusions: This article provides the most comprehensive analysis of the contribution of four viral causes to severe ALRI to date. Our results can be used in further cost-effectiveness analyses of vaccine development and implementation for a number of respiratory viruses.

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Figures

Figure 1
Figure 1
Details of the systematic review and study selection process.
Figure 2
Figure 2
Geographic distribution of studies included in this review (N = 51).
Figure 3
Figure 3
Proportion of studies retained for the final analyses that investigated individual viruses: approximately half investigated influenza virus (IV), parainfluenza virus (PIV), and/or adenovirus (AV), with no studies on coronavirus (CV) before the 2003 SARS-CV outbreak. Twenty studies only described one viral agent (11 of these respiratory syncytial virus, RSV).
Figure 4
Figure 4
Meta-analysis of the proportion of patients aged 0-4 years with severe acute lower respiratory infections (ALRI) in whom a viral infection was detected (asterisk denotes investigation by polymerase-chain reaction).
Figure 5
Figure 5
Meta-analysis of the proportion of patients aged 0-4 years with severe acute lower respiratory infections (ALRI) in whom multiple viral infections were detected (asterisk denotes investigation by polymerase-chain reaction).
Figure 6
Figure 6
Meta-analysis of the proportion of patients aged 0-4 years with severe acute lower respiratory infections (ALRI) in whom a laboratory confirmed influenza infection was detected (asterisk denotes investigation by polymerase-chain reaction).
Figure 7
Figure 7
Meta-analysis of the proportion of patients aged 0-4 years with severe acute lower respiratory infections (ALRI) in whom parainfluenza infection was confirmed (asterisk denotes investigation by polymerase-chain reaction).
Figure 8
Figure 8
Meta-analysis of the proportion of patients aged 0-4 years with severe acute lower respiratory infections (ALRI) in whom adenovirus infection was confirmed (asterisk denotes investigation by polymerase-chain reaction).
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