Global burden of influenza-associated lower respiratory tract infections and hospitalizations among adults: A systematic review and meta-analysis

  1. Lafond, Kathryn ORCID logo
  2. Porter, Rachael ORCID logo
  3. Whaley, Melissa J.
  4. ZHOU, Suizan ORCID logo
  5. Zhang, Ran ORCID logo
  6. Aleem, Mohammad ORCID logo
  7. thapa, binay ORCID logo
  8. Sar, Borann
  9. Proschle, Viviana Sotomayor
  10. Peng, Zhibin
  11. Feng, Luzhao
  12. Coulibaly, Daouda
  13. Nkwembe, Edith
  14. Olmedo, Alfredo ORCID logo
  15. Ampofo, William ORCID logo
  16. Saha, Siddhartha ORCID logo
  17. Chadha, Mandeep
  18. Mangiri, Amalya
  19. Setiawaty, Vivi ORCID logo
  20. Ali, Sami Sheikh
  21. Chaves, Sandra ORCID logo
  22. Otorbaeva, Dinagul
  23. Keosavanh, Onechanh
  24. Saleh, Majd ORCID logo
  25. Ho, Antonia ORCID logo
  26. Alexander, Burmaa ORCID logo
  27. Oumzil, Hicham
  28. Baral, Kedar ORCID logo
  29. Huang, Q. Sue ORCID logo
  30. Adebayo, Adedeji A.
  31. Al Abaidani, Idris ORCID logo
  32. von Horoch, Marta
  33. Cohen, Cheryl
  34. Tempia, Stefano ORCID logo
  35. MMBAGA, VIDA ORCID logo
  36. Chittaganpitch, Malinee
  37. Casal, Mariana ORCID logo
  38. Dang, Duc Anh
  39. couto, paula ORCID logo
  40. Harish, Nair ORCID logo
  41. Bresee, Joseph S.
  42. Olsen, Sonja ORCID logo
  43. Azziz-Baumgartner, Eduardo
  44. Nuorti, Pekka ORCID logo
  45. Widdowson, Marc-Alain ORCID logo

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WeightNameValue
1000 Titel
  • Global burden of influenza-associated lower respiratory tract infections and hospitalizations among adults: A systematic review and meta-analysis
1000 Autor/in
  1. Lafond, Kathryn |
  2. Porter, Rachael |
  3. Whaley, Melissa J. |
  4. ZHOU, Suizan |
  5. Zhang, Ran |
  6. Aleem, Mohammad |
  7. thapa, binay |
  8. Sar, Borann |
  9. Proschle, Viviana Sotomayor |
  10. Peng, Zhibin |
  11. Feng, Luzhao |
  12. Coulibaly, Daouda |
  13. Nkwembe, Edith |
  14. Olmedo, Alfredo |
  15. Ampofo, William |
  16. Saha, Siddhartha |
  17. Chadha, Mandeep |
  18. Mangiri, Amalya |
  19. Setiawaty, Vivi |
  20. Ali, Sami Sheikh |
  21. Chaves, Sandra |
  22. Otorbaeva, Dinagul |
  23. Keosavanh, Onechanh |
  24. Saleh, Majd |
  25. Ho, Antonia |
  26. Alexander, Burmaa |
  27. Oumzil, Hicham |
  28. Baral, Kedar |
  29. Huang, Q. Sue |
  30. Adebayo, Adedeji A. |
  31. Al Abaidani, Idris |
  32. von Horoch, Marta |
  33. Cohen, Cheryl |
  34. Tempia, Stefano |
  35. MMBAGA, VIDA |
  36. Chittaganpitch, Malinee |
  37. Casal, Mariana |
  38. Dang, Duc Anh |
  39. couto, paula |
  40. Harish, Nair |
  41. Bresee, Joseph S. |
  42. Olsen, Sonja |
  43. Azziz-Baumgartner, Eduardo |
  44. Nuorti, Pekka |
  45. Widdowson, Marc-Alain |
1000 Mitwirkende/r
  1. Global Respiratory Hospitalizations–Influenza Proportion Positive (GRIPP) Working Group |
1000 Erscheinungsjahr 2021
1000 Publikationstyp
  1. Artikel |
1000 Online veröffentlicht
  • 2021-03-01
1000 Erschienen in
1000 Quellenangabe
  • 18(3):e1003550
1000 Copyrightjahr
  • 2021
1000 Lizenz
1000 Verlagsversion
  • https://doi.org/10.1371/journal.pmed.1003550 |
1000 Ergänzendes Material
  • https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003550#sec016 |
1000 Publikationsstatus
1000 Begutachtungsstatus
1000 Sprache der Publikation
1000 Abstract/Summary
  • BACKGROUND: Influenza 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 FINDINGS: We 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 <65 years contribute most influenza-associated LRI hospitalizations and episodes (3,464,000 [95% CI 1,885,000–5,978,000] LRI hospitalizations and 31,087,000 [95% CI 19,987,000–44,444,000] LRI episodes), hospitalization rates were highest in those ≥65 years (437/100,000 person-years [95% CI 265–612/100,000 person-years]). For this analysis, published articles were limited in their inclusion of stratified testing data by year and age group. Lack of information regarding influenza vaccination of the study population was also a limitation across both types of data sources. CONCLUSIONS: In 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.
1000 Sacherschließung
lokal Influenza
lokal Respiratory infections
lokal Influenza A virus
lokal Influenza viruses
lokal Vaccination and immunization
lokal Systematic reviews
lokal Metaanalysis
lokal Age groups
1000 Fächerklassifikation (DDC)
1000 Liste der Beteiligten
  1. https://orcid.org/0000-0001-5018-9591|https://orcid.org/0000-0002-6632-4038|https://frl.publisso.de/adhoc/uri/V2hhbGV5LCBNZWxpc3NhIEou|https://orcid.org/0000-0002-7201-0019|https://orcid.org/0000-0002-5483-2836|https://orcid.org/0000-0003-1634-8725|https://orcid.org/0000-0002-3866-0771|https://frl.publisso.de/adhoc/uri/U2FyLCBCb3Jhbm4=|https://frl.publisso.de/adhoc/uri/UHJvc2NobGUsIFZpdmlhbmEgU290b21heW9y|https://frl.publisso.de/adhoc/uri/UGVuZywgWmhpYmlu|https://frl.publisso.de/adhoc/uri/RmVuZywgTHV6aGFv|https://frl.publisso.de/adhoc/uri/Q291bGliYWx5LCBEYW91ZGE=|https://frl.publisso.de/adhoc/uri/Tmt3ZW1iZSwgRWRpdGg=|https://orcid.org/0000-0001-7098-148X|https://orcid.org/0000-0001-7208-0829|https://orcid.org/0000-0002-7494-267X|https://frl.publisso.de/adhoc/uri/Q2hhZGhhLCBNYW5kZWVw|https://frl.publisso.de/adhoc/uri/TWFuZ2lyaSwgQW1hbHlh|https://orcid.org/0000-0002-1196-7909|https://frl.publisso.de/adhoc/uri/QWxpLCBTYW1pIFNoZWlraA==|https://orcid.org/0000-0002-9453-7057|https://frl.publisso.de/adhoc/uri/T3RvcmJhZXZhLCBEaW5hZ3Vs|https://frl.publisso.de/adhoc/uri/S2Vvc2F2YW5oLCBPbmVjaGFuaA==|https://orcid.org/0000-0002-1222-9705|https://orcid.org/0000-0003-1465-3785|https://orcid.org/0000-0002-1135-9735|https://frl.publisso.de/adhoc/uri/T3VtemlsLCBIaWNoYW0=|https://orcid.org/0000-0003-4394-9745|https://orcid.org/0000-0002-3923-5195|https://frl.publisso.de/adhoc/uri/QWRlYmF5bywgQWRlZGVqaSBBLg==|https://orcid.org/0000-0002-9007-2686|https://frl.publisso.de/adhoc/uri/dm9uIEhvcm9jaCwgTWFydGE=|https://frl.publisso.de/adhoc/uri/Q29oZW4sIENoZXJ5bA==|https://orcid.org/0000-0003-4395-347X|https://orcid.org/0000-0002-8776-9212|https://frl.publisso.de/adhoc/uri/Q2hpdHRhZ2FucGl0Y2gsIE1hbGluZWU=|https://orcid.org/0000-0001-8937-2588|https://frl.publisso.de/adhoc/uri/RGFuZywgRHVjIEFuaA==|https://orcid.org/0000-0003-1900-2543|https://orcid.org/0000-0002-9432-9100|https://frl.publisso.de/adhoc/uri/QnJlc2VlLCBKb3NlcGggUy4=|https://orcid.org/0000-0002-8983-1913|https://frl.publisso.de/adhoc/uri/QXp6aXotQmF1bWdhcnRuZXIsIEVkdWFyZG8=|https://orcid.org/0000-0002-8427-8004|https://orcid.org/0000-0002-0682-6933|https://frl.publisso.de/adhoc/uri/R2xvYmFsIFJlc3BpcmF0b3J5IEhvc3BpdGFsaXphdGlvbnPigJNJbmZsdWVuemEgUHJvcG9ydGlvbiBQb3NpdGl2ZSAoR1JJUFApIFdvcmtpbmcgR3JvdXA=
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