title: Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982-2012: A Systematic Analysis.
abstract: BACKGROUND
  The global burden of pediatric severe respiratory illness is substantial, and influenza viruses contribute to this burden. Systematic surveillance and testing for influenza among hospitalized children has expanded globally over the past decade. However, only a fraction of the data has been used to estimate influenza burden. In this analysis, we use surveillance data to provide an estimate of influenza-associated hospitalizations among children worldwide.
  
  
  RESULTS
  We aggregated data from a systematic review (n = 108) and surveillance platforms (n = 37) to calculate a pooled estimate of the proportion of samples collected from children hospitalized with respiratory illnesses and positive for influenza by age group (<6 mo, <1 y, <2 y, <5 y, 5-17 y, and <18 y). We applied this proportion to global estimates of acute lower respiratory infection hospitalizations among children aged <1 y and <5 y, to obtain the number and per capita rate of influenza-associated hospitalizations by geographic region and socio-economic status. Influenza was associated with 10% (95% CI 8%-11%) of respiratory hospitalizations in children <18 y worldwide, ranging from 5% (95% CI 3%-7%) among children <6 mo to 16% (95% CI 14%-20%) among children 5-17 y. On average, we estimated that influenza results in approximately 374,000 (95% CI 264,000 to 539,000) hospitalizations in children <1 y-of which 228,000 (95% CI 150,000 to 344,000) occur in children <6 mo-and 870,000 (95% CI 610,000 to 1,237,000) hospitalizations in children <5 y annually. Influenza-associated hospitalization rates were more than three times higher in developing countries than in industrialized countries (150/100,000 children/year versus 48/100,000). However, differences in hospitalization practices between settings are an important limitation in interpreting these findings.
  
  
  CONCLUSIONS
  Influenza is an important contributor to respiratory hospitalizations among young children worldwide. Increasing influenza vaccination coverage among young children and pregnant women could reduce this burden and protect infants <6 mo.
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.|School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Kathryn E
authors.initials: KE
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authors.affiliation: Centre for Global Health Research, University of Edinburgh, Edinburgh, United Kingdom.|Public Health Foundation of India, New Delhi, India.
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authors.affiliation: Afghanistan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan.
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authors.affiliation: National Directorate of Public Health, Ministry of Health, Luanda, Angola.
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authors.affiliation: National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
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authors.affiliation: Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
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authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China.
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authors.forename: Daddi
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authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.|Department of Paediatrics, University of Auckland, Auckland, New Zealand.|Centre for International Health, University of Otago, Dunedin, New Zealand.
authors.forename: Stephen R C
authors.initials: SR
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authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
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authors.affiliation: Ministerio de Salud Publica y Asistencia Social, Guatemala City, Guatemala.
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authors.affiliation: National Institute of Virology, Pune, India.
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authors.affiliation: National Institute of Health Research and Development, Jakarta, Indonesia.
authors.forename: Ondri Dwi
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authors.affiliation: Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Gideon O
authors.initials: GO
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authors.affiliation: Ministry of Health, Bishkek, Kyrgyzstan.
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authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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authors.affiliation: National Influenza Centre, Virology Unit, Institut Pasteur of Madagascar, Antananarivo, Madagascar.
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Heraud
authors.affiliation: Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico.
authors.forename: Daniel E
authors.initials: DE
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authors.affiliation: National Centre for Public Health, Chisinau, Republic of Moldova.
authors.forename: Radu
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authors.forename: Pagbajabyn
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authors.affiliation: Institut National d'Hygiène, Ministère de la Santé, Rabat, Morocco.
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authors.affiliation: Federal Ministry of Health, Abuja, Nigeria.
authors.forename: Adebayo
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authors.forename: Marta
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authors.affiliation: Research Institute for Tropical Medicine, Manila, Philippines.
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authors.forename: Thierry
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authors.affiliation: National Institute for Communicable Diseases, Johannesburg, South Africa.|Zoonoses Research Unit, Department Medical Virology, University of Pretoria, Pretoria, South Africa.|Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Marietjie
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authors.affiliation: Ministry of Health, Dar es Salaam, Tanzania.
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authors.forename: Malinee
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authors.forename: Tran Hien
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authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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authors.affiliation: Centre for Global Health Research, University of Edinburgh, Edinburgh, United Kingdom.
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authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D014943:Global Health; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000821:virology