作者
Rose G Bender,Sarah Brooke Sirota,Lucien R Swetschinski,Regina-Mae Villanueva Dominguez,Amanda Novotney,Eve E Wool,Kevin S Ikuta,Avina Vongpradith,Emma L B Rogowski,Matthew Doxey,Christopher Troeger,Samuel B Albertson,Jianing Ma,Jiawei He,Kelsey Maass,Eric A. F. Simões,Meriem Abdoun,Jeza Muhamad Abdul Aziz,Deldar Morad Abdulah,Samir Abu‐Rumeileh,Hasan Abualruz,Salah AbuRuz,Abiola Victor Adepoju,Rishan Adha,Wirawan Adikusuma,Saryia Adra,Ali Afraz,Seyed Mahmoud Reza Aghamiri,Antonella Agodi,Amir Mahmoud Ahmadzade,Haroon Ahmed,Ayman Ahmed,Karolina Akinosoglou,Tareq Mohammed Ali AL-Ahdal,Rasmieh Al‐Amer,Mohammed ALBashtawy,Mohammad Al‐bataineh,Hediyeh Alemi,Adel Ali Saeed Al-Gheethi,Abid Ali,Syed Shujait Ali,Jaber S Alqahtani,Mohammad Alqudah,Jaffar A. Al‐Tawfiq,Yaser Mohammed Al-Worafi,Karem H. Alzoubi,Reza Amani,Prince M. Amegbor,Edward Kwabena Ameyaw,John Amuasi,Abhishek Anil,Philip Emeka Anyanwu,Mosab Arafat,Damelash Areda,Reza ArefNezhad,Kendalem Asmare Atalell,Firayad Ayele,Ahmed Y Azzam,Hassan Babamohamadi,François-Xavier Babin,Yogesh Bahurupi,Stephen Baker,Biswajit Banik,Martina Barchitta,Hiba Jawdat Barqawi,Zarrin Basharat,Pritish Baskaran,Kavita Batra,Ravi Batra,Nebiyou Simegnew Bayileyegn,Apostolos Beloukas,James A. Berkley,Kebede Beyene,Ashish Bhargava,Priyadarshini Bhattacharjee,Julia Bielicki,Mariah Malak Bilalaga,Veera Raghavulu Bitra,Colin Brown,Katrin Burkart,Yasser Bustanji,Sinclair Carr,Yaacoub Chahine,Vijay Kumar Chattu,Fatemeh Chichagi,Hitesh Chopra,Isaac Sunday Chukwu,Eunice Chung,Sriharsha Dadana,Xiaochen Dai,Lalit Dandona,Rakhi Dandona,Isaac Darban,Nihar Ranjan Dash,Mohsen Dashti,Mohadese Dashtkoohi,Denise Dekker,Iván Delgado‐Enciso,Vinoth Gnana Chellaiyan,Kuldeep Dhama
摘要
Background Lower respiratory infections (LRIs) are a major global contributor to morbidity and mortality.In 2020-21, non-pharmaceutical interventions associated with the COVID-19 pandemic reduced not only the transmission of SARS-CoV-2, but also the transmission of other LRI pathogens.Tracking LRI incidence and mortality, as well as the pathogens responsible, can guide health-system responses and funding priorities to reduce future burden.We present estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 of the burden of non-COVID-19 LRIs and corresponding aetiologies from 1990 to 2021, inclusive of pandemic effects on the incidence and mortality of select respiratory viruses, globally, regionally, and for 204 countries and territories.Methods We estimated mortality, incidence, and aetiology attribution for LRI, defined by the GBD as pneumonia or bronchiolitis, not inclusive of COVID-19.We analysed 26 259 site-years of mortality data using the Cause of Death Ensemble model to estimate LRI mortality rates.We analysed all available age-specific and sex-specific data sources, including published literature identified by a systematic review, as well as household surveys, hospital admissions, health insurance claims, and LRI mortality estimates, to generate internally consistent estimates of incidence and prevalence using DisMod-MR 2.1.For aetiology estimation, we analysed multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature data using a network analysis model to produce the proportion of LRI deaths and episodes attributable to the following pathogens: Acinetobacter baumannii, Chlamydia spp, Enterobacter spp, Escherichia coli, fungi, group B streptococcus, Haemophilus influenzae, influenza viruses, Klebsiella pneumoniae, Legionella spp, Mycoplasma spp, polymicrobial infections, Pseudomonas aeruginosa, respiratory syncytial virus (RSV), Staphylococcus aureus, Streptococcus pneumoniae, and other viruses (ie, the aggregate of all viruses studied except influenza and RSV), as well as a residual category of other bacterial pathogens.Findings Globally, in 2021, we estimated 344 million (95% uncertainty interval [UI] 325-364) incident episodes of LRI, or 4350 episodes (4120-4610) per 100 000 population, and 2•18 million deaths (1•98-2•36), or 27•7 deaths (25•1-29•9) per 100 000.502 000 deaths (406 000-611 000) were in children younger than 5 years, among which 254 000 deaths (197 000-320 000) occurred in countries with a low Socio-demographic Index.Of the 18 modelled pathogen categories in 2021, S pneumoniae was responsible for the highest proportions of LRI episodes and deaths, with an estimated 97•9 million (92•1-104•0) episodes and 505 000 deaths (454 000-555 000) globally.The pathogens responsible for the second and third highest episode counts globally were other viral aetiologies (46•4 million [43•6-49•3] episodes) and Mycoplasma spp (25•3 million [23•5-27•2]), while those responsible for the second and third highest death counts were S aureus (424 000 [380 000-459 000]) and K pneumoniae (176 000 [158 000-194 000]).From 1990 to 2019, the global all-age non-COVID-19 LRI mortality rate declined by 41•7% (35•9-46•9), from 56•5 deaths (51•3-61•9) to 32•9 deaths (29•9-35•4) per 100 000.From 2019 to 2021, during the COVID-19 pandemic and implementation of associated nonpharmaceutical interventions, we estimated a 16•0% (13•1-18•6) decline in the global all-age non-COVID-19 LRI mortality rate, largely accounted for by a 71•8% (63•8-78•9) decline in the number of influenza deaths and a 66•7% (56•6-75•3) decline in the number of RSV deaths.Interpretation Substantial progress has been made in reducing LRI mortality, but the burden remains high, especially in low-income and middle-income countries.During the COVID-19 pandemic, with its associated non-pharmaceutical interventions, global incident LRI cases and mortality attributable to influenza and RSV declined substantially.Expanding access to health-care services and vaccines, including S pneumoniae, H influenzae type B, and novel RSV vaccines, along with new low-cost interventions against S aureus, could mitigate the LRI burden and prevent transmission of LRI-causing pathogens.