Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982–2012: A Systematic Analysis

posted on 24.03.2016 by Kathryn E. Lafond, Harish Nair, Mohammad Hafiz Rasooly, Fátima Valente, Robert Booy, Mahmudur Rahman, Paul Kitsutani, Hongjie Yu, Guiselle Guzman, Daouda Coulibaly, Julio Armero, Daddi Jima, Stephen R. C. Howie, William Ampofo, Ricardo Mena, Mandeep Chadha, Ondri Dwi Sampurno, Gideon O. Emukule, Zuridin Nurmatov, Andrew Corwin, Jean Michel Heraud, Daniel E. Noyola, Radu Cojocaru, Pagbajabyn Nymadawa, Amal Barakat, Adebayo Adedeji, Marta von Horoch, Remigio Olveda, Thierry Nyatanyi, Marietjie Venter, Vida Mmbaga, Malinee Chittaganpitch, Tran Hien Nguyen, Andros Theo, Melissa Whaley, Eduardo Azziz-Baumgartner, Joseph Bresee, Harry Campbell, Marc-Alain Widdowson


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.

Methods and Findings

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.


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.