• Ting Shi, David A McAllister, Katherine L O'Brien, SimoesEric A FEAFUniversity of Colorado, Aurora, CO, USA., Shabir A Madhi, Bradford D Gessner, Fernando P Polack, Evelyn Balsells, Sozinho Acacio, Claudia Aguayo, Issifou Alassani, Asad Ali, Martin Antonio, Shally Awasthi, Juliet O Awori, Eduardo Azziz-Baumgartner, Henry C Baggett, Vicky L Baillie, Angel Balmaseda, Alfredo Barahona, Sudha Basnet, Quique Bassat, Wilma Basualdo, Godfrey Bigogo, Louis Bont, Robert F Breiman, W Abdullah Brooks, Shobha Broor, Nigel Bruce, Dana Bruden, Philippe Buchy, Stuart Campbell, Phyllis Carosone-Link, Mandeep Chadha, James Chipeta, Monidarin Chou, Wilfrido Clara, Cheryl Cohen, Elizabeth de Cuellar, Duc-Anh Dang, Budragchaagiin Dash-Yandag, Maria Deloria-Knoll, Mukesh Dherani, Tekchheng Eap, Bernard E Ebruke, Marcela Echavarria, Carla Cecília de Freitas Lázaro Emediato, Rodrigo A Fasce, Daniel R Feikin, Luzhao Feng, Angela Gentile, Aubree Gordon, Doli Goswami, Sophie Goyet, Michelle Groome, Natasha Halasa, Siddhivinayak Hirve, Nusrat Homaira, HowieStephen R CSRCMedical Research Council Unit The Gambia, Basse, The Gambia; Department of Paediatrics, University of Auckland, Auckland, New Zealand; Centre for International Health, University of Otago, Dunedin, New Zealand., Jorge Jara, Imane Jroundi, Cissy B Kartasasmita, Najwa Khuri-Bulos, Karen L Kotloff, Anand Krishnan, Romina Libster, Olga Lopez, Marilla G Lucero, Florencia Lucion, Socorro P Lupisan, Debora N Marcone, John P McCracken, Mario Mejia, Jennifer C Moisi, Joel M Montgomery, David P Moore, Cinta Moraleda, Jocelyn Moyes, Patrick Munywoki, Kuswandewi Mutyara, Mark P Nicol, D James Nokes, Pagbajabyn Nymadawa, Maria Tereza da Costa Oliveira, Histoshi Oshitani, Nitin Pandey, Gláucia Paranhos-Baccalà, Lia N Phillips, Valentina Sanchez Picot, Mustafizur Rahman, Mala Rakoto-Andrianarivelo, Zeba A Rasmussen, Barbara A Rath, Annick Robinson, Candice Romero, Graciela Russomando, Vahid Salimi, Pongpun Sawatwong, Nienke Scheltema, Brunhilde Schweiger, ScottJ Anthony GJAGKenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; London School of Hygiene & Tropical Medicine, London, UK., Phil Seidenberg, Kunling Shen, Rosalyn Singleton, Viviana Sotomayor, Tor A Strand, Agustinus Sutanto, Mariam Sylla, Milagritos D Tapia, Somsak Thamthitiwat, Elizabeth D Thomas, Rafal Tokarz, Claudia Turner, Marietjie Venter, Sunthareeya Waicharoen, Jianwei Wang, Wanitda Watthanaworawit, Lay-Myint Yoshida, Hongjie Yu, Heather J Zar, Harry Campbell, Harish Nair, and RSV Global Epidemiology Network.
• Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.
• Lancet. 2017 Sep 2; 390 (10098): 946-958.

BackgroundWe have previously estimated that respiratory syncytial virus (RSV) was associated with 22% of all episodes of (severe) acute lower respiratory infection (ALRI) resulting in 55 000 to 199 000 deaths in children younger than 5 years in 2005. In the past 5 years, major research activity on RSV has yielded substantial new data from developing countries. With a considerably expanded dataset from a large international collaboration, we aimed to estimate the global incidence, hospital admission rate, and mortality from RSV-ALRI episodes in young children in 2015.MethodsWe estimated the incidence and hospital admission rate of RSV-associated ALRI (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies. We estimated the RSV-ALRI incidence for 132 developing countries using a risk factor-based model and 2015 population estimates. We estimated the in-hospital RSV-ALRI mortality by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies. We also estimated overall RSV-ALRI mortality by identifying studies reporting monthly data for ALRI mortality in the community and RSV activity.FindingsWe estimated that globally in 2015, 33·1 million (uncertainty range [UR] 21·6-50·3) episodes of RSV-ALRI, resulted in about 3·2 million (2·7-3·8) hospital admissions, and 59 600 (48 000-74 500) in-hospital deaths in children younger than 5 years. In children younger than 6 months, 1·4 million (UR 1·2-1·7) hospital admissions, and 27 300 (UR 20 700-36 200) in-hospital deaths were due to RSV-ALRI. We also estimated that the overall RSV-ALRI mortality could be as high as 118 200 (UR 94 600-149 400). Incidence and mortality varied substantially from year to year in any given population.InterpretationGlobally, RSV is a common cause of childhood ALRI and a major cause of hospital admissions in young children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine or monoclonal antibody could have a substantial effect on disease burden in this age group.FundingThe Bill & Melinda Gates Foundation.Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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