{
  "abstract": "Background: Lower respiratory infection (LRI) remains an important cause of death and health loss in children younger than 5 years. We examined the residual global and Chinese under-5 LRI burden, vaccine-relevant pathogen inequalities, and the separate clinical-care needs of children hospitalized with pneumonia in China.\n\nMethods: GBD and related public data were used to characterize under-5 LRI incidence, deaths, DALYs, SDI gradients, pathogen-attributed burden, and national Hib3 and PCV3 coverage. A separate single-center pediatric pneumonia hospitalization cohort from China-Japan Friendship Hospital (July 1, 2024 to December 31, 2025) characterized clinical severity, respiratory support, length of stay, and pathogen testing among children aged 0 to 4 years. The components were analyzed in parallel, were not pooled, and were not used to validate one another.\n\nResults: From 1990 to 2021, global under-5 LRI deaths declined from 1,898,507 to 503,409, and DALYs declined from 169,370,501 to 44,882,094. GBD 2023 estimates for China showed 2,895,598 incident under-5 LRI cases, 4,859 deaths, and 436,398 DALYs. In 2021, Streptococcus pneumoniae caused 166,379 under-5 LRI deaths, representing 33.1% of all such deaths. Streptococcus pneumoniae and the Haemophilus influenzae proxy together accounted for 81.0% of the pathogen-specific mortality-rate gap between the lowest and highest SDI quintiles. The hospital dataset included 1,717 pediatric pneumonia records, including 889 children aged 0 to 4 years. In this subgroup, 170 (19.1%) were recorded as severe, 184 (20.7%) received respiratory support, and 92 (10.3%) received high-flow oxygen therapy, non-invasive ventilation, or invasive mechanical ventilation.\n\nConclusions: Global under-5 LRI burden has declined substantially, but residual burden remains concentrated in lower-SDI settings and is weighted toward vaccine-relevant bacterial pathogens. Separate hospitalization data from China show persistent severe-disease and respiratory-support needs among young children. Childhood LRI control should address vaccine equity alongside early recognition, oxygen capacity, and inpatient pneumonia management.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pediatrics, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Beijing, China",
    "Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Xingyue Su"
    },
    {
      "affs": [
        0
      ],
      "name": "Die Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Jing Liu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Di Lv"
    },
    {
      "affs": [
        0
      ],
      "name": "Jianning Guo"
    },
    {
      "affs": [
        0
      ],
      "name": "Qin Hui"
    },
    {
      "affs": [
        0
      ],
      "name": "Fang Ye"
    },
    {
      "affs": [
        0
      ],
      "name": "Yuanmei Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Chao Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Lijuan Tang"
    },
    {
      "affs": [
        0
      ],
      "name": "Meihong Xia"
    },
    {
      "affs": [
        0
      ],
      "name": "Qi Zhang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bs0fgz1btdq6q.bib",
  "cited_by": 0,
  "doi": "10.3389/fmed.2026.1971991",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13736825/",
  "id": "bs0fgz1btdq6q",
  "issns": [
    "2296-858X"
  ],
  "landing_url": "https://doi.org/10.3389/fmed.2026.1971991",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2713|Pneumonia and Respiratory Infections"
    ]
  ],
  "openalex": "W7223178522",
  "pdf_url": "https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1971991/pdf",
  "pmcid": "PMC13736825",
  "pmid": "42991848",
  "published": "2026-10-22",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/bs0fgz1btdq6q.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:22:12Z",
      "native_id": "PMC13736825",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fmed.2026.1971991"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Pneumonia and Respiratory Infections",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Global and China lower respiratory infection burden in children under 5 years: implications for vaccine equity and pediatric clinical care",
  "title_text": "Global and China lower respiratory infection burden in children under 5 years: implications for vaccine equity and pediatric clinical care",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:22:12Z",
  "url": "https://research.draconitic.com/paper/bs0fgz1btdq6q",
  "venue": "Frontiers in Medicine",
  "versions": []
}