Global and China lower respiratory infection burden in children under 5 years: implications for vaccine equity and pediatric clinical care
- 1Department of Pediatrics, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Beijing, China
- 2Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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.
Methods: 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.
Results: 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.
Conclusions: 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.
Related
- Age-related clinical characteristics of respiratory syncytial virus infection in hospitalized children: a retrospective study
- Clinical impact of the BIOFIRE FILMARRAY Pneumonia Panel combined with antimicrobial stewardship education on pediatric patients with lower respiratory tract infection: a pre–post study from a tertiary center in Nara, Japan
- Clinical Characteristics of Respiratory Syncytial Virus Infection in Korean Children: An 11-Year Multicenter Retrospective Study.
- Development of a clinical prediction score for recurrent wheezing following acute lower respiratory tract infection in children
- Pediatric RSV-associated lower respiratory tract infection burden in G20 countries in 2023
BibTeX
@article{su2026global,
title = {{Global and China lower respiratory infection burden in children under 5 years: implications for vaccine equity and pediatric clinical care}},
author = {Xingyue Su and Die Liu and Jing Liu and Di Lv and Jianning Guo and Qin Hui and Fang Ye and Yuanmei Chen and Chao Wang and Lijuan Tang and Meihong Xia and Qi Zhang},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1971991},
url = {https://doi.org/10.3389/fmed.2026.1971991},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Global and China lower respiratory infection burden in children under 5 years: implications for vaccine equity and pediatric clinical care
AU - Xingyue Su
AU - Die Liu
AU - Jing Liu
AU - Di Lv
AU - Jianning Guo
AU - Qin Hui
AU - Fang Ye
AU - Yuanmei Chen
AU - Chao Wang
AU - Lijuan Tang
AU - Meihong Xia
AU - Qi Zhang
PY - 2026
DA - 2026/10/22
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1971991
UR - https://doi.org/10.3389/fmed.2026.1971991
AB - 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. Methods: 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. Results: 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. Conclusions: 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.
SN - 2296-858X
ER -