Work

Global and China lower respiratory infection burden in children under 5 years: implications for vaccine equity and pediatric clinical care

Year: 2026

Type: article

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.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1971991