The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990–2019: a systematic analysis of the Global Burden of Disease Study 2019

GBD 2019 Child and Adolescent Communicable Disease Collaborators, Peter S. Azzopardi, Jessica A. Kerr, Kate L. Francis, Susan M. Sawyer, Elissa Clare Kennedy, Andrew C. Steer, Stephen Michael Graham, Russell M. Viner, Joseph L. Ward, Julie Hennegan, Minh D. Pham, Christine Marie D. Habito, Jaameeta Kurji, Karly I. Cini, James G. Beeson, Alex Brown, Christopher J.L. Murray, Mohsen Abbasi-Kangevari, Hassan AbolhassaniVictor Adekanmbi, Suneth Buddhika Agampodi, Muktar Beshir Ahmed, Marjan Ajami, Hossein Akbarialiabad, Mostafa Akbarzadeh-Khiavi, Tareq Mohammed Ali AL-Ahdal, Musa Mohammed Ali, Shohreh Alian Samakkhah, Yousef Alimohamadi, Vahid Alipour, Adel Al-Jumaily, Sohrab Amiri, Mohammad Hosein Amirzade-Iranaq, Amir Anoushiravani, Davood Anvari, Jalal Arabloo, Morteza Arab-Zozani, Mesay Arkew, Benedetta Armocida, Ali A. Asadi-Pooya, Zatollah Asemi, Saeed Asgary, Seyyed Shamsadin Athari, Hiva Azami, Mohammadreza Azangou-Khyavy, Hosein Azizi, Nader Bagheri, Sara Bagherieh, Francesco Barone-Adesi, Sandra Barteit, Sanjay Basu, Melaku Ashagrie Belete, Luis Belo, Alemshet Yirga Berhie, Ali Bijani, Boris Bikbov, Katrin Burkart, Giulia Carreras, Periklis Charalampous, Endeshaw Chekol Abebe, Natália Cruz-Martins, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Sayih Mehari Degualem, Andreas K. Demetriades, Alemayehu Anley Demlash, Abebaw Alemayehu Desta, Mostafa Dianatinasab, Saeid Doaei, Fariba Dorostkar, Diyan Ermawan Effendi, Amir Emami, Luchuo Engelbert Bain, Sharareh Eskandarieh, Firooz Esmaeilzadeh, Ali Faramarzi, Ali Fatehizadeh, Pietro Ferrara, Getahun Fetensa, Florian Fischer, Luisa S. Flor, Ali Forouhari, Masoud Foroutan, Santosh Gaihre, Nasrin Galehdar, Silvano Gallus, Rupesh K. Gautam, Mesfin Gebrehiwot, Teferi Gebru Gebremeskel, Lemma Getacher, Motuma Erena Getachew, Seyyed Hadi Ghamari, Mohammad Ghasemi Nour, Pouya Goleij, Mohamad Golitaleb, Giuseppe Gorini, Vijai Kumar Gupta, Maryam Hashemian, Hadi Hassankhani, Mohammad Heidari, Demisu Zenbaba Heyi, Gaetano Isola, Jalil Jaafari, Fatemeh Javanmardi, Jost B. Jonas, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Zubair Kabir, Laleh R. Kalankesh, Rohollah Kalhor, Joonas H. Kauppila, Harkiran Kaur, Gbenga A. Kayode, Leila Keikavoosi-Arani, Mohammad Khammarnia, Moien A.B. Khan, Khaled Khatab, Hamid Reza Khayat Kashani, Ali Asghar Kolahi, Hamid Reza Koohestani, Ai Koyanagi, G. Anil Kumar, Om P. Kurmi, Hmwe Hmwe Kyu, Carlo La Vecchia, Tea Lallukka, Stephen S. Lim, Joana A. Loureiro, Soleiman Mahjoub, Razzagh Mahmoudi, Azeem Majeed, Elaheh Malakan Rad, Afshin Maleki, Fariborz Mansour-Ghanaei, Abdoljalal Marjani, Alexander G. Mathioudakis, Fereshteh Mehri, Alexios Fotios A. Mentis, Tomislav Mestrovic, Andreea Mirica, Awoke Misganaw, Abdollah Mohammadian-Hafshejani, Hussen Mohammed, Shafiu Mohammed, Ali H. Mokdad, Peyman Mokhtarzadehazar, Lorenzo Monasta, Maryam Moradi, Maliheh Moradzadeh, Negar Morovatdar, Ulrich Otto Mueller, Francesk Mulita, Getaneh Baye B. Mulu, Saravanan Muthupandian, Ganesh R. Naik, Abdulqadir J.J. Nashwan, Seyed Aria Nejadghaderi, Henok Biresaw Netsere, Nurulamin M. Noor, Maryam Noori, Bogdan Oancea, Ayodipupo Sikiru Oguntade, Hassan Okati-Aliabad, Adrian Otoiu, Alicia Padron-Monedero, Reza Pakzad, Anamika Pandey, Shahina Pardhan, Romil R. Parikh, Jay Patel, Umberto Pensato, Prince Peprah, Norberto Perico, Dimitri Poddighe, Maarten J. Postma, Fakher Rahim, Vafa Rahimi-Movaghar, Shayan Rahmani, Vahid Rahmanian, Salman Rawaf, Iman Razeghian-Jahromi, Misganu Teshoma Regasa, Giuseppe Remuzzi, Mohsen Rezaeian, Abanoub Riad, Esperanza Romero-Rodríguez, Luca Ronfani, Koushik Roy Pramanik, Siamak Sabour, Saeid Sadeghian, Mohammad Reza Saeb, Azam Safary, Amirhossein Sahebkar, Biniyam Sahiledengle, Sara Samadzadeh, Arash Sarveazad, Yashendra Sethi, Saeed Shahabi, Fariba Shahraki-Sanavi, Mehran Shams-Beyranvand, Kiomars Sharafi, Nigussie Tadesse Sharew, Aziz Sheikh, Rahim Ali Sheikhi, Rahman Shiri, Bogdan Socea, Mohammad Sadegh Soltani-Zangbar, Rafael Tabarés-Seisdedos, Shima Tabatabai, Moslem Taheri Soodejani, Razieh Tavakoli Oliaee, Amir Tiyuri, Marcos Roberto Tovani-Palone, Abdul Rohim Tualeka, Rohollah Valizadeh, Jef Van den Eynde, Tommi Juhani Vasankari, Theo Vos, Mandaras Tariku Walde, Yanzhong Wang, Fei Long Wei, Ronny Westerman, Vikas Yadav, Sanni Yaya, Iman Zare, Bin Zhu, Mohammad Zoladl, Alimuddin Zumla, Simon I. Hay, George C. Patton

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Abstract

Background: Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. Methods: In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0–24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990–2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. Findings: In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15–19 years in low-SDI settings. Interpretation: Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. Funding: The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation.

Original languageEnglish
Pages (from-to)313-335
Number of pages23
JournalThe Lancet
Volume402
Issue number10398
DOIs
Publication statusPublished - 22 Jul 2023

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