A new study illustrates the substantial global burden of upper respiratory and ear infections, researchers reported this week in The Lancet Infectious Diseases.
Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study, an international team of researchers explored the fatal and non-fatal burden of upper respiratory infections (URIs) and otitis media (a common complication of URIs typically called ear infections) across all age-groups in 2014 countries and territories from 1990 to 2021, focusing on children younger than 5 years. Although the two conditions are closely related, their combined global burden has not been studied comprehensively.
URIs are caused by a variety of viral and bacterial pathogens, including rhinoviruses, influenza virus, Streptococcus pneumoniae, and Haemophilus influenzae. While they rarely cause severe disease or death, they pose a substantial economic and healthcare burden, particularly when they lead to more serious infections, and they can contribute to antimicrobial resistance (AMR) when antibiotics are inappropriately prescribed.
"The inappropriate prescription of antibiotics in some cases of URI facilitates an environment conducive to the emergence of AMR, especially as most URIs are self-limiting and require only symptomatic relief," the study authors wrote.
Strategies needed for prevention, early diagnosis, management
In 2021, there were 12.8 billion URI episodes and 19,600 deaths due to URIs, while otitis media accounted for 391 million episodes and 536 deaths. For both conditions, the highest incidence rates in 2021 were seen in children younger than 2 years. Together, the combined burden of URIs and otitis media in 2021 was 6.86 million years lived with disability and 8.16 million disability-adjusted life-years (DALYs) for all ages. Infants aged 1 to 5 months had the highest combined DALY rate in 2021 (647 per 100, 000) followed by early neonates (aged 0 to 6 days; 582 per 100,000) and late neonates (aged 7 to 24 days; 482 per 100,000).
Given the close association between URIs and otitis media, the authors say there is a need for comprehensive strategies that address prevention, early diagnosis, and effective management of these conditions together.
The potential for URIs to progress to more severe diseases, their contribution to AMR, and the pandemic potential of some URI pathogens necessitate comprehensive research and evidence-based strategies.
"The potential for URIs to progress to more severe diseases, their contribution to AMR, and the pandemic potential of some URI pathogens necessitate comprehensive research and evidence-based strategies," they wrote. "Future studies are needed to better understand where strategies such as strengthening vaccination programmes, enhancing antibiotic stewardship, and promoting public health campaigns focused on hygiene and prevention are most needed."
A commentary in the same journal adds that "increasing vaccine uptake, encouraging breastfeeding, reducing exposure to second-hand smoke, and minimising overcrowding at daycare programmes" could help reduce the burden.
