Centre for Global Health Research, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
Department of Pediatrics, King George's Medical University, Lucknow, India.
Elife. 2019 Aug 27;8:e46202. doi: 10.7554/eLife.46202.
Control of pneumonia and diarrhea mortality in India requires understanding of their etiologies. We combined time series analysis of seasonality, climate region, and clinical syndromes from 243,000 verbal autopsies in the nationally representative Million Death Study. Pneumonia mortality at 1 month-14 years was greatest in January (Rate ratio (RR) 1.66, 99% CI 1.51-1.82; versus the April minimum). Higher RRs at 1-11 months suggested respiratory syncytial virus (RSV) etiology. India's humid subtropical region experienced a unique summer pneumonia mortality. Diarrhea mortality peaked in July (RR 1.66, 1.48-1.85) and January (RR 1.37, 1.23-1.48), while deaths with fever and bloody diarrhea (indicating enteroinvasive bacterial etiology) showed little seasonality. Combining mortality at ages 1-59 months with prevalence surveys, we estimate 40,600 pneumonia deaths from , 20,700 from RSV, 12,600 from influenza, and 7200 from type b and 24,700 diarrheal deaths from rotavirus occurred in 2015. Careful mortality studies can elucidate etiologies and inform vaccine introduction.
控制印度肺炎和腹泻死亡率需要了解其病因。我们结合了来自全国代表性的百万死亡研究中 243000 例口述尸检的季节性、气候区域和临床综合征的时间序列分析。1 个月至 14 岁的肺炎死亡率在 1 月最高（比率比 (RR) 1.66，99%置信区间 1.51-1.82；与 4 月的最低值相比）。1-11 个月时更高的 RR 表明存在呼吸道合胞病毒 (RSV) 病因。印度湿润的亚热带地区经历了独特的夏季肺炎死亡率。腹泻死亡率在 7 月（RR 1.66，1.48-1.85）和 1 月（RR 1.37，1.23-1.48）达到峰值，而伴有发热和血性腹泻的死亡（表明肠侵袭性细菌病因）季节性不强。将 1-59 月龄的死亡率与流行情况调查相结合，我们估计 2015 年有 40600 例肺炎死亡归因于 ，20700 例归因于 RSV，12600 例归因于流感，7200 例归因于 b 型和 24700 例腹泻死亡归因于轮状病毒。仔细的死亡率研究可以阐明病因并为疫苗接种提供信息。
