Abstract: More than 20% of all childhood deaths are thought to be acute respiratory (ARI) deaths; most of these occur in developing countries. Bacterial pathogens are implied in 70–90% of pediatric ARI deaths, while 10–30% are attributed to respiratory syncytial viruses (RSV). This implies that influenza is not an important cause of severe pediatric ARI. Influenza A,B virus infections may nevertheless cause ARI deaths by triggering bacterial superinfections. The mechanism of triggering is still poorly understood, as well as the consequences in terms of disease burden. However, recent studies have shed additional light on the triggering mechanism and provided an example of an influenza-triggered outbreak of severe pediatric pneumococcal disease. Further, new studies have quantified the impact of influenza on pediatric hospitalizations in the US—and argued that they may be similar in magnitude to that of RSV. In the tropics, the year-round circulation of influenza viruses prohibits the use of traditional tools to observe and quantify the attributable burden as the increase in severe ARI outcomes during influenza periods. Also, several studies of pathogens isolated from ARI-hospitalized children suggest a minor role of influenza viruses. However, since influenza may trigger bacterial super infections it is likely that undiagnosed influenza infections cause a significant subset of ARI deaths in developing countries. The void of data demonstrating the impact on ARI hospitalizations and deaths in the tropics has put influenza viruses at a disadvantage in terms of being recognized as serious pathogens. With the availability of new mucosal live-attenuated influenza vaccine formulations, it may be prudent to re-examine this issue for children living in tropical developing countries. Vaccine probe studies are needed to assess the true influenza-related disease burden.

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   |clé=     ISTEX:2CDFFDCAD6578BE7AF38F51CFCF84B14681AA990
   |texte=   Influenza-related morbidity and mortality among children in developed and developing countries
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