Burden of 46 key pathogens among children in G20 countries, 2023: A systematic analysis and regional comparison

BACKGROUND: Infectious diseases remain a major public health threat to child survival and health, with particularly substantial burdens attributable to lower respiratory infections, diarrheal diseases, and CNS infections. Although the Global Burden of Disease (GBD) studies have previously evaluated specific pathogens or individual clinical syndromes, a descriptive assessment of the burden attributable to major pathogens across multiple infectious syndromes in children within G20 countries remains limited. Using the most recent GBD 2023 dataset, this study aimed to systematically evaluate the burden and temporal trends of 46 key pathogens among children aged 0-14 years in G20 countries from 1990 to 2023. METHODS: Data were obtained from the Global Burden of Disease Study 2023 (GBD 2023). We extracted estimates of deaths and disability-adjusted life years (DALYs) attributable to 46 pathogens among children aged 0-14 years in G20 countries between 1990 and 2023, and calculated corresponding death and DALY rates. Temporal trends were assessed using the estimated annual percentage change (EAPC). Regional disparities were examined through stratified analyses based on the Socio-demographic Index (SDI). The principal infectious syndromes analyzed included lower respiratory infections, diarrheal diseases, and meningitis. RESULTS: In 2023, Streptococcus pneumoniae was the leading pathogen contributing to death and DALY loss among children in G20 countries, accounting for approximately 66,400 deaths (95% UI: 56,400-77,000) and 5.90 million DALYs (95% UI: 5.01-6.85 million). It also represented the predominant pathogen responsible for meningitis-related burden. Klebsiella pneumoniae ranked second, causing approximately 21,500 deaths (95% UI: 17,900-24,700), followed closely by Adenovirus (approximately 16,700 deaths; 95% UI: 9,300-26,200) and Rotavirus (approximately 16,100 deaths; 95% UI: 11,100-22,900). In terms of temporal trends, death from Haemophilus influenzae meningitis exhibited the most pronounced decline, with an average annual reduction of 9.06% (95% CI: -9.98 to -8.14). Regional analyses indicated that India, South Africa, and Indonesia bore the greatest burden within the G20. Age-stratified analyses revealed that infants younger than one year experienced substantially higher disease burdens than other pediatric age groups. Correlation analyses further demonstrated a significant inverse relationship between SDI and pathogen-attributable death rates (r = -0.8456, p < 0.001). CONCLUSIONS: Although the overall burden of pediatric infectious diseases in G20 countries has declined markedly since 1990, substantial burdens attributable to pathogens such as Streptococcus pneumoniae, rotavirus, and Klebsiella pneumoniae persist in lower-SDI member states. Moving forward, priority should be given to increasing coverage of pneumococcal conjugate vaccines and rotavirus vaccines in resource-limited G20 settings, strengthening pathogen surveillance, and improving access to timely diagnosis and treatment for severe infections in order to further reduce health inequalities.