ORIGINAL RESEARCH article
Front. Microbiol.
Sec. Virology
Global Burden of Lower Respiratory Infections Attributable to Cytomegalovirus, 1990-2021: A Systematic Analysis from the MICROBE Database
Provisionally accepted
Wanwan Zhang1*
Min Liu2
Haoyu Ji1
Emmanuel Mensah1Shirong Li2
Hanli Wang1Zhiwei Lu1
Shuoshuo Wei1
Yusheng Cheng1
Lei Zha1- 1First Affiliated Hospital of Wannan Medical College, Wuhu, China
- 2Wuhu Hospital Affiliated to East China Normal University, Wuhu, China
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Objectives: This study aimed to investigate the global epidemiological characteristics and disease burden of lower respiratory infections (LRIs) attributable to cytomegalovirus (CMV) from 1990 to 2021. Methods: We systematically assessed the global burden and temporal trends of CMV-associated LRIs across different ages, sexes, geographic regions, and socioeconomic statuses using data from the MICROBE database spanning 1990 to 2021. Key metrics included mortality, disability-adjusted life years (DALYs), and their corresponding age-standardized rates (ASRs) Results: Globally, the number of DALYs due to CMV-attributed LRI decreased from an estimated 734,208 (95% UI: 612,175-856,241) in 1990 to 530,465 (95% UI: 469,046-591,884) in 2021, while the number of deaths increased from 16,141 (95% UI: 14,247-18,034) to 19,235 (95% UI: 17,204-21,266) over the same period. The age-standardized DALY rate (ASDR) declined from 13.89 (95% UI: 11.86-15.93) in 1990 to 6.95 (95% UI: 6.08-7.83) in 2021. Similarly, the age-standardized mortality rate (ASMR) dropped from 0.40 (95% UI: 0.35-0.44) to 0.24 (95% UI: 0.21-0.27). In 2021, the disease burden was highest in regions with low Socio-demographic Index (SDI). From 1990 to 2021, both ASMR and ASDR for CMV-attributable LRI decreased as SDI increased, and projections indicate a continued decline over the next 30 years. Conclusions: The global burden of CMV-attributable LRI has declined significantly from 1990 to 2021. However, targeted and cost-effective interventions are urgently needed to prevent and reduce the burden of CMV-associated LRI, particularly in low-SDI regions, children, and the elderly.
Keywords: Cytomegalovirus, deaths, Disability‐adjusted life years, Global burden of disease, Lower respiratory infection
Received: 27 Aug 2025; Accepted: 30 Oct 2025.
Copyright: © 2025 Zhang, Liu, Ji, Mensah, Li, Wang, Lu, Wei, Cheng and Zha. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wanwan Zhang, 20249353@stu.wnmc.edu.cn
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