Health

How many people die from the flu?

How many people die from the flu?

  • Gordon, A. and Reingold, A. (2018). The burden of influenza: a complex problem. Current epidemiological reports, 5(1), 1–9. https://doi.org/10.1007/s40471-018-0136-1

  • Charbonneau, DH, & James, LN (2019). FluView and FluNet: Tools for Influenza Activity and Surveillance. Medical Reference Services Quarterly, 38(4), 358–368. https://doi.org/10.1080/02763869.2019.1657734

  • Macias, AE, McElhaney, JE, Chaves, SS, Nealon, J., Nunes, MC, Samson, SI, Seet, BT, Weinke, T., & Yu, H. (2021). Burden of influenza disease beyond respiratory diseases. The vaccine, 39A6–A14. https://doi.org/10.1016/j.vaccine.2020.09.048

  • Paget J, Spreeuwenberg P, Charu V, Taylor RJ, Iuliano AD, Bresee J, Simonsen L, Viboud C; Global Seasonal Influenza Mortality Collaborative Network and GLaMOR Teams*. Global mortality associated with seasonal influenza epidemics: New burden estimates and predictors from the GLaMOR project. J Glob Health. 2019 Dec;9(2):020421. doi: 10.7189/jogh.09.020421. https://pubmed.ncbi.nlm.nih.gov/31673337/

    This shows the median estimate of annual influenza mortality between 2002-2011, excluding the 2009 “swine flu” pandemic season.

    Other global estimates of seasonal influenza mortality have been made by the Institute for Health Measurement and Evaluation (IHME) and the Centers for Disease Control and Prevention (CDC).

    The estimates made by GLaMOR were comparable to those of the CDC, while the IHME estimates were about 4-5 times lower. This may be because IHME estimated influenza mortality by first estimating the number of deaths caused by lower respiratory disease and then estimating the proportion of those primarily attributed to influenza in vital records, verbal autopsies, and other mortality data. This approach would miss many deaths due to complications of influenza and deaths not reported to be due to influenza due to limited testing.

    The CDC and GLaMOR models also likely underestimate overall influenza mortality, as they only use data on deaths from respiratory illnesses. While this would include deaths caused by influenza where, for example, influenza is listed as a secondary cause of death on death certificates, would to be missing some caused by the flu but attributed to another cause such as cardiovascular disease. If these models had used all-cause mortality to estimate influenza-related deaths, they would have been more sensitive (capturing more deaths from influenza) but also less specific (capturing more deaths from other diseases that cannot be easily distinguished).

    Compared to CDC estimates, GLaMOR used many country-specific indicators to extrapolate seasonal influenza mortality to countries that did not provide weekly or monthly influenza mortality records or influenza surveillance data, while CDC extrapolated this using mostly Global WHO health assessments. respiratory mortality.

  • Eurostat. (2022). Causes of Death—Standardized Mortality Rate. European Commission. https://ec.europa.eu/eurostat/databrowser/view/HLTH_CD_ASDR2__custom_3500876/default/table?lang=en
    Transport accidents are counted under (V01–V99, Y85) in ICD-10. In the 27 EU countries, these rates were 9.02, 9.15 and 8.77 per 100,000 people aged 65 and over in 2015, 2016 and 2017, respectively.

    Influenza mortality estimates are much lower in ICD-10 because only deaths in which influenza is listed as the cause of death on death certificates are considered, while the estimates we show above include those caused indirectly by influenza. This means that ICD-10 mortality rates are likely to be greatly underestimated due to influenza. However, deaths due to traffic accidents are more likely to be listed as the primary cause of death on death certificates and much less likely to be underreported by death records.

  • Acosta, E., Hallman, SA, Dillon, LY, Ouellette, N., Bourbeau, R., Herring, DA, Inwood, K., Earn, DJD, Madrenas, J., Miller, MS, & Gagnon, A. (2019). Determinants of influenza mortality trends: an age-period-cohort analysis of influenza mortality in the United States, 1959–2016. Demographics, 56(5), 1723–1746. https://doi.org/10.1007/s13524-019-00809-y

    From 1960 to 2015, flu deaths were estimated using the Serfling model, which estimates excess deaths during flu seasons using data from the rest of the year and taking into account changes that occur from year to year. Since 1997, there has also been routine testing for “flu-like illnesses” in hospitals to determine the proportion of them that are actually caused by flu rather than other illnesses. Therefore, estimates from 1997 to 2015 were also calculated using the Serfling-surveillance model, which calculated the proportion of tests that were positive for influenza. This also confirms the estimates from the regular Serfling model. In addition, deaths among children under 5 years of age were excluded in both models, as they would likely include deaths from respiratory syncytial virus.

    Mortality in the US was slightly lower during the 2009 swine flu pandemic season than in normal flu seasons, as severe disease shifted from the elderly to young and middle-aged adults. However, the 2009 swine flu pandemic led to more deaths than a normal flu season in other countries such as Mexico.

    Gagnon, A., Acosta, E., Hallman, S., Bourbeau, R., Dillon, LY, Ouellette, N., Earn, DJD, Herring, DA, Inwood, K., Madrenas, J., & Miller, MS (2018). The pandemic paradox: Infection with pandemic H2N2 influenza in early life increased the likelihood of death during the 2009 H1N1 pandemic. Races, 9(1), e02091-17. https://doi.org/10.1128/mBio.02091-17

  • Influenza viruses are thought to be transmitted more effectively during the winter due to lower temperatures and humidity. But in many tropical countries, flu outbreaks coincide with warm rainy seasons, so the trends may have multiple causes. Other explanations include seasonal changes in human immunity or changes in human behavior, such as more indoor mixing and crowding. Petrova, VN, & Russell, CA (2018). Evolution of seasonal influenza viruses. Nature Reviews Microbiology, 16(1), 47–60. https://doi.org/10.1038/nrmicro.2017.118

  • Between 1860 and 1900, there was a slight increase in the risk of death from influenza, which may have been caused by worsening health conditions as more people moved to crowded urban areas.

    Acosta, E., Hallman, SA, Dillon, LY, Ouellette, N., Bourbeau, R., Herring, DA, Inwood, K., Earn, DJD, Madrenas, J., Miller, MS, & Gagnon, A. (2019). Determinants of influenza mortality trends: an age-period-cohort analysis of influenza mortality in the United States, 1959–2016. Demography, 56(5), 1723–1746. https://doi.org/10.1007/s13524-019-00809-y

  • Cutler, D., & Miller, G. (2005). The Role of Public Health Improvement in Health Progress: The Twentieth-Century United States. Demographics, 42(1), 1–22. https://doi.org/10.1353/dem.2005.0002

  • Barberis, I., Myles, P., Ault, SK, Bragazzi, NL, and Martini, M. (2016). History and evolution of influenza control by vaccination: from the first monovalent vaccine to universal vaccines. Journal of preventive medicine and hygiene, 57(3), E115–E120. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139605/

  • Centers for Disease Control and Prevention and the National Center for Immunization and Respiratory Diseases. (2021). Historical Reference of Seasonal Influenza Vaccine Doses Distributed. https://www.cdc.gov/flu/prevent/vaccine-supply-historical.htm

  • These estimates are more variable for young age groups, especially those born after 1990, because the number of influenza deaths by comparison was low, especially because deaths of children under 5 were excluded from the model to avoid counting respiratory deaths. syncytial virus.
    Acosta, E., Hallman, SA, Dillon, LY, Ouellette, N., Bourbeau, R., Herring, DA, Inwood, K., Earn, DJD, Madrenas, J., Miller, MS, & Gagnon, A. (2019). Determinants of influenza mortality trends: an age-period-cohort analysis of influenza mortality in the United States, 1959–2016. Demographics, 56(5), 1723–1746. https://doi.org/10.1007/s13524-019-00809-y

  • Metcalf, CJE, Paireau, J., O’Driscoll, M., Pivette, M., Hubert, B., Pontais, I., Nickbakhsh, S., Cummings, DAT, Cauchemez, S., & Salje, H. (2022). Comparison of age and gender trajectories of morbidity and mortality of SARS-CoV-2 with other respiratory pathogens. Royal Society Open Science, 9(6), 211498. https://doi.org/10.1098/rsos.211498

    In this post, we show the relative risks of death. This is because it is more difficult to give an absolute risk of dying from the flu at different ages, as death rates vary widely over time and between countries, as we saw earlier. The absolute risks depend on how many people are infected during the flu season, availability of health care, vaccination rates, etc. However, the relatively the risk of death—the relationship between the risk of death in one age group versus another—tends to be more consistent.

  • The shape of this age-mortality curve is often described by the Gompertz function. Olshansky, SJ, & Carnes, BA (1997). Ever since Gompertz. Demographics, 34(1), 1-15. https://link.springer.com/content/pdf/10.2307/2061656.pdf

  • Belongia, EA, Simpson, MD, King, JP, Sundaram, ME, Kelley, NS, Osterholm, MT, & McLean, HQ (2016). Variable influenza vaccine efficacy by subtype: a systematic review and meta-analysis of studies of negative test designs. The Lancet Infectious Diseases, 16(8), 942–951. https://doi.org/10.1016/S1473-3099(16)00129-8

  • Tricco, AC, Chit, A., Soobiah, C., Hallett, D., Meier, G., Chen, MH, Tashkandi, M., Bauch, CT, & Loeb, M. (2013). Comparing the efficacy of influenza vaccine with mismatched and matched strains: a systematic review and meta-analysis. BMC Medicine, 11(1), 153. https://doi.org/10.1186/1741-7015-11-153

  • P. Spreeuwenberg; et al. (December 1, 2018). “A Reassessment of the Global Mortality of the 1918 Influenza Pandemic”. American Journal of Epidemiology. 187 (12): 2561–2567. doi:10.1093/aje/kwy191. PMID 30202996. Online here.

  • Paget J, Spreeuwenberg P, Charu V, Taylor RJ, Iuliano AD, Bresee J, Simonsen L, Viboud C; Global Seasonal Influenza Mortality Collaborative Network and GLaMOR Collaborative Teams*. Global mortality associated with seasonal influenza epidemics: New burden estimates and predictors from the GLaMOR project. J Glob Health. 2019 Dec;9(2):020421. doi: 10.7189/jogh.09.020421. https://pubmed.ncbi.nlm.nih.gov/31673337/

  • Worobey, M., Han, G.-Z., & Rambaut, A. (2014). Genesis and pathogenesis of the 1918 pandemic influenza A H1N1 virus. Proceedings of the National Academy of Sciences, 111(22), 8107–8112. https://doi.org/10.1073/pnas.1324197111
    Gagnon, A., Miller, MS, Hallman, SA, Bourbeau, R., Herring, DA, Earn, DJD, & Madrenas, J. (2013). Age-related mortality during the 1918 influenza pandemic: Unraveling the mystery of high mortality among young adults. PloS One, 8(8), e69586. https://doi.org/10.1371/journal.pone.0069586
    Luk, J., Gross, P., & Thompson, WW (2001). Observations on mortality during the 1918 influenza pandemic. Clinical infectious diseases, 33(8), 1375–1378. https://doi.org/10.1086/322662

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