HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Simonsen, L Articles by Schonberger, L B Search for Related Content PubMed PubMed Citation Articles by Simonsen, L Articles by Schonberger, L B

The impact of influenza epidemics on mortality: introducing a severity index.

L Simonsen, M J Clarke, G D Williamson, D F Stroup, N H Arden and L B Schonberger

Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

OBJECTIVES: The purpose of this study was to assess the impact of recent influenza epidemics on mortality in the United States and to develop an index for comparing the severity of individual epidemics. METHODS: A cyclical regression model was applied to weekly national vital statistics from 1972 through 1992 to estimate excesses in pneumonia and influenza mortality and all-cause mortality for each influenza season. Each season was categorized on the basis of increments of 2000 pneumonia and influenza excess deaths, and each of these severity categories was correlated with a range of all-cause excess mortality. RESULTS: Each of the 20 influenza seasons studied was associated with an average of 5600 pneumonia and influenza excess deaths (range, 0-11,800) and 21,300 all-cause excess deaths (range, 0-47,200). Most influenza A(H3N2) seasons fell into severity categories 4 to 6 (23,000-45,000 all-cause excess deaths), whereas most A(H1N1) and B seasons were ranked in categories 1 to 3 (0-23,000 such deaths). CONCLUSIONS: From 1972 through 1992, influenza epidemics accounted for a total of 426,000 deaths in the United States, many times more than those associated with recent pandemics. The influenza epidemic severity index was useful for categorizing severity and provided improved seasonal estimates of the total number of influenza-related deaths.

This article has been cited by other articles:

				B. G. Hale, R. E. Randall, J. Ortin, and D. Jackson The multifunctional NS1 protein of influenza A viruses J. Gen. Virol., October 1, 2008; 89(10): 2359 - 2376. [Abstract] [Full Text] [PDF]

				F. Carrat, E. Vergu, N. M. Ferguson, M. Lemaitre, S. Cauchemez, S. Leach, and A.-J. Valleron Time Lines of Infection and Disease in Human Influenza: A Review of Volunteer Challenge Studies Am. J. Epidemiol., April 1, 2008; 167(7): 775 - 785. [Abstract] [Full Text] [PDF]

				N. Janus, L.-V. Vacher, S. Karie, E. Ledneva, and G. Deray Vaccination and chronic kidney disease Nephrol. Dial. Transplant., March 1, 2008; 23(3): 800 - 807. [Full Text] [PDF]

				T. Jefferson, R. Foxlee, C. D. Mar, L. Dooley, E. Ferroni, B. Hewak, A. Prabhala, S. Nair, and A. Rivetti Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review BMJ, January 12, 2008; 336(7635): 77 - 80. [Abstract] [Full Text] [PDF]

				M. A. Campos, S. Alazemi, G. Zhang, R. A. Sandhaus, and A. Wanner Influenza Vaccination in Subjects With {alpha}1-Antitrypsin Deficiency Chest, January 1, 2008; 133(1): 49 - 55. [Abstract] [Full Text] [PDF]

				A. G. S. C. Jansen, E. A. M. Sanders, A. W. Hoes, A. M. van Loon, and E. Hak Influenza- and respiratory syncytial virus-associated mortality and hospitalisations Eur. Respir. J., December 1, 2007; 30(6): 1158 - 1166. [Abstract] [Full Text] [PDF]

				H. Zeng, C. Goldsmith, P. Thawatsupha, M. Chittaganpitch, S. Waicharoen, S. Zaki, T. M. Tumpey, and J. M. Katz Highly Pathogenic Avian Influenza H5N1 Viruses Elicit an Attenuated Type I Interferon Response in Polarized Human Bronchial Epithelial Cells J. Virol., November 15, 2007; 81(22): 12439 - 12449. [Abstract] [Full Text] [PDF]

				A. Ortqvist, F. Granath, J. Askling, and J. Hedlund Influenza vaccination and mortality: prospective cohort study of the elderly in a large geographical area Eur. Respir. J., September 1, 2007; 30(3): 414 - 422. [Abstract] [Full Text] [PDF]

				W. J. Alonso, C. Viboud, L. Simonsen, E. W. Hirano, L. Z. Daufenbach, and M. A. Miller Seasonality of Influenza in Brazil: A Traveling Wave from the Amazon to the Subtropics Am. J. Epidemiol., June 15, 2007; 165(12): 1434 - 1442. [Abstract] [Full Text] [PDF]

				M. Madjid, C. C. Miller, V. V. Zarubaev, I. G. Marinich, O. I. Kiselev, Y. V. Lobzin, A. E. Filippov, and S. W. Casscells III Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: results from 8 years of autopsies in 34 892 subjects Eur. Heart J., May 2, 2007; 28(10): 1205 - 1210. [Abstract] [Full Text] [PDF]

				M. C. Dessing, K. F. van der Sluijs, S. Florquin, S. Akira, and T. van der Poll Toll-Like Receptor 2 Does Not Contribute to Host Response during Postinfluenza Pneumococcal Pneumonia Am. J. Respir. Cell Mol. Biol., May 1, 2007; 36(5): 609 - 614. [Abstract] [Full Text] [PDF]

				A. P. Galvani, T. C. Reluga, and G. B. Chapman Long-standing influenza vaccination policy is in accord with individual self-interest but not with the utilitarian optimum PNAS, March 27, 2007; 104(13): 5692 - 5697. [Abstract] [Full Text] [PDF]

				W S Lim Pandemic flu: clinical management of patients with an influenza-like illness during an influenza pandemic Thorax, January 1, 2007; 62(suppl_1): 1 - 46. [Full Text] [PDF]

				L. A. McNamee and A. G. Harmsen Both Influenza-Induced Neutrophil Dysfunction and Neutrophil-Independent Mechanisms Contribute to Increased Susceptibility to a Secondary Streptococcus pneumoniae Infection Infect. Immun., December 1, 2006; 74(12): 6707 - 6721. [Abstract] [Full Text] [PDF]

				J. A. McCullers Insights into the Interaction between Influenza Virus and Pneumococcus Clin. Microbiol. Rev., July 1, 2006; 19(3): 571 - 582. [Abstract] [Full Text] [PDF]

				A. C. Lowen, S. Mubareka, T. M. Tumpey, A. Garcia-Sastre, and P. Palese The guinea pig as a transmission model for human influenza viruses PNAS, June 27, 2006; 103(26): 9988 - 9992. [Abstract] [Full Text] [PDF]

				V. T. Peltola, K. L. Boyd, J. L. McAuley, J. E. Rehg, and J. A. McCullers Bacterial Sinusitis and Otitis Media following Influenza Virus Infection in Ferrets. Infect. Immun., May 1, 2006; 74(5): 2562 - 2567. [Abstract] [Full Text] [PDF]

				L. Bonneux and W. Van Damme An iatrogenic pandemic of panic. BMJ, April 1, 2006; 332(7544): 786 - 788. [Full Text] [PDF]

				L. Simonsen, R. Taylor, C. Viboud, J. Dushoff, and M. Miller US flu mortality estimates are based on solid science BMJ, January 21, 2006; 332(7534): 177 - 178. [Full Text]

				J. Dushoff, J. B. Plotkin, C. Viboud, D. J. D. Earn, and L. Simonsen Mortality due to Influenza in the United States--An Annualized Regression Approach Using Multiple-Cause Mortality Data Am. J. Epidemiol., January 15, 2006; 163(2): 181 - 187. [Abstract] [Full Text] [PDF]

				J. J. Mazza, S. H. Yale, J. R. Arrowood, C. E. Reynolds, I. Glurich, P.-H. Chyou, J. G. Linneman, and K. D. Reed Efficacy of the Influenza Vaccine in Patients with Malignant Lymphoma Clin. Med. Res., November 1, 2005; 3(4): 214 - 220. [Abstract] [Full Text] [PDF]

				J. S. Brownstein, K. P. Kleinman, and K. D. Mandl Identifying Pediatric Age Groups for Influenza Vaccination Using a Real-Time Regional Surveillance System Am. J. Epidemiol., October 1, 2005; 162(7): 686 - 693. [Abstract] [Full Text] [PDF]

				W. W. Thompson, D. K. Shay, E. Weintraub, L. Brammer, N. J. Cox, and K. Fukuda Influenza Vaccination Among the Elderly in the United States Arch Intern Med, September 26, 2005; 165(17): 2038 - 2039. [Full Text] [PDF]

				D. R. Olson, L. Simonsen, P. J. Edelson, and S. S. Morse Epidemiological evidence of an early wave of the 1918 influenza pandemic in New York City PNAS, August 2, 2005; 102(31): 11059 - 11063. [Abstract] [Full Text] [PDF]

				L. Simonsen, T. A. Reichert, C. Viboud, W. C. Blackwelder, R. J. Taylor, and M. A. Miller Impact of Influenza Vaccination on Seasonal Mortality in the US Elderly Population Arch Intern Med, February 14, 2005; 165(3): 265 - 272. [Abstract] [Full Text] [PDF]

				T. A. Reichert, L. Simonsen, A. Sharma, S. A. Pardo, D. S. Fedson, and M. A. Miller Influenza and the Winter Increase in Mortality in the United States, 1959-1999 Am. J. Epidemiol., September 1, 2004; 160(5): 492 - 502. [Abstract] [Full Text] [PDF]

				K. F. van der Sluijs, L. J. R. van Elden, M. Nijhuis, R. Schuurman, J. M. Pater, S. Florquin, M. Goldman, H. M. Jansen, R. Lutter, and T. van der Poll IL-10 Is an Important Mediator of the Enhanced Susceptibility to Pneumococcal Pneumonia after Influenza Infection J. Immunol., June 15, 2004; 172(12): 7603 - 7609. [Abstract] [Full Text] [PDF]

				A. H. Mokdad, J. S. Marks, D. F. Stroup, and J. L. Gerberding Actual Causes of Death in the United States, 2000 JAMA, March 10, 2004; 291(10): 1238 - 1245. [Abstract] [Full Text] [PDF]

				B. Dauber, G. Heins, and T. Wolff The Influenza B Virus Nonstructural NS1 Protein Is Essential for Efficient Viral Growth and Antagonizes Beta Interferon Induction J. Virol., February 15, 2004; 78(4): 1865 - 1872. [Abstract] [Full Text] [PDF]

				H. Jin, H. Zhou, B. Lu, and G. Kemble Imparting Temperature Sensitivity and Attenuation in Ferrets to A/Puerto Rico/8/34 Influenza Virus by Transferring the Genetic Signature for Temperature Sensitivity from Cold-Adapted A/Ann Arbor/6/60 J. Virol., January 15, 2004; 78(2): 995 - 998. [Abstract] [Full Text] [PDF]

				M. Madjid, M. Naghavi, S. Litovsky, and S. W. Casscells Influenza and Cardiovascular Disease: A New Opportunity for Prevention and the Need for Further Studies Circulation, December 2, 2003; 108(22): 2730 - 2736. [Full Text] [PDF]

				C. Viboud, P.-Y. Boelle, F. Carrat, A.-J. Valleron, and A. Flahault Prediction of the Spread of Influenza Epidemics by the Method of Analogues Am. J. Epidemiol., November 15, 2003; 158(10): 996 - 1006. [Abstract] [Full Text] [PDF]

				M. Madjid, S. Lillibridge, P. Mirhaji, and W. Casscells Influenza as a bioweapon J R Soc Med, July 1, 2003; 96(7): 345 - 346. [Full Text] [PDF]

				L. Simonsen, W. C. Blackwelder, T. A. Reichert, and M. A. Miller Estimating Deaths Due to Influenza and Respiratory Syncytial Virus JAMA, May 21, 2003; 289(19): 2499 - 2500. [Full Text] [PDF]

				N. M. Ferguson, S. Mallett, H. Jackson, N. Roberts, and P. Ward A population-dynamic model for evaluating the potential spread of drug-resistant influenza virus infections during community-based use of antivirals J. Antimicrob. Chemother., April 1, 2003; 51(4): 977 - 990. [Abstract] [Full Text] [PDF]

				W. W. Thompson, D. K. Shay, E. Weintraub, L. Brammer, N. Cox, L. J. Anderson, and K. Fukuda Mortality Associated With Influenza and Respiratory Syncytial Virus in the United States JAMA, January 8, 2003; 289(2): 179 - 186. [Abstract] [Full Text] [PDF]

				S. S. Chiu, Y. L. Lau, K. H. Chan, W. H. S. Wong, and J.S. M. Peiris Influenza-Related Hospitalizations among Children in Hong Kong N. Engl. J. Med., December 26, 2002; 347(26): 2097 - 2103. [Abstract] [Full Text] [PDF]

				F.-C. Tsui, M. M. Wagner, V. Dato, and C.-C. H. Chang Value of ICD-9-Coded Chief Complaints for Detection of Epidemics J. Am. Med. Inform. Assoc., November 1, 2002; 9(90061): S41 - 47. [Abstract] [Full Text] [PDF]

				K. M. Neuzil, C. Hohlbein, and Y. Zhu Illness Among Schoolchildren During Influenza Season: Effect on School Absenteeism, Parental Absenteeism From Work, and Secondary Illness in Families Arch Pediatr Adolesc Med, October 1, 2002; 156(10): 986 - 991. [Abstract] [Full Text] [PDF]

				P. A. Piedra, L. Yan, K. Kotloff, K. Zangwill, D. I. Bernstein, J. King, J. Treanor, F. Munoz, M. Wolff, I. Cho, et al. Safety of the Trivalent, Cold-Adapted Influenza Vaccine in Preschool-Aged Children Pediatrics, October 1, 2002; 110(4): 662 - 672. [Abstract] [Full Text] [PDF]

				F. Carrat, C. Sahler, S. Rogez, M. Leruez-Ville, F. Freymuth, C. Le Gales, M. Bungener, B. Housset, M. Nicolas, and C. Rouzioux Influenza Burden of Illness: Estimates From a National Prospective Survey of Household Contacts in France Arch Intern Med, September 9, 2002; 162(16): 1842 - 1848. [Abstract] [Full Text] [PDF]

				G. K. Geiss, M. Salvatore, T. M. Tumpey, V. S. Carter, X. Wang, C. F. Basler, J. K. Taubenberger, R. E. Bumgarner, P. Palese, M. G. Katze, et al. Cellular transcriptional profiling in influenza A virus-infected lung epithelial cells: The role of the nonstructural NS1 protein in the evasion of the host innate defense and its potential contribution to pandemic influenza PNAS, August 6, 2002; 99(16): 10736 - 10741. [Abstract] [Full Text] [PDF]

				F. C. Curriero, K. S. Heiner, J. M. Samet, S. L. Zeger, L. Strug, and J. A. Patz Temperature and Mortality in 11 Cities of the Eastern United States Am. J. Epidemiol., January 1, 2002; 155(1): 80 - 87. [Abstract] [Full Text] [PDF]

				J. J. Goronzy, J. W. Fulbright, C. S. Crowson, G. A. Poland, W. M. O'Fallon, and C. M. Weyand Value of Immunological Markers in Predicting Responsiveness to Influenza Vaccination in Elderly Individuals J. Virol., December 15, 2001; 75(24): 12182 - 12187. [Abstract] [Full Text] [PDF]

				S. Inouye, M. H. Kramer, K. Fukuda, W. W. Thompson, N. Cox, T. Yamazaki, T. Suzuki, K. Yamamoto, T. A. Reichert, N. Sugaya, et al. Vaccinating Japanese Schoolchildren against Influenza N. Engl. J. Med., June 21, 2001; 344(25): 1946 - 1948. [Full Text] [PDF]

				T. A. Reichert, N. Sugaya, D. S. Fedson, W. P. Glezen, L. Simonsen, and M. Tashiro The Japanese Experience with Vaccinating Schoolchildren against Influenza N. Engl. J. Med., March 22, 2001; 344(12): 889 - 896. [Abstract] [Full Text] [PDF]

				J. C. Lin and K. L. Nichol Excess Mortality Due to Pneumonia or Influenza During Influenza Seasons Among Persons With Acquired Immunodeficiency Syndrome Arch Intern Med, February 12, 2001; 161(3): 441 - 446. [Abstract] [Full Text] [PDF]

				R. B. Couch Influenza: Prospects for Control Ann Intern Med, December 19, 2000; 133(12): 992 - 998. [Abstract] [Full Text] [PDF]

				R. B. Couch Prevention and Treatment of Influenza N. Engl. J. Med., December 14, 2000; 343(24): 1778 - 1787. [Full Text] [PDF]

				I. Gemmell, P. McLoone, F. Boddy, G. J Dickinson, and G. Watt Seasonal variation in mortality in Scotland Int. J. Epidemiol., April 1, 2000; 29(2): 274 - 279. [Abstract] [Full Text] [PDF]

				K. M. Neuzil, B. G. Mellen, P. F. Wright, E. F. Mitchel, and M. R. Griffin The Effect of Influenza on Hospitalizations, Outpatient Visits, and Courses of Antibiotics in Children N. Engl. J. Med., January 27, 2000; 342(4): 225 - 231. [Abstract] [Full Text] [PDF]

				K. M. Neuzil, G. W. Reed, E. F. Mitchel Jr, and M. R. Griffin Influenza-Associated Morbidity and Mortality in Young and Middle-Aged Women JAMA, March 10, 1999; 281(10): 901 - 907. [Abstract] [Full Text] [PDF]

				W. P. Glezen Influenza Control--Unfinished Business JAMA, March 10, 1999; 281(10): 944 - 945. [Full Text] [PDF]