Archive for December, 2016
Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries.
Thursday, December 15th, 2016
12/14/2012: A 20-year-old man shoots and kills his mother at their Newtown, Connecticut, home then drives to nearby Sandy Hook Elementary School, where he kills 20 first graders and six school employees before turning a gun on himself.
Thursday, December 15th, 2016
Cerebral Malaria: New study reveals the processes that lead to fatal outcomes
Wednesday, December 14th, 2016“…..as red blood cells containing the parasite adhere to cerebral blood vessels (a hallmark of Cerebral Malaria), the immune system attempts to clean them off. Despite these efforts, endothelial cells making up the walls of cerebral blood vessels shed bits of the parasite, which CD8+ T cells recognize, causing those immune cells to attach to and attack the vessels. Once the CD8+T cells amassed on the surface of brain blood vessels, the vessels began to leak. The subsequent leaking led to swelling and increased pressure in the brain, which was fatal. ….”
WHO’s World Malaria Report 2016
Wednesday, December 14th, 201613 December 2016 | GENEVA – WHO’s World Malaria Report 2016 reveals that children and pregnant women in sub-Saharan Africa have greater access to effective malaria control. Across the region, a steep increase in diagnostic testing for children and preventive treatment for pregnant women has been reported over the last 5 years. Among all populations at risk of malaria, the use of insecticide-treated nets has expanded rapidly.
But in many countries in the region, substantial gaps in programme coverage remain. Funding shortfalls and fragile health systems are undermining overall progress, jeopardizing the attainment of global targets.
Scale-up in malaria control
Sub-Saharan Africa carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths. Children under five years of age are particularly vulnerable, accounting for an estimated 70% of all malaria deaths.
Diagnostic testing enables health providers to rapidly detect malaria and prescribe life-saving treatment. New findings presented in the report show that, in 2015, approximately half (51%) of children with a fever seeking care at a public health facility in 22 African countries received a diagnostic test for malaria, compared to 29% in 2010.
To protect women in areas of moderate and high malaria transmission in Africa, WHO recommends “intermittent preventive treatment in pregnancy” (IPTp) with sulfadoxine-pyrimethamine. The treatment, administered at each scheduled antenatal care visit after the first trimester, can prevent maternal and infant mortality, anaemia, and the other adverse effects of malaria in pregnancy.
According to available data, there was a five-fold increase in the percentage of women receiving the recommended 3 or more doses of this preventive treatment in 20 African countries. Coverage reached 31% in 2015, up from 6% in 2010.
Insecticide-treated nets are the cornerstone of malaria prevention efforts in Africa. The report found that more than half (53%) of the population at risk in sub-Saharan Africa slept under a treated net in 2015, compared to 30% in 2010.
Last month, WHO released the findings of a major 5-year evaluation in 5 countries. The study showed that people who slept under long-lasting insecticidal nets (LLINs) had significantly lower rates of malaria infection than those who did not use a net, even though mosquitoes showed resistance to pyrethroids (the only insecticide class used in LLINs) in all of these areas.
An unfinished agenda
Malaria remains an acute public health problem, particularly in sub-Saharan Africa. According to the report, there were 212 million new cases of malaria and 429 000 deaths worldwide in 2015.
There are still substantial gaps in the coverage of core malaria control tools. In 2015, an estimated 43% of the population in sub-Saharan Africa was not protected by treated nets or indoor spraying with insecticides, the primary methods of malaria vector control.
In many countries, health systems are under-resourced and poorly accessible to those most at risk of malaria. In 2015, a large proportion (36%) of children with a fever were not taken to a health facility for care in 23 African countries.
“We are definitely seeing progress,” notes Dr Pedro Alonso, Director of the WHO Global Malaria Programme. “But the world is still struggling to achieve the high levels of programme coverage that are needed to beat this disease.”
Global targets
At the 2015 World Health Assembly, Member States adopted the Global Technical Strategy for Malaria 2016-2030. The Strategy set ambitious targets for 2030 with milestones every 5 years to track progress.
Eliminating malaria in at least 10 countries is a milestone for 2020. The report shows that prospects for reaching this target are bright: In 2015, 10 countries and territories reported fewer than 150 indigenous cases of malaria, and a further 9 countries reported between 150 and 1000 cases.
Countries that have achieved at least 3 consecutive years of zero indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. In recent months, the WHO Director-General certified that Kyrgyzstan and Sri Lanka had eliminated malaria.
But progress towards other key targets must be accelerated. The Strategy calls for a 40% reduction in malaria case incidence by the year 2020, compared to a 2015 baseline. According to the report, less than half (40) of the 91 countries and territories with malaria are on track to achieve this milestone. Progress has been particularly slow in countries with a high malaria burden.
An urgent need for more funding
Sustained and sufficient funding for malaria control is a serious challenge. Despite a steep increase in global investment for malaria between 2000 and 2010, funding has since flat-lined. In 2015, malaria funding totalled US$ 2.9 billion, representing only 45% of the funding milestone for 2020 (US$ 6.4 billion).
Governments of malaria-endemic countries provided about 31% of total malaria funding in 2015. The United States of America is the largest international malaria funder, accounting for about 35% of total funding in 2015, followed by the United Kingdom of Great Britain and Northern Ireland (16%).
If global targets are to be met, funding from both domestic and international sources must increase substantially.
Note to editors
RTS,S/AS01 malaria vaccine
Last month, WHO announced that the world’s first malaria vaccine would be rolled out through pilot projects in 3 countries in sub-Saharan Africa. Vaccinations will begin 2018. The vaccine, known as RTS,S, acts against P. falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa. Advanced clinical trials have shown RTS,S to provide partial protection against malaria in young children.
WHO multi-country evaluation on LLINs
On 16 November 2016, WHO released the findings of a 5-year evaluation conducted in 340 locations across 5 countries: Benin, Cameroon, India, Kenya and Sudan. The findings of this study reaffirm the WHO recommendation of universal LLIN coverage for all populations at risk of malaria.
For more information, please contact:
Saira Stewart
Technical officer, WHO
Mobile: +41 79 500 6538
Email: stewarts@who.int
Gregory HÄRTL
Coordinator, News, Social Media and Monitoring
Telephone: +41 22 791 4458
Mobile: +41 79 203 6715
Email: hartlg@who.int
Emergent Biosolutions gets Health Canada approval for Botulism antitoxin
Tuesday, December 13th, 2016Emergent BioSolutions Inc. today announced that Health Canada has approved the company’s New Drug Submission (NDS) for its botulism antitoxin, BAT® [Botulism Antitoxin Heptavalent (A, B, C, D, E, F, G) – (Equine)]. BAT is indicated for the treatment of symptomatic botulism following documented or suspected exposure to botulinum neurotoxin serotypes A, B, C, D, E, F, or G in adults and pediatric patients…….
Emergent has an existing ten-year contract, executed in 2012, to supply BAT to the Canadian Department of National Defense as well as the Public Health Agency of Canada and individual provincial health authorities. In addition, Emergent has been supplying BAT to the U.S. Strategic National Stockpile as part of a $450 million contract with the Biomedical Advanced Research and Development Authority (BARDA), within the Office of the Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services. BAT, which was licensed by the U.S. Food and Drug Administration in 2013, is the only botulism antitoxin available in the U.S. for treating naturally occurring, non-infant botulism, and for administering to patients under emergency conditions…..”
Police in Jakarta say they have foiled a plot by extremists to detonate a bomb (a pressure cooker packed with three kilograms of high explosives) at the presidential palace.
Monday, December 12th, 2016Cyclone slams into southern India killing at least 2 and forcing the evacuation of thousands.
Monday, December 12th, 2016
CDC: The impact of annual influenza vaccination and the burden of influenza in the United States for the 2015-2016 influenza season
Monday, December 12th, 2016Estimated Influenza Illnesses, Medical Visits, Hospitalizations, and Deaths Averted by Vaccination in the United States
Introduction:
This web page provides estimates on the impact of annual influenza vaccination and the burden of influenza in the United States for the 2015-2016 influenza season, and will be updated annually.
For the past several years, CDC has used a model to estimate the numbers of influenza illnesses, medical visits, and hospitalizations, and the impact of influenza vaccination on these numbers in the United States (1-5). The methods used to calculate the estimates have been described previously (1,2) and are outlined briefly below. CDC uses the estimates of the burden of influenza in the population and the impact of influenza vaccination in influenza-related communications. Annual estimates on the number of influenza-related illnesses, medical visits, and hospitalizations, will be used to derive a five-year range to characterize the influenza burden in the United States. This range will be updated every five years.
Additionally, this web page provides estimates of influenza deaths and deaths averted by influenza vaccination. CDC calculates estimated influenza deaths in two ways: 1) using reports of pneumonia & influenza (P&I) deaths and 2) using reports of respiratory & circulatory (R&C) deaths attributable to influenza. P&I deaths are now available in real-time, while data on R&C deaths are available after a three-year delay. While both estimates are useful, P&I deaths represent only a fraction of the total number of deaths from influenza because they do not capture the deaths that occurred among people not tested for influenza or deaths that result from respiratory and cardiovascular complications. Calculations based on R&C deaths are used in CDC influenza-related communications materials because these calculations provide a more complete estimate of the actual burden of influenza. CDC will continue to present the mortality burden of influenza as a range, rather than a median or average, to better reflect the variability of influenza and will update estimates of R&C deaths as the data become available.
2015-2016 Estimates:
For the 2015-2016 influenza season, CDC estimates that influenza vaccination prevented approximately 5.1 million influenza illnesses, 2.5 million influenza-associated medical visits, and 71,000 influenza-associated hospitalizations (see Table 1). These estimates of averted disease burden are comparable to some previous seasons (see Table 2). During the 2015-2016 influenza season, CDC estimates that influenza vaccination prevented 3,000 P&I deaths (see Table 1). This estimate is similar to estimates of averted P&I deaths during previous seasons (see Table 2). Past comparative data suggest that for the 2015-2016 season the total number of influenza-associated R&C deaths prevented by vaccination may be between two and four times greater than estimates using only P&I deaths (see Table 2).
To calculate these estimates, CDC used 2015-2016 estimates of influenza vaccination coverage(https://www.cdc.gov/flu/fluvaxview/index.htm) (32.2% to 69.7%, depending on age group), vaccine effectiveness(https://www.cdc.gov/flu/professionals/vaccination/effectiveness-studies.htm#table) (24% to 57%, depending on age group), and influenza hospitalizations rates (20.3 per 100,000 to 321.1 per 100,000, depending on age group and adjusted for influenza testing and test sensitivity).
2015-2016 Discussion:
During the 2015-2016 season, influenza A (H3N2) viruses circulated early in the season but influenza A (H1N1)pdm09 viruses predominated overall (6). The season was notable because influenza activity peaked in mid-March, 2016; one of the later peaks on record. In the United States influenza activity most commonly peaks between December and February. The overall burden of influenza was substantial with an estimated 25 million influenza illnesses, 11 million influenza-associated medical visits, 310,000 influenza-related hospitalizations, and 12,000 P&I deaths (see Table 3). (Note that past comparative data suggest that the total number of influenza-associated R&C deaths may be between two and four times greater than estimates using only P&I deaths). Overall, the burden estimates for last season are lower than the estimated burden for the three previous seasons, but are near the middle of the range for the previous five seasons (see Table 4).
While influenza seasons can vary in severity, during most seasons people 65 years and older experience the greatest burden of severe influenza disease. This was also true for the 2015-2016 season. While people in this age group accounted for only 15% of the U.S. population, they made up 50% of influenza-associated hospitalizations and 64% of P&I deaths during the 2015-2016 season. Influenza vaccination is the best way to prevent influenza virus infection, and among adults 65 years and older CDC estimates that vaccination prevented 23% of influenza-related hospitalizations during the 2015-2016 season. Vaccine coverage dropped by about 3 percentage points in this age group (to about 63%) between the 2014-2015 and 2015-2016 influenza seasons (7). Such drops in influenza vaccination coverage are costly for older adults, who are at high risk of serious influenza-related complications. If, instead of declining, vaccine coverage had increased by just 5 percentage point in this age group, an additional 36,000 illnesses and more than 3,000 additional hospitalizations could have been prevented during the 2015-2016 season.
The fraction of averted illness from vaccination was lowest among the broader range of working-age adults, aged 18 to 64 years, owing to low vaccination coverage in general in this age group, a drop in vaccine coverage among people 50 to 64 years old, and lower vaccine effectiveness among people 50 to 64 years during the 2015-2016 season (see Table 5). With more than 16 million illnesses from influenza estimated last season and vaccine coverage estimated at 36%, increasing vaccination coverage among persons 18 to 64 years old could have a large impact on reducing illness and work absenteeism. Specifically, if vaccination coverage had increased by 5 percentage points among adults aged 18 to 64 years during the 2015-2016 season, 300,000 additional influenza illnesses and 2,000 additional hospitalizations could have been prevented.
If vaccination rates increased by just 5 percentage points across the entire population, another 500,000 influenza illnesses, 230,000 influenza-associated medical visits, and 6,000 influenza-associated hospitalizations could be prevented. If vaccination rates improved to the Healthy People goal of 70 percent for all age groups, another 2.4 million influenza illnesses and 19,000 influenza-associated hospitalizations could have been prevented. Similarly, improvements to vaccine effectiveness could provide incremental public health benefit.
Strategies to improve vaccine coverage in all ages include ensuring influenza vaccination status is assessed at each heath care encounter during the influenza season (October through May), ensuring that everyone 6 months and older receive a recommendation to get vaccinated and an offer of vaccination from their provider, using standing orders in the health care office, using patient reminder/recall systems aided by immunization information systems, and expanding vaccination access through use of nontraditional settings for vaccination (e.g., pharmacies, workplaces, and schools) to reach persons who might not visit a physician’s office during the influenza season.
Conclusion:
Influenza vaccination during the 2015-2016 influenza season prevented an estimated 5.1 million illnesses, 2.5 million medical visits, 71,000 hospitalizations, and 3,000 P&I deaths. (Note that past comparative data suggest that the total number of influenza-associated R&C deaths prevented by vaccination may be between two and four times greater than estimates using only P&I deaths). Efforts to increase vaccination coverage will further reduce the burden of influenza, especially among working-age adults younger than 65 years, who continue to have the lowest influenza vaccination coverage. This report underscores the benefits of the current vaccination program, but also highlights areas where improvements in vaccine uptake and vaccine effectiveness could deliver even greater benefits to the public’s health.
Although the timing and intensity of influenza virus circulation for the 2016-2017 season cannot be predicted, peak weeks of influenza activity have occurred between December and February during about 75% of seasons over the past 30 years, and significant circulation of influenza viruses can occur as late as May. Therefore, vaccination should be offered to anyone aged ≥6 months by the end of October if possible and for as long as influenza viruses continue to circulate.
Limitations:
These estimates are subject to several limitations. First, influenza vaccination coverage estimates were derived from reports by survey respondents, not vaccination records, and are subject to recall bias. Second, these coverage estimates are based on telephone surveys with relatively low response rates; nonresponse bias may remain after weighting. Estimates of the number of persons vaccinated based on these survey data have often exceeded the actual number of doses distributed, indicating that coverage estimates used in this report may overestimate the numbers of illnesses and hospitalizations averted by vaccination. Third, this model only calculates outcomes directly averted among persons who were vaccinated. If there is indirect protection from decreased exposure to infectious persons in a partially vaccinated population (i.e., herd immunity), the model would underestimate the number of illnesses and hospitalizations prevented by vaccination. Fourth, vaccine effectiveness among adults 65 years and older might continue to decrease with age, reaching very low levels among the oldest adults who also have the highest rates of influenza vaccination; thus, the model might have overestimated the effect in this group. Fifth, due to data availability, we are unable to estimate influenza-associated R&C deaths for the 2014-2015 or 2015-2016 seasons. P&I deaths are a fraction of all deaths associated with influenza. Based on past studies, (8,9) the total number of R&C deaths associated with influenza that occurred during the 2015-2016 season may be two to four times higher than reported P&I deaths. As data on R&C deaths become available CDC will update estimates of influenza-associated deaths (see CDC Study: Flu Vaccine Saved 40,000 Lives During 9 Year Period(https://www.cdc.gov/flu/news/flu-vaccine-saved-lives.htm)).
Previous Estimates:
Previous estimates of the burden of illness, medical visits, and hospitalizations related to influenza are available online and in scientific publications(https://www.cdc.gov/flu/about/disease/burden.htm#flu-related-illness). (1-5) Estimates using the same methodology as for the 2015-2016 season are shown in the tables below to provide context for the current season’s estimates.
The estimates of P&I deaths related to influenza are a fraction of all deaths related to influenza that occurred a given season. Data on the number of R&C deaths are available with a three-year lag and, therefore, are available for the 2010-2011 through 2013-2014 influenza season. Using these data, CDC estimates that influenza-associated R&C deaths have ranged from a low of 12,000 (during 2011-2012) to a high of 56,000 (during 2012-2013).
2015-2016 Tables for Influenza Burden and Burden-Averted Estimates:
Table 1: Estimated number and fraction of influenza illnesses, medical visits, hospitalizations, and pneumonia and influenza deaths averted by vaccination, by age group — United States, 2015-2016 influenza season
| Age (yrs) | Averted illnesses |
Averted medical visits |
Averted hospitalizations |
Averted pneumonia & influenza deaths* |
|||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| No. | 95% CI | No. | 95% CI | No. | 95% CI | Fraction prevented (%) |
95% CI | No. | 95% CI | ||
| 6 months-4 | 980,052 | 710,239-1,322,705 | 656,635 | 474,202-889,804 | 6,832 | 4,951-9,221 | 32.0 | 27.6-36.9 | 105 | 66-156 | |
| 5-17 | 1,281,134 | 940,148-1,733,726 | 666,190 | 485,103-908,476 | 3,513 | 2,578-4,754 | 24.2 | 21.0-27.8 | 62 | 42-78 | |
| 18-49 | 1,591,114 | 1,264,333-1,999,398 | 588,712 | 465,711-747,321 | 8,931 | 7,097-11,223 | 14.1 | 12.3-15.7 | 236 | 190-285 | |
| 50-64 | 743,725 | 360,432-1,209,238 | 319,802 | 153,599-527,189 | 7,887 | 3,822-12,824 | 9.5 | 4.92-14.3 | 261 | 123-423 | |
| ≥65 | 487,473 | 262,848-816,276 | 272,985 | 147,356-460,045 | 44,316 | 23,895-74,207 | 22.5 | 13.5-31.4 | 2,217 | 1,167-3,620 | |
| All ages | 5,083,498 | 3,538,000-7,081,344 | 2,504,323 | 1,725,971-3,532,835 | 71,479 | 42,344-112,228 | 18.9 | 14.3-24.2 | 2,882 | 1,588-4,562 | |
*Only data on pneumonia & influenza deaths are available in real-time during an influenza season; however, these are only a subset of the total deaths associated with influenza, which may be 2 to 4 times higher when other complications are also considered.
Table 2: Estimated number and fraction of influenza illnesses, medical visits, hospitalizations, and pneumonia and influenza deaths averted by vaccination, by season— United States, 2010-11 through 2015-16 influenza seasons
| Season | Averted illnesses |
Averted medical visits |
Averted hospitalizations |
Averted deaths | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pneumonia & influenza deaths* |
Respiratory & circulatory deaths† |
|||||||||||
| No. | 95% CI | No. | 95% CI | No. | 95% CI | Fraction prevented (%) |
95% CI | No. | 95% CI | No. | 95% CI | |
| 2010-2011 | 5,039,277 | 3,435,322-7,716,921 | 2,514,353 | 1,702,599-3,885,779 | 70,821 | 33,965-141,708 | 20.8 | 13.1-30.3 | 3,434 | 1,422-6,906 | 9,880 | 3,883- 19,362 |
| 2011-2012 | 1,981,571 | 1,160,279-3,666,130 | 968,312 | 555,687-1,809,753 | 39,301 | 17,610-88,885 | 22.7 | 13.0-34.0 | 1,227 | 505-2,450 | 3,618 | 1,400- 6,909 |
| 2012-2013 | 5,628,332 | 4,235,767-8,327,082 | 2,701,875 | 1,997,056-4,085,452 | 61,522 | 31,580-162,836 | 11.1 | 6.25-19.6 | 1,823 | 724-5,517 | 5,280 | 2,149- 15,029 |
| 2013-2014 | 6,683,929 | 5,037,991-8,898,309 | 3,080,284 | 2,252,594-4,190,948 | 86,730 | 56,447-129,736 | 21.5 | 17.2-26.1 | 3,840 | 2,298-5,844 | 9,172 | 5,267- 14,465 |
| 2014-2015 | 1,606,813 | 609,744-3,456,741 | 792,958 | 296,449-1,744,001 | 47,449 | 10,795-144,291 | 7.5 | 2.09-15.9 | 1,419 | 312-4,255 | – | – |
| 2015-2016 | 5,083,498 | 3,538,000-7,081,344 | 2,504,323 | 1,725,971-3,532,835 | 71,479 | 42,344-112,228 | 18.9 | 14.3-24.2 | 2,882 | 1,588-4,562 | – | – |
*Only data on pneumonia & influenza deaths are available in real-time during an influenza season; however, these are only a subset of the total deaths associated with influenza that occur each year, which may be 2 to 4 times higher when other complications are also considered.
†Data on respiratory & circulatory deaths are available with a three-year lag; therefore, estimates on averted respiratory & circulatory deaths are only available through 2013-2014 influenza season at this time.
Table 3: Estimated influenza disease burden, by age group — United States, 2015-2016 influenza season
| Age (yrs) | Total population |
Estimated illnesses |
Estimated medical visits |
Estimated hospitalizations |
Estimated excess pneumonia & influenza deaths* |
|||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. | 95% CI | No. | 95% CI | Hosp. rate (per 100,000) |
No. | 95% CI | No. | 95% Cr I† | ||
| <5 | 19,907,281 | 2,207,454 | 1,914,725-2,597,610 | 1,478,994 | 1,271,529-1,757,051 | 77.3 | 15,389 | 13,349-18,109 | 218 | 163-341 |
| 5-17 | 53,737,830 | 3,985,210 | 3,362,617-4,780,978 | 2,072,309 | 1,746,545-2,513,438 | 20.3 | 10,927 | 9,220-13,109 | 193 | 147-832 |
| 18-49 | 136,800,721 | 9,717,671 | 8,434,252-11,413,475 | 3,595,538 | 3,069,688-4,288,400 | 39.9 | 54,545 | 47,342-64,064 | 1,432 | 1,264-1,659 |
| 50-64 | 63,212,136 | 6,979,986 | 6,316,499-7,811,225 | 3,001,394 | 2,664,703-3,437,918 | 117.1 | 74,021 | 66,985-82,836 | 2,439 | 2,105-2,893 |
| ≥65 | 47,760,852 | 1,686,841 | 1,476,732-2,023,024 | 944,631 | 814,401-1,141,033 | 321.1 | 153,349 | 134,248-183,911 | 7,639 | 6,348-9,404 |
| All ages | 321,418,820 | 24,577,163 | 21,504,826-28,626,313 | 11,092,867 | 9,566,867-13,137,840 | 95.9 | 308,232 | 271,143-362,029 | 11,995 | 10,634-13,914 |
*Only data on pneumonia & influenza deaths are available in real-time during an influenza season; however, these are only a subset of the total deaths associated with influenza that occur each year, which may be 2 to 4 times higher when other complications are also considered.
†A 95% credible interval (95% Cr I) is provided because of the Monte Carlo approach used to estimate excess pneumonia & influenza deaths.
Table 4: Estimated influenza disease burden, by season — United States, 2010-11 through 2015-16 influenza seasons
| Season | Estimated illnesses |
Estimated medical visits |
Estimated hospitalizations |
Estimated excess deaths |
|||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Pneumonia & influenza deaths* |
Respiratory & circulatory deaths† |
||||||||||
| No. | 95% CI | No. | 95% Cr I+ | Hosp. rate (per 100,000) |
No. | 95% CI | No. | 95% Cr I§ | No. | 95% Cr I¶ | |
| 2010-2011 | 21,096,749 | 17,582,319-27,698,870 | 9,956,056 | 8,187,913-13,224,822 | 91.2 | 281,589 | 239,013-373,931 | 13,541 | 12,111-15,372 | 39,008 | 34,283-44,986 |
| 2011-2012 | 9,231,004 | 7,281,179-13,835,345 | 4,298,616 | 3,392,861-6,450,996 | 44.8 | 139,497 | 115,865-206,066 | 4,154 | 3,691-4,747 | 12,182 | 10,638-14,346 |
| 2012-2013 | 35,590,424 | 30,113,616-44,250,092 | 16,638,347 | 13,979,214-20,765,551 | 188.8 | 592,688 | 509,813-733,307 | 19,962 | 18,006-22,434 | 56,102 | 50,252-63,709 |
| 2013-2014 | 28,445,377 | 24,968,054-33,040,119 | 12,613,671 | 10,942,829-14,817,158 | 101.9 | 322,123 | 283,230-376,646 | 13,590 | 12,252-15,307 | 31,864 | 27,832-37,234 |
| 2014-2015 | 34,292,299 | 30,332,937-40,051,029 | 16,184,354 | 14,105,043-19,181,789 | 221.8 | 707,155 | 624,149-838,516 | 19,490 | 17,718-21,740 | – | – |
| Approximate 5-season range (No.) |
9,200,000-35,600,000 | 4,300,000-16,700,000 | 140,000-710,000 | 4,000-20,000 | 12,000-56,000** | ||||||
| 2015-2016 | 24,577,163 | 21,504,826-28,626,313 | 11,092,867 | 9,566,867-13,137,840 | 95.9 | 308,232 | 271,143-362,029 | 11,995 | 10,634-13,914 | – | – |
*Only data on pneumonia & influenza deaths are available in real-time during an influenza season; however, they are only a subset of the total deaths associated with influenza that occur each year, which may be 2 to 4 times higher when deaths due to other complications are also considered.
†Data on respiratory & circulatory deaths are available with a three-year lag; therefore, estimates on averted respiratory & circulatory deaths are available for the 2010-2011 through 2013-2014 influenza seasons but not for the 2014-2015 or 2015-2016 seasons.
§A 95% credible interval (95% Cr I) is provided because of the Monte Carlo approach used to estimate excess pneumonia & influenza deaths.
¶Range is based on 4 seasons with available data on respiratory & circulatory deaths.
Table 5: Influenza vaccine coverage and vaccine effectiveness, by age group — United States, 2015-2016 influenza season
| Age | Vaccine coverage * | Vaccine effectiveness † | ||
|---|---|---|---|---|
| % | 95% CI | % | 95% CI | |
| 6 months-4 years | 70 | 68-71 | 57 | 33-72 |
| 5-17 years | 56 | 55-57 | 51 | 33-64 |
| 18-49 years | 32 | 31-33 | 49 | 35-60 |
| 50-64 years | 43 | 43-44 | 24 | -1-43 |
| ≥65 years | 63 | 62-64 | 41 | 4-64 |
*Estimates from FluVaxView. (7)
†Estimates from US Flu VE Network. (9)
Questions & Answers:
How does CDC estimate the number of hospitalizations, illnesses, and medically-attended illnesses associated with influenza that occurred in the United States?
Laboratory-confirmed influenza-associated hospitalization rates by age group were obtained from FluSurv-NET, a collaboration between CDC, the Emerging Infections Program Network, and selected state and local health departments in 13 geographically distributed areas in the United States that conduct population-based surveillance. Reported hospitalization rates were adjusted using a multiplier to correct for underreporting, which is calculated from the percent of persons hospitalized with respiratory illness who were tested for influenza and the average sensitivity of influenza testing in surveillance hospitals. These values were measured from data collected during four post-pandemic seasons; data from two seasons were previously reported (2).
Adjusted rates were applied to the U.S. population by age group to calculate the numbers of influenza-associated hospitalizations. The numbers of influenza illnesses were then estimated from hospitalizations based on previously measured ratios that reflect the estimated number of ill persons per hospitalization in each age group (5).
The numbers of persons seeking medical care for influenza were then calculated using age group-specific data on the percentages of persons with a respiratory illness who sought medical care, which were estimated from results of the 2010 Behavioral Risk Factor Surveillance Survey (10).
How does CDC estimate the number of influenza-associated deaths that occurred during the influenza season?
The annual number of excess deaths related to influenza during the season is estimated using a statistical model of weekly deaths that accounts for seasonal trends and indicators for influenza activity and circulation of respiratory syncytial virus (RSV) obtained from viral surveillance activities (11,12). The methods have been previously described elsewhere in detail (13).
Data on deaths were obtained from the US National Center for Health Statistics (NCHS) (11). Data on deaths with pneumonia or influenza listed as a cause of death are available in real-time so can be included in the estimation of burden for the 2015-2016 influenza season; however, previous studies have shown these deaths account for a fraction of all deaths that are related to influenza. Most influenza-related deaths are not due directly to influenza virus infection but are due to secondary bacterial infection or worsening of underlying chronic health conditions, such as chronic heart or lung disease. Even when influenza likely contributed to the events leading to a death, it is often not recognized and rarely listed on the death certificate. Deaths with any respiratory or circulatory (R&C) causes listed on the death certificate are likely more inclusive of deaths related to influenza than P&I deaths; however, data on R&C deaths are not available for up to three years so we are able to calculate annual estimates only for the 2010-2011 through 2013-2014 influenza seasons.
In 2010, CDC estimated the number of influenza-associated P&I deaths and number of influenza-associated deaths with any respiratory or circulatory (R&C) causes listed on the death certificate from 1976-1977 through 2006-2007 influenza seasons (8). From the historical analysis of R&C deaths, we estimate that the total number of influenza-associated deaths that occurred during the influenza season could be two to four times higher than the number of P&I deaths. The current estimate of influenza-associated P&I deaths that occurred during the 2015-2016 season is within the range of P&I mortality estimates from the historical data but roughly half the estimates of influenza-associated R&C deaths.
How does CDC estimate the number of influenza-associated outcomes that were prevented with influenza vaccination?
The annual estimates of influenza vaccination coverage by month during each season and the final end-of-season vaccine effectiveness measurements were used to estimate how many persons were not protected by vaccination during the season and thus were at risk for these outcomes.
The rate of each outcome among persons at risk was then used to estimate the number of influenza-associated outcomes that would have been expected in the same population if no one had been protected by vaccination. Finally, the averted outcomes attributable to vaccination were calculated as the difference between outcomes in the hypothetical unvaccinated population and the observed vaccinated population.
Estimates of 2015-2016 influenza vaccination coverage by month from July 2015 through April 2016, were based on self-report or parental report of vaccination status using data from the National Immunization Survey for children aged 6 months-17 years and Behavioral Risk Factor Surveillance Survey data for adults aged ≥18 years (7).
Vaccine effectiveness estimates for the 2015-2016 season were derived from the US Influenza Vaccine Effectiveness Network, a group of five academic institutions that conduct annual vaccine effectiveness studies (9). The network estimates the effectiveness of vaccination for preventing real-time reverse transcription polymerase chain reaction-positive influenza among persons with acute respiratory illness of ≤7 days duration seen in hospitals, emergency departments, or outpatient clinics in communities in four states.
Calculations were stratified by month of the year to account for annual variations in the timing of disease and vaccination and then summed across the whole season. The prevented fraction was calculated as the number of averted illnesses divided by the total illnesses that would have been expected in an unvaccinated population.
Can you explain the change in the range used to describe influenza-related deaths?
The previous range used to describe influenza-related deaths, from 3,000 to 49,000, was based on data from 30 influenza seasons from 1976 through 2007 (8). The range described in the tables above, 12,000 to 56,000, is based on data from the 2010-2011 through 2013-2014 influenza seasons. Over the past six influenza seasons, the U.S. has experienced several seasons with high rates of hospitalization and severe disease, which may explain why the range over just four seasons has higher numbers of influenza-related deaths than the previously published range.
In addition, other factors may also contribute to why some seasons have different numbers of influenza deaths than seen in the past, including changes in the way that death certificates are filed, changes in the age structure of the population, or changes in the prevalence of chronic medical conditions that put people at high-risk of influenza complications.
How does CDC track flu-related deaths in the United States?
See “Estimating Seasonal Influenza-Associated Deaths in the United States” for the answer to this question.
Why are estimated pediatric deaths in this report different from the number of pediatric deaths reported through the Influenza-Associated Pediatric Mortality Surveillance System?
Deaths associated with laboratory-confirmed influenza in children aged <18 years became nationally notifiable in 2004 and are reported to CDC through the Influenza-Associated Pediatric Mortality Surveillance System. The number of reported deaths is published each week in FluView(https://www.cdc.gov/flu/weekly/index.htm). However, the number of reported deaths is likely an underestimate of the total number of flu-related pediatric deaths because not all children may be tested for flu or children may be tested later in their illness when seasonal influenza can no longer be detected from respiratory samples.
CDC estimates the numbers of flu-related deaths using statistical models to account for likely under-reporting. The estimates of pneumonia and influenza (P&I) deaths associated with flu in this report are from one such model. Previously published reports have found that the estimated numbers of flu-related deaths in children from statistical models may be two to three times higher than the number of reported deaths. (14)
Can you explain the change in the estimate of influenza-related hospitalizations?
Influenza hospitalizations have always varied from season to season. In the past, CDC had referred to an average number of hospitalizations that was estimated based on records during 1979-2001 from about 500 hospitals across the United States. The average number of people hospitalized was “more than 200,000” but individual seasons over that time period ranged from a low of 157,911 for 1990-1991 to a high of 430,960 for 1997-1998. The new range of 140,000 to 710,000 is based on data from more recent seasons. CDC believes the recent five-year range in this report better represents the variability of influenza seasons than an average estimate.
Can you explain why some of the estimates on this website are different from previously published estimates using this methodology? (For example, total flu-related hospitalization during 2014-2015 was previously estimated to be 974,000, but the current estimate is 707,000 people)?
CDC estimates the burden of influenza using influenza-related hospitalizations and a set of multipliers for the ratio of hospitalizations to cases and the proportion of people who seek clinical care for acute respiratory illness (2). The surveillance system used to estimate influenza-related hospitalizations, FluSurv-NET, collects data on patients hospitalized who have laboratory-confirmed influenza. Influenza testing is done at the request of the clinician, but not everyone is tested. Also, influenza tests are not perfectly accurate. Thus, the reports of laboratory-confirmed influenza-related hospitalizations to FluSurv-NET are likely underestimates of the true number. To adjust for this, we collect data annually from participating FluSurv-NET sites on the amount of influenza testing and the type of test that is used at the site, and this information is used to correct for the underestimate. These testing data are often not available for up to a year after the influenza season, and thus the most recent season’s estimates may need to be revised when more recent data become available, as was the case for the 2014-2015 season.
References:
- Kostova D, Reed C, Finelli L, Cheng PY, Gargiullo PM, Shay DK, et al. Influenza Illness and Hospitalizations Averted by Influenza Vaccination in the United States, 2005-2011. PLoS One. 2013;8(6):e66312.
- Reed C, Chaves SS, Daily Kirley P, Emerson R, Aragon D, Hancock EB, et al. Estimating influenza disease burden from population-based surveillance data in the United States. PLoS One. 2015;10(3):e0118369.
- Centers for Disease Control and Prevention. Estimated influenza illnesses and hospitalizations averted by influenza vaccination – United States, 2012-13 influenza season. MMWR Morb Mortal Wkly Rep. 2013 Dec 13;62(49):997-1000.
- Reed C, Kim IK, Singleton JA, Chaves SS, Flannery B, Finelli L, et al. Estimated influenza illnesses and hospitalizations averted by vaccination-United States, 2013-14 influenza season. MMWR Morb Mortal Wkly Rep. 2014 Dec 12;63(49):1151-4.
- Centers for Disease Control and Prevention. Estimated Influenza Illnesses and Hospitalizations Averted by Vaccination — United States, 2014–15 Influenza Season. 2015 December 10, 2015 [cited 2016 October 27]; Available from: http://www.cdc.gov/flu/about/disease/2014-15.htm
- Davlin SL, Blanton L, Kniss K, Mustaquim D, Smith S, Kramer N, et al. Influenza Activity – United States, 2015-16 Season and Composition of the 2016-17 Influenza Vaccine. MMWR Morb Mortal Wkly Rep. 2016 Jun 10;65(22):567-75.
- Centers for Disease Control and Prevention. Flu Vaccination Coverage, United States, 2015–16 Influenza Season. 2016 September 29, 2016 [cited 2016 October 27]; Available from: http://www.cdc.gov/flu/fluvaxview/coverage-1516estimates.htm
- Centers for Disease Control and Prevention. Estimates of deaths associated with seasonal influenza — United States, 1976-2007. MMWR Morb Mortal Wkly Rep. 2010 Aug 27;59(33):1057-62.
- Flannery B, Chung J. Influenza Vaccine Effectiveness, Including LAIV vs IIV in Children and Adolescents, US Flu VE Network, 2015–16. Advisory Committee on Immunization Practices; 2016 June 22; Atlanta, GA; 2016.
- Biggerstaff M, Jhung M, Kamimoto L, Balluz L, Finelli L. Self-reported influenza-like illness and receipt of influenza antiviral drugs during the 2009 pandemic, United States, 2009-2010[332 Kb, 26 pages](https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2016-06/influenza-05-flannery.pdf). Am J Public Health. 2012 Oct;102(10):e21-6.
- Centers for Disease Control and Prevention. Overview of Influenza Surveillance in the United States. 2016 October 13, 2016 [cited 2016 November 1]; Available from: http://www.cdc.gov/flu/weekly/overview.htm
- Centers for Disease Control and Prevention. The National Respiratory and Enteric Virus Surveillance System (NREVSS). 2016 October 26, 2016 [cited 2016 November 1]; Available from: https://www.cdc.gov/surveillance/nrevss/index.html
- Foppa IM, Cheng PY, Reynolds SB, Shay DK, Carias C, Bresee JS, et al. Deaths averted by influenza vaccination in the U.S. during the seasons 2005/06 through 2013/14. Vaccine. 2015 Jun 12;33(26):3003-9.
- Wong KK, Cheng P, Foppa I, Jain S, Fry AM, Finelli L. Estimated paediatric mortality associated with influenza virus infections, United States, 2003-2010. Epidemiol Infect. 2014 May 15:1-8
Authors
Melissa A. Rolfes, PhD, MPH1; Ivo M. Foppa, ScD1,2; Shikha Garg, MD1; Brendan Flannery, PhD1; Lynnette Brammer, MPH1; James A. Singleton, PhD3; Erin Burns, MA1; Daniel Jernigan, MD1; Carrie Reed, DSc1; Sonja J. Olsen, PhD1; Joseph Bresee, MD1
1 Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
2 Battelle Memorial Institute, Atlanta, GA, USA
3 Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA