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      Annual estimates of the burden of seasonal influenza in the United States: A tool for strengthening influenza surveillance and preparedness

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          Abstract

          Background

          Estimates of influenza disease burden are broadly useful for public health, helping national and local authorities monitor epidemiologic trends, plan and allocate resources, and promote influenza vaccination. Historically, estimates of the burden of seasonal influenza in the United States, focused mainly on influenza‐related mortality and hospitalization, were generated every few years. Since the 2010‐2011 influenza season, annual US influenza burden estimates have been generated and expanded to include estimates of influenza‐related outpatient medical visits and symptomatic illness in the community.

          Methods

          We used routinely collected surveillance data, outbreak field investigations, and proportions of people seeking health care from survey results to estimate the number of illnesses, medical visits, hospitalizations, and deaths due to influenza during six influenza seasons (2010‐2011 through 2015‐2016).

          Results

          We estimate that the number of influenza‐related illnesses that have occurred during influenza season has ranged from 9.2 million to 35.6 million, including 140 000 to 710 000 influenza‐related hospitalizations.

          Discussion

          These annual efforts have strengthened public health communications products and supported timely assessment of the impact of vaccination through estimates of illness and hospitalizations averted. Additionally, annual estimates of influenza burden have highlighted areas where disease surveillance needs improvement to better support public health decision making for seasonal influenza epidemics as well as future pandemics.

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          Most cited references14

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          Hospitalizations associated with influenza and respiratory syncytial virus in the United States, 1993-2008.

          Age-specific comparisons of influenza and respiratory syncytial virus (RSV) hospitalization rates can inform prevention efforts, including vaccine development plans. Previous US studies have not estimated jointly the burden of these viruses using similar data sources and over many seasons. We estimated influenza and RSV hospitalizations in 5 age categories (<1, 1-4, 5-49, 50-64, and ≥65 years) with data for 13 states from 1993-1994 through 2007-2008. For each state and age group, we estimated the contribution of influenza and RSV to hospitalizations for respiratory and circulatory disease by using negative binomial regression models that incorporated weekly influenza and RSV surveillance data as covariates. Mean rates of influenza and RSV hospitalizations were 63.5 (95% confidence interval [CI], 37.5-237) and 55.3 (95% CI, 44.4-107) per 100000 person-years, respectively. The highest hospitalization rates for influenza were among persons aged ≥65 years (309/100000; 95% CI, 186-1100) and those aged <1 year (151/100000; 95% CI, 151-660). For RSV, children aged <1 year had the highest hospitalization rate (2350/100000; 95% CI, 2220-2520) followed by those aged 1-4 years (178/100000; 95% CI, 155-230). Age-standardized annual rates per 100000 person-years varied substantially for influenza (33-100) but less for RSV (42-77). Overall US hospitalization rates for influenza and RSV are similar; however, their age-specific burdens differ dramatically. Our estimates are consistent with those from previous studies focusing either on influenza or RSV. Our approach provides robust national comparisons of hospitalizations associated with these 2 viral respiratory pathogens by age group and over time.
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            Methods for current statistical analysis of excess pneumonia-influenza deaths.

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              Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April–July 2009

              Through July 2009, a total of 43,677 laboratory-confirmed cases of influenza A pandemic (H1N1) 2009 were reported in the United States, which is likely a substantial underestimate of the true number. Correcting for under-ascertainment using a multiplier model, we estimate that 1.8 million–5.7 million cases occurred, including 9,000–21,000 hospitalizations.
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                Author and article information

                Contributors
                ydi8@cdc.gov
                Journal
                Influenza Other Respir Viruses
                Influenza Other Respir Viruses
                10.1111/(ISSN)1750-2659
                IRV
                Influenza and Other Respiratory Viruses
                John Wiley and Sons Inc. (Hoboken )
                1750-2640
                1750-2659
                14 February 2018
                January 2018
                : 12
                : 1 , Influenza Disease Burden ( doiID: 10.1111/irv.2018.12.issue-1 )
                : 132-137
                Affiliations
                [ 1 ] Influenza Division National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Atlanta GA USA
                [ 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 USA
                Author notes
                [*] [* ] Correspondence

                Melissa A Rolfes, Centers for Disease Control and Prevention, Atlanta, GA, USA.

                Email: ydi8@ 123456cdc.gov

                Author information
                http://orcid.org/0000-0002-0483-9941
                Article
                IRV12486
                10.1111/irv.12486
                5818346
                29446233
                b0482cf0-bd63-43ff-bb30-e4955d2e139d
                Published 2018. This article is a U.S. Government work and is in the public domain in the USA. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 August 2017
                Page count
                Figures: 1, Tables: 2, Pages: 6, Words: 4177
                Funding
                Funded by: World Health Organization
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                irv12486
                January 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.2.2 mode:remove_FC converted:19.02.2018

                Infectious disease & Microbiology
                burden,influenza,united states
                Infectious disease & Microbiology
                burden, influenza, united states

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