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J Infect. 2014 Apr;68(4):363-71. doi: 10.1016/j.jinf.2013.11.013. Epub 2013 Dec 1.

The burden of influenza in England by age and clinical risk group: a statistical analysis to inform vaccine policy.

Author information

1
Complex Systems in Biology Group, Centre for Vascular Research, University of New South Wales, Sydney, Australia. Electronic address: d.cromer@unsw.edu.au.
2
Public Health England, London, United Kingdom.
3
Public Health England, London, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
4
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
5
Research and Surveillance Unit, Royal College of General Practitioners, Birmingham, United Kingdom.

Abstract

OBJECTIVES:

To assess the burden of influenza by age and clinical status and use this to inform evaluations of the age and risk-based influenza vaccination policy in the United Kingdom.

METHODS:

Weekly laboratory reports for influenza and 7 other respiratory pathogens were extracted from the national database and used in a regression model to estimate the proportion of acute respiratory illness outcomes attributable to each pathogen.

RESULTS:

Influenza accounted for ∼10% of the attributed respiratory admissions and deaths in hospital. Healthy children under five had the highest influenza admission rate (1.9/1000). The presence of co-morbidities increased the admission rate by 5.7 fold for 5-14 year olds (from 0.1 to 0.56/1000), the relative risk declining to 1.8 fold in 65+ year olds (from 0.46 to 0.84/1000). The majority (72%) of influenza-attributable deaths in hospital occurred in 65+ year olds with co-morbidities. Mortality in children under 15 years was low with around 12 influenza-attributable deaths in hospital per year in England; the case fatality rate was substantially higher in risk than non-risk children. Infants under 6 months had the highest consultation and admission rates, around 70/1000 and 3/1000 respectively.

CONCLUSIONS:

Additional strategies are needed to reduce the remaining morbidity and mortality in the high-risk and elderly populations, and to protect healthy children currently not offered the benefits of vaccination.

KEYWORDS:

Disease burden; Influenza; Modelling; Policy; Regression; Vaccination

PMID:
24291062
DOI:
10.1016/j.jinf.2013.11.013
[Indexed for MEDLINE]
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