Observations on Excess Mortality Associated with Epidemic Influenza

Eickhoff, Theodore C.; Sherman, Ida L.; Serfling, Robert E.

doi:10.1001/jama.1961.03040220024005

Cited by 253 publications

(131 citation statements)

References 3 publications

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“…Until now it was assumed that the main risks of influenza infection in patients with diabetes mellitus lie in the occurrence of ketoacidosis [4] and secondary bacterial infection [5]. From this study it can be concluded that impaired immune response to the influenza virus itself may contribute to increased morbidity and mortality.…”

Section: Controlmentioning

confidence: 82%

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Humoral immune response and delayed type hypersensitivity to influenza vaccine in patients with diabetes mellitus

Diepersloot

Bouter

Beyer³

et al. 1987

Diabetologia

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Summary.The antibody response and delayed type hypersensitivity reaction to commercially available trivalent influenza vaccine in 159 patients with diabetes mellitus was compared with response and reaction in 28 healthy volunteers. A correction for prevaccination titres was made. No differences were found between diabetic patients and control subjects with respect to antibody response to the three vaccine strains as measured by the difference between geometric mean titres of post-and prevaccination sera. In Type 1 (insulin-dependent) diabetic patients the incidence of non-responders to two vaccine components was significantly increased (p< 0.05). The delayed type hypersensitivity reaction to influenza antigen was significantly decreased in patients with high concentrations of glycosylated haemoglobin (p<0.01). These findings suggest a role for impaired immune response in the increased influenza morbidity and mortality in patients with diabetes mellitus. Implications for therapy and vaccination strategy are discussed.

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Section: Controlmentioning

confidence: 82%

“…The increased risk of complications in these patients is generally ascribed to the occurrence of diabetic ketoacidosis [4] and secondary bacterial infection, mainly by Staphylococcus aureus [5]. Patients with diabetes mellitus are often carriers of Staphylococcus aureus, and they have been shown to have an impaired immune response to this micro-organism [6,7].…”

mentioning

confidence: 99%

Humoral immune response and delayed type hypersensitivity to influenza vaccine in patients with diabetes mellitus

Diepersloot

Bouter

Beyer³

et al. 1987

Diabetologia

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“…Influenza was associated with increased numbers of deaths, not only from the infection itself but also from other conditions. Subsequent observations have confirmed associations between influenza and excess deaths from cerebrovascular disease, diabetes and respiratory diseases [2][3][4][5], but the contribution of influenza to these deaths is often not recognized in individuals when they die. A further problem in assessing the impact of influenza is that it often occurs concurrently with RSV and other respiratory viruses.…”

Section: Introductionmentioning

confidence: 99%

Impact of influenza and respiratory syncytial virus on mortality in England and Wales from January 1975 to December 1990

1996

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SUMMARYThe effects of influenza A and B and RSV on mortality in England and Wales were assessed by regression analysis for the period 1975-90. Morbidity data from sentinel practices were used to calculate 4-weekly rates of aggregated upper respiratory tract infections (URTI); PHLS laboratory reports were used as indices of infection, and 4-weekly death rates from all causes, excluding childbirths, were used to study relationships with mortality. Deaths correlated strongly with influenza A and B reports, temperature, and interactions between aggregated URTI and temperature, and RSV outbreaks and temperature. Estimates of 'seasonal' 4-weekly mortality associated with URTI were made by substituting into primary regression models the mean of annual trough consultation rates for aggregated URTI and baseline values for RSV and influenza. Peak 4-weekly mortality associated with URTIs was estimated at c. 24000 and c. 28000 during combined influenza and RSV epidemics of 1975-6 and 1989-90 respectively. Secondary regression analysis was carried out with the estimated 'seasonal' 4-weekly deaths associated with URTI as dependant variable and laboratory data as regressors. Estimated excess mortality associated with influenza was considerable even during years without major epidemics. Overall during the 15 winters the estimated mortality associated with RSV was 60-80% more than that associated with influenza. The modelling permits only a crude estimate of RSV associated mortality. None the less it suggests that RSV is an important cause of winter mortality.

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“…Excesses of serious morbidity and death have consistently been demonstrated in elderly patients with certain chronic medical conditions during outbreaks of influenza [1][2][3][4]. On the basis of these observations, the Department of Health, the Welsh Office, and the Scottish Home and Health Department suggest that annual influenza immunization be considered for elderly persons living in residential homes and long-stay hospitals, and for patients, especially the elderly, suffering with chronic pulmonary disease, chronic heart disease, chronic renal disease, diabetes and other less common endocrine disorders, and conditions involving immunosuppressive therapy [5].…”

Section: Introductionmentioning

confidence: 99%

Acute upper respiratory tract viral illness and influenza immunization in homes for the elderly

Nicholson¹,

Baker²,

Farquhar³

et al. 1990

Epidemiol. Infect.

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SUMMARYOccupants of 482 long-stay and 33 short-stay beds in 11 Leicester City Council homes for the elderly were studied during a 30-week period from September 1988 to March 1989 to determine the incidence, aetiology, morbidity, and mortality of acute upper respiratory tract viral infections and the use of influenza vaccine.Influenza immunization rates by home ranged from 15·4 to 90% (mean 45%). There were no differences in the distribution of medical conditions by home. The highest immunization rates were seen in people with chest disease (77%), heart disease (60%), diabetes (56%), and those with three medical conditions (75%). There was an average of 0·7 upper respiratory episodes per bed per annum with a mortality of 3·4% (6/179). Half of all episodes were seen by a general medical practitioner and 81 of 90 (90%) referrals were prescribed antibiotics costing approximately £7.50 per patient. Lower respiratory tract complications developed during 45 (25%) of 179 episodes including 3 of 12 coronavirus infections, 3 of 9 respiratory syncytial virus infections, 2 of 4 adenovirus infections, 1 of 11 rhinovirus infections, but none of 5 influenza infections. Respiratory infections were caused mostly by pathogens other than influenza virus during the influenza period documented nationally. This highlights the role of coronaviruses, respiratory syncytial virus, and unidentified agents in the elderly, and questions the assumptions made in American estimates on the impact of influenza and the value of influenza vaccines.

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Observations on Excess Mortality Associated with Epidemic Influenza

Cited by 253 publications

References 3 publications

Humoral immune response and delayed type hypersensitivity to influenza vaccine in patients with diabetes mellitus

Humoral immune response and delayed type hypersensitivity to influenza vaccine in patients with diabetes mellitus

Impact of influenza and respiratory syncytial virus on mortality in England and Wales from January 1975 to December 1990

Acute upper respiratory tract viral illness and influenza immunization in homes for the elderly

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