Mortality Associated With Influenza and Respiratory Syncytial Virus in the US, 1999-2018.
Mortality Associated With Influenza and Respiratory Syncytial Virus in the US, 1999-2018.
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DOI：
10.1001/jamanetworkopen.2022.0527
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发表时间：
2022-02-01
影响因子：
13.8
通讯作者：
Viboud C
中科院分区：
文献类型：
--
作者：
Hansen CL;Chaves SS;Demont C;Viboud C
从1999年到2018年，美国呼吸道合胞病毒(RSV)和流感的超额死亡率是多少？这项横断面研究估计，每年与呼吸道合胞病毒有关的潜在呼吸道死亡人数平均为6,549人(范围为5,035-7,645人)，平均每年与流感有关的潜在呼吸系统死亡人数为10 171人(范围为393至23 176人)，流感的年际变化大于呼吸道合胞病毒的年际变化。这两种病毒的死亡率最高的是65岁或以上的人；在1岁以下的儿童中，RSV的死亡率是流感死亡率的5倍。这项研究表明，尽管流行病学发生了变化，但地方性呼吸道病毒在美国继续造成显著的死亡人数，特别是在婴儿和老年人中。自2009年以来，呼吸道合胞病毒(RSV)死亡率估计值一直没有更新，也没有研究评估2009年大流行后流感死亡率的变化。需要更新负担估计，以确定这些病毒流行病学的长期变化。评估1999年至2018年美国RSV和流感的超额死亡率。这项横断面研究使用了1999年至2018年5030万份美国死亡证明的数据，创建了特定年龄的线性回归模型，并评估了与RSV和流感相关的季节性基线以上的每周死亡率波动。统计分析时间为1999年1月3日至2018年12月29日，共1043周。与呼吸道合胞病毒和流感有关的超额死亡率是根据每个季节观察到的潜在呼吸道死亡率与预期潜在死亡率之间的差异估计的。这项分析包括5030万份死亡证明(50.1%的女性和49.9%的男性；平均死亡年龄为72.7[18.6]岁)，1岁以下儿童的死亡证明为1.0%，65岁或以上的成人死亡证明为73.4%。平均每年有6549例(95%可信区间，6140-6958)潜在呼吸道死亡与呼吸道合胞病毒有关，包括1岁以下儿童中的96例死亡(95%可信区间，92-99)。对于流感，每年有10例 171(95%可信区间，9652-10 691)潜在的呼吸道死亡，1岁以下儿童死亡23例(95%可信区间，19-27岁)。这两种病毒每10万 人口的平均死亡率最高的是65岁或以上的成年人，呼吸道合胞病毒和流感的平均死亡率分别为14.7岁(95%CI，13.8-15.5)和20.5(95%CI，19.4-21.5)。与先前的估计相比，65岁或65岁以上人群中的流感死亡比例较低(75.1%[95%可信区间，67.4%-82.8%])。流感死亡率在65岁或以上的人群中最高，在甲型H3N2病毒占主导地位的季节(2017年至2018年，18 739[95%CI，16 616-21 336]死亡)和5至49岁人群(2013年至2014年，1,683[95%CI，1,583-1,787]死亡)中最高。结果对死亡结果和方法的选择很敏感，最广泛的结果与呼吸道合胞病毒的年平均死亡23 352(95%CI，21 814-24 891)和流感的27 171(95%CI，25 142-29 199)有关。这项研究表明，RSV对婴儿的风险比流感更大，而两者都与老年人的大量死亡有关。流感具有很大的年际变异性，根据传播的病毒影响不同的年龄段。2009年甲型H1N1pdm2009流感大流行病毒的出现使死亡率向中年人转移，这一趋势至今仍在观察到。这项研究的估计为评估与呼吸道病毒干预措施相关的死亡率效益提供了一个基准，包括新的或改进的免疫战略。这项横断面研究使用了5030万份美国死亡证明的数据，以评估1999至2018年间呼吸道合胞病毒(RSV)和流感的超额死亡率。
What was the excess mortality from respiratory syncytial virus (RSV) and influenza in the US from 1999 to 2018? This cross-sectional study estimates a mean of 6549 underlying respiratory deaths associated with RSV each year (range, 5035-7645) and estimates a mean of 10 171 underlying respiratory deaths associated with influenza per year (range, 393 to 23 176), with greater interannual variation for influenza than for RSV. The highest mortality for both viruses was among individuals aged 65 years or older; RSV mortality was 5-fold higher than influenza mortality among children younger than 1 year. This study suggests that, despite changes in epidemiology, endemic respiratory viruses continue to have a significant death toll in the US, especially among infants and elderly individuals. Respiratory syncytial virus (RSV) mortality estimates have not been updated since 2009, and no study has assessed changes in influenza mortality after the 2009 pandemic. Updated burden estimates are needed to characterize long-term changes in the epidemiology of these viruses. To evaluate excess mortality from RSV and influenza in the US from 1999 to 2018. This cross-sectional study used data from 50.3 million US death certificates from 1999 to 2018 to create age-specific linear regression models and assess weekly mortality fluctuations above a seasonal baseline associated with RSV and influenza. Statistical analysis was performed for 1043 weeks from January 3, 1999, to December 29, 2018. Excess mortality associated with RSV and influenza estimated from the difference between observed and expected underlying respiratory mortality each season. There were 50.3 million death certificates (50.1% women and 49.9% men; mean [SD] age at death, 72.7 [18.6] years) included in this analysis, 1.0% for children younger than 1 year and 73.4% for adults aged 65 years or older. A mean of 6549 (95% CI, 6140-6958) underlying respiratory deaths were associated with RSV annually, including 96 (95% CI, 92-99) deaths among children younger than 1 year. For influenza, there were 10 171 (95% CI, 9652-10 691) underlying respiratory deaths per year, with 23 deaths (95% CI, 19-27) among children younger than 1 year. The highest mean mortality rate per 100 000 population for both viruses was among adults aged 65 years or older at 14.7 (95% CI, 13.8-15.5) for RSV and 20.5 (95% CI, 19.4-21.5) for influenza. A lower proportion of influenza deaths occurred among those aged 65 years or older compared with earlier estimates (75.1% [95% CI, 67.4%-82.8%]). Influenza mortality was highest among those aged 65 years or older in seasons when A/H3N2 predominated (18 739 [95% CI, 16 616-21 336] deaths in 2017-2018) and among those aged 5 to 49 years when A/H1N1pdm2009 predominated (1683 [95% CI, 1583-1787] deaths in 2013-2014). Results were sensitive to the choice of mortality outcome and method, with the broadest outcome associated with annual means of 23 352 (95% CI, 21 814-24 891) excess deaths for RSV and 27 171 (95% CI, 25 142-29 199) for influenza. This study suggests that RSV poses a greater risk than influenza to infants, while both are associated with substantial mortality among elderly individuals. Influenza has large interannual variability, affecting different age groups depending on the circulating virus. The emergence of the influenza A/H1N1pdm2009 pandemic virus in 2009 shifted mortality toward middle-aged adults, a trend still observed to date. This study’s estimates provide a benchmark to evaluate the mortality benefits associated with interventions against respiratory viruses, including new or improved immunization strategies. This cross-sectional study uses data from 50.3 million US death certificates to evaluate excess mortality from respiratory syncytial virus (RSV) and influenza from 1999 to 2018.
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DOI：
10.1016/j.diagmicrobio.2017.12.011
发表时间：
2018-11-01
影响因子：
2.9
作者：
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通讯作者：
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影响因子：
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DOI：
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影响因子：
11.1
作者：
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影响因子：
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影响因子：
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作者：
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