Burden of influenza-associated deaths in the Americas, 2002-2008

Po-Yung Cheng, Rakhee Palekar, Eduardo Azziz-Baumgartner, Danielle Iuliano, Airlane P Alencar, Joseph Bresee, Otavio Oliva, Maria de Fatima Marinho de Souza, Marc-Alain Widdowson

Research output: Contribution to journalA1: Web of Science-articlepeer-review


BACKGROUND: Influenza disease is a vaccine-preventable cause of morbidity and mortality. The Pan American Health Organization (PAHO) region has invested in influenza vaccines, but few estimates of influenza burden exist to justify these investments. We estimated influenza-associated deaths for 35 PAHO countries during 2002-2008.

METHODS: Annually, PAHO countries report registered deaths. We used respiratory and circulatory (R&C) codes from seven countries with distinct influenza seasonality and high-quality mortality data to estimate influenza-associated mortality rates by age group (0-64, 65-74, and ≥ 75 years) with a Serfling regression model or a negative binomial model. We calculated the percent of all R&C deaths attributable to influenza by age group in these countries (etiologic fraction) and applied it to the age-specific mortality in 13 countries with good mortality data but poorly defined seasonality. Lastly, we grouped the remaining 15 countries into WHO mortality strata and applied the age and mortality stratum-specific rate of influenza mortality calculated from the 20 countries. We summed each country's estimate to arrive at an average total annual number and rate of influenza deaths in the Americas.

RESULTS: For the 35 PAHO countries, we estimated an annual mean influenza-associated mortality rate of 2·1/100,000 among <65-year olds, 31·9/100 000 among those 65-74 years, and 161·8/100,000 among those ≥ 75 years. We estimated that annually between 40,880 and 160,270 persons (mean, 85,100) die of influenza illness in the PAHO region.

CONCLUSION: Influenza remains an important cause of mortality in the Americas.

Original languageEnglish
JournalInfluenza and Other Respiratory Viruses
Volume9 Suppl 1
Pages (from-to)13-21
Number of pages9
Publication statusPublished - 2015


  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Americas
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Influenza A Virus, H1N1 Subtype
  • Influenza Vaccines
  • Influenza, Human/mortality
  • Male
  • Middle Aged
  • Models, Statistical
  • Time Factors
  • Young Adult


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