title: Excess mortality from seasonal influenza is negligible below the age of 50 in Israel: implications for vaccine policy.
abstract: OBJECTIVE
  Evaluation of the severity of pandemic influenza requires reliable estimates of mortality attributable to the seasonal influenza.
  
  
  METHODS
  Excess age-specific mortality during periods of influenza activity was evaluated in Israel during the period 1999-2006 for three death categories. For each respiratory year, the lowest monthly moving average for the mortality rate was subtracted from each month in the period of influenza activity. Average mortality rates in years with minimal influenza activity were deducted from corresponding months to exclude winter mortality unrelated to influenza. The sums of these results were used as estimates of excess mortality rates.
  
  
  RESULTS
  Overall excess mortality rates ranged from 7.7 to 36.1 per 100,000 for all causes, and from 4.4 to 24.4 per 100,000 for respiratory and circulatory causes. Influenza was associated with an average of 869 (range 280-1,516) deaths annually from respiratory and circulatory diseases during seasons with significant influenza activity. About 90% of the influenza-associated mortality from respiratory and circulatory diseases was in the age group 65+ years and about 1% in the age group <50 years. The age group <50 years accounted for an annual average of seven deaths from respiratory and circulatory diseases.
  
  
  CONCLUSIONS
  Annual mortality associated with seasonal influenza is highly variable. Under the age of 50 years, there is minimal seasonal influenza associated mortality. This information provides an important baseline for evaluating the severity of the A(H1N1) 2009 influenza pandemic, where persons under 50 years of age were often disproportionately represented.
authors: Tel Aviv District Health Office, Ministry of Health, 12 Ha'arba'a Street, Tel-Aviv, Israel. yifat.linhart@telaviv.health.gov.il
authors: Y
authors: Y
authors: Linhart
authors: T
authors: T
authors: Shohat
authors: M
authors: M
authors: Bromberg
authors: E
authors: E
authors: Mendelson
authors: R
authors: R
authors: Dictiar
authors: M S
authors: MS
authors: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006291:Health Policy; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000472:pathogenicity*; D053122:Influenza A Virus, H3N2 Subtype / Q000472:pathogenicity*; D009981:Influenza B virus / Q000472:pathogenicity*; D007252:Influenza Vaccines / Q000627:therapeutic use; D007251:Influenza, Human / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control*; D007557:Israel / Q000453:epidemiology; D008875:Middle Aged; D015233:Models, Statistical; D012621:Seasons; D014611:Vaccination; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines