title: Influenza-related mortality trends in Japanese and American seniors: evidence for the indirect mortality benefits of vaccinating schoolchildren.
abstract: BACKGROUND
  The historical Japanese influenza vaccination program targeted at schoolchildren provides a unique opportunity to evaluate the indirect benefits of vaccinating high-transmitter groups to mitigate disease burden among seniors. Here we characterize the indirect mortality benefits of vaccinating schoolchildren based on data from Japan and the US.
  
  
  METHODS
  We compared age-specific influenza-related excess mortality rates in Japanese seniors aged ≥65 years during the schoolchildren vaccination program (1978-1994) and after the program was discontinued (1995-2006). Indirect vaccine benefits were adjusted for demographic changes, socioeconomics and dominant influenza subtype; US mortality data were used as a control.
  
  
  RESULTS
  We estimate that the schoolchildren vaccination program conferred a 36% adjusted mortality reduction among Japanese seniors (95%CI: 17-51%), corresponding to ∼1,000 senior deaths averted by vaccination annually (95%CI: 400-1,800). In contrast, influenza-related mortality did not change among US seniors, despite increasing vaccine coverage in this population.
  
  
  CONCLUSIONS
  The Japanese schoolchildren vaccination program was associated with substantial indirect mortality benefits in seniors.
authors.affiliation: Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America. vcharu@gmail.com
authors.forename: Vivek
authors.initials: V
authors.lastname: Charu
authors.forename: Cécile
authors.initials: C
authors.lastname: Viboud
authors.forename: Lone
authors.initials: L
authors.lastname: Simonsen
authors.forename: Katharine
authors.initials: K
authors.lastname: Sturm-Ramirez
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Shinjoh
authors.forename: Gerardo
authors.initials: G
authors.lastname: Chowell
authors.forename: Mark
authors.initials: M
authors.lastname: Miller
authors.forename: Norio
authors.initials: N
authors.lastname: Sugaya
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D006801:Humans; D007252:Influenza Vaccines / Q000494:pharmacology; D007251:Influenza, Human / Q000453:epidemiology / Q000401:mortality*; D007564:Japan / Q000453:epidemiology; D009026:Mortality / Q000639:trends; D012572:School Health Services / Q000639:trends*; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000401:mortality* / Q000706:statistics & numerical data
chemical_list: D007252:Influenza Vaccines
references.citation: Arch Intern Med. 2005 Feb 14;165(3):265-72
references.pmid: 15710788
references.citation: Clin Infect Dis. 2007 Jan 15;44(2):197-202
references.pmid: 17173216
references.citation: Nat Med. 1999 Jun;5(6):592
references.pmid: 10371479
references.citation: Vaccine. 2006 Feb 20;24(8):1159-69
references.pmid: 16213065
references.citation: Vaccine. 2006 Feb 20;24(8):1047-62
references.pmid: 16298026
references.citation: Clin Infect Dis. 2005 Oct 1;41(7):939-47
references.pmid: 16142657
references.citation: Bull World Health Organ. 1969;41(3):537-42
references.pmid: 5309469
references.citation: JAMA. 2005 Oct 26;294(16):2043-51
references.pmid: 16249418
references.citation: MMWR Recomm Rep. 2010 Aug 6;59(RR-8):1-62
references.pmid: 20689501
references.citation: Vaccine. 2008 Nov 25;26(50):6451-4
references.pmid: 18573292
references.citation: Vaccine. 2005 Feb 18;23(13):1540-8
references.pmid: 15694506
references.citation: Am J Hyg. 1953 Sep;58(2):179-82
references.pmid: 13080258
references.citation: J Infect Dis. 2010 Dec 1;202(11):1626-33
references.pmid: 21028955
references.citation: Clin Infect Dis. 2010 Dec 15;51(12):1362-9
references.pmid: 21070141
references.citation: J Infect Dis. 1980 Feb;141(2):258-64
references.pmid: 7365278
references.citation: Br J Gen Pract. 2004 Sep;54(506):684-9
references.pmid: 15353055
references.citation: MMWR Morb Mortal Wkly Rep. 2010 Oct 8;59(39):1266-9
references.pmid: 20930704
references.citation: JAMA. 2010 Mar 10;303(10):943-50
references.pmid: 20215608
references.citation: J Infect Dis. 2005 Jul 15;192(2):233-48
references.pmid: 15962218
references.citation: PLoS Med. 2007 May;4(5):e174
references.pmid: 17518515
references.citation: N Engl J Med. 2008 Dec 11;359(24):2579-85
references.pmid: 19073977
references.citation: Science. 2006 Feb 3;311(5761):615-6
references.pmid: 16456066
references.citation: Pediatrics. 1999 Jun;103(6):e73
references.pmid: 10353970
references.citation: MMWR Recomm Rep. 2004 May 28;53(RR-6):1-40
references.pmid: 15163927
references.citation: J Infect Dis. 1993 Oct;168(4):881-7
references.pmid: 8376833
references.citation: J Infect Dis. 1970 Jul-Aug;122(1):16-25
references.pmid: 5433709
references.citation: N Engl J Med. 2001 Jun 21;344(25):1947; author reply 1947-8
references.pmid: 11419437
references.citation: Emerg Infect Dis. 2010 Jun;16(6):926-35
references.pmid: 20507742
references.citation: Vaccine. 1999 Jul 30;17 Suppl 1:S3-10
references.pmid: 10471173
references.citation: Vaccine. 2006 Oct 30;24(42-43):6468-75
references.pmid: 16876293
references.citation: Semin Pediatr Infect Dis. 2002 Apr;13(2):104-11
references.pmid: 12122948
references.citation: Pediatrics. 2000 Nov;106(5):973-6
references.pmid: 11061762
references.citation: Science. 2009 Sep 25;325(5948):1705-8
references.pmid: 19696313
references.citation: JAMA. 2004 Sep 15;292(11):1333-40
references.pmid: 15367555
references.citation: N Engl J Med. 2001 Jun 21;344(25):1946-7; author reply 1947-8
references.pmid: 11419435
references.citation: N Engl J Med. 2001 Mar 22;344(12):889-96
references.pmid: 11259722
references.citation: Pediatr Infect Dis J. 2008 Oct;27(10 Suppl):S104-9
references.pmid: 18820568
references.citation: N Engl J Med. 2001 Jun 21;344(25):1946; author reply 1947-8
references.pmid: 11419436
references.citation: J Clin Virol. 2006 Dec;37(4):237-43
references.pmid: 17008123
references.citation: JAMA. 2003 Jan 8;289(2):179-86
references.pmid: 12517228
references.citation: Clin Infect Dis. 2004 Oct 1;39(7):920-7
references.pmid: 15472840
references.citation: Epidemiol Infect. 2006 Feb;134(1):71-8
references.pmid: 16316494