title: Global Mortality Impact of the 1957-1959 Influenza Pandemic.
abstract: BACKGROUND
  Quantitative estimates of the global burden of the 1957 influenza pandemic are lacking. Here we fill this gap by modeling historical mortality statistics.
  
  
  METHODS
  We used annual rates of age- and cause-specific deaths to estimate pandemic-related mortality in excess of background levels in 39 countries in Europe, the Asia-Pacific region, and the Americas. We modeled the relationship between excess mortality and development indicators to extrapolate the global burden of the pandemic.
  
  
  RESULTS
  The pandemic-associated excess respiratory mortality rate was 1.9/10,000 population (95% confidence interval [CI], 1.2-2.6 cases/10,000 population) on average during 1957-1959. Excess mortality rates varied 70-fold across countries; Europe and Latin America experienced the lowest and highest rates, respectively. Excess mortality was delayed by 1-2 years in 18 countries (46%). Increases in the mortality rate relative to baseline were greatest in school-aged children and young adults, with no evidence that elderly population was spared from excess mortality. Development indicators were moderate predictors of excess mortality, explaining 35%-77% of the variance. Overall, we attribute 1.1 million excess deaths (95% CI, .7 million-1.5 million excess deaths) globally to the 1957-1959 pandemic.
  
  
  CONCLUSIONS
  The global mortality rate of the 1957-1959 influenza pandemic was moderate relative to that of the 1918 pandemic but was approximately 10-fold greater than that of the 2009 pandemic. The impact of the pandemic on mortality was delayed in several countries, pointing to a window of opportunity for vaccination in a future pandemic.
authors.affiliation: Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Cécile
authors.initials: C
authors.lastname: Viboud
authors.affiliation: Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland Department of Global Health, George Washington University, Washington D.C. Department of Public Health, University of Copenhagen, Denmark.
authors.forename: Lone
authors.initials: L
authors.lastname: Simonsen
authors.affiliation: Department of Epidemiology, Ministerio de Salud, and.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Fuentes
authors.affiliation: Department of Mathematical Sciences, University of South Dakota, Vermillion Biodiversity Laboratories, National Center for the Environment, Universidad de Chile, Santiago, Chile.
authors.forename: Jose
authors.initials: J
authors.lastname: Flores
authors.affiliation: Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Miller
authors.affiliation: Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland School of Public Health, Georgia State University, Atlanta.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Chowell
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D014943:Global Health; D049673:History, 20th Century; D006801:Humans; D007223:Infant; D053121:Influenza A Virus, H2N2 Subtype; D007251:Influenza, Human / Q000453:epidemiology* / Q000266:history / Q000401:mortality* / Q000821:virology; D008875:Middle Aged; D058873:Pandemics / Q000266:history*; D055815:Young Adult
keywords: development indicators; global disease burden; health indicators; historical studies; models; mortality rates; pandemic influenza; pandemic planning; severity; vital statistics