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Flu's Toll Higher Than Thought

Study finds huge increase in deaths, especially in elderly

TUESDAY, Jan. 7, 2003 (HealthDayNews) -- Deaths caused by influenza and other respiratory infections have increased substantially over the past two decades, hitting the oldest Americans the hardest, federal epidemiologists report.

And the toll will continue to rise, because the number of Americans 85 and older is rising steadily, says a report in tomorrow's issue of the Journal of the American Medical Association.

Year-to-year comparisons are difficult, because deaths vary considerably; there were more than 32,000 deaths in the 1977-1978 flu season, compared to 16,000 the previous season. However, both numbers pale in comparison to the 72,399 deaths in the 1997-1998 season and the 64,664 deaths in the 1998-1999 season, says the report by William W. Thompson and other epidemiologists at the U.S. Centers for Disease Control and Prevention (CDC).

The study also singles out respiratory syncytial virus (RSV), generally regarded as a threat primarily to children, as a serious cause of death in older people as well.

"These data indicate that the magnitude of the problem is larger than we once thought," CDC Director Dr. Julie Gerberding says in a statement.

Thompson and his colleagues used a new mathematical model to estimate the number of deaths caused by influenza and other respiratory illnesses. Estimating that number has been difficult since the exact cause of death in persons with severe medical conditions, such as heart disease, can be difficult to determine.

An accompanying editorial by Dr. David M. Morens, an epidemiologist at the National Institute of Allergy and Infectious Diseases, says the new estimated yearly deaths are "surprising."

"This range may approach or succeed each year the total number of U.S. lives lost during the entire decade-long Vietnam War, surely placing influenza in the forefront of public health priorities," Morens writes.

Physicians and older Americans can do a lot to reduce the toll, Morens says. Older people should be aware that someone 85 or older is 16 times more likely to die of an influenza-related death than someone aged 65 to 69, he says.

Protection starts with the flu vaccine, Morens says. "The problem is partly that the public doesn't accept the flu vaccine and doesn't think the problem is as serious as these numbers show," he adds.

"Physicians should also do more work at prevention." he says. "Part of the role of all primary-care providers is to prevent disease. A lot more work needs to be done."

Today's flu vaccine is not perfect, Morens acknowledges, but it does reduce the risk of infection by 68 percent. "Better vaccines are in the process of development, but what I am trying to say is that we can't wait for the magic day when we have a perfect vaccine," he says.

Some common-sense rules can reduce the risk for older people, Morens says. "They should be informed about the risk of getting exposed to people who have serious illnesses," he says. "They should think before venturing into crowded places, for example."

Even in January, it's not too late to get a flu shot, says Dr. Norman H. Edelman, consultant for scientific affairs for the American Lung Association. A lot of winter lies ahead and "it only takes two weeks for immunity to build up. We strongly advise a flu shot, especially for the elderly. People with a preexisting lung or heart disease are particularly vulnerable."

Some children with chronic disease might also be candidates for the flu vaccine, Edelman says. "Our latest literature advises parents to consult their physicians," he says.

What To Do

You can learn more about influenza from the U.S. Centers for Disease Control and Prevention or the American Lung Association.

SOURCES: David M. Morens, M.D., epidemiologist, National Institute of Allergy and Infectious Diseases, Bethesda, Md.; Norman H. Edelman, M.D., consultant, scientific affairs, American Lung Association, New York City; Jan. 8, 2003, Journal of the American Medical Association
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