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US had record flu deaths last year, says CDC

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4136 (Published 01 October 2018) Cite this as: BMJ 2018;363:k4136
  1. Owen Dyer
  1. Montreal

A record number of US patients died from flu last year, with 80 000 deaths recorded in 2017-18, says the director of the Centers for Disease Control and Prevention (CDC), Robert Redfield.

He gave the 80 000 estimate during an interview with the Associated Press in New York. It has not yet been published in official data, which is expected within weeks, but the CDC said that the published figure would not be lower.

It means that the 2017-18 period will have had the highest number of deaths from flu, by some margin, since tracking began in 1976. The previous record was 56 000 in 2012-13. The lowest figure in recent years was 12 000 in 2011-12.

The figures are not exact because they are calculated by a statistical model based on incomplete reporting. They are largely based on death certificate reports of influenza or pneumonia and can miss indirect flu deaths such as those from flu related myocardial infarction, which recent research suggests is more common than previously believed.1

Last year also saw a record number of flu related hospital admissions at around 900 000, surpassing the previous milestone of 710 000 in 2014-15.

Child flu deaths, the only flu deaths to be precisely collated in the United States, numbered 180 last year, the highest figure since the 2009 H1N1 pandemic. The previous highest recorded figure in a regular flu season was 171 in 2012-13.

“We lost 80 000 people last year to the flu,” Redfield told the Associated Press. “I’d like to see more people get vaccinated.”

The flu vaccine’s relatively poor match to circulating strains in recent years—and the public’s awareness of this—has seen immunisation rates stall at just under half. Last year 47% of US people received a flu shot, the same proportion as the previous year. But vaccination rates fell slightly among children aged 6 months to 4 years, down to 67.8% from 70.0% the previous year, wiping out about five years of incremental gains in uptake.

The US surgeon general, Jerome Adams, noted that 80% of the 180 children who died from flu last year were unvaccinated. Several US public health officials said last week that they had done a poor job of explaining that the vaccine can prevent complications and deaths, even when it fails to prevent infection.

“This is a vaccine that can do other things,” said Daniel Jernigan, head of the CDC’s influenza division, at a New York event. “We may not have been making as much of a push for that in the past.”

Recent vaccines have been poorly matched to circulating strains, and this fact was publicised early in the last flu season, possibly discouraging uptake. An interim CDC estimate of last year’s vaccine, published in February 2018, found it 37% effective at preventing illness overall and just 25% effective against the dominant and most virulent H3N2 strain.2 More recent analysis suggested that it was 40% effective at preventing illness overall.3

As the first reports of the 2018-19 season emerge doctors hope that milder strains are circulating this year and that the vaccine, which has had two of its three components changed, will be a better match.

Jernigan said, “We don’t know what’s going to happen, but we’re seeing more encouraging signs than we were early last year.”

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