Burden of the disease
- WHO _ Seasonal influenza 11/7/2020
- WHO Influenza (Seasonal) 6 November 2018
Is influenza really a severe disease?
Influenza is a severe disease, with 3 to 5 million severe cases reported worldwide each year. It can result in serious complications such as pneumonia, myocarditis, encephalitis, stroke and multi-organ failure1,2,3 Influenza is a contributing factor to 5 of the 10 top causes of death worldwide, including cardiovascular diseases, the leading cause of death globally3,4,5,6
Influenza is a highly contagious respiratory disease which can be contracted by both healthy and at-risk individuals. Elderly people (aged >70 years), people living with heart disease & diabetes are at higher risk of severe influenza related complications3,4,5,7
Acute illnesses such as influenza infection can contribute to functional decline and long-term disability. A study has shown that >30% of elderly patients had a worse functional status after hospitalization for acute medical illness, as caused by a new disability at discharge. Of those, only 30% functionally recovered after one year.8,9
Immediately following influenza infection, the risk of a heart attack is elevated six times in persons aged 35 years and older10 People living with diabetes are 3 times more likely to be hospitalized due to influenza11 and the risk of death from influenza complications is 6 times higher in this group.12
- WHO. Influenza (Seasonal) - https://www.who.int/en/news-room/fact-sheets/detail/influenza-(seasonal)
- Centers for Disease Control and Prevention (CDC 2019), Flu Symptoms & Complications, https://www.cdc.gov/flu/symptoms/symptoms.htm? CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fconsumer%2Fsymptoms.htm
- Center for Disease Control and Prevention (CDC 2019). Heart Disease & Stroke. https://www.cdc.gov/flu/highrisk/heartdisease.htm? CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fheartdisease%2Findex.htm
- Wesseling G. (2007). Occasional review: influenza in COPD: pathogenesis, prevention and treatment. International Journal of Chronic Obstructive Pulmonary Disease, 2(1): 5-10. https://europepmc.org/abstract/med/18044060
- Centers for Disease Control and Prevention (CDC 2019). Influenza. Diabetes. https://www.cdc.gov/flu/highrisk/diabetes.htm? CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fdiabetes%2Findex.htm
- World Health Organization (WHO 2018). The top 10 causes of death https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
- Health Direct, Australian Department of Health (2018) https://www.healthdirect.gov.au/influenza-a-flu
- Gozalo P.L., Pop-Vicas A., Feng Z., Gravenstein S., Mor V. (2012). The impact of influenza on functional decline. J Amer Geriatr Soc. 2012 Jul;60(7):1260-7. Epub 2012 Jun 21. https://www.ncbi.nlm.nih.gov/pubmed/22724499
- Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical Illness, Cynthia M. Boyd, MD, MPH, 2008 https://www.ncbi.nlm.nih.gov/pubmed/19093915
- Kwong, J. et. al. (2018). Acute Myocardial Infarction After Laboratory-Confirmed Influenza Infection. The New England Journal of Medicine, 78(4), p.349. https://www.nejm.org/doi/full/10.1056/NEJMoa1702090
- Hulme KD, Gallo LA, Short KR. (2017) Influenza virus and glycemic variability in diabetes: a killer combination? Front Microbiol; 8:861. https://www.ncbi.nlm.nih.gov/pubmed/28588558
- Public Health England (PHE). (2018). Influenza: The green book, chapter 19. https://www.gov.uk/government/publications/influenza-the-green book-chapter-19
Chronic conditions that can be exacerbated by influenza
World Health Organization (WHO 2018). The top 10 causes of death https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
Is influenza B as severe as influenza A?
Yes, in fact influenza B is similar to type A in form i.e. clinical and biological symptoms, and severity16,17 Influenza B is a significant cause of absenteeism, clinic visits, hospitalizations and deaths across all ages18,19,20 It affects and causes mortality in all age groups18. 1 in 3 of hospital admissions with influenza globally were due to influenza B (2014-2015 season).21
Amongst all cases reported with influenza B infection in ICUs, case fatality rates doubled between seasons 2016-17 and 2017-18. The dominant B/Yamagata virus circulation with mixed A virus pattern in 2017/18 caused high severity, long duration of peak influenza activity and all-cause excess mortality in the EU/EEA.22
16. A.Chagvardieff et al. (2018) Prospective comparative study of characteristics associated with influenza A and B in adults, https://doi.org/10.1016/j.medmal.2017.11.007
17. Glezen PW and al, (2013) am J publ Health, The burden of influenza B: a structured literature review. https://ajph.aphapublications.org/doi/10.2105/AJPH.2012.301137
18. Ambrose CS, Levin MJ. (2012) The rationale for quadrivalent influenza vaccines. Hum Vaccin Immunother. 2012; 8(1):81-88 https://www.tandfonline.com/doi/full/10.4161/hv.8.1.17623
19. Simonsen L. et al., (2000) JID 831-837. The impact of influenza epidemics on hospitalizations. https://academic.oup.com/jid/article/181/3/831/911149
20. Belshe RB. Vaccine. (2010);28(suppl 4):D45-D53. The need for quadrivalent vaccine against seasonal influenza. https://www.sciencedirect.com/science/article/pii/S0264410X10011370?via%3Dihub
21. Puig-Barberà et al. BMC Public Health (2016), 16(Suppl 1):757 https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-0163378-1
22. Eurosurveillance (2018) Dominant influenza A(H3N2) and B/Yamagata virus circulation in EU/EEA, 2016/17 and 2017/18 seasons, respectively. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.13.18-00146#html_fulltext
Severe clinical impact of influenza B during the 2017-18 season in Europe
Eurosurveillance (2018) Dominant influenza A(H3N2) and B/Yamagata virus circulation in EU/EEA, 2016/17 and 2017/18 seasons, respectively. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.13.18-00146#html_fulltext
Economic Burden of Influenza
In the US, influenza accounts for 65% of the annual economic burden of vaccine-preventable diseases1. The total impact of an influenza epidemic in industrialized countries (including direct and indirect costs) may reach €57 million per million people2
- PNAS US economic burden
- Public health and economic impact of seasonal influenza vaccination with quadrivalent influenza vaccines compared to trivalent influenza vaccines in Europe
- The Cost Of US Adult Vaccine Avoidance_ $8.95 Billion In 2015 _ Health Affairs
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