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Lancet Pub. Health: Influenza-associated excess respiratory mortality in China, 2010-15: a population-based study

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  • Lancet Pub. Health: Influenza-associated excess respiratory mortality in China, 2010-15: a population-based study

    Lancet Public Health. 2019 Sep;4(9):e473-e481. doi: 10.1016/S2468-2667(19)30163-X.
    Influenza-associated excess respiratory mortality in China, 2010-15: a population-based study.

    Li L1, Liu Y2, Wu P1, Peng Z3, Wang X4, Chen T5, Wong JYT1, Yang J6, Bond HS1, Wang L2, Lau YC1, Zheng J3, Feng S1, Qin Y1, Fang VJ1, Jiang H3, Lau EHY1, Liu S2, Qi J2, Zhang J4, Yang J5, He Y4, Zhou M2, Cowling BJ1, Feng L7, Yu H8.
    Author information

    1 WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China. 2 National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. 3 Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. 4 School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China. 5 National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese CDC, Beijing, China. 6 Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China. 7 Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. Electronic address: fenglz@chinacdc.cn. 8 Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China. Electronic address: cfetpyhj@vip.sina.com.

    Abstract

    BACKGROUND:

    The estimation of influenza-associated excess mortality in countries can help to improve estimates of the global mortality burden attributable to influenza virus infections. We did a study to estimate the influenza-associated excess respiratory mortality in mainland China for the 2010-11 through 2014-15 seasons.
    METHODS:

    We obtained provincial weekly influenza surveillance data and population mortality data for 161 disease surveillance points in 31 provinces in mainland China from the Chinese Center for Disease Control and Prevention for the years 2005-15. Disease surveillance points with an annual average mortality rate of less than 04% between 2005 and 2015 or an annual mortality rate of less than 03% in any given years were excluded. We extracted data for respiratory deaths based on codes J00-J99 under the tenth edition of the International Classification of Diseases. Data on respiratory mortality and population were stratified by age group (age <60 years and ≥60 years) and aggregated by province. The overall annual population data of each province and national annual respiratory mortality data were compiled from the China Statistical Yearbook. Influenza surveillance data on weekly proportion of samples testing positive for influenza virus by type or subtype for 31 provinces were extracted from the National Sentinel Hospital-based Influenza Surveillance Network. We estimated influenza-associated excess respiratory mortality rates between the 2010-11 and 2014-15 seasons for 22 provinces with valid data in the country using linear regression models. Extrapolation of excess respiratory mortality rates was done using random-effect meta-regression models for nine provinces without valid data for a direct estimation of the rates.
    FINDINGS:

    We fitted the linear regression model with the data from 22 of 31 provinces in mainland China, representing 830% of the total population. We estimated that an annual mean of 88 100 (95% CI 84 200-92 000) influenza-associated excess respiratory deaths occurred in China in the 5 years studied, corresponding to 82% (95% CI 79-86) of respiratory deaths. The mean excess respiratory mortality rates per 100 000 person-seasons for influenza A(H1N1)pdm09, A(H3N2), and B viruses were 16 (95% CI 15-17), 26 (24-28), and 23 (21-25), respectively. Estimated excess respiratory mortality rates per 100 000 person-seasons were 15 (95% CI 11-19) for individuals younger than 60 years and 385 (368-402) for individuals aged 60 years or older. Approximately 71 000 (95% CI 67 800-74 100) influenza-associated excess respiratory deaths occurred in individuals aged 60 years or older, corresponding to 80% of such deaths.
    INTERPRETATION:

    Influenza was associated with substantial excess respiratory mortality in China between 2010-11 and 2014-15 seasons, especially in older adults aged at least 60 years. Continuous and high-quality surveillance data across China are needed to improve the estimation of the disease burden attributable to influenza and the best public health interventions are needed to curb this burden.
    FUNDING:

    National Science Fund for Distinguished Young Scholars, National Science and Technology Major Project of China, National Institute of Health Research, the Harvard Center for Communicable Disease Dynamics from the National Institute of General Medical Sciences, and the China-US Collaborative Program on Emerging and Re-emerging Infectious Disease.
    Copyright 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.


    PMID: 31493844 DOI: 10.1016/S2468-2667(19)30163-X
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  • #2
    Lancet Public Health. 2019 Sep;4(9):e436-e437. doi: 10.1016/S2468-2667(19)30158-6.
    Influenza surveillance in China: a big jump, but further to go.

    Huo X1, Zhu FC2.
    Author information

    1 Key Laboratory of Enteric Pathogenic Microbiology (National Health Commission), Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; Center for Global Health, Nanjing Medical University, Nanjing, China. 2 Key Laboratory of Enteric Pathogenic Microbiology (National Health Commission), Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; Center for Global Health, Nanjing Medical University, Nanjing, China. Electronic address: jszfc@vip.sina.com.

    PMID: 31493834 DOI: 10.1016/S2468-2667(19)30158-6
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