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As nation gets older, flu deaths on the rise
Compiled from Times wires Despite the advent of a vaccine 40 years ago, flu deaths have increased dramatically during the past decade because the nation is getting older and the virus may be getting bolder. The annual toll has climbed from about 20,000 deaths per year in the 1970s to an average of about 36,000 per year in the 1990s, according to a study by the Centers for Disease Control and Prevention published today in the Journal of the American Medical Association. In the United States, that's more deaths each year than from AIDS. About 90 percent of all flu deaths occur among people over the age of 65, a group that is especially vulnerable because annual vaccinations do not protect aging immune systems as well as they do younger ones, said Dr. Keiji Fukuda, the principal researcher for the study. Plus, only about 65 percent of older people get flu shots. Another factor is growth of a certain strain of influenza -- called A(H3N2) -- that is far deadlier than others. That strain was responsible for 80 percent of flu deaths in the 1990s. In the 1970s and 1980s, flu was so mild that it killed fewer than 5,600 people in three separate years. But between autumn 1992 and spring 1999, annual flu deaths never dropped below 27,000 and reached a high of 51,296 in the 1997-1998 season. Experts said the 1999-2000 season was probably even worse, but final statistics aren't yet available. It's still too early to tell for the current season because February is the traditional peak, but deaths are a bit below average so far. Nonetheless, the long-range trend remains troubling. Health and Human Services Secretary Tommy Thompson said the news "that influenza may be taking an even larger toll than we have realized" underscores the importance of flu shots. While drug breakthroughs in the mid 1990s helped tame AIDS and reduce the U.S. death toll from 51,000 in 1995 to about 15,000 in 2001, the main weapon doctors have against flu -- a vaccine -- has proven disappointingly ineffective in older people. Between 1976 and 1999, the number of U.S. adults 85 and older doubled. And the researchers found that this age group was 16 times more likely to die of flu-related causes than people ages 65 to 69. Flu can progress to pneumonia and other life-threatening lung infections and can weaken elderly people, making them more vulnerable to other serious ailments, such as heart disease. Annual flu vaccinations have been recommended for people 65 and older since the 1960s and for those 50 and older since 2000. The CDC also recommends flu vaccinations for anyone with chronic medical conditions such as heart disease, lung problems or diabetes. And vaccinations are encouraged for children aged 6-to-23 months. While two-thirds of the elderly get vaccinated, only about one-third of younger people at risk get the shots. It's not too late to get vaccinated for this season, Fukuda said. Thompson noted that flu shots are free under Medicare and said new federal rules should help increase vaccination rates by allowing hospitalized Medicare patients to get flu shots without a doctor's order. For the study, researchers developed a new statistical model to create a more accurate estimate of flu deaths using national mortality and virus surveillance data. But the paper did not reveal the details of the statistical analysis, nor did it provide influenza death rates for people of different ages. That, in particular, was a serious drawback, said Dr. David Freedman, a statistician at the University of California at Berkeley. "It is startling to see a paper without age-specific death rates," Freedman said, because without them it is impossible to assess the scientists' conclusions that the increased deaths were solely because of increased numbers of elderly people. The study found that older people also are disproportionately affected by another respiratory virus previously thought to be more common in children. The researchers estimate there are 11,000 deaths annually from respiratory syncytial virus, which can cause coldlike symptoms and pneumonia. Their study confirmed that RSV is the most common cause of viral death in children under 5. But to researchers' surprise, the study found that 78 percent of RSV deaths occur in people 65 and older. Vaccines against RSV are being developed. As bad as flu was in the 1990s, it will likely get much worse, the CDC predicts. A 1999 CDC study said a pandemic of flu that spreads fast, far and fatally is inevitable. A similar pandemic killed more than 20-million people worldwide in 1918. If one of the same virulence strikes again, it would likely kill up to 207,000 Americans, the CDC estimated. Flu and pneumonia, lumped together for statistical purposes, are the No. 7 cause of death in America, after heart disease, cancer, stroke, chronic lung diseases, accidents, and diabetes. It is the No. 4 cause of death for people 85 and older. -- Information from Knight Ridder, Associated Press and New York Times was used in this report.
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