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Last year was the worst season for influenza mortality in decades

Barbara Loe Fisher, Joe Mercola, and other antivaxers frequently deny that the flu is dangerous and that all the promotion of flu vaccines every year is a plot by big pharma to make money based on fear. The CDC argues otherwise, reporting that influenza mortality last season was higher than iit’s been in decades. Roughly 80,000 people are estimated to have died last season from influenza or complications from the flu.

A couple of days ago, I wrote about “Vaccine Injury Awareness Week,” a fake “awareness” week made up by the grande dame of the antivaccine movement, Barbara Loe Fisher, founder of the National Vaccine Information Center (NVIC) and über-quack Joe Mercola. In their rant about wanting to increase “awareness” of vaccine injuries, which to them and other antivaccine activists, seems to encompass everything from autism, to sudden infant death syndrome (SIDS), to shaken baby syndrome (which to some antivaxers is a misdiagnosis for “vaccine injury”), to autoimmune diseases, to diabetes, to asthma, to…well…just about everything, they attacked the influenza vaccine as ineffective and dangerous. More importantly, they dropped a common antivaccine trope that influenza isn’t that big a deal, that it isn’t a major public health problem. They cited the usual antivaccine misinformation, misrepresenting the “assumptions” that are used to estimate influenza mortality, which in recent years has been estimated somewhere between 12,000 and 56,000 people die of influenza or influenza-related complications every year. The idea, of course, was to portray the yearly public health campaign to persuade people to get their flu vaccines as unnecessary and a product of big pharma trying to make money.

So the timing of this announcement from the Centers for Disease Control and Prevention (CDC) is rather unfortunate for the NVIC and Joe Mercola. Reported in various news outlets, including the AP, the CDC estimates that 80,000 people died of the flu or its complications last year:

An estimated 80,000 Americans died of flu and its complications last winter — the disease’s highest death toll in at least four decades.

The director of the Centers for Disease Control and Prevention, Dr. Robert Redfield, revealed the total in an interview Tuesday night with The Associated Press.

Flu experts knew it was a very bad season, but at least one found the size of the estimate surprising.

“That’s huge,” said Dr. William Schaffner, a Vanderbilt University vaccine expert. The tally was nearly twice as much as what health officials previously considered a bad year, he said.

In recent years, flu-related deaths have ranged from about 12,000 to 56,000, according to the CDC.

This figure jibes with the impression I’ve heard from a lot of my colleagues in internal medicine, who tole me last year that admissions for the flu and complications due to the flu, were much higher than usual last flu season. As the CDC notes, one reason the flu season was so severe last year was because that it was driven by a strain of flu (influenza A virus H3N2) that tends to put more people in the hospital and cause more deaths, particularly among young children and the elderly.

It also didn’t help that last year was one of the years when flu vaccine efficacy wasn’t that great—at least not against H3N2, the most dangerous strain in circulation last year. Canadian researchers earlier this year reported in Eurosurveillance that the H3N2 component of the vaccine had dismal efficacy:

Their midseason estimate, based on data from the four provinces where roughly 80 percent of Canadians live, suggested that the H3N2 component of the vaccine is 17 percent effective at preventing infection. Last year it was estimated at 37 percent in Canada and 34 percent in the U.S.

Public health authorities have come to expect protection against H3N2 — the weak link of the vaccine — to be in the low-to-mid 30 percent range at best. But this estimate is half that. And the fact that it was so much lower came as a surprise to the Centers for Disease Control and Prevention’s flu experts, who have yet to analyze their midseason flu vaccine effectiveness data.

“It was lower than what the Canadians or we experienced last year,” said Alicia Fry, head of epidemiology for the CDC’s influenza division. Given that there haven’t been major changes in the viruses, “it is a surprising result.”

Granted, the study had relatively low numbers of people and the estimates for efficacy against the various strains had wide confidence intervals, but it was a disappointing result. The CDC’s own estimate of the overall effectiveness of last year’s flu vaccine was 36% and 25% against the H3N2 strain. As I said before, last year the flu vaccine wasn’t that great, at least not against the worst strains. (Effectiveness against H1N1, for instance, was 67%.)

The CDC’s going to have to update its summary of the 2017-2018 flu season, it appears, given that there’s no estimate of influenza mortality and the total death toll. There is, however, this:

As of August 25, 2018, a total of 180 pediatric deaths had been reported to CDC during the 2017-2018 season. This number exceeds the previously highest number of flu-associated deaths in children reported during a regular flu season (171 during the 2012-2013 season). Approximately 80% of these deaths occurred in children who had not received a flu vaccination this season. For the most recent data and more information visit FluView: Influenza-Associated Pediatric Mortality.

Since flu-associated deaths in children became a nationally notifiable condition in 2004, the total number of flu-associated deaths among children during one season has ranged from 37 (during the 2011-2012 season) to 180 (during the 2017-18 season, as of August 11); this excludes the 2009 pandemic, when 358 pediatric deaths from April 15, 2009 through October 2, 2010 were reported to CDC.

Yes, children die from the flu, antivaxers. They do, no matter how much you try to deny it. So do adults, a lot of adults.

Of course, I can easily predict that antivaxers will try to downplay this estimate of 80,000 deaths from the flu last year. Just like Mercola and Fisher, they’ll try to claim that, because the estimate isn’t strictly an estimate of people who die with “influenza” listed as the cause of death on their death certificate and a laboratory-verified influenza infection. The CDC specifically answers this question:

Seasonal influenza may lead to death from other causes, such as pneumonia, congestive heart failure, or chronic obstructive pulmonary disease. It has been recognized for many years that influenza is underreported on death certificates and patients aren’t always tested for seasonal influenza infection, particularly the elderly who are at greatest risk of seasonal influenza complications and death. Some deaths – particularly among the elderly – are associated with secondary complications of seasonal influenza (including bacterial pneumonias). Influenza virus infection may not be identified in many instances because influenza virus is only detectable for a short period of time and/or many people don’t seek medical care until after the first few days of acute illness. For these and other reasons, statistical modeling strategies have been used to estimate seasonal flu-related deaths for many decades. Only counting deaths where influenza was included on a death certificate would be a gross underestimation of seasonal influenza’s true impact.

I like to go back to Mark Crislip’s discussion of influenza mortality and why it’s hard to estimate excess mortality from influenza, starting with the common estimate of 36,000 deaths a year from influenza:

36,000 is a lot of people. That’s about 120 deaths per million people in the US. In Oregon, population about 3 million, that would be about 360 people a year, which is two deaths a day for the six month flu season.

2,400,000 people die every year in the US, about 6600 a day. In Oregon, that is about 65 deaths a day. No one outside a epidemiologist is going to notice 2 extra deaths a day during flu season. I have seen a lot of people die of influenza, but I have a biased experience: I am an infectious disease doc, so I am likely to see people with influenza, especially patients with disease severe enough to kill them.

About the same number of people die from car accidents and die from handguns in the US each year as die from influenza. I have never known a person in my real, as opposed to my professional, life to die from influenza or handguns or a car accident. My personal experience suggests no one dies from these causes, but since I take care of patients at one of the Portland trauma hospitals, I know what cars and guns do to people. My professional life confirms that people do indeed die from being shot or car accidents. I would wager that most people reading this blog have not known anyone who has died from influenza, guns or car accidents.

Mark’s probably right about most people not knowing anyone who died of the flu, handgun, or a car crash, but I can’t help but note that I’ve known people who’ve died from two out of these these three causes. A friend of mine from college died in a car crash, and I knew someone who ultimately committed suicide. However, I have never personally known anyone who’s died of the flu or its complications. The point still stands, though, and the example described by Mark illustrates why statistical modeling is needed to estimate the number of deaths due to the flu. Of course, like climate science denialists who don’t trust climate models and dismiss them as so hopelessly flawed as not to be believed, antivaxers dismiss the epidemiological statistical models used to estimate influenza mortality. They don’t understand the models; so they dismiss them.

In any event, I have a word for Barbara Loe Fisher, Joe Mercola, and all the antivaxers out there trying to claim that influenza is not that big a deal, that it’s not a major public health threat, that the CDC and public health officials are intentionally exaggerating the death toll in order to sell you vaccines every year: You’re full of crap.

Get your flu vaccines, everyone. Yes, the influenza vaccine is highly imperfect, but it’s the best we have and will remain so until a universal flu vaccine is finally developed, tested, and shown to work.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

50 replies on “Last year was the worst season for influenza mortality in decades”

In Victoria, Australia, we had a 40% increase in flu vaccinations and 85% drop in flu cases this season compared to last season.
Possibly we got some herd immunity benefits.

Antivaccine activists have also told me in comment threads that 181 children out of the U.S. population is a small number.

Interestingly, they don’t apply that sort of “it’s only a couple of hundred a year” to the things they are mistakenly trying to blame vaccines for. (I wonder where, between the 181 they dismiss and 1500/year from SIDS, they would recognize significance.) Beyond that, they’re again trying to tell people that they, or their children, would be better off dead than autistic, which would be ridiculous if it wasn’t cruel.

I so wish the CDC, AMA, AAFP and AAP would do would you just did–telling the public that Fisher, Mercola and all anti-vaxxers that they are full of crap.

Every child at my church got flu last year–except for mine. (No one was hospitalized or died, thank God.) One family got it twice. My family got flu shots instead. My children are not looking forward to their flu shots, but I’m looking forward to whatever protection the vaccine can give. A universal vaccine seems like a high priority!

Having had the 1968 Hong Kong flu when I was sick as a dog, ever since I have religiously gotten my flu shot. I don’t care if it was only 10% effective, so far flu vaccines have been more effective, given its extremely low risk of adverse effects. I live an extremely healthy life for senior citizen, vegan, no sweets, never smoked, and exercise regularly; but understanding how viruses work, every little bit of protection is better than none. And I realize that there are other microbes out there that can cause flu-like symptoms; but the 3 – 4 flu strains contained in the vaccine are usually the most prevalent and anything I can do to change the odds-on my favor is better than nothing. So, a little stick and, though no guarantees, I have done all that is possible.

I would recommend that senior citizens like myself and others with immune problems get the high-dose version of the vaccine. The higher amount of antigen, to some extent, compensates for the lower immune response.

Even when it’s only 10% effective, you’re still significantly less like to be sick as a dog. I’d trade sick as a cat for sick as a dog anytime.

This is an interesting little bit of news. Antivaxxers may glom onto the news that the vaccine had 17% efficacy as proof positive that the vaccine doesn’t work, but they have to concede that 80,000 people died, meaning that the flu isn’t harmless. I wonder which way they’ll go. I also wonder how much of the flu mortality last year was due to non-vaccination. If the vaccine has such poor efficacy, does lack of vaccination inflate the number of illnesses?

I get vaccinated for it every year. I seemed to contract it every year for a while there and have had no brushes with it since I got serious about always being vaccinated. Flu is misery and I’ll take any out I can get, even if the efficacy is only 17%.

Flu vaccination rates fall well short of what is needed for herd immunity, mostly because (at least in the US) most people have to go out of their way to get a vaccination. That’s even before you consider the difficulty of predicting what strains will be active, and as Yogi Berra said, “Prediction is difficult, especially about the future.” So I am not surprised that many people who do get flu shots nevertheless get the flu.

That said, we are dealing with people who are capable of a fair amount of cognitive dissonance. So it would not surprise me in the least if the anti-vax crowd tries to have it both ways.

Due to last winters flue season, our healthcare has started paying for the better vaccine. The “normal one” got covered but didn’t include the additional strain. For the better one people would have to pay. Good or bad news is, so many people got really sick, now the better vaccine is free for everyone.

“Antivaccine activists have also told me in comment threads that 181 children out of the U.S. population is a small number.”

They don’t think 500-600 measles deaths a year (before the vaccine) was a big deal either.

I have actually had anti-vaxers tell me that it is just natural selection if my son with a genetic heart disease dies from a vaccine preventable disease. They are not nice people.

Yeah, there is one particular odious person who claims that Olivia Dahl died from measles because she was fed bad food. Her father, Roald Dahl, was an avid gardener who had an extensive veggie garden. One of his wives had to convince him to plant more ornamentals.

I learned this from a biography I read about him years ago. There was a photo of him tending a flower garden dedicated to oldest child. The one that he memorialized in The BFG.

For what it’s worth, my sister-in-law, who is a statistician, and owns an operates a company which does statistical analyses for drug companies, claims that the numbers reported for influenza deaths is fraudulent. According to her, there are fewer than 200 deaths per year from the flu, if that many, and that the vaccines have no effect at all.

Of course she’s a Christian fundamentalist antivaccine fanatic, but I’m SURE that doesn’t result in any cognitive bias on her part.

But it does raise questions about how accurate the journal articles are these days, what with people like this running the numbers.

Ugh, I’d thought I’d put last year’s flu behind me. That was gnarly. I was vaccinated, so was the person I caught it from. I’m kind of guiltily glad I only had an attenuated version of that bug. But I still spent the entire week of Thanksgiving living on soup and bubbly water.

I actually know 2 people who died from gunshots, one suicide and one murder, 5 people who died in car accidents, and 1 person who died from the flu.

Not if you take it as sarcasm.

Some of us who are old enough can also list the numbers of people we have known who have died and why. While a high school friend and a college friend both died in car crashes, the most common cause of death in our family/friends is smoking related cancer. There are two suicides, but no murders.

The deaths happen, because it is just a matter of time.

And those are just the beginning, when I think about it there were many more. I failed to mention the cousin of spouse who died in a car crash, my first boyfriend who died of pancreatic cancer in his early forties, and neither of the airplane related deaths of my mother (crash) and spouse’s father (pressure change causing a gastrointestinal tear resulting in sepsis).

“Fortunately” the only influenza death was one of my stepmother’s brothers who died during the 1918 influenza epidemic before she was born. Another one of her brothers died of in his forties due to their genetic form of high blood pressure, which she and her four remaining siblings avoided due to the introduction of diuretic blood pressure medication in the 1950s. They lived into their 80s and 90s (she died of smoking related lung cancer in her early 80s).

I am in my very early sixties. This is just the age where my grandmother and both of her surviving siblings (their two brothers both died before age ten due to now vaccine preventable diseases) had strokes. My great aunts both died from the stokes, my grandmother did not. Instead she became delusional and violent. The county demanded she be placed in supervised care, so my grandfather worked until he died to pay for her to not be in a state facility. When I was eleven years old he died, so my parents had to sell all of his property to pay for her care until she died seven years later.

Yes, I watch my diet and exercise. I also take my blood pressure and cholesterol medication. Because I know what happens when you ignore science based medicine.

Plus what you can learn through genealogy. Though it helps when trying to clean out her house my second cousin sent me letters her mother wrote to my mother (they were cousins). That is where I learned about the strokes. I really need to finish scanning those for my siblings.

rebeccalesses,

As Chris suggested, I read Sullivanthepoop’s comment as sarcasm rather than the baring of their soul, so I commented in the same vein. But I might be wrong, in which case I humbly and wholeheartedly apologize to them, to you and to anyone else who found my comment offensive.

Also as Chris mentioned, for anyone who has reached a certain time in their life it would be the rare person who does not know numerous people who have witnesses such tragedies among their relations; like horoscopes, one size fits all. I know I have. Well, except for the shootings, which are less common here than in the US. These personal experiences do not stop me from being able to laugh at the absurdity of life, and its end.

I someone who died from a gunshot wound (murder) and one who came very close to dying & was left disabled for life (attempted murder.) At least two who died in car crashes. Not sure about flu but I grew up with an older family so I wouldn’t be surprised if one or more had died prom pneumonia or other flu complications.

Off topic, but curious:

I was in line at the supermarket last night, right in front of a lady who was looking at the magazines. She mentioned that the slow pace of the line forced us to look at the magazine covers. She explained about the benefits of the protein diet and switched to criticizing doctors. As part of the conversation on metabolism etc, I allowed as how I know something about biochemistry. Then she said the following:

“I took my Jamey to Dr Burzynski, and he cured him of cancer in ten months. It has never come back. Do you know about Dr Burzynski?”

“Yes.”

After all these years, I finally met one of the Burzynski supporters — she introduced the topic out of the blue. I’m afraid there was neither time nor opportunity to carry on an extended inquiry about the cancer in question or what sort of treatment happened. I paid for my groceries and we parted ways. I didn’t explain what it is I know about Burzynski, so she probably thinks that I too believe in antineoplastons.

I should point out that a number of years ago, columnist Tom Elias was featured in the local newspaper (the Daily Breeze) and Elias would include a mention of his book about Burzynski at the end of his column. It may be that Burzynski was better known among readers of the Elias columns than just about anywhere else.

You have greater equanimity than I. I probably would have taken myself out of line right quick. Or dropped my groceries and run away.
People do share the weirdest things when you’re waiting around.

Just had a look at AOA site. Not a peep about the news on influenza.
There is an article about a gym owner in Kansas City sponsoring a billboard proclaiming that vaccines kill. The article tries to equate this with the billboard’s put up by MADD to educate about the dangers drink driving!

Am I going to have to explain what “estimates” are here? 80,000 my @ss. The CDC’s estimates of anything are always complete bunk. How any rational person still believes their ballyhoo is beyond me. They are making themselves into a laughing stock at this point. They can make up any estimate they want, and who is going to say otherwise? Certainly not this slavish blogger.

If you have more accurate estimates available, we would be delighted to hear them. I am pretty sure that most people reading the blog are aware of what “estimates” are.

We also understand what epidemiology is.

Let me explain it to Veneficus: If you get the flu, and then get pneumonia and die, you died from both the flu and pneumonia. But your doctor might not think of the root cause of the pneumonia, and put that and not flu on your death certificate.

You still died of the flu. That’s what epidemiology does; looks at reported deaths for the root causes. The estimates allow for a range for cases that are not clear cut.

Public health departments and the CDC do this anything there is a greater number of deaths than is normal for a particular location at that time of year. That’s why the death toll from Maria in Puerto Rico rose.

Who are you and why should we believe you? What are your credentials in epidemiology? Have you even taken one class in calculus?

We know it is difficult to count humans. We don’t need a lecture from some stranger on teh internets who thinks insults are a valid substitute for data.

Am I going to have to explain what “estimates” are here?

Sure. A hilarious display of statistical ignorance would be icing on the cake.

It’s a bit ironic that the anti-vaxxers are even able to make these arguments. After all, they can only pooh-pooh the severity of these diseases BECAUSE vaccines have been so wildly successful. “Pshaw, in my day polio was nothing; everybody got German measles, no biggie. You don’t see anyone dropping dead of smallpox, do you? Vaccines are massive overkill for such a trivial threat; just another moneymaker for Big Pharma, trying to scare people into whooping-coughing up more money.”

Exactly. It also doesn’t help that so many people mix up a bad cold and the flu. How many times do you hear someone say they had “a touch of the flu” when they actually mean the had the common cold? This downplays the seriousness of influenza making it that much easier to dismiss the need for vaccination.

So you are saying the “estimates” are likely wildly off because no one including doctors can tell the difference between a cold and the flu. That makes sense. Now you are using your brains.

Thanks for the link. Not surprisingly, it shows nowhere near 80k deaths from influenza.

You’re really not good at this. Weren’t you going to teach everyone about “estimates”?

Veneficus, you have proven you cannot read graphs, tables, nor words with scientific/math meanings.

Again: what are your qualifications in epidemiology?

Veneficus, you have just proven that you do not know how to read graphs, tables and medical/math vocabulary. Plus, you seem okay with at at least 180 verified pediatric deaths due to influenza.

You have proven yourself both ignorant and a monster who does not care about kids dying from preventable diseases.

So what are your qualifications in epidemiology? Why should we care about your opinions?

If you scarequote estimate, you certainly have better one ?
Problem is caused by indirect deaths. Influenza virus has a protein called hemagglutinin, which sticks red cells together into a mass. This is certainly stroke inducing, but exact numbers are difficult to estimate.

No I’m saying that it is easy to underestimate and subsequently downplay the seriousness of influenza if you confuse it with the common cold.

Real science can be messy because it deals with real life Veneficus. Real experts understand that. You can hardly blame vaccines for ???? if you aren’t prepared to blame the flu for any arising complications.

Apologies to Orac for the repeat post and for corresponding privately because my post about this didn’t post..

I am 60 and have influenza right now because of a local religious cult that largely does not believe in vaccinating themselves or their children. I was behind a Mennonite woman and her 4-6-year-old child in a store before I realized the kid was really sick–pale, had coughed and sneezed and was a bit snotty and runny-nosed. Then his mother turned around and sneezed about a foot away from me, so I realized then that she might also be sick.

It hit me like fifty bricks within eight hours.

Sorry if this is offensive to anyone, but these Mennonite women are instantly recognizable because of their standard girly costume and snoods. I’ve talked to a few of them in the past about the vaccine issue.They are not fanatical anti-vaxxers, but they think being forced to vaccinate their kids in order to attend school is unethical and wrong. A lot of them home-school, though. They seem to have the standard view for religious fanatics and extreme libertarians that their children are their property to abuse and recklessly fail to protect from disease however they want. At least a lot of their kids are home-schooled and are probably exposing fewer children except within their own closed community.

I got last year’s influenza vaccine, and this hit me harder and faster than anything I can remember.

Mennonite belief is sort of Amish Lite. They stay under the radar here and have a very large community near here.

For Orac, it may be time to look at these religious cults and their anti-vaxx beliefs in further detail..

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