Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Total excess mortality has been
used to measure the burden of influenza for many years. Dr Thompson and colleagues1 stated that this death category includes diagnoses
that "are not causally linked with respiratory viral infections." Seasonal
total excess deaths, however, comprise a small proportion of total mortality;
we believe that it is not possible with the limited clinical information on
death certificates to accurately designate those complicated by influenza.
Even cases listing burns or trauma as the underlying cause of death may be
influenza-related if the virus infection occurred coincident with the trauma
or was nosocomial. Because neither past nor the current proposed models are
able to directly identify influenza-caused deaths, we see no reason to abandon
total excess mortality and substitute attributable "respiratory and circulatory
deaths." For the sake of continuity and comparability, we believe that the
established category should be retained while assessing the value of alternative
Glezen WP, Couch RB. Estimating Deaths Due to Influenza and Respiratory Syncytial VirusEstimating Deaths Due to Influenza and Respiratory Syncytial Virus. JAMA. 2003;289(19):2499-2502. doi:10.1001/jama.289.19.2499-a