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May 21, 2003

Estimating Deaths Due to Influenza and Respiratory Syncytial Virus—Reply

JAMA. 2003;289(19):2499-2502. doi:10.1001/jama.289.19.2499-a

To the Editor: Dr Thompson and colleagues1 developed a statistical model to estimate deaths attributable to influenza and respiratory syncytial virus (RSV). We are concerned that their model was inappropriate. When designing a model to attribute causality to deaths, a reasonable initial approach would be to assume that the number of deaths due to a specific virus in any given week was proportional to the number of laboratory reports of that virus in that week. The total number of deaths would be the sum of the contributions from each virus, plus the seasonal background of deaths due to other causes. Similar models have been used successfully to estimate the proportion of gastrointestinal disease attributable to rotavirus2 and the proportion of bronchiolitis and pneumonia attributable to RSV and other pathogens.3 Additional terms and factors could be included to account, for example, for improving sensitivity of surveillance over time, but the core of the model would remain linear and additive.

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