Influenza-associated excess mortality in the Philippines, 2006-2015

• Published in: PloS one 2020-06, Vol.15 (6), p.e0234715-e0234715
• Main Authors: Cheng, Kent Jason Go, Rivera, Adovich Sarmiento, Lam, Hilton Yu, Ulitin, Allan Rodriguez, Nealon, Joshua, Dizon, Ruby, Wu, David Bin-Chia, Mossong, Joël
• Format: Article
• Language: English
• Subjects: Adults; Age; Age groups; Biology and life sciences; Children; Chronic illnesses; Dependent variables; Fatalities; Fever; Forecasts and trends; Health surveillance; Humidity; Independent variables; Infections; Influenza; Influenza A; Laboratories; Medical statistics; Medicine and Health Sciences; Model matching; Mortality; Older people; Patient outcomes; People and Places; Philippines; Public health; Rain; Regression analysis; Regression models; Seasonal variations; Trends; Typhoons; Vaccines
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0234715

Influenza-associated mortality has not been quantified in the Philippines. Here, we constructed multiple negative binomial regression models to estimate the overall and age-specific excess mortality rates (EMRs) associated with influenza in the Philippines from 2006 to 2015. The regression analyses used all-cause mortality as the dependent variable and meteorological controls, time, influenza A and B positivity rates (lagged for up to two time periods), and annual and semiannual cyclical seasonality controls as independent variables. The regression models closely matched observed all-cause mortality. Influenza was estimated to account for a mean of 5,347 excess deaths per year (1.1% of annual all-cause deaths) in the Philippines, most of which (67.1%) occurred in adults aged [greater than or equal to]60 years. Influenza A accounted for 85.7% of all estimated excess influenza deaths. The annual estimated influenza-attributable EMR was 5.09 (95% CI: 2.20-5.09) per 100,000 individuals. The EMR was highest for individuals aged [greater than or equal to]60 years (44.63 [95% CI: 4.51-44.69] per 100,000), second highest for children aged less than 5 years (2.14 [95% CI: 0.44-2.19] per 100,000), and lowest for individuals aged 10 to 19 years (0.48 [95% CI: 0.10-0.50] per 100,000). Estimated numbers of excess influenza-associated deaths were considerably higher than the numbers of influenza deaths registered nationally. Our results suggest that influenza causes considerable mortality in the Philippines-to an extent far greater than observed from national statistics-especially among older adults and young children.