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Inference of age-dependent case-fatality ratios for seasonal influenza virus subtypes A(H3N2) and A(H1N1)pdm09 and B lineages using data from the Netherlands
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  • Scott McDonald,
  • Anne Teirlinck,
  • Mariette Hooiveld,
  • Liselotte Asten,
  • Adam Meijer,
  • Marit de Lange,
  • Arianne van Gageldonk-Lafeber,
  • Jacco Wallinga
Scott McDonald
National Institute for Public Health and the Environment (RIVM)

Corresponding Author:[email protected]

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Anne Teirlinck
National Institute for Public Health and the Environment (RIVM)
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Mariette Hooiveld
Netherlands institute of health services research (NIVEL)
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Liselotte Asten
National Institute for Public Health and the Environment
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Adam Meijer
National Institute for Public Health and the Environment (RIVM)
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Marit de Lange
Rijksinstituut voor Volksgezondheid en Milieu
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Arianne van Gageldonk-Lafeber
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Jacco Wallinga
National Institute of Public Health and the Environment
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Background. Despite the known relatively high disease burden of influenza, data are lacking regarding a critical epidemiological indicator, the case-fatality ratio. Our objective was to infer age-group and influenza (sub)type specific values by combining modelled estimates of symptomatic incidence and influenza-attributable mortality. Methods. The setting was the Netherlands, 2011/12 through 2019/20 seasons. Sentinel surveillance data from general practitioners and laboratory testing were synthesised to supply age-group specific estimates of incidence of symptomatic infection, and ecological additive modelling was used to estimated influenza-attributable deaths. These were combined in an Bayesian inferential framework to estimate case-fatality ratios for influenza A(H3N2), A(H1N1)pdm09 and influenza B, per 5-year age-group. Results. Case-fatality estimates were highest for influenza A(H3N2) followed by influenza B and then A(H1N1)pdm09, and were highest for the 85+ years age-group, at 4.76% (95% credible interval (CrI): 4.52-5.01%) for A(H3N2), followed by influenza B at 4.08% (95% CrI: 3.77-4.39%) and A(H1N1)pdm09 at 2.51% (95% CrI: 2.09-2.94%). For 55-59 through 85+ years, the case-fatality risk was estimated to double with every 3.7 years of age. Conclusions. These estimated case-fatality ratios, per influenza sub(type) and per age-group, constitute valuable information for public health decision-making, for assessing the retrospective and prospective value of preventative interventions such as vaccination, and for health economic evaluations.
23 Jan 2023Submitted to Influenza and other respiratory viruses
25 Jan 2023Submission Checks Completed
25 Jan 2023Assigned to Editor
29 Jan 2023Reviewer(s) Assigned
06 Mar 2023Review(s) Completed, Editorial Evaluation Pending
07 Mar 2023Editorial Decision: Revise Minor
25 Apr 20231st Revision Received
27 Apr 2023Submission Checks Completed
27 Apr 2023Assigned to Editor
03 May 2023Editorial Decision: Accept