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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Public Health 1/2017

Estimates of hospitalization attributable to influenza and RSV in the US during 1997–2009, by age and risk status

BMC Public Health > Ausgabe 1/2017
Gonçalo Matias, Robert Taylor, François Haguinet, Cynthia Schuck-Paim, Roger Lustig, Vivek Shinde
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The online version of this article (doi:10.​1186/​s12889-017-4177-z) contains supplementary material, which is available to authorized users.



Estimates of influenza and respiratory syncytial virus (RSV) burden must be periodically updated to inform public health strategies. We estimated seasonal influenza- and RSV-attributable hospitalizations in the US from 1997 to 2009 according to age and risk status (NCT01599390).


Multiple linear regression modelling was used to attribute hospitalizations to influenza or RSV using virological surveillance and hospitalization data. Hospitalization data were obtained from the US Nationwide Inpatient Sample and virology data were obtained from FluView (Centers for Disease Control and Prevention). Outcomes included any mention of ICD-coded respiratory disease and cardiorespiratory disease diagnoses. We also explored a broader definition of respiratory disease that included mention of relevant respiratory sign/symptoms and viral infection (“respiratory broad”).


Applying the respiratory broad outcome, our model attributed ~300,000 and ~200,000 hospitalizations to influenza and RSV, respectively. Influenza A/H3N2 was the predominant cause of influenza-related hospitalizations in most seasons, except in three seasons when influenza B was dominant; likewise, A/H3N2 caused most influenza-related hospitalizations in all age segments, except in children <18 years where the relative contribution of A/H3N2 and B was similar. Most influenza A- and B-related hospitalizations occurred in seniors while approximately one half and one third of all RSV-related events occurred in children 0–4 years and seniors 65+ years, respectively. High-risk status was associated with higher risk of both influenza- and RSV-attributable hospitalizations in adults, but not in children.


Our study assessed the burden of influenza and RSV, information that is important for both cost effectiveness studies and for prioritization of the development of antivirals and vaccines. For seniors, we found that the burdens of influenza and RSV were both substantial. Among children <18 years, about half of all influenza hospitalizations were due to influenza B, most occurring in children without noted risk conditions. RSV hospitalizations among children were confined to those 0–4 years. Our study also demonstrated the importance of the outcome used to estimate hospitalization burden. Our findings highlight the burden of influenza among children regardless of risk status and underscore the prevalence of RSV infections among both young children and older adults.
Additional file 1: Table S1. Seasonal burden of hospitalization attributable to influenza and RSV by season in the US, 1997–2009 (respiratory broad outcome, any mention). 1Annual mean rate per 100,000 population; *Data included up to 31st March 2009; CI: confidential interval. Table S2. Number of hospitalizations attributable to influenza and RSV according to risk status and age in the US, 1997–2009 (respiratory broad outcome, any mention). SD: standard deviation; RSV: respiratory syncytial virus. (DOCX 42 kb)
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