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[독감] 미국 및 유럽의 2013년 계절성 독감 현황

건강과대안 — Fri, 11 Jan 2013 11:18:14 +0000

미국과 유럽의 보건당국에서 공식적으로 발표한 계절성 독감 현황입니다.

미국 질병관리본부(CDC)의 추정에 따르면, 해마다 2만4천명이 계절성 독감으로 사망하고
있습니다. 지난 2003년 겨울에는 무려 4만8천명이 계절성 독감으로 사망한 것으로
추정하고 있습니다.

올해는 미국과 유럽에서 H3N2 타입의 계절성 독감 바이러스가 조금 더 일찍 유행하고
있으며, 미국 전역에서 2000여 명이 독감으로 입원했으며, 그중에서 어린이 18명이
사망했다고 밝혔습니다.

미국은 4주전부터 최근까지 2.8%에서 5.6%로 증가하였으며, 중국 북부지역도 3.2%에서
4.2%로 증가 추세에 있습니다. 우리나라에서 주로 유행하고 있는 계절성 인플루엔자
바이러스는 H1N1형이고, 미국과 중국에서 주로 유행하고 있는 바이러스는 H3N2형입니다.

미국이나 중국에서 들어오는 선박이나 배를 통한 여행객과 화물 등을 통해 그 지역에서
현재 유행하고 있는 H3N2형이 국내에서 유행할 가능성도 높습니다.

다만 이번 독감의 바이러스 유형과 전파 양상으로 보면… 현재까진 2009년 전세계적인
신종플루 대유행과 같은 비상사태가 발생할 가능성은 현재로서는 별로 없어 보입니다.

계절성 독감의 피크 시기가 예년보다 조금 더 앞당겨 진 정도의 상황이라 판단되며,
어린이와 노약자는 독감 예방주사를 접종받을 필요가 있고… 보건당국은 전 세계적인 상황을
예의주시하면서 백신과 치료약을 충분히 비축해두고, 입원실 확보 등 신속 대응체계를 점검
할 필요가 있을 것 같습니다.

그래도 해마다 겨울철 인플루엔자 바이러스로 인하여 수 많은 사람들이 사망하고 있으며,
올해는 평균보다 사망자 수가 더 늘어날 가능성이 높다는 점을 유의해야 합니다.

================

2012-2013 Influenza Season Week 52 ending December 29, 2012

All data are preliminary and may change as more reports are received.

Synopsis:

During week 52 (December 23-29), influenza activity increased in the U.S.

Viral Surveillance: Of 9,363 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, 2,961 (31.6%) were positive for influenza.
Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
Influenza-Associated Pediatric Deaths: Two influenza-associated pediatric deaths were reported and were associated with influenza B viruses.
Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 5.6%; above the national baseline of 2.2%. Nine of 10 regions reported ILI above region-specific baseline levels. New York City and 29 states experienced high ILI activity; 9 states experienced moderate ILI activity; 4 states experienced low ILI activity; 6 states experienced minimal ILI activity, and the District of Columbia and 2 states had insufficient data.
Geographic Spread of Influenza: Forty-one states reported widespread geographic influenza activity; 7 states reported regional activity; the District of Columbia reported local activity; 1 state reported sporadic activity; Guam reported no influenza activity, and Puerto Rico, the U.S. Virgin Islands, and 1 state did not report.

A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/overview.htm

National and Regional Summary of Select Surveillance Components
HHS Surveillance Regions*	Data for current week			Data cumulative since September 30, 2012 (Week 40)
HHS Surveillance Regions*	Out-patient ILI†	% positive for flu‡	Number of jurisdictions reporting regional or widespread activity§	2009 H1N1	A (H3)	A(Subtyping not performed)	B	Pediatric Deaths
Nation	Elevated	31.6%	48 of 54	194	10,612	5,621	5,621	18
Region 1	Elevated	45.3%	6 of 6	18	850	204	59	1
Region 2	Elevated	36.6%	2 of 4	21	722	683	161	3
Region 3	Elevated	43.3%	4 of 6	37	1,688	105	171	0
Region 4	Elevated	28.3%	8 of 8	20	1,410	3,368	1,058	4
Region 5	Elevated	58.4%	6 of 6	29	1,985	174	417	5
Region 6	Elevated	24.7%	5 of 5	7	599	529	971	4
Region 7	Elevated	33.9%	4 of 4	2	868	173	422	0
Region 8	Elevated	30.3%	6 of 6	25	940	297	1,174	0
Region 9	Normal	22.9%	3 of 5	32	599	58	137	0
Region 10	Elevated	31.5%	4 of 4	3	951	30	138	1

*HHS regions (Region 1 CT, ME, MA, NH, RI, VT; Region 2: NJ, NY, Puerto Rico, US Virgin Islands; Region 3: DE, DC, MD, PA, VA, WV; Region 4: AL, FL, GA, KY, MS, NC, SC, TN; Region 5: IL, IN, MI, MN, OH, WI; Region 6: AR, LA, NM, OK, TX; Region 7: IA, KS, MO, NE; Region 8: CO, MT, ND, SD, UT, WY; Region 9: AZ, CA, Guam, HI, NV; and Region 10: AK, ID, OR, WA).
† Elevated means the % of visits for ILI is at or above the national or region-specific baseline
‡ National data are for current week; regional data are for the most recent three weeks
§ Includes all 50 states, the District of Columbia, Guam, Puerto Rico, and U.S. Virgin Islands

U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states and Puerto Rico report to CDC the number of respiratory specimens tested for influenza and the number positive by influenza virus type and influenza A virus subtype. Region specific data can be found at http://gis.cdc.gov/grasp/fluview/fluportaldashboard.html.

	Week 52
No. of specimens tested	9,363
No. of positive specimens (%)	2,961 (31.6%)
Positive specimens by type/subtype
Influenza A	2,346 (79.2%)
2009 H1N1	25 (1.1%)
Subtyping not performed	1,112 (47.4%)
H3	1,209 (51.5%)
Influenza B	615 (20.8%)

View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation

Since the start of the season, influenza A (H3N2) viruses have predominated nationally, followed by influenza B viruses, while 2009 H1N1 viruses have been identified rarely. The predominant circulating virus has varied by state and by region.

Antigenic Characterization:

CDC has antigenically characterized 413 influenza viruses [17 2009 H1N1 viruses, 281 influenza A (H3N2) viruses, and 115 influenza B viruses] collected by U.S. laboratories since October 1, 2012.

2009 H1N1 [17]:

• All 17 2009 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2012-2013 influenza vaccine for the Northern Hemisphere.

Influenza A (H3N2) [281]:

279 (99.3%) of the 281 H3N2 influenza viruses tested have been characterized as A/Victoria/361/2011-like, the influenza A (H3N2) component of the 2012-2013 Northern Hemisphere influenza vaccine.
2 (0.7%) of the 281 H3N2 viruses tested showed reduced titers with antiserum produced against A/Victoria/361/2011.

Influenza B (B/Yamagata/16/88 and B/Victoria/02/87 lineages) [115]:

Yamagata Lineage [79]: 79 (68.7%) of the 115 influenza B viruses tested so far this season have been characterized as B/Wisconsin/1/2010-like, the influenza B component of the 2012-2013 Northern Hemisphere influenza vaccine.
Victoria Lineage [36]: 36 (31.3%) of 115 influenza B viruses tested have been from the B/Victoria lineage of viruses.

Antiviral Resistance:

Testing of 2009 H1N1, influenza A (H3N2), and influenza B virus isolates for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) is performed at CDC using a functional assay. Additional 2009 influenza A (H1N1) clinical samples are tested for a single mutation in the neuraminidase of the virus known to confer oseltamivir resistance (H275Y). The data summarized below combine the results of both testing methods. These samples are routinely obtained for surveillance purposes rather than for diagnostic testing of patients suspected to be infected with antiviral-resistant virus.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among 2009 influenza A (H1N1) and A (H3N2) viruses (the adamantanes are not effective against influenza B viruses). As a result, data from adamantane resistance testing are not presented below.

Neuraminidase Inhibitor Resistance Testing Results on Samples Collected Since October 1, 2012
	Virus Samples tested (n)	Resistant Viruses, Number (%)	Virus Samples tested (n)	Resistant Viruses, Number (%)
	Oseltamivir		Zanamivir
Influenza A (H3N2)	526	0 (0.0)	526	0 (0.0)
Influenza B	226	0 (0.0)	226	0 (0.0)
2009 H1N1	39	0 (0.0)	30	0 (0.0)

Weekly
August 27, 2010 / 59(33);1057-1062

Influenza infections are associated with thousands of deaths every year in the United States, with the majority of deaths from seasonal influenza occurring among adults aged ≥65 years (1–4). For several decades, CDC has made annual estimates of influenza-associated deaths, which have been used in influenza research and to develop influenza control and prevention policy. To update previously published estimates of the numbers and rates of influenza-associated deaths during 1976–2003 by adding four influenza seasons through 2006–07, CDC used statistical models with data from death certificate reports. National mortality data for two categories of underlying cause of death codes, pneumonia and influenza causes and respiratory and circulatory causes, were used in regression models to estimate lower and upper bounds for the number of influenza-associated deaths. Estimates by seasonal influenza virus type and subtype were examined to determine any association between virus type and subtype and the number of deaths in a season. This report summarizes the results of these analyses, which found that, during 1976–2007, estimates of annual influenza-associated deaths from respiratory and circulatory causes (including pneumonia and influenza causes) ranged from 3,349 in 1986–87 to 48,614 in 2003–04. The annual rate of influenza-associated death in the United States overall during this period ranged from 1.4 to 16.7 deaths per 100,000 persons. The findings also indicated the wide variation in the estimated number of deaths from season to season was closely related to the particular influenza virus types and subtypes in circulation.

The current study extends estimates of influenza-associated deaths from two previous CDC studies (2,3) by adding data from four more influenza seasons for a total of 31 influenza seasons (1976–2007). Estimates are provided for three age groups (<19 years, 19--64 years, and ≥65 years) and for two categories of underlying cause of death codes: 1) pneumonia and influenza causes and 2) respiratory and circulatory causes. Deaths from pneumonia and influenza causes are highly correlated with the circulation of influenza (1) and can be considered a lower bound for deaths associated with influenza (2,4). However, a diagnosis of influenza virus infection often is not confirmed with sensitive and specific laboratory diagnostics, particularly among older persons, and even when identified is rarely recorded on death certificates (5). Many deaths associated with influenza infections occur from secondary infections such as bacterial pneumonia or complications of chronic conditions such as congestive heart failure and chronic obstructive pulmonary disease (6). Therefore, estimates using underlying respiratory and circulatory mortality data (which include pneumonia and influenza causes) can provide an upper bound for influenza-associated deaths (2,7).

Using methods published previously (2,3), CDC estimated the numbers and rates of influenza-associated deaths by virus type and subtype by using Poisson regression models that incorporated weekly national respiratory viral surveillance data. Weekly influenza test results by virus type and subtype were provided by approximately 80 World Health Organization (WHO) and 70 National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories in the United States (8). Prominent influenza type and subtype were defined as at least 20% of all isolates that were tested in that season. Mortality data were obtained from the National Vital Statistics System and reflect the underlying cause of death recorded on death certificates (9). Deaths were categorized using the International Classification of Diseases eighth revision (ICD-8), ninth revision (ICD-9), or 10th revision (ICD-10), as appropriate. Weekly estimates of the U.S. population by age group were used as part of the model to correspond to the weekly viral surveillance estimates. All data for deaths with underlying pneumonia and influenza causes and respiratory and circulatory causes were actual counts based on the death certificate ICD codes. To estimate the proportion of deaths that were influenza associated, the average annual number of deaths estimated by the model was divided by the average annual counts of death with underlying pneumonia and influenza causes and respiratory and circulatory causes.

For deaths with underlying pneumonia and influenza causes during 1976–2007 in the United States, the models estimated an annual overall average of 6,309 (range: 961 in 1986–87 to 14,715 in 2003–04) influenza-associated deaths (Table 1). For these underlying causes, the average annual rate of influenza-associated death was 2.4 deaths per 100,000 (range: 0.4–5.1).

Among persons aged <19 years, an estimated annual average of 97 (range: 41 in 1981--82 to 234 in 1977--78) influenza-associated deaths with underlying pneumonia and influenza causes occurred (Table 1). The average annual rate of influenza-associated deaths for this age group was 0.1 deaths per 100,000 persons (range: 0.1–0.3). Among adults aged 19–64 years, an estimated annual average of 666 (range: 173 in 1981–82 to 1,459 in 2004–05) influenza-associated deaths with underlying pneumonia and influenza causes occurred. The average annual rate of influenza-associated deaths for this age group was 0.4 deaths per 100,000 persons (range: 0.1–0.8). Among adults aged ≥65 years, an estimated annual average of 5,546 (range: 673 in 1978–79 to 13,245 in 2003–04) influenza-associated deaths with underlying pneumonia and influenza causes occurred. The average annual rate of influenza-associated deaths for this age group was 17.0 deaths per 100,000 (range: 2.4–36.7). Deaths among persons aged ≥65 years accounted for 87.9% of the overall estimated average annual influenza-associated deaths with underlying pneumonia and influenza causes.

For deaths with underlying respiratory and circulatory causes (including pneumonia and influenza causes) during 1976–2007, the models estimated an annual U.S. average overall of 23,607 (range: 3,349 in 1986–87 to 48,614 in 2003–04) influenza-associated deaths (Table 2). For these underlying causes, the average annual rate of influenza-associated death was 9.0 deaths per 100,000 (range: 1.4–16.7).

Among persons aged <19 years, an estimated annual average of 124 (range: 57 in 1981--82 to 197 in 1977--78) influenza-associated deaths with underlying respiratory and circulatory causes occurred (Table 2). The average annual rate of influenza-associated deaths for this age group was 0.2 deaths per 100,000 persons (range: 0.1–0.3). Among adults aged 19–64 years, an estimated annual average of 2,385 (range: 504 in 1981–82 to 4,752 in 2003–04) influenza-associated deaths with underlying respiratory and circulatory causes occurred. The average annual rate of influenza-associated deaths for this age group was 1.5 deaths per 100,000 persons (range: 0.4–3.1). Among adults aged ≥65 years, an estimated annual average of 21,098 (range: 2,344 in 1986–87 to 43,727 in 2003–04) influenza-associated deaths with underlying respiratory and circulatory causes occurred. The average annual rate of influenza-associated deaths for this age group was 66.1 deaths per 100,000 (range: 8.0–121.1). Deaths among persons aged ≥65 years accounted for 89.4% of the overall estimated average annual influenza-associated deaths with underlying respiratory and circulatory causes.

For both causes, the average mortality rates for the 22 seasons during which influenza A(H3N2) was a prominent strain were 2.7 times higher than for the nine seasons that it was not. The average annual number of influenza-associated deaths during influenza A(H3N2) prominent seasons was 7,722 for pneumonia and influenza causes and 28,909 for respiratory and circulatory causes, compared with 2,856 deaths for pneumonia and influenza causes and 10,648 deaths for respiratory and circulatory causes in seasons in which it was not.

The distribution of mortality across age groups was similar for the two groups of coded deaths. For pneumonia and influenza causes, the proportions of average deaths overall were 1.5%, 10.6%, and 87.9% for persons aged <19 years, 19--64 years, and ≥65 years, respectively. For respiratory and circulatory causes, the proportions were 0.5%, 10.1%, and 89.4%.

Based on an average annual count of 74,363 for all pneumonia and influenza deaths, and an average annual estimate of 6,309 deaths associated with influenza in this category, 8.5% of all pneumonia and influenza deaths were influenza associated. Based on an annual average count of 1,132,319 for all respiratory and circulatory deaths and an average annual estimate of 23,607 deaths associated with influenza in this category, 2.1% of all respiratory and circulatory deaths were influenza associated.

Reported by

MG Thompson, PhD, DK Shay, MD, H Zhou, MSc, MPH, CB Bridges, MD, PY Cheng, PhD, E Burns, MA, JS Bresee, MD, NJ Cox, PhD, Influenza Div, National Center for Immunization and Respiratory Diseases, CDC.

Editorial Note

This report updates estimates of the number of influenza-associated deaths from the 1976–77 through 2006–07 influenza seasons and demonstrates the substantial variability in mortality estimates by year, influenza virus type/subtype, and age group. The estimated rates of influenza-associated hospitalizations and deaths vary substantially from one influenza season to the next, depending, in part, on the characteristics of the circulating influenza virus strains (10). Because of this variability, a single estimate cannot be used to summarize influenza-associated deaths. This report provides estimates for two categories of underlying cause of death codes, pneumonia and influenza causes and respiratory and circulatory causes; if only one category is used to summarize the mortality effects of influenza, the respiratory and circulatory data likely provide the most accurate estimates. During the past three decades, the estimated number of annual influenza-associated deaths from respiratory and circulatory causes ranged from a low of 3,349 to a high of 48,614 deaths.

A previous study (2) presented an average annual estimate of 25,420 influenza-associated respiratory and circulatory deaths during a 23-season period; this study estimated an average of 23,607 annual influenza-associated deaths using the same model but over a 31-year period. The findings in this report are similar to those of previous CDC studies (2,3) and other cross-decade studies that used similar models (4,7).

When describing the severity of seasonal influenza epidemics, examining seasons with the same circulating influenza virus type is useful. For example, during seasons with prominent circulation of influenza A(H3N2) viruses, 2.7 times more deaths occurred than during seasons when A(H3N2) viruses were not prominent. An annual estimate of 36,155 influenza-associated respiratory and circulatory deaths often is quoted from an earlier CDC study (2); however, that average was calculated for the period 1990–1999, when more severe influenza A(H3N2) viruses were prominent for eight of the nine seasons.

Variations in influenza-associated mortality by age group also should be noted. As reported in this and other studies (2,3), approximately 90% of influenza-associated deaths occur among adults aged ≥65 years. An estimated annual average of 124 persons aged <19 years and 2,385 aged 19--64 years die from influenza-associated respiratory or circulatory causes. Future research that considers years-of-life-lost is needed to better communicate the mortality burden of influenza in these younger populations. Future research also is needed to estimate and communicate the risk for influenza-associated mortality among different demographic and health risk groups.

The findings in this report are subject to at least four limitations. First, the models do not account for cocirculating pathogens such as respiratory syncytial virus (RSV). Future research should replicate and extend models that distinguish between deaths associated with influenza versus RSV (2). Second, estimates over time might not be comparable because the influenza virus surveillance data used to model mortality rely on national influenza testing practices, which have changed over the past decade (8). Future research should consider how trends in testing practices can be included in these models and cross-season estimates of influenza-associated mortality. Third, increases in the U.S. population aged ≥65 years during the study period could have contributed to a general increase in influenza-associated mortality. Age-adjusting future estimates or estimating deaths in smaller age categories among older adults could address this issue. Finally, because the estimates made in this report rely on national death certificate data and these data currently are available only through 2007, preliminary estimates of 2009 influenza A(H1N1)-associated deaths are not directly comparable with these results.*

Debate will continue regarding the most appropriate statistical models and cause of death categories to use in estimating the number of influenza-associated deaths (1,7). This study’s provision of estimates for more narrow (pneumonia and influenza causes) and more broad (respiratory and circulatory causes) categories continues the strategy of comparing and contrasting results from different models as advocated by CDC (1–3) and others (7).

Influenza infections are associated with substantial medical costs, hospitalizations, lost productivity, and thousands of deaths every year in the United States. Annual influenza vaccination is the best way to reduce the risk for complications from influenza infections and is now recommended for all persons aged ≥6 months in the United States. Prompt treatment with influenza antiviral medications can reduce the risk for severe illness and death among persons at increased risk for influenza or who are hospitalized with suspected or confirmed influenza.

References

Thompson WW, Moore MR, Weintraub E, et al. Estimating influenza-associated deaths in the United States. Am J Pub Health 2009;99:S225–30.

Thompson WW, Shay DK, Weintraub E, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 2003;289:179–86.

Thompson WW, Weintraub E, Dhankhar P, et al. Estimates of US influenza-associated deaths made using four different methods. Influenza Other Respi Viruses 2009;3:37–49.

Simonsen L, Reichert TA, Viboud C, Blackwelder WC, Taylor RJ, Miller MA. Impact of influenza vaccination on seasonal mortality in the US elderly population. Arch Intern Med 2005;165:265–72.

Wiselka M. Influenza: diagnosis, management, and prophylaxis. BMJ 1994;308:1341–5.

Schanzer DL, Langley JM, Tam TW. Co-morbidities associated with influenza-attributed mortality, 1994–2000, Canada. Vaccine 2008;26:4697–703.

Newall AT, Viboud C, Wood JG. Influenza-attributable mortality in Australians aged more than 50 years: a comparison of different modelling approaches. Epidemiol Infect 2010;138:836–42.

Brammer L, Budd A, Cox N. Seasonal and pandemic influenza surveillance considerations for constructing multicomponent systems. Influenza Other Respi Viruses 2009:3,51–8.

CDC. Mortality data, multiple cause detail, 1972–2007. Public use data tapes contents and documentation package. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2007.

Russell CA, Jones TC, Barr IG, et al. Influenza vaccine strain selection and recent studies on the global migration of seasonal influenza viruses. Vaccine 2008;26(Suppl 4):D31–4.

* CDC estimates of 2009 H1N1 deaths are available at http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm.

*TABLE 1. Estimated number of annual influenza-associated deaths with underlying pneumonia and influenza causes, by age group — United States, 1976–77 through 2006–07 influenza seasons**
Season	Prominent influenza type/subtype†	<19 yrs		19–64 yrs		≥65 yrs		Overall
Season	Prominent influenza type/subtype†	No.	(95% CI§)	No.	(95% CI)	No.	(95% CI)	No.	(95% CI)
1976–77	B / A(H3N2)	155	(85–488)	485	(357–958)	2,126	(1,847–3,013)	2,766	(2,289–4,459)
1977–78	A(H3N2) / A(H1N1)	234	(171–458)	771	(671–1,139)	3,889	(3,668–4,610)	4,894	(4,510–6,207)
1978–79	A(H1N1)	128	(86–343)	235	(159–530)	673	(511–1,327)	1,036	(756–2,200)
1979–80	B	100	(65–280)	336	(270–594)	1,706	(1,530–2,321)	2,142	(1,865–3,195)
1980–81	A(H3N2) / A(H1N1)	115	(78–284)	483	(411–715)	3,054	(2,878–3,650)	3,652	(3,367–4,649)
1981–82	B / A(H1N1)	41	(18–155)	173	(112–402)	903	(746–1,490)	1,117	(876–2,047)
1982–83	A(H3N2)	114	(78–222)	621	(512–859)	4,393	(4,091–5,035)	5,128	(4,681–6,116)
1983–84	A(H1N1) / B	123	(78–241)	466	(343–735)	2,548	(2,168–3,279)	3,137	(2,589–4,255)
1984–85	A(H3N2)	130	(100–217)	805	(743–1,056)	6,663	(6,459–7,363)	7,598	(7,302–8,636)
1985–86	B / A(H3N2)	88	(52–172)	487	(388–728)	3,607	(3,328–4,313)	4,182	(3,768–5,213)
1986–87	A(H1N1)	70	(47–167)	186	(127–454)	705	(510–1,478)	961	(684–2,099)
1987–88	A(H3N2)	75	(44–144)	509	(425–729)	4,375	(4,087–5,017)	4,959	(4,556–5,890)
1988–89	B / A(H1N1)	120	(71–212)	536	(391–798)	3,559	(3,095–4,331)	4,215	(3,557–5,341)
1989–90	A(H3N2)	91	(65–158)	662	(581–888)	6,158	(5,882–6,857)	6,911	(6,528–7,903)
1990–91	B	56	(35–123)	363	(284–598)	2,907	(2,624–3,659)	3,326	(2,943–4,380)
1991–92	A (H3N2) / A(H1N1)	82	(53–158)	592	(496–833)	5,494	(5,151–6,269)	6,168	(5,700–7,260)
1992–93	B / A(H3N2)	88	(57–164)	638	(533–913)	5,673	(5,290–6,587)	6,399	(5,880–7,664)
1993–94	A (H3N2)	77	(63–142)	647	(592–881)	6,705	(6,491–7,535)	7,429	(7,146–8,558)
1994–95	A(H3N2) / B	71	(47–128)	599	(512–818)	5,997	(5,692–6,752)	6,667	(6,251–7,698)
1995–96	A(H1N1) / A(H3N2)	76	(38–144)	508	(377–761)	4,357	(3,877–5,236)	4,941	(4,292–6,141)
1996–97	A(H3N2) / B	97	(71–153)	857	(764–1,103)	8,719	(8,348–9,582)	9,673	(9,183–10,838)
1997–98	A(H3N2)	78	(66–141)	787	(725–1,038)	8,528	(8,271–9,405)	9,393	(9,062–10,584)
1998–99	A(H3N2) / B	85	(65–146)	854	(749–1,102)	8,716	(8,336–9,589)	9,655	(9,150–10,837)
1999–00	A(H3N2)	85	(67–159)	911	(826–1,187)	9,598	(9,242–10,540)	10,594	(10,135–11,886)
2000–01	B / A(H1N1)	67	(43–136)	482	(340–774)	3,362	(2,824–4,350)	3,911	(3,207–5,260)
2001–02	A(H3N2)	107	(80–176)	1,218	(1,086–1,535)	11,966	(11,471–13,001)	13,291	(12,637–14,712)
2002–03	B / A(H1N1)	82	(40–148)	677	(483–990)	5,097	(4,421–6,068)	5,856	(4,944–7,206)
2003–04	A(H3N2)	103	(87–184)	1,367	(1,250–1,741)	13,245	(12,777–14,422)	14,715	(14,114–16,347)
2004–05	A(H3N2) / B	115	(83–192)	1,459	(1,269–1,781)	12,872	(12,276–13,854)	14,446	(13,628–15,827)
2005–06	A(H3N2)	101	(64–193)	1,268	(1,080–1,646)	10,415	(9,782–11,449)	11,784	(10,926–13,288)
2006–07	A(H1N1) / B / A(H3N2)	67	(20–212)	657	(355–1,147)	3,906	(2,973–5,176)	4,630	(3,348–6,535)
Average		97	(65–201)	666	(555–949)	5,546	(5,182–6,373)	6,309	(5,802–7,524)
Minimum		41	(18–123)	173	(112–402)	673	(510–1,327)	961	(684–2,047)
Maximum		234	(171–488)	1,459	(1,269–1,781)	13,245	(12,777–14,422)	14,715	(14,114–16,347)
* Deaths were categorized using the International Classification of Diseases eighth revision (ICD-8), ninth revision (ICD-9), or 10th revision (ICD-10), as appropriate. † Prominent influenza type and subtype were defined as at least 20% of all isolates that were typed or subtyped in that season. § Confidence interval.

*TABLE 2. Estimated number of annual influenza-associated deaths with underlying respiratory and circulatory causes, by age group — United States, 1976–77 through 2006–07 influenza seasons**
Season	Prominent influenza type/subtype†	<19 yrs		19–64 yrs		≥65 yrs		Overall
Season	Prominent influenza type/subtype†	No.	(95% CI§)	No.	(95% CI)	No.	(95% CI)	No.	(95% CI)
1976–77	B / A(H3N2)	136	(51–590)	2,089	(1,500–4,520)	14,387	(13,026–18,767)	16,612	(14,577–23,877)
1977–78	A(H3N2) / A(H1N1)	197	(120–530)	3,901	(3,409–5,808)	23,889	(22,890–27,398)	27,987	(26,419–33,736)
1978–79	A(H1N1)	136	(71–418)	1,160	(758–2,981)	3,385	(2,565–6,701)	4,681	(3,394–10,100)
1979–80	B	108	(59–354)	814	(474–2,395)	9,436	(8,607–12,428)	10,358	(9,140–15,177)
1980–81	A(H3N2) / A(H1N1)	123	(70–343)	2,631	(2,243–4,087)	16,894	(16,112–19,690)	19,648	(18,425–24,120)
1981–82	B / A(H1N1)	57	(21–271)	504	(205–1,927)	4,808	(4,104–7,597)	5,369	(4,330–9,795)
1982–83	A(H3N2)	146	(83–363)	3,109	(2,582–4,521)	22,916	(21,662–25,741)	26,171	(24,327–30,625)
1983–84	A(H1N1) / B	168	(84–410)	1,547	(914–3,127)	12,010	(10,399–15,248)	13,725	(11,397–18,785)
1984–85	A(H3N2)	156	(113–364)	3,932	(3,636–5,287)	30,849	(30,074–33,718)	34,937	(33,823–39,369)
1985–86	B / A(H3N2)	120	(53–322)	1,493	(1,039–2,833)	15,785	(14,731–18,638)	17,398	(15,823–21,793)
1986–87	A(H1N1)	97	(54–332)	908	(612–2,376)	2,344	(1,575–5,541)	3,349	(2,241–8,249)
1987–88	A(H3N2)	106	(55–284)	2,188	(1,808–3,313)	18,986	(17,940–21,541)	21,280	(19,803–25,138)
1988–89	B / A(H1N1)	161	(80–378)	1,478	(855–2,772)	13,454	(11,814–16,440)	15,093	(12,749–19,590)
1989–90	A(H3N2)	120	(73–306)	2,559	(2,226–3,693)	23,903	(22,995–26,556)	26,582	(25,294–30,555)
1990–91	B	87	(42–274)	874	(527–2,039)	11,303	(10,307–14,099)	12,264	(10,876–16,412)
1991–92	A (H3N2) / A(H1N1)	111	(61–301)	2,413	(2,027–3,559)	20,935	(19,797–23,722)	23,459	(21,885–27,582)
1992–93	B / A(H3N2)	131	(71–340)	1,769	(1,345–3,018)	21,143	(19,931–24,273)	23,043	(21,347–27,631)
1993–94	A (H3N2)	102	(73–280)	2,518	(2,314–3,645)	24,317	(23,617–27,133)	26,937	(26,004–31,058)
1994–95	A(H3N2) / B	102	(53–263)	2,070	(1,730–3,083)	21,739	(20,779–24,283)	23,911	(22,562–27,629)
1995–96	A(H1N1) / A(H3N2)	117	(45–305)	1,747	(1,218–2,902)	15,754	(14,197–18,678)	17,618	(15,460–21,885)
1996–97	A(H3N2) / B	134	(93–312)	2,771	(2,409–3,896)	30,448	(29,273–33,300)	33,353	(31,775–37,508)
1997–98	A(H3N2)	105	(77–279)	2,938	(2,707–4,082)	29,198	(28,382–32,093)	32,241	(31,166–36,454)
1998–99	A(H3N2) / B	117	(72–290)	2,735	(2,361–3,882)	29,076	(27,871–31,951)	31,928	(30,304–36,123)
1999–00	A(H3N2)	114	(80–289)	3,418	(3,078–4,651)	32,988	(31,862–36,088)	36,520	(35,020–41,028)
2000–01	B / A(H1N1)	107	(46–298)	1,140	(603–2,490)	10,800	(9,059–14,148)	12,047	(9,708–16,936)
2001–02	A(H3N2)	151	(103–331)	3,986	(3,473–5,381)	40,833	(39,338–44,233)	44,970	(42,914–49,945)
2002–03	B / A(H1N1)	117	(42–295)	1,847	(1,095–3,206)	16,981	(14,874–20,213)	18,945	(16,011–23,714)
2003–04	A(H3N2)	135	(100–331)	4,752	(4,349–6,299)	43,727	(42,261–47,394)	48,614	(46,710–54,024)
2004–05	A(H3N2) / B	147	(86–321)	4,491	(3,804–5,862)	42,479	(40,579–45,630)	47,117	(44,469–51,813)
2005–06	A(H3N2)	130	(74–333)	4,130	(3,428–5,687)	35,841	(33,840–39,305)	40,101	(37,342–45,325)
2006–07	A(H1N1) / B / A(H3N2)	102	(13–368)	2,033	(1,015–4,110)	13,438	(10,343–17,839)	15,573	(11,371–22,317)
Average		124	(68–338)	2,385	(1,927–3,788)	21,098	(19,832–24,206)	23,607	(21,828–28,332)
Minimum		57	(13–263)	504	(205–1,927)	2,344	(1,575–5,541)	3,349	(2,241–8,249)
Maximum		197	(120–590)	4,752	(4,349–6,299)	43,727	(42,261–47,394)	48,614	(46,710–54,024)
* Includes cause of death codes for influenza and pneumonia. Deaths were categorized using the International Classification of Diseases eighth revision (ICD-8), ninth revision (ICD-9), or 10th revision (ICD-10), as appropriate. † Prominent influenza type and subtype were defined as at least 20% of all isolates that were typed or subtyped in that season. § Confidence interval.

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All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (http://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

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[돼지독감] 신종플루 백신접종 순응도의 개인별 차이 존재 이유

건강과대안 — Sat, 09 Oct 2010 16:48:08 +0000

Why Some Will Get Flu Vaccine — and Why Some Won’t

65% of Moms Say Their Kids Will Get Flu Vaccine

By Daniel J. DeNoon
WebMD Health News
http://www.webmd.com/cold-and-flu/news/20101007/why-some-will-get-flu-vaccine-and-why-some-wont

Oct. 7, 2010 – This year, 95% of doctors but only 65% of mothers say they’ll get their children vaccinated against the flu.

The figures come from a series of surveys commissioned by the National Foundation for Infectious Diseases (NFID), which strongly supports the CDC’s recommendation that everyone over age 6 months get the flu vaccine.

The surveys, conducted in August and September, offer an intriguing look at who does and doesn’t get their recommended flu vaccination — and why.

“There is growing recognition of the threat flu poses and a growing understanding that vaccination is a best buy. It is the best way to protect yourself against the flu,” CDC Director Thomas Frieden, MD, MHP, said at a news conference to announce the findings.

The survey findings support Frieden’s assertion. While only 18% of mothers said they’d changed their position on flu vaccination since last year, nearly all mothers who shifted opinions (88%) decided to vaccinate their kids.

The top reasons why mothers decided to vaccinate their children against the flu:

96% want to protect their family.

95% want to protect their communities.

95% want to protect other children with underlying health conditions.

93% worry that the flu can hospitalize a healthy child; 92% worry it can kill.

71% said last year’s flu pandemic made them more aware of how severe flu can be for children.

Mother’s whose kids had once had the flu are more likely to plan to vaccinate their kids than those whose kids have never had the flu (70% vs. 56%).

Doctors and Flu Vaccination

If you haven’t heard, 40% of people in health-care-associated jobs get flu shots. But the NFID poll of pediatricians and primary care doctors found that 95% of doctors plan to get their flu vaccine this year. Only 2% said they definitely would not.

And they aren’t just getting protection for themselves: 96% of doctors recommend the vaccine to their close friends and extended families.

But even doctors don’t know everything about flu vaccination. Only 39% of primary care doctors and just 75% of pediatricians know that the flu vaccine isn’t recommended for kids younger than 6 months of age. Only 65% of doctors know that the vaccine now is recommended for all healthy adults ages 18-49.

Flu Vaccine Myths

If doctors are a bit confused over the universal recommendation for flu vaccination, the general public is guilty of some wishful thinking.

One in 10 Americans gets the flu each year. While 90% of deaths are in the elderly, many deaths and hospitalizations occur in otherwise healthy children and adults. And even a “mild” case of the flu will make you miserable for a week.

Yet among the 43% of Americans who say they probably or definitely won’t get their flu vaccine this year:

71% say there are other effective ways to prevent flu (Fact: While hand washing helps, it’s not nearly as effective as vaccination).

69% say they’re healthy, so why worry about the flu.

62% believe the flu vaccine can cause the flu (Fact: It can’t) or cause side effects (Fact: The odds of serious harm from a flu shot are extremely small).

51% worry about vaccine ingredients.

47% say they never get the flu.

35% say their immune system will be stronger if they get the flu.

29% say they don’t believe in any vaccines.

18% say it’s inconvenient to get vaccinated.

62% of adults think the flu vaccine protects against only one flu strain (Fact: It protects against three strains — type B flu, type A H1N1 flu, and type A H3N2 flu).

34% of adults think hand washing works just as well as vaccination.

43% of adults don’t know that grownups under age 50 can get the nasal mist vaccine instead of the flu shot.

The survey of mothers, conducted Aug. 12-25 among a national sample of 505 mothers of children ages 6 months to 18 years, has a margin of error of plus or minus 4 percentage points. It was fielded by Opinion Research Corporation.

The survey of doctors, conducted in September among 101 pediatricians and 300 primary care physicians, has a margin of error of plus or minus 5.8 percentage points. It was fielded by Sermo Inc.

The adult survey, conducted Aug. 27-30 in 1,010 adult men and women age 18 and older, has a margin of error of plus or minus 3 percentage points. It was fielded by Opinion Research Corporation.

[돼지독감] 미국인 43%, “신종플루 백신 접종받지 않을 것”

건강과대안 — Sat, 09 Oct 2010 16:34:07 +0000

미국인의 43%가 올해 신종플루 백신을 접종하지 않겠다고 밝힌 여론조사 결과가 나왔습니다. 아이를 둔 엄마들 중에서 1/3도 자신의 아이에게 신종플루 접종을 받게 하지 않을 것이라고 답변했다고 합니다.

반면 의사들 중 90%는 백신접종을 받을 것이라고 답변했으며, 신종플루 백신 접종을 받지 않을 것이라고 답변한 의사는 2%에 불과했다고 합니다.

올해 미 정부당국은 H1N1을 포함한 계절성 독감백신을 1억1천9백만명 분을 공급했는데, 이는 지난해보다 3천만명 분을 더 늘린 것입니다.(지난해에도 엄청난 신종플루 백신이 남아 돌아서 예산낭비 논란이 있었는데… 신종플루 위험성이 더욱 낮아진 올해는 잉여백신 문제가 더욱 심각해질 것으로 추정됩니다)

과학적으로 백신 접종은 바이러스성 전염병을 예방하는 최선의 길인데도 불구하고, 백신에 대한 대중들의 미신에 의해 백신 접종 불순응이 상당한 것은 사실에 가까울 것입니다.

그러나 WHO를 비롯한 전문가들이 신종플루의 위험성을 지나치게 과장한 것이 결국 대중들의 백신 불순응에 영향을 끼친 것은 아닌지에 대한 분석은 전혀 없어 아쉽습니다.

=========================================================

Many Americans Plan to Skip Flu Shot This Year

By Steven Reinberg
HealthDay Reporter by Steven Reinberg
healthday Reporter – Thu Oct 7, 7:08 pm ET
http://news.yahoo.com/s/hsn/20101007/hl_hsn/manyamericansplantoskipflushotthisyear

THURSDAY, Oct. 7 (HealthDay News) — Although vaccination against influenza can protect people from illness and help prevent the spread of flu, many Americans say they and their children won’t be getting a shot this coming season, new surveys reveal.

Despite the attention surrounding last year’s outbreak of H1N1 flu, 43 percent of Americans say they will not be getting the vaccine this fall, according to a survey from the National Foundation for Infectious Diseases (NFID).

Another survey from the same group found a third of American mothers saying they have no plans to get a flu shot for their children.

Those decisions could come back to haunt Americans, experts said.

“Flu is serious. Every year millions of people get sick; more than 200,000 people are hospitalized and thousands of people die from influenza,” Dr. Thomas R. Frieden, director of the U.S. Centers for Disease Control and Prevention, said during a Thursday morning press conference. In keeping with CDC guidelines, “everyone over the age of 6 months should get a flu shot,” he said.

Flu vaccination remains the best way to protect yourself against the illness, Frieden added.

“There is plenty of vaccine available,” he said. “This year we think that the three strains of influenza in the flu vaccine are going to be excellent matches with the flu that’s circulating.”

This year’s shot contains vaccine against the H1N1 pandemic flu that caused a major outbreak in the last flu season, Frieden noted.

“More than 119 million doses [of flu vaccine] have already been distributed in the United States. That’s more than 30 million more doses than were distributed by this time last year,” Dr. Daniel Jernigan, Deputy Director of CDC’s Influenza Division, said during the press conference.

However, as important as flu vaccine is, many people still don’t get vaccinated.

Flu expert Dr. Marc Siegel noted that many people who opt not to get a flu shot are falling prey to myths about the vaccine. “It’s all because of this nonsense that’s been circulating that somehow the flu shot is dangerous,” he said. “The fear of the vaccine outweighs the fear of the disease and that’s a huge mistake, because the disease is more dangerous than the vaccine.”

In addition, children should be vaccinated not only so they won’t get the flu, but so they can’t spread it, Siegel, an associate professor of medicine at New York University, said. “Children don’t have any immunity. They are super-spreaders of the flu,” he explained.

According to the NFID telephone survey of more than 1,000 adults, conducted in late August, one big factor in deciding to get vaccinated is a doctor’s recommendation. In addition, the desire to protect family members and not having to be laid up for a week were also reasons cited by most people who planned on getting the shot, the survey found.

In addition, 77 percent of Americans are aware that new recommendations support most people getting a flu shot and are planning to get vaccinated. And awareness of the vaccine’s effectiveness does seem to boost acceptance, the survey found.

Among mothers, 80 percent said they had not changed their attitude about flu vaccine since last year’s H1N1 scare and 65 percent do plan to have their children vaccinated. However, 33 percent don’t plan on vaccinating their children, while 2 percent are undecided, according to the survey. The survey was conducted in mid-August and involved more than 600 mothers of children aged 6 to 18.

Among the 43 percent of Americans who don’t plan on being vaccinated misconceptions — and what the researchers call “magical thinking” — were cited as reasons for not getting a shot. These include mistaken beliefs that there are other ways to protect yourself from flu (71 percent), or the belief that they are healthy and the flu “doesn’t worry them” (69 percent).

About half of those who are balking at getting the shot worry that the vaccine may be harmful, while 62 percent believe that the vaccine actually gives you the flu (it doesn’t) or side effects. Forty-eight percent don’t believe the vaccine will match the flu that is circulating and so won’t be effective.

Other misconceptions abound: According to the survey, 62 percent of all Americans mistakenly think the vaccine protects against just one strain of flu, and 34 percent think hand-washing is as effective as the vaccine in preventing influenza.

“The idea that you are not going to spread the flu by washing your hands has never been proven,” Siegal noted.

The story is different for those folks charged with advising people on flu: doctors.

In a separate NFID online survey of 400 physicians, conducted in mid-September, an overwhelming 90 percent said they planned to get vaccinated. Three percent remained uncertain and less than 2 percent of doctors said they would not get vaccinated.

In addition, most doctors recommend flu shots to their families, friends and patients, the survey found.

According to NFID, each year flu causes more than 200,000 hospitalizations and between 3,330 and 49,000 deaths, depending on the severity of circulating strains.

[돼지독감] 신종플루 치명률 계절독감과 비슷(법정전염병 발생현황)

건강과대안 — Wed, 29 Sep 2010 18:27:57 +0000

“신종플루 치명률 계절독감과 비슷”

출처 : 연합뉴스 2010/09/29 14:27
http://www.yonhapnews.co.kr/politics/2010/09/29/0505000000AKR20100929119700017.HTML?template=2087

(서울=연합뉴스) 정주호 기자 = 올들어 국내에서 모두 5만6천여명이 신종인플루 엔자에 감염됐으며 신종플루의 치명률이 계절독감과 유사한 수준인 것으로 나타났다.

국회 보건복지위 소속 전현희 의원(민주당)이 29일 질병관리본부로부터 제출받은 법정전염병 발생현황 자료를 분석한 결과 올들어 8월말 현재 5만6천848명이 신종플루에 감염된 것으로 집계됐다.

   지난해 신종플루 확진 환자는 모두 70만6천911명이었다.

   지난 2∼3월에 6명의 신종플루 사망자가 나온 것을 포함해 지금까지 국내에서 270명이 신종플루에 감염돼 사망한 것으로 나타났다.

   이에 따라 2008년 12월부터 2010년 8월까지의 신종플루 치명률은 0.035%로 분석됐다. 환자 3천명당 1명이, 인구 10만명당 0.54명이 사망한 셈이다.

   질병관리본부 관계자는 “다른 전염병에 비해 치명률이 낮은 편이며 계절독감 치명률과 유사한 수준”이라고 말했다.

   인구 10만명당 신종플루 환자를 연령별로 보면 0∼9세 5천510명, 10∼19세 4천58명, 20∼29세 1천291명, 30∼39세 661명, 40∼49세 349명, 50∼59세 327명, 60∼69세 188명, 70세 이상 139명이었다.

   반면 연령별 치명률은 70세 이상 1.97%, 60∼69세 0.79%로 다른 연령층에 비해 높았다. 특히 60대 이상의 사망환자가 149명으로 전체 사망자 중 55.2%를 차지했다.

   아울러 작년에 1천494명의 신종플루 환자가 해외에서 유입돼 들어온 데 이어 올해도 모두 14명의 신종플루 환자가 국내에 들어온 것으로 보고됐다.

   전현희 의원은 “지난달 인도에서 79명이 신종플루로 사망했고 뉴질랜드와 태국에서도 신종플루 감염자가 지속적으로 발생하는 만큼 해외 유입을 차단하기 위한 검역을 강화할 필요가 있다”고 말했다.

   jooho@yna.co.kr

[돼지독감] 65세 이상 노인, 독감 백신 효과 없어?..‘08 김우주교수 연구팀, 높은 혈청 방어율 유도 주장

건강과대안 — Thu, 25 Feb 2010 14:31:47 +0000

65세 이상 노인, 독감 백신 효과 없어?
국제 CC 연구, 65세 이상 노인 독감 백신효과 미약
‘08 김우주교수 연구팀, 높은 혈청 방어율 유도 주장

출처 : 하이닥 김경원 기자 richgold97@hidoc.co.kr 기사입력 2010-02-22 16:25
http://health.jknews.co.kr/article/news/20100222/5915297.htm

65세 이상 노인에 대한 독감 백신 접종이 실제 독감 예방에 효과가 없다는 연구결과가 나와 논란이 예상된다.

외신들은 최근 이탈리아 로마 소재의 보건분야 국제 비영리단체인 ‘코흐레인 콜레보레이션(CC)’ 코머스 제퍼슨 박사 연구팀의 이 같은 연구결과를 보도했다.

연구팀은 전 세계에서 계절성 독감(인플루엔자) 백신 효과에 관한 연구보고서 75개를 수집-분석한 결과, 실제 계절성 독감 백신 접종이 계절성 독감 예방에 효과가 있다는 증거는 거의 없었다고 밝혔다.

즉, 우리나라를 비롯해 세계 여러 나라 보건당국에서 면역력이 취약한 65세 이상 노인을 대상으로 매년 독감 예방 무료 접종을 실시하고 있지만 효과는 장담할 수 없다는 이야기다. 이는 지난해 3월 고대의대 김우주 교수 연구팀이 2007~2008년 독감백신유용성에 대한 연구사업을 실시한 결과에 반하는 연구결과다.

김우주 교수 연구팀은 건강한 성인뿐만 아니라 고령자군과 만성질환이 있는 환자군에서도 독감백신 접종 후 높은 혈청 방어율(seroprotection)이 유도됐다고 밝힌 바 있다.

AD 그러나 코머스 박사 연구팀은 “65세 이상 노인에서 독감 백신의 효과가 매우 미약한 것으로 나타났다”면서 “독감 시즌에 독감을 예방하기 위해 백신 접종을 하는 외에 개인위생을 준수하고 충분한 물과 음식을 섭취하는 것이 필요하다”고 권고했다.

한편, 인플루엔자 바이러스는 변이가 많은 바이러스로 매년마다 유행하는 종류가 다르므로 매년 새로 접종을 받아야 하는 것으로 알려져 있다. 백신은 매년 그 해에 유행하게 될 종류의 바이러스에 대한 것으로 만들어지며, 보통 10~12월에 접종이 이뤄지고 있다.

우리나라에서는 50세 이상의 모든 성인에서 접종이 권유되고 있으며, 특히 심혈관계질환자, 만성 폐질환자 등 만성질환자를 비롯해 65세 이상 노인, 면역저하자, 6~59개월 사이의 영유아 등이 우선접종대상자로 꼽힌다.

==============================================

Influenza Vaccines: Poor Evidence for Effectiveness in Elderly

http://www.sciencedaily.com/releases/2010/02/100216203146.htm

ScienceDaily (Feb. 17, 2010) — Evidence for the safety and efficacy of influenza vaccines in the over 65s is poor, despite the fact that vaccination has been recommended for the prevention of influenza in older people for the past 40 years. These are the conclusions of a new Cochrane Systematic Review.

Adults aged 65 and over are some of the most vulnerable during influenza season and a priority for vaccination programmes. However, very few systematic reviews of the effectiveness of vaccines in this group have ever been carried out.

The researchers conducted a thorough search of studies based on previous vaccine trials. Randomised controlled trials (RCTs) are often considered the “gold standard,” but of the 75 studies included in their review, the researchers were only able to identify one recent RCT with “real” outcomes. In other words, this was the only RCT that used influenza cases as an outcome, as opposed to surrogate outcomes such as measurements of influenza antibodies in the blood. All the other studies included in the review were deemed of low quality and open to bias.

Limited reliable evidence from the studies suggests that the effectiveness of influenza vaccines is modest at best. “Our estimates are consistently below those usually quoted by economists and in decision making,” says lead researcher Tom Jefferson of the Cochrane Collaboration in Rome, Italy. “But until we have all available evidence, it is hard to reach any clear conclusions about the effectiveness of influenza vaccines in older people.”

“As the evidence is so scarce at the moment, we should be looking at other strategies to complement vaccinations. Some of these are very simple things like personal hygiene, and adequate food and water,” says Jefferson. “Meanwhile, we need to undertake a high quality, publicly funded trial that runs over several seasons to try to resolve some of the uncertainties we’re currently facing.”

Jefferson is also one of the authors of a second review publishing this week, which focuses on the efficacy of influenza vaccinations in healthcare workers who work with the elderly. The results are also inconclusive, with each of the four trials included in the review being of inadequate quality and reaching implausible conclusions. The researchers were unable to draw any conclusions about whether vaccinating healthcare workers helps to prevent influenza symptoms and death in people aged over 60.

========================

인플루엔자 백신(성인)의 유용성 평가 연구 / 식품의약품안전청 [편] 식품의약품안전청 2008

*연구책임자 : 김우주(고대 구로병원 감염내과 교수, 감염병학 전공)
*2개년 총연구비 : 3억1천만원
*원문공개 : 국회도서관

표제지
용역연구개발과제 최종보고서[개인신상정보 삭제]
제출문
목차
연구결과보고서 요약문[개인신상정보 삭제] 8
Summary[개인신상정보 삭제] 10
총괄연구개발과제 연구결과 12
제1장 총괄연구개발과제의 최종 연구개발 목표 12
1.1. 총괄연구개발과제의 목표 12
1.2. 총괄연구개발과제의 목표달성도 13
1.3. 국내·외 기술개발 현황 14
제2장 총괄연구개발과제의 최종 연구개발 내용 및 방법 15
2.1. 인플루엔자 백신접종의 면역원성 및 면역 지속능 평가 15
2.2. 인플루엔자 백신의 안전성 조사 21
제3장 총괄연구개발과제의 최종 연구개발 결과 23
3.1. 연구수행체계 및 대상군의 특성 23
3.2. 인플루엔자 백신 접종 후 면역원성 평가 25
3.3. 인플루엔자 백신 접종 후 면역지속능 평가 30
3.4. 인플루엔자 백신 접종 후 안전성 평가 40
제4장 총괄연구개발과제의 연구결과 고찰 및 결론 41
4.1. 연구결과의 고찰 41
4.2. 연구의 결론 47
제5장 총괄연구개발과제의 연구성과 48
제6장 기타 중요변경사항 50
제7장 참고문헌 51
제8장 첨부서류 54
총괄 연구과제 요약[개인신상정보 삭제] 56

[돼지독감] 미 질병관리본부 신종플루 공식통계 및 추정통계

건강과대안 — Sat, 16 Jan 2010 19:03:28 +0000

[미 질병관리본부 신종플루 공식 통계]

입원 환자 : 38,455명
사망 환자 : 1,779명

[미 질병관리본부 신종플루 추정 통계]

신종플루 추정 감염자 : 3천9백만명~8천만명 (평균 5천5백만명)
신종플루 추정 입원자 : 17만3천명~36만2천명(평균 24만6천명)
신종플루 추정 사망자 : 7천8백80명~1만6천4백60명(평균 1만1천1백60명)

*** 미국에서 계절성 독감으로 인한 사망자가 연평균 3만6천명라는 사실을 염두에 두고 평가를 해보면…

공식 통계로 잡힌 신종플루 사망자는 계절성 독감 사망자의 1/20에 불과하다. 추정사망자 통계를 가지고 관대하게 평가하다고 하더라도 신종플루 사망자는 계절성 독감 사망자의 1/3에 불과했다는 점을 확인할 수 있다.

참고로 현재까지 신종플루로 사망한 사람은 전세계적으로 13,000~15,000명 정도로 집계되고 있고… 추정 사망자로 높게 잡는다고 하더라도 10만명~15만명 수준을 넘지 않을 것으로 보인다.

그런데 해마다 전세계적으로 계절성 독감으로 사망하는 사람이 25만~50만명으로 추정된다.

따라서 미국 질병관리본부(CDC)의 통계에 따른 계절성 독감 사망자와 비교해본 수치와 세계보건기구(WHO) 또는 유럽연합질병관리본부(ECDC)의 통계에 따른 계절성 독감 사망자와 비교해본 수치의 비율이 거의 비슷하다.(미국에서 신종플루 사망자와 계절성 독감 사망자의 비율은 전세계 신종플루 사망자와 전세계 계절성 독감 사망자의 비율과 비슷하다.)

따라서 2009 신종플루 대유행 선언은 지나치게 과장되었음을 확인할 수 있다. 객관적으로 봤을 때, 2009 신종플루는 대유행 인플루엔자라기 보다는 돼지독감 바이러스가 인간에게 전염된 약간 특이한 형태(전염율은 일반 계절성 독감보다 높으나 치명율은 계절성 독감보다 훨씬 낮으며, 65세 이하의 젊은층에게 더 피해를 끼쳤음. 국내에서는 특이하게 65세 이상의 기저질환자의 사망이 압도적으로 많았음.)의 계절성 독감 바이러스라고 생각한다.

=========================

CDC Estimates of 2009 H1N1 Cases and Related Hospitalizations and Deaths from April-December 12, 2009, By Age Group

2009 H1N1	Mid-Level Range*	Estimated Range *
Cases
0-17 years	~18 million	~12 million to ~26 million
18-64 years	~32 million	~23 million to ~47 million
65 years and older	~5 million	~4 million to ~7 million
Cases Total	~55 million	~39 million to ~80 million
Hospitalizations
0-17 years	~78,000	~55,000 to ~115,000
18-64 years	~145,000	~102,000 to ~213,000
65 years and older	~23,000	~16,000 to ~34,000
Hospitalizations Total	~246,000	~173,000 to ~362,000
Deaths
0-17 years	~1,180	~830 to ~1,730
18-64 years	~8,620	~6,090 to ~12, 720
65 years and older	~1,360	~960 to ~2,010
Deaths Total	~11,160	~7,880 to ~16,460

(출처 : http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm)

Percentage of Visits for Influenza-like Illness (ILI) Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), National Summary 2008-2009 and Previous Two Seasons

출처 : 미 질병관리본부 (Posted January 15, 2010, 5:00 PM ET, for Week Ending January 8, 2010)
http://www.cdc.gov/h1n1flu/updates/us/#iligraph

**PERCENTAGE OF VISITS FOR INFLUENZA-LIKE-ILLNESS REPORTED BY SENTINEL PROVIDERS 2009-2010**
Week	Age 0-4	Age 5-24	Age 25-64	Age 25-49	Age 50-64	Age over 64	Total ILI	Total Patients	% Unweighted ILI	% Weighted ILI
35	3712	12930	3851	x	x	425	20918	612507	3.41514464324489	3.4732640676835
36	4082	13326	4477	x	x	514	22399	602176	3.71967663938782	4.06321953907124
37	4481	15359	5668	x	x	650	26158	688867	3.79724968680456	4.24531323184887
38	4503	14082	5186	x	x	582	24353	653067	3.72902014647808	4.17942338153808
39	5040	16405	6085	x	x	568	28098	655255	4.28810157877468	4.89294937942399
40	8950	26138	x	8051	2126	872	46137	805069	5.73081313527164	6.16663957444425
41	10846	30233	x	9449	2585	1001	54114	811607	6.66751272475472	7.09287934696687
42	12274	36618	x	11285	2781	1004	63962	851344	7.51306170008833	7.71641644615004
43	12388	34425	x	11137	2841	1044	61835	839902	7.36216844346126	7.60255809880468
44	11109	28187	x	9154	2411	1018	51879	820196	6.32519544108969	6.7689366829816
45	9367	18745	x	7151	2042	857	38162	746318	5.11336990398195	5.49631201112116
46	6658	11126	x	4782	1348	622	24536	627837	3.90802071238235	4.25024554240254

x = Age group not used that week

Laboratory Confirmed Influenza-Associated Hospitalizations
and Deaths from August 30 2009 to January 9, 2010

Posted January 15, 2010, 11:00 AM ET
Data reported to CDC by January 12, 2010, 12:00 AM ET

Cases Defined by	Hospitalizations	Deaths
Influenza Laboratory-Tests**	38,455	1,779
Reports can be based on syndromic, admission or discharge data, or a combination of data elements that could include laboratory-confirmed and influenza-like illness hospitalizations. Laboratory confirmation includes any positive influenza test (rapid influenza tests, RT-PCR, DFA, IFA, or culture), whether or not typing was done. The table shows aggregate reports of all laboratory confirmed influenza hospitalizations and deaths (including 2009 H1N1 and seasonal flu) since August 30, 2009 received by CDC from U.S. states and territories. This table will be updated weekly each Friday at 11 a.m. For the 2009-2010 influenza season, states are reporting based on new case definitions for hospitalizations and deaths effective August 30, 2009. CDC will continue to use its traditional surveillance systems to track the progress of the 2009-2010 influenza season. For more information about influenza surveillance, including reporting of influenza-associated hospitalizations and deaths, see Questions and Answers: Monitoring Influenza Activity, Including 2009 H1N1. The number of 2009 H1N1 hospitalizations and deaths reported to CDC from April – August 2009 is available on the Past Situation Updates page. For state level information, refer to state health departments. International Human Cases of 2009 H1N1 Flu Infection See: World Health Organization. States report weekly to CDC either 1) laboratory-confirmed influenza hospitalizations and deaths or 2) pneumonia and influenza syndrome-based cases of hospitalization and death resulting from all types or subtypes of influenza. Although only the laboratory confirmed cases are included in this report, CDC continues to analyze data both from laboratory confirmed and syndromic hospitalizations and deaths.

Cases Defined by

Hospitalizations

Deaths

Influenza Laboratory-Tests**

38,455

1,779

*Reports can be based on syndromic, admission or discharge data, or a combination of data elements that could include laboratory-confirmed and influenza-like illness hospitalizations.

*Laboratory confirmation includes any positive influenza test (rapid influenza tests, RT-PCR, DFA, IFA, or culture), whether or not typing was done.

The table shows aggregate reports of all laboratory confirmed influenza hospitalizations and deaths (including 2009 H1N1 and seasonal flu) since August 30, 2009 received by CDC from U.S. states and territories**. This table will be updated weekly each Friday at 11 a.m. For the 2009-2010 influenza season, states are reporting based on new case definitions for hospitalizations and deaths effective August 30, 2009.

CDC will continue to use its traditional surveillance systems to track the progress of the 2009-2010 influenza season. For more information about influenza surveillance, including reporting of influenza-associated hospitalizations and deaths, see Questions and Answers: Monitoring Influenza Activity, Including 2009 H1N1.

The number of 2009 H1N1 hospitalizations and deaths reported to CDC from April – August 2009 is available on the Past Situation Updates page.

For state level information, refer to state health departments.

International Human Cases of 2009 H1N1 Flu Infection
See: World Health Organization.

**States report weekly to CDC either 1) laboratory-confirmed influenza hospitalizations and deaths or 2) pneumonia and influenza syndrome-based cases of hospitalization and death resulting from all types or subtypes of influenza. Although only the laboratory confirmed cases are included in this report, CDC continues to analyze data both from laboratory confirmed and syndromic hospitalizations and deaths.

U.S. Influenza-associated Pediatric Mortality
Posted January 15, 2010 (Updated Weekly)
Data reported to CDC by January 9, 2010
Date Reported	Laboratory-Confirmed 2009 H1N1 Influenza Pediatric Deaths	Laboratory-Confirmed Influenza A Subtype Unknown Pediatric Deaths	Laboratory-Confirmed Seasonal Influenza	Total
This Week (Week 1, January 3, 2009 to January 9, 2010)	6	1	0	7
Since August 30, 2009	195	40	1	236
Cumulative since April 26, 2009	255	43	2	300
This table is based on data reported to CDC through the Influenza-Associated Pediatric Mortality Surveillance System. Influenza-associated deaths in children (persons less than 18 years) was added as nationally notifiable condition in 2004. For more information about influenza-associated pediatric mortality, see FluView.

View Full Screen | View PowerPoint Presentation

=================

CDC Estimates of 2009 H1N1 Influenza Cases, Hospitalizations and Deaths in the United States, April – December 12, 2009

출처 : 미 질병관리본부, January 15, 2010 1:00 PM ET
http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm

[돼지독감] “신종플루 대유행은 ‘허위 대유행’”..제약회사들이 대유행 선언토록 공포심 조장”

건강과대안 — Tue, 12 Jan 2010 10:15:29 +0000

“신종플루 대유행은 ‘허위 대유행’”

제약회사들이 대유행 선언토록 공포심 조장”

출처 : 연합뉴스 2010/01/12 09:15 송고

(서울=연합뉴스) 신종플루(인플루엔자 A［H1N1］) 확산세가 주춤한 가운데 제약회사들이 `대유행(pandemic)’을 선언하도록 세계보건기구(WHO)에 압력을 가하기 위해 신종플루 공포를 확산시켰다는 주장이 나와 파문을 일으키고 있다.

유럽회의 의원총회(PACE)의 볼프강 보다르크 보건분과위원장은 신종플루 대유행은 신종플루 백신으로 막대한 이익을 챙긴 제약회사들이 주도한 ‘허위 대유행’이며 금세기 최대 의학 비리 가운데 하나라고 주장했다고 영국 일간 선지가 11일 보도했다.

WHO는 신종플루가 확산하자 지난해 6월 인플루엔자 경보의 최고 단계인 대유행을 선언했었다.
보다르크 위원장은 신종플루는 “일반적인 종류의 독감일 뿐”이라면서 사망률이 계절성 독감의 10분의 1도 안된다고 지적했다.

그는 신종플루에 대한 공포심 조장은 대유행이 선언되면 ‘대박’을 터트릴 것이라는 걸 알고 있던 제약회사 대표들에게 다시없는 기회를 제공했다고 말했다.

그는 “우리는 어떤 근거로 누가 (대유행) 결정을 내렸으며, 제약업계가 의사결정에 어떻게 영향력을 미쳤는지 알길 원한다”면서 “WHO 내 일군의 사람들이 제약업계와 매우 긴밀한 관계를 맺고 있다”고 주장했다.
47개 유럽국가 정부 간 협력기구인 유럽회의는 이달 말 긴급회의를 열고 제약회사들이 신종플루 대유행 선언에 어떤 영향을 미쳤는지 논의할 예정이다.

이와 관련, WHO는 최근 신종플루 대유행이 아직 끝나지 않았다는 입장을 재확인했지만 신종플루 사망자 수는 애초 우려했던 것보다 훨씬 적다.
보다르크 위원장은 또 신종플루 백신의 안전성에 대해서도 의문을 제기했다.

그는 앞서 프랑스 일간 뤼마니테 일요판과 인터뷰에서 “백신이 너무 급하게 개발됐으며 일부 성분은 충분한 시험을 거치지 못했다”고 주장했다.

yunzhen@yna.co.kr

[돼지독감] WHO 신종플루와 계절성 독감 사망 비교

건강과대안 — Tue, 29 Dec 2009 12:32:08 +0000

2009 대유행 인플루엔자와 계절성 독감 사망 비교

2009.12.22 WHO
http://www.who.int/csr/disease/swineflu/notes/briefing_20091222/en/index.html

* 계절성 독감에 비해 2009 대유행 인플루엔자 바이러스는 어린 연령층(Younger age groups)에 더 치명적임.

사망자 수나 치사율로 봤을 때 2009 인플루엔자 대유행(pandemic)이 일반적 계절독감보다 심각한 것은 아니지만 아직은 정확한 비교가 어려운 상황임. 정확한 사망자 수, 치사율 평가는 대유행 정점을 지나 1~2년 뒤에나 가능할 것임.

*2009 인플루엔자 대유행(pandemic) 사망자는 실험실 확정진단(laboratory-confirmed deaths)을 받은 사례로 집계된 경우만 한정되어 있음. 감염 사실이 확인되지 않은 사망자도 있어 실제 수치는 통상적으로 이보다 많기 때문에 정확한 비교를 할 수 없음.

* 계절성 독감 유행 시 사망자의 약 90%가 만성질병을 앓는, 취약한 노령층인 반면 신종플루의 경우 감염자, 입원 환자, 집중치료 환자, 사망자 등에서 어린 연령층(Younger age groups)이 더 취약한 것으로 드러남.

Comparing deaths from pandemic and seasonal influenza

Pandemic (H1N1) 2009 briefing note 20

22 DECEMBER 2009 | GENEVA — Efforts to assess the severity of the H1N1 influenza pandemic sometimes compare numbers of confirmed deaths with those estimated for seasonal influenza, either nationally or worldwide. Such comparisons are not reliable for several reasons and can be misleading.

Numbers of deaths for seasonal influenza are estimates. They use statistical models designed to calculate so-called excess mortality that occurs during the period when influenza viruses are circulating widely in a given population.

Estimates using all-cause mortality

The models use data, as recorded in death certificates and medical records, indicating mortality from all causes, and compare the number of deaths during epidemics of seasonal influenza with baseline data on deaths during the rest of the year. The assumption is that infections with influenza viruses contribute to the “excess mortality” observed during the influenza season.

During epidemics of seasonal influenza, around 90% of deaths occur in the frail elderly, who often suffer from one or more chronic medical conditions. Although influenza can worsen these conditions and contribute to death, testing for influenza viruses is not done in most cases, and deaths are usually attributed to an underlying medical condition.

Methods for estimating excess mortality were introduced in the 19th century to capture these influenza-associated deaths that would otherwise be missed. Such estimates have helped counter assumptions that influenza is a mild illness that rarely kills.

Laboratory-confirmed deaths

In contrast, numbers of deaths from pandemic influenza, as notified by national authorities and tabulated by WHO, are laboratory-confirmed deaths, not estimates. For several reasons, these numbers do not give a true picture of mortality during the pandemic, which is unquestionably higher than indicated by laboratory-confirmed cases.

As pandemic influenza mimics the signs and symptoms of many common infectious diseases, doctors often do not suspect H1N1 infection and do not test. This is especially true in developing countries, where deaths from respiratory diseases, including pneumonia, are common occurrences. Moreover, routine testing for pandemic influenza is costly and demanding, and beyond the reach of most countries.

When testing confirms H1N1 infection in patients with underlying medical conditions, many doctors record these deaths as due to the medical condition, and not to the pandemic virus. These cases are also missed in official statistics.

As recent studies have shown, some tests for H1N1 infection are not entirely reliable, and false-negative results are a frequent problem. Accurate test results further depend on how and when samples were taken. Even in the best-equipped hospitals, doctors have reported seeing patients with distinctive and virtually identical disease profiles, yet only some have positive test results.

Moreover, in a large number of developing countries, systems for vital registration are either weak or non-existent, meaning that most deaths are neither investigated nor certified in terms of the cause.

Younger age groups

Comparisons of deaths from pandemic and seasonal influenza do not accurately measure the impact of the pandemic for another reason. Compared with seasonal influenza, the H1N1 virus affects a much younger age group in all categories – those most frequently infected, hospitalized, requiring intensive care, and dying.

WHO continues to assess the impact of the influenza pandemic as moderate. Accurate assessments of mortality and mortality rates will likely be possible only one to two years after the pandemic has peaked, and will rely on methods similar to those used to calculate excess mortality during seasonal influenza epidemics.