, 39:399 | Cite as

Excess mortality from seasonal influenza is negligible below the age of 50 in Israel: implications for vaccine policy

  • Y. Linhart
  • T. Shohat
  • M. Bromberg
  • E. Mendelson
  • R. Dictiar
  • M. S. Green
Clinical and Epidemiological Study



Evaluation of the severity of pandemic influenza requires reliable estimates of mortality attributable to the seasonal influenza.


Excess age-specific mortality during periods of influenza activity was evaluated in Israel during the period 1999–2006 for three death categories. For each respiratory year, the lowest monthly moving average for the mortality rate was subtracted from each month in the period of influenza activity. Average mortality rates in years with minimal influenza activity were deducted from corresponding months to exclude winter mortality unrelated to influenza. The sums of these results were used as estimates of excess mortality rates.


Overall excess mortality rates ranged from 7.7 to 36.1 per 100,000 for all causes, and from 4.4 to 24.4 per 100,000 for respiratory and circulatory causes. Influenza was associated with an average of 869 (range 280–1,516) deaths annually from respiratory and circulatory diseases during seasons with significant influenza activity. About 90% of the influenza-associated mortality from respiratory and circulatory diseases was in the age group 65+ years and about 1% in the age group <50 years. The age group <50 years accounted for an annual average of seven deaths from respiratory and circulatory diseases.


Annual mortality associated with seasonal influenza is highly variable. Under the age of 50 years, there is minimal seasonal influenza associated mortality. This information provides an important baseline for evaluating the severity of the A(H1N1) 2009 influenza pandemic, where persons under 50 years of age were often disproportionately represented.


Influenza Mortality Season Age-specific Israel 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Y. Linhart
    • 1
    • 2
  • T. Shohat
    • 2
    • 3
  • M. Bromberg
    • 3
  • E. Mendelson
    • 2
    • 4
  • R. Dictiar
    • 3
  • M. S. Green
    • 5
  1. 1.Tel Aviv District Health Office Ministry of HealthTel-AvivIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Israel Center for Disease Control Ministry of HealthTel HashomerIsrael
  4. 4.Central Virology Laboratory Ministry of HealthTel HashomerIsrael
  5. 5.School of Public HealthUniversity of HaifaHaifaIsrael

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