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Morbidity profiles of patients consulting during influenza and respiratory syncytial virus active periods

  • D. M. FLEMING (a1), A. J. ELLIOT (a1) and K. W. CROSS (a1)

We compared the burden of illness due to a spectrum of respiratory diagnostic categories among persons presenting in a sentinel general practice network in England and Wales during periods of influenza and of respiratory syncytial virus (RSV) activity. During all periods of viral activity, incidence rates of influenza-like illness, bronchitis and common cold were elevated compared to those in baseline periods. Excess rates per 100 000 of acute bronchitis were greater in children aged <1 year (median difference 2702, 95% CI 929–4867) and in children aged 1–4 years (994, 95% CI 338–1747) during RSV active periods rather than influenza; estimates for the two viruses were similar in other age groups. Excess rates of influenza-like illness in all age groups were clearly associated with influenza virus activity. For common cold the estimates of median excess rates were significantly higher in RSV active periods for the age groups <1 year (3728, 95% CI 632–5867) and 5–14 years (339, 95% CI 59–768); estimates were similar in other age groups for the two viruses. The clinical burden of disease associated with RSV is as great if not greater than influenza in patients of all ages presenting to general practitioners.

Corresponding author
*Author for correspondence: Dr D. M. Fleming, Birmingham Research Unit of the Royal College of General Practitioners, Lordswood House, 54 Lordswood Road, Harborne, Birmingham, B17 9DB, UK. (Email:
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1. Serfling RE, Sherman IL, Houseworth WJ. Excess pneumonia-influenza mortality by age and sex in three major influenza A2 epidemics, United States, 1957–58, 1960 and 1963. American Journal of Epidemiology 1967; 86: 433441.
2. Nguyen-Van-Tam JS. Epidemiology of influenza. In: Nicholson KG, Webster RG, Hay AJ eds. Textbook of Influenza. Oxford: Blackwell Sciences, 1998, pp. 181206.
3. Nicholson KG. Human influenza. In: Nicholson KG, Webster RG, Hay AJ eds. Textbook of Influenza. Oxford: Blackwell Sciences, 1998, pp. 219264.
4. Fleming DM. The contribution of influenza to combined acute respiratory infections, hospital admissions, and deaths in winter. Communicable Disease and Public Health 2000; 3: 3238.
5. Fleming D, Harcourt S, Smith G. Influenza and adult hospital admissions for respiratory conditions in England 1989–2001. Communicable Disease and Public Health 2003; 6: 231237.
6. Simonsen L, et al. Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. Journal of Infectious Diseases 1998; 178: 5360.
7. Fleming DM, et al. The duration and magnitude of influenza epidemics: a study of surveillance data from sentinel general practices in England, Wales and the Netherlands. European Journal of Epidemiology 1999; 15: 467473.
8. Mufson MA, et al. Epidemiology of respiratory syncytial virus infection among infants and children in Chicago. American Journal of Epidemiology 1973; 98: 8895.
9. Anderson LJ, Parker RA, Strikas RL. Association between respiratory syncytial virus outbreaks and lower respiratory tract deaths of infants and young children. Journal of Infectious Diseases 1990; 161: 640646.
10. Fleming DM, Cross KW. Respiratory syncytial virus or influenza? Lancet 1993; 342: 15071510.
11. Nicholson KG. Impact of influenza and respiratory syncytial virus on mortality in England and Wales from January 1975 to December 1990. Epidemiology and Infection 1996; 116: 5163.
12. Crowcroft NS, Cutts F, Zambon MC. Respiratory syncytial virus: an underestimated cause of respiratory infection, with prospects for a vaccine. Communicable Disease and Public Health 1999; 2: 234241.
13. Zambon MC, et al. Contribution of influenza and respiratory syncytial virus to community cases of influenza-like illness: an observational study. Lancet 2001; 358: 14101416.
14. Thompson WW, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. Journal of the American Medical Association 2003; 289: 179186.
15. Fleming DM, Pannell RS, Cross KW. Mortality in children from influenza and respiratory syncytial virus. Journal of Epidemiology and Community Health 2005; 59: 586590.
16. Agius G, et al. An epidemic of respiratory syncytial virus in elderly people: clinical and serological findings. Journal of Medical Virology 1990; 30: 117127.
17. Falsey AR, et al. Viral respiratory infections in the institutionalized elderly: clinical and epidemiologic findings. Journal of the American Geriatrics Society 1992; 40: 115119.
18. Falsey AR, et al. Respiratory syncytial virus and influenza A infections in the hospitalized elderly. Journal of Infectious Diseases 1995; 172: 389394.
19. Falsey AR, et al. Respiratory syncytial virus infection in elderly and high-risk adults. New England Journal of Medicine 2005; 352: 17491759.
20. Stockton J, et al. Multiplex PCR for typing and subtyping influenza and respiratory syncytial viruses. Journal of Clinical Microbiology 1998; 36: 29902995.
21. Aymard M, et al. Surveillance and impact of influenza in Europe. Groupe Regional d'Observation de la Grippe and European Influenza Surveillance Scheme. Vaccine 1999; 17 (Suppl, 1): S3041.
22. Meerhoff TJ, et al. Harmonising the virological surveillance of influenza in Europe: results of an 18-country survey. Virus Research 2004; 103: 3133.
23. Fleming DM, et al. Respiratory illness associated with influenza and respiratory syncytial virus infection. Archives of Disease in Childhood 2005; 90: 741746.
24. Fleming DM. Weekly Returns Service of the Royal College of General Practitioners. Communicable Disease and Public Health 1999; 2: 96100.
25. Campbell MJ, Gardner MJ. Calculating confidence intervals for some non-parametric analyses. In: Gardner MJ, Altman DG eds. Statistics with Confidence: Confidence Intervals and Statistical Guidelines. London: British Medical Association, 1989, pp. 7179.
26. Sunderland RS, Fleming DM. Continuing decline in acute asthma episodes in the community. Archives of Disease in Childhood 2004; 89: 282285.
27. Elliot AJ, Fleming DM. Surveillance of influenza-like illness in England and Wales during 1966–2006. Eurosurveillance 2006; 11(10) (
28. Hall CB, Long CE, Schnabel KC. Respiratory syncytial virus infections in previously healthy working adults. Clinical Infectious Diseases 2001; 33: 792796.
29. Bustamante-Calvillo ME, et al. Molecular detection of respiratory syncytial virus in postmortem lung tissue samples from Mexican children deceased with pneumonia. Pediatric Infectious Disease Journal 2001; 20: 495501.
30. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet 2003; 361: 22262234.
31. Djelantik IG, et al. Incidence and clinical features of hospitalization because of respiratory syncytial virus lower respiratory illness among children less than two years of age in a rural Asian setting. Pediatric Infectious Disease Journal 2003; 22: 150157.
32. Stensballe LG, Devasundaram JK, Simoes EA. Respiratory syncytial virus epidemics: the ups and downs of a seasonal virus. Pediatric Infectious Disease Journal 2003; 22: S2132.
33. World Health Organisation. Epidemic and pandemic alert and response – diseases ( Accessed 24 October 2005.
34. Jefferson T, et al. Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review. Lancet 2005; 366: 11651174.
35. The MIST (Management of Influenza in the Southern Hemisphere Trialists) Study Group. Randomised trial of efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections. Lancet 1998; 352: 18771881.
36. Makela MJ, et al. Clinical efficacy and safety of the orally inhaled neuraminidase inhibitor zanamivir in the treatment of influenza: a randomized, double-blind, placebo-controlled European study. Journal of Infection 2000; 40: 4248.
37. Zambon M, et al. Diagnosis of influenza in the community: relationship of clinical diagnosis to confirmed virological, serologic, or molecular detection of influenza. Archives of Internal Medicine 2001; 161: 21162122.
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