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To the Editor: Dr Thompson and colleagues¹ presented a model that uses influenza and RSV surveillance data to estimate virus-associated mortality. The authors propose that this model replace Serfling-type models, which have been used for 40 years to estimate deaths attributed to influenza by subtracting a model-generated baseline from observed winter deaths.^2-3

The model of Thompson et al averages 34 470 (range, 7608-68 328) total seasonal influenza-related deaths for 1976-1999. This average, much higher than previous reports (approximately 20 000; range, 0-40 000 for 1972-1992),³ suggests that the Serfling models underestimate the mortality burden and that the new model corrects this problem. In fact this is not the case. A Serfling-type model⁴ estimated an average of 37 500 (range 0-74 500) all-cause excess deaths for 1976-1999. Both models report an increase in influenza-related deaths in the 1990s, which for Serfling models is fully explained by a rapidly increasing population of very elderly Americans (for whom influenza-related . . . [Full Text of this Article]