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To the Editor: Total excess mortality has been used to measure the burden of influenza for many years. Dr Thompson and colleagues¹ stated that this death category includes diagnoses that "are not causally linked with respiratory viral infections." Seasonal total excess deaths, however, comprise a small proportion of total mortality; we believe that it is not possible with the limited clinical information on death certificates to accurately designate those complicated by influenza. Even cases listing burns or trauma as the underlying cause of death may be influenza-related if the virus infection occurred coincident with the trauma or was nosocomial. Because neither past nor the current proposed models are able to directly identify influenza-caused deaths, we see no reason to abandon total excess mortality and substitute attributable "respiratory and circulatory deaths." For the sake of continuity and comparability, we believe that the established category should be retained while assessing the value . . . [Full Text of this Article]

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