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Emerg Infect Dis. 1999 Sep-Oct; 5(5): 659–671.
PMCID: PMC2627723

The economic impact of pandemic influenza in the United States: priorities for intervention.


We estimated the possible effects of the next influenza pandemic in the United States and analyzed the economic impact of vaccine-based interventions. Using death rates, hospitalization data, and outpatient visits, we estimated 89,000 to 207,000 deaths; 314,000 to 734,000 hospitalizations; 18 to 42 million outpatient visits; and 20 to 47 million additional illnesses. Patients at high risk (15% of the population) would account for approximately 84% of all deaths. The estimated economic impact would be US$71.3 to $166.5 billion, excluding disruptions to commerce and society. At $21 per vaccinee, we project a net savings to society if persons in all age groups are vaccinated. At $62 per vaccinee and at gross attack rates of 25%, we project net losses if persons not at high risk for complications are vaccinated. Vaccinating 60% of the population would generate the highest economic returns but may not be possible within the time required for vaccine effectiveness, especially if two doses of vaccine are required.

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Selected References

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  • Simonsen L, Clarke MJ, Schonberger LB, Arden NH, Cox NJ, Fukuda K. Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. J Infect Dis. 1998 Jul;178(1):53–60. [PubMed]
  • Kavet J. A perspective on the significance of pandemic influenza. Am J Public Health. 1977 Nov;67(11):1063–1070. [PubMed]
  • Campbell DS, Rumley MH. Cost-effectiveness of the influenza vaccine in a healthy, working-age population. J Occup Environ Med. 1997 May;39(5):408–414. [PubMed]
  • Carrat F, Valleron AJ. Influenza mortality among the elderly in France, 1980-90: how many deaths may have been avoided through vaccination? J Epidemiol Community Health. 1995 Aug;49(4):419–425. [PMC free article] [PubMed]
  • Riddiough MA, Sisk JE, Bell JC. Influenza vaccination. JAMA. 1983 Jun 17;249(23):3189–3195. [PubMed]
  • Patriarca PA, Arden NH, Koplan JP, Goodman RA. Prevention and control of type A influenza infections in nursing homes. Benefits and costs of four approaches using vaccination and amantadine. Ann Intern Med. 1987 Nov;107(5):732–740. [PubMed]
  • Schoenbaum SC, McNeil BJ, Kavet J. The swine-influenza decision. N Engl J Med. 1976 Sep 30;295(14):759–765. [PubMed]
  • Cliff AD, Haggett P. Statistical modelling of measles and influenza outbreaks. Stat Methods Med Res. 1993;2(1):43–73. [PubMed]
  • Barker WH, Mullooly JP. Impact of epidemic type A influenza in a defined adult population. Am J Epidemiol. 1980 Dec;112(6):798–811. [PubMed]
  • Simonsen L, Clarke MJ, Williamson GD, Stroup DF, Arden NH, Schonberger LB. The impact of influenza epidemics on mortality: introducing a severity index. Am J Public Health. 1997 Dec;87(12):1944–1950. [PubMed]
  • Fox JP, Hall CE, Cooney MK, Foy HM. Influenzavirus infections in Seattle families, 1975-1979. I. Study design, methods and the occurrence of infections by time and age. Am J Epidemiol. 1982 Aug;116(2):212–227. [PubMed]
  • Glezen WP, Decker M, Joseph SW, Mercready RG., Jr Acute respiratory disease associated with influenza epidemics in Houston, 1981-1983. J Infect Dis. 1987 Jun;155(6):1119–1126. [PubMed]
  • 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. Am J Epidemiol. 1967 Sep;86(2):433–441. [PubMed]
  • Barker WH, Mullooly JP. Pneumonia and influenza deaths during epidemics: implications for prevention. Arch Intern Med. 1982 Jan;142(1):85–89. [PubMed]
  • Glezen WP, Payne AA, Snyder DN, Downs TD. Mortality and influenza. J Infect Dis. 1982 Sep;146(3):313–321. [PubMed]
  • McBean AM, Babish JD, Warren JL. The impact and cost of influenza in the elderly. Arch Intern Med. 1993 Sep 27;153(18):2105–2111. [PubMed]
  • Barker WH. Excess pneumonia and influenza associated hospitalization during influenza epidemics in the United States, 1970-78. Am J Public Health. 1986 Jul;76(7):761–765. [PubMed]
  • Kaufmann AF, Meltzer MI, Schmid GP. The economic impact of a bioterrorist attack: are prevention and postattack intervention programs justifiable? Emerg Infect Dis. 1997 Apr-Jun;3(2):83–94. [PMC free article] [PubMed]

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