Excess mortality due to pneumonia or influenza during influenza seasons among persons with acquired immunodeficiency syndrome

Background: Anecdotal reports suggest that influenza-related morbidity may be high among persons with acquired immunodeficiency syndrome (AIDS), but l ittle information is available concerning the population-level impact of in fluenza on mortality in persons with AIDS. Methods: Using the Multiple Cause-of-Death data files, which contain inform ation on all deaths occurring in the United States each year, we calculated the numbers of excess deaths and rates of excess death due to pneumonia or influenza among persons with AIDS aged 13 years and older during the influ enza seasons 1991-1992 through 1993-1994. For comparison, numbers of excess deaths and excess death rates were also calculated for several other group s including the general US population aged 13 years and older and the gener al US population aged 65 years and older. Results: During the 1991-1992, 1992-1993, and 1993-1994 influenza seasons, there were 261, 254, and 191 excess deaths due to pneumonia or influenza in persons with AIDS and excess death rates of 19.74, 15.38, and 10.17 deaths per 10 000 persons, respectively, compared with a summer baseline period. For the same seasons, we observed excess death rates of 1.40, 1.62, and 1.4 8 for the general US population aged 13 years and older and 8.10, 9.28, and 8.54 for the general US population aged 65 years and older. Thus, persons with AIDS had excess death rates substantially higher than the general US p opulation and similar to, if not somewhat higher than, the general US popul ation aged 65 years and older, a group that is already targeted for annual vaccination. The findings were similar when we compared the preinfluenza se ason with the influenza season. Conclusions: Persons with AIDS have significant excess mortality due to pne umonia or influenza during influenza seasons and should be considered a hig h-risk group that is targeted for the prevention of influenza.