Rapid aging of influenza epidemics in China from 2005/06 to 2016/17: A population-based study

China is an aging society, and the older population is at a higher risk of influenza infection and influenza-related mortality. However, there is limited knowledge regarding the aging of influenza epidemics, which is crucial for estimating the disease burden.

We collected weekly influenza surveillance data from 2005/06 to 2016/17, and quantified the aging of influenza-like illness (ILI) and influenza virus-positive cases in China via the mean age of the influenza cases and the proportion of individuals aged 65 and above among the influenza cases.

On average, the mean age of ILI cases and influenza-positive cases increased by 0.52 years and 0.60 years per year, respectively, which is approximately three times the annual increase in the mean age of the population. Additionally, the proportion of individuals aged 65 and above among influenza-positive cases increased from 0.5% to 4.0%. The aging of patients infected with influenza B/Yamagata was the most rapid, with a mean age increase of 0.73 years per year, followed by those infected with influenza A (H1N1) and influenza A (H3N2). Conversely, there was no significant increase in the mean age of patients infected with influenza B/Victoria. The aging rate of influenza epidemics in southern China was significantly higher than in northern China.

Based on estimates of excess mortality due to influenza from 2010/11 to 2014/15, by 2050, the annual number of respiratory disease-related deaths associated with influenza is projected to increase 2.5-fold. This finding highlights the importance of influenza vaccination among older individuals in China.