There were far more casualties of the 2009 swine flu pandemic than official figures state, according to a new study.
At least 200,000 people died during the pandemic and the true figure could be twice that, researchers said yesterday.
The figures compare with fewer than 19,000 deaths confirmed in laboratories and reported to the World Health Organisation.
Dr Lone Simonsen of George Washington University, USA, and colleagues from around the world investigated the death toll from the 2009 outbreak of the H1N1 virus, with funding from the World Health Organisation.
So the team looked at weekly virology figures from the WHO and actual mortality figures from 21 countries (with 35% of the world’s population) to estimate the number of respiratory deaths.
Using a new statistical method, they projected these results to the rest of the world. The number of respiratory deaths could be up to ten times that of previous WHO estimates.
The H1N1 virus also kills by exacerbating existing health problems such as heart disease. This means that the total number of deaths in 2009 might be as high as 400,000.
Most casualties were younger than 65 years of age, the researchers conclude. An almost 20-fold higher death rate was seen in some South American countries than in New Zealand, Australia and most parts of Europe.
The new findings suggest that the public health response to the 2009 outbreak of H1N1 was not excessive, as some have claimed, the researchers claim.
Details appear in the journal PLoS Medicine.
Dr Simonsen commented: "This study confirms that the H1N1 virus killed many more people globally than originally believed."
Simonsen, L. et al. PLoS Medicine 27 November 2013 (in press).
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