AbstractBackgroundInformation on influenza-associated mortality in Russia is limited and largely related to deaths with influenza in the diagnosis that represent a small fraction of all influenza-associated deaths.MethodsUsing previously developed methodology (Goldstein et al., Epidemiology 2012), we regressed the monthly rates of mortality for respiratory causes, as well as circulatory causes (available from the Russian Federal State Statistics Service (Rosstat)) during the 2013/14 through the 2018/19 influenza seasons linearly against the monthly proxies for the incidence of influenza A/H3N2, A/H1N1 and B (obtained using data from the Smorodintsev Research Institute of Influenza (RII) on influenza/ARI consultations, testing of respiratory specimens and genetic/antigenic characterization of influenza viruses), adjusting for the baseline rates of mortality not associated with influenza circulation and temporal trends.ResultsFor the 2013/14 through the 2018/19 seasons, influenza circulation was associated with an average annual 17636 (95% CI (9482,25790)) deaths for circulatory causes and 4179 (3250,5109) deaths for respiratory causes, with the largest number of deaths (32298 (18071,46525) for circulatory causes and 6689 (5019,8359) for respiratory causes) estimated during the 2014/15 influenza season. Influenza A/H3N2 was responsible for 51.8% of all circulatory influenza-associated deaths and 37.2% of all respiratory influenza-associated deaths. Influenza A/H1N1 was responsible for 23.4% of all circulatory influenza-associated deaths and 29.5% of all respiratory influenza-associated deaths. Influenza B was responsible for 24.9% of all circulatory influenza-associated deaths and 33.3% of all respiratory influenza-associated deaths, with the overwhelming majority of those deaths being caused by the B/Yamagata viruses. Compared to the 2013/14 through the 2015/16 seasons, during the 2016/17 through the 2018/19 seasons (when levels of influenza vaccination were significantly higher), the volume of influenza-associated mortality declined by about 16.1%, or 3809 annual respiratory and circulatory deaths.ConclusionsInfluenza circulation is associated with a substantial mortality burden in Russia, particularly for circulatory deaths, with some reduction in mortality rates observed following the major increase in influenza vaccination coverage. Those results support the potential utility of further extending the levels of influenza vaccination, the use of quadrivalent influenza vaccines, and extra efforts for protecting individuals with circulatory disease in Russia, including vaccination and the use of antiviral medications.