Epidemiology and Infection

Modelling the unidentified mortality burden from thirteen infectious pathogenic microorganisms in infants

P. V. MARKOV a1 and N. S. CROWCROFT a1c1
a1 Immunisation Department, Health Protection Agency Communicable Disease Surveillance Centre, London, UK

Article author query
markov pv   [PubMed][Google Scholar] 
crowcroft ns   [PubMed][Google Scholar] 


Official statistics routinely underestimate mortality from specific microorganisms and deaths are assigned to non-specific syndromes. Here we estimate mortality attributed to specific pathogens by modelling non-specific infant deaths from laboratory reports and codes on death certificates for these pathogens, 1993–2000 in England and Wales using a generalized linear model. In total, 22·4–59·8% of non-specific deaths in infants (25–66 deaths a year) are attributable to specific pathogens. Yearly deaths from Bordetella pertussis in neonates are 6·8 [95% confidence interval (CI) 1·5–11·9]. In post-neonates 9·4 (95% CI 2·3–16·6) deaths a year are attributable to Neisseria meningitidis, 7·3 (95% CI 2·4–12·3) to Streptococcus pneumoniae, from 2·8 (95% CI 0·8–4·9) to 15·1 (95% CI 9·4–20·9) to respiratory syncytial virus (RSV) and 3 (95% CI 0·3–5·9) to parainfluenza type 2. Our results suggest there is substantial hidden mortality for a number of pathogens in infants. A considerable proportion of deaths classified to infectious syndromes are non-infectious, suggesting low specificity of death certification. Laboratory reports were the more reliable source, reinforcing the asset of strong surveillance systems.

(Accepted April 3 2006)
(Published Online June 2 2006)

c1 Immunisation Department, Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK. (Email: natasha.crowcroft@hpa.org.uk)