Epidemiology and Infection


Excess mortality monitoring in England and Wales during the influenza A(H1N1) 2009 pandemic


a1 Statistics Unit, Health Protection Agency Centre for Infections, London, UK

a2 Immunisation, Hepatitis and Blood Safety and Respiratory Diseases Departments, Health Protection Agency Centre for Infections, London, UK


We present the results from a novel surveillance system for detecting excess all-cause mortality by age group in England and Wales developed during the pandemic influenza A(H1N1) 2009 period from April 2009 to March 2010. A Poisson regression model was fitted to age-specific mortality data from 1999 to 2008 and used to predict the expected number of weekly deaths in the absence of extreme health events. The system included adjustment for reporting delays. During the pandemic, excess all-cause mortality was seen in the 5–14 years age group, where mortality was flagged as being in excess for 1 week after the second peak in pandemic influenza activity; and in age groups >45 years during a period of very cold weather. This new system has utility for rapidly estimating excess mortality for other acute public health events such as extreme heat or cold weather.

(Accepted February 23 2011)

(Online publication March 25 2011)


c1 Author for correspondence: Dr P. Hardelid, Dr Foster Unit at Imperial College, 12 Smithfield St, London EC1A 9LA, UK. (Email: p.hardelid@imperial.ac.uk)