title: Modelling the unidentified mortality burden from thirteen infectious pathogenic microorganisms in infants.
abstract: 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.
authors.affiliation: Immunisation Department, Health Protection Agency Communicable Disease Surveillance Centre, London, UK.
authors.forename: P V
authors.initials: PV
authors.lastname: Markov
authors.forename: N S
authors.initials: NS
authors.lastname: Crowcroft
mesh_terms: D001419:Bacteria / Q000145:classification / Q000472:pathogenicity; D001424:Bacterial Infections / Q000382:microbiology / Q000401:mortality*; D002423:Cause of Death; D003644:Death Certificates; D018563:Disease Notification / Q000706:statistics & numerical data; D004739:England; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D015233:Models, Statistical; D012042:Registries / Q000706:statistics & numerical data; D014777:Virus Diseases / Q000401:mortality* / Q000821:virology; D014780:Viruses / Q000145:classification / Q000472:pathogenicity; D014852:Wales