Infection-related mortality in children with malignancy in England and Wales, 2003-2005.
BACKGROUND
Infections are an important component of treatment-related mortality in children with malignancy. Infection-related mortality is potentially preventable and it is important to identify areas where prevention and treatment can be improved such as through vaccination, early diagnosis and aggressive management. The aim of this study is to describe the infections contributing to deaths in children under 15 years with malignancy in England and Wales in the period 2003-2005.


METHODS
Analysis of death certificate data of children under 15 years in England and Wales from 2003-2005 identified all patients with pre-selected ICD-10 codes relating to haematological malignancy or solid tumours and an infectious disease as the main or underlying cause of death.


RESULTS
There were 82 infection-related deaths contributing to approximately 25% of all deaths from haematological malignancy and 5% of all deaths from solid tumours during 2003-2005. This included 15 relapsed patients (18%), 5 haematopoietic stem cell transplant patients (6%) and 4 patients with Down's syndrome (5%). Organisms were documented in 44 deaths (54%). Seventeen infections (21%) were fungal of which 12 (15%) were Aspergillus; 17 (21%) were bacterial, including 9 (11%) Gram-negative isolates. There were 10 (12%) infection-related deaths where viruses were identified of which three deaths were from respiratory syncytial virus (RSV).


CONCLUSIONS
This study shows that infections still make an important contribution to deaths amongst children with malignancy. Effective prevention strategies need to be identified and strengthened.
St George's University of London, Paediatric Infectious Diseases Unit, Cranmer Terrace, London, UK. jbate@sgul.ac.uk
Jessica
J
Bate
Shamez
S
Ladhani
Mike
M
Sharland
Julia
J
Chisholm
Theresa
T
Lamagni
Mary
M
Ramsay
Alan
A
Johnson
Richard
R
Pebody
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000401:mortality*; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D013997:Time Factors; D014852:Wales / Q000453:epidemiology