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.

The changing profile of infant mortality from bacterial, viral and fungal infection over two decades

“…Overall, our findings are in keeping with other similar studies which report ~10% neonatal deaths and ~20% post‐neonatal infant deaths from infectious causes . Our data evaluate more thoroughly clinical and microbiological data than do studies utilizing death certificate data: microbiological and post‐mortem results may not be known when the death certificate is issued . In comparison to such studies, we identified the causal pathogens in 72% of cases and identified that preterm infants account for almost two‐thirds of infection‐related infant deaths.…”

A 28‐year study of human parainfluenza in Rio Grande do Sul, Southern Brazil

“…In the present study, 2.43% of the patients infected with hPIV died; when only hospitalized patients with SARI are considered, the mortality rate for hPIV infection increases to 4.57% and occurs mainly in children and elderly people with underlying diseases, such as cardiovascular and/or pneumopathy; of note, these comorbidities increase the risk to virus infection, including influenza infection . In England and Wales, it has been estimated that three deaths occur per year due to infection by hPIV2 in children up to 1‐year old. In addition, hPIV has also been associated with mortality and a greater impact in the elderly above 75 years .…”

Emergency Department Visit Data for Rapid Detection and Monitoring of Norovirus Activity, United States

“…Linear regression models were fitted to assess the degree of correlation between syndromic surveillance ED visit data from the BioSense system and norovirus outbreak activity following an approach that has been described ( 14 ). In a series of linear regression models, BioSense ED visits mapped by chief complaint to diarrhea and nausea/vomiting (as a monthly proportion of all ED visits) were regressed on monthly reported norovirus outbreaks from January 2007–April 2010.…”