Article Text

Download PDFPDF
Infection is associated with one in five childhood deaths in England and Wales: analysis of national death registrations data, 2013–15
  1. Laura Ferreras-Antolín1,2,
  2. Godwin Oligbu1,3,
  3. Ifeanyichukwu O Okike4,
  4. Shamez Ladhani1,5
  1. 1 Paediatric Infectious Diseases Research Group, St. George’s University of London, London, UK
  2. 2 Paediatrics, St. George's University Hospitals NHS Foundation Trust, London, UK
  3. 3 Paediatrics, Dr Gray’s Hospital, Grampian, UK
  4. 4 Paediatrics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
  5. 5 Immunisation Department, Public Health England, London, UK
  1. Correspondence to Dr Shamez Ladhani, Immunisation Department, Public Health England, London NW9 5EQ, UK; shamez.ladhani{at}


Objective To estimate the contribution of infections to childhood deaths in England and Wales over a 3-year period.

Design Retrospective analysis of national electronic death registration data.

Setting England and Wales.

Patients Children aged 28 days to 15 years who died during 2013–15.

Main outcome measures The proportion of children who died of infection compared with total deaths over 3 years; the main pathogens responsible for infection-related deaths in different age groups; comparison with similar data from 2003 to 2005.

Results There were 5088 death registrations recorded in children aged 28 days to <15 years in England and Wales during the three calendar years, 2013–2015 (17.6 deaths/100 000 children annually) compared with 6897 (23.9/100 000) during 2003–05 (incidence rate ratios (IRR) 0.74, 95% CI 0.71 to 0.77). During 2013–15, there were 951 (18.7%, 951/5088) infection-related deaths compared with 1368 (19.8%, 1368/6897) during 2003–05, equivalent to an infection-related mortality rate of 3.3/100 000 compared with 4.8/100 000 during the two periods (IRR 0.69, 95% CI 0.64 to 0.75), respectively. An underlying comorbidity was recorded in 55.0% (523/951) of death registrations during 2013–15 and increased with age. Where recorded, respiratory tract infection was the most commonly reported presentation (374/876, 42.7%) during 2013–15. Central nervous system infections accounted for only 4.8% (42/876). Overall, 63.1% (378/599) of infection-related deaths were associated with a bacterial, 34.2% (205/599) with a viral and 2.5% (15/599) with a fungal infection.

Conclusions Beyond the neonatal period, all-cause and infection-related childhood mortality rates have declined by 26% and 31%, respectively, over the past decade. However, infection continues to contribute to one in five childhood deaths.

  • general paediatrics
  • mortality
  • vaccine
  • infectious diseases

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @shamezladhani

  • Contributors SL conceived the work; LF-A, IOO, GO and SL extracted and analysed the data. LF-A wrote the first draft of the manuscript. All authors contributed to the discussion and edited the manuscript. All authors approved the final submitted version.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Public Health England has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

Linked Articles

  • Atoms
    Nick Brown