Epidemiologist National Child Mortality Database/Cardiff University Axbridge, England, United Kingdom
Background: The National Child Mortality Database records data across England on all children’s deaths. Infectious diseases continue to account for a significant burden of mortality in children. Objective: To describe the characteristics of children and young people who died with, or because, of an infection, and investigate factors associated with these deaths and identify common themes. Design/Methods: We analysed data on childhood (0-17 years) deaths in England between Apr 2019 and Mar 2022 where infection may have contributed to death, or where infection provided a complete and sufficient explanation of death. Pathogens and clinical conditions were identified using free text searching, followed by record-level review. National census data (2021) were used as denominators to calculate annual risk of death per 100,000 children. Underlying health conditions were identified using a combination of data recorded in the National Child Mortality Database and Hospital Episode Statistics. Results: There were 1,507 deaths (4.20 annual deaths per 100,000 children) where infection either caused or contributed to the death, accounting for 15% of all child deaths in this period. In 553 infection was identified as a complete and sufficient explanation of death. Risk of death was highest in infants, children from Black or Asian backgrounds, and in areas of higher deprivation. A pathogen was reported in 65% of deaths; 43% (238/553) were bacterial, 27% (149/553) viral and 3% (17/553) fungal. Group B Streptococcus was the most commonly identified organism (49/553, 9%), followed by coronavirus (45/553, 8%) and Escherichia coli (43/553, 8%). The most common clinical presentation was septicaemia/sepsis (285/553, 52%), while 35% (191/553) had a lower respiratory tract infection. Half of all infection-related deaths (275/553, 50%) were in children with existing life-limiting condition. Of the remaining 954, where infection likely contributed to the death, characteristics of this broader group were similar, although Pseudomonas and coronavirus were the most common pathogens reported (64/954, 8% each). 79% (749/954) of these deaths occurred in children with existing life limiting condition.
Conclusion(s): Infection was implicated in 1 in 7 childhood deaths in England during 2019-22. Infants, children from deprived areas, and those from Asian or Black background had the highest infection-related death rates. Where identified, bacterial infection was the most prevalent, especially group B streptococcal disease in young infants.
