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BACKGROUND: Cases of infectious disease resulting in death are important for identifying changes in populations at risk, trends in distribution of disease, and mortality burden. In Texas, deaths are reportable to the Vital Statistics Unit (VSU) and surveillance for most notifiable infectious conditions is conducted by the Emerging and Acute Infectious Disease (EAID) Branch. Using data supplied by VSU, EAID evaluated completeness of infectious disease reporting.
METHODS: VSU staff provided an electronic file of deaths in 2012 with pre-selected ICD-10 codes corresponding to notifiable infectious conditions. EAID staff then reviewed each death record to determine if the patient was previously reported to the disease database (NBS). Deaths caused by multiple notifiable conditions were reviewed independently for each condition. Medical records were obtained for deceased patients that were not identified as previously reported. Each medical record was reviewed to determine if the patient’s laboratory, epidemiologic and clinical presentation met the surveillance case definition. Those that met case definition were added to NBS and included in Texas’s disease counts for 2012.
RESULTS: Of 19 conditions initially selected, deaths occurred for 14 conditions. For 9 conditions (prion diseases, influenza-associated pediatric mortality, hepatitis, Haemophilus Influenza, listeriosis, meningitis (non-meningococcoal), acute meningococcal meningitis, pertussis, and streptococcal disease), no new cases were ascertained by the review of death certificate data and resulted in 100% estimated reporting completeness. In review of the death data, 2 new cases each of legionellosis and salmonellosis were identified. Legionellosis (156 total cases reported, pre-study) and salmonellosis (4990 cases reported, pre study) resulted in 99% (95%CI 96-100%) and 100% (95%CI 100-100%) estimated reporting completeness. Tetanus had two reported cases in NBS, while 1 new case was ascertained by review of 3 death certificates with tetanus mentioned in the cause of death. Tetanus had an estimated reporting completeness of 66% (95% CI 9-99%). Deaths reported for measles and varicella were not consistent with surveillance case definitions.
CONCLUSIONS: Review of death certificate data indicated that reporting of infectious disease deaths is fairly complete. Some additional cases were found, primarily for conditions that are traditionally associated with large sample sizes, high mortality rates, or underreporting. Study of diseases with low numbers or absent data should be followed for multiple years to obtain a higher sample count. Multiple year evaluation of diseases with low incidence or high rates of underreporting may be required to fully evaluate utility of death certificate new case ascertainment and estimation of reporting completeness.