Intended for healthcare professionals

CCBYNC Open access

Rapid response to:


Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study

BMJ 2009; 339 doi: (Published 10 December 2009) Cite this as: BMJ 2009;339:b5213

Rapid Response:

Re: Author's response

Donaldson et al state [1]:

"The official estimate of influenza mortality is produced by the
Health Protection Agency. It is derived from excess all-cause death
registrations in the winter. When the number of all-cause death
registrations rises above an ‘expected’ level in a given week, this excess
is counted. The estimates for the last five years in England & Wales
are: 1965 (2004-05 winter season), 0 (2005-06), 0 (2006-07), 426 (2007-
08), and 10351 (2008-09) . The highest estimate in recent years was for
the 1999-2000 ‘flu season, at 21,497."


"A second estimate of ‘flu deaths is found in the annual mortality
statistics produced by the Office for National Statistics. These
statistics record the underlying cause of death. They are based on all
registered deaths, based on the information on death certificates. The
number of deaths for England & Wales with an underlying cause of
influenza (ICD-10 code J10-J11) for the four recent calendar years are: 39
(2008), 31 (2007), 17 (2006) and 44 (2005). Many more deaths are
attributed to pneumonia, some of which will be secondary to influenza.
Coding of death certificates takes place through out the year. Summary
mortality statistics for the year are normally published in the following

On the other hand a BBC report with which Donaldson was associated in
September 2007 stated [2]:

"According to Department of Health figures, flu contributes to over
25,000 excess winter deaths every year and thousands of people are
hospitalised due to serious complications."

In 2006 I also downloaded from the Department of Health website other
statements about flu mortality which were not only mutually contradictory
but also out of line with the present disclosure or, indeed, the BBC
report [3]. Donaldson's own publication 'Explaining Pandemic Flu" stated:

"Ordinary flu occurs every year during the winter months in the UK.
It affects 10-15% of the UK population, causing around 12,000 deaths every

While an information page reported:

"Even during a winter where the incidence of flu is low, 3-4000
deaths may be attributed to 'flu; this can rise much higher in epidemic
years, for example there were an estimated 13,000 deaths in 1993 which
were attributable to 'flu and 29,000 in 1989/90."

Obviously there are many discrepancies here which need further

[1] Donaldson et al,'Author's response' BMJ Rapid Responses, 24
December 2009

[2] 'At risk urged to get flu shot', BBC News 27 December 2007,

[3] John Stone, 'Some published UK data', BMJ Rapid Responses 2
November 2007,

Competing interests:
None declared

Competing interests: No competing interests

26 December 2009
John Stone
Contributing editor: Age of Autism
London N22