Outbreaks of a presumed infectious pathogen creating on/off switching in deaths

Abstract

Background: There is now increasing international evidence for a series of outbreaks of a presumed infectious pathogen which result in 12-month periods of higher deaths, medical admissions, sickness absence, higher gender ratio at birth, stillbirths and certain congenital abnormalities. This study investigates the increase in deaths accompanying these outbreaks in the UK. Methods:Monthly deaths for local government areas in the UK were analysed using a running (moving) 12-month total. The magnitude of sudden step-like increases in deaths were calculated by comparing successive 12-month periods.Results: Statistically significant and large increases in death are observed at approximate 2-year intervals across all local government geographies. Such local 'outbreaks' aggregate to give periods of higher regional and national deaths. Conclusions:A new type of infectious outbreak appears to have been identified, with the potential for a profound change in public health policy. The immune modifying virus cytomegalovirus can be circumstantially implicated.Keywords: Emerging infectious diseases, death, all-cause mortality, spatial analysis, United Kingdom BackgroundThere is now increasing evidence for novel outbreaks of a presumed infectious pathogen. The unique feature of these outbreaks is that various measures of morbidity and mortality all rise for a 12-month period before reverting to baseline levels [1][2][3][4][5][6]. These outbreaks can be traced back to the 1950's, but presumably occur prior to this [7]. The effect upon deaths has been documented in the UK, across Europe, Australia, New Zealand, USA [7][8][9][10], and Canada (unpublished), and occurs in sub-local authority small areas [4,11,12]. The simplest way of detecting these unique events is to utilize a running (moving) 12-month total of deaths. A moving 12-month total is a simple but elegant way to detect on/off or high/low behaviour in a time series. In a running total, such on/off behaviour creates saw-tooth features in which the upward face of the saw-tooth repre- sents 'on' while the downward face represents 'off'. The apex of the saw-tooth gives the magnitude of the increase which prevailed during the previous 12-month period. A running total also has the advantage that seasonality is removed, and that the resulting trend has lower statistical uncertainty due to 12-month totals, rather than the use of monthly data. The is absolutely no demographicbased reason for such saw-tooth behaviour to occur. This study uses local government monthly data from the UK to demonstrate this behaviour. OUTBREAKS OF A PRESUMED INFECTIOUS PATHOGEN CREATING ON/ OFF SWITCHING IN DEATHS