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Our ref: FoI/09/01511

17 November 2009

Dear Mr McGillivray

Thank you for your email of 2 November which requested information under the Freedom of Information (Scotland) Act 2002 on the number of deaths from seasonal influenza in Scotland since the start of the H1N1 Swine Flu pandemic. I have been asked to provide a response to the question you have raised.

Thus far this flu season (2009-10), there have been no deaths from seasonal influenza communicated to colleagues in NHS Health Protection Scotland. However, I detail below some of the difficulties that exist around identifying deaths as a result of influenza.

The General Register Office for Scotland (GRO(S)) receives all data held on each death registered in Scotland and this is collated into the GRO(S) Annual Report. From time to time, GRO(S) also compiles reports comparing trends over time. If influenza is recorded at any point on a death certificate this information is counted in these official statistics.

GRO(S) have recently produced a report compiling information on influenza deaths across the period 1990 to the end of the 2008/2009 seasonal flu season, and this is available at: http://www.gro-scotland.gov.uk/statistics/publications-and-data/increased-winter-mortality/increased-winter-mortality-in-scotland-2008-09.html.

In this report, GRO(S) comment on the difficulty of capturing data on influenza related deaths. In overview, it is likely that to date there has been under-reporting of influenza, which is due to the fact that recording of deaths is often ascribed to a complication of influenza rather than to influenza itself. In many cases, the episode of influenza has passed, and the physician reporting the death may not record this infection on the death certificate. Furthermore a number of experts suggest that stress on the body caused by influenza may precipitate heart attacks, strokes and other conditions in those who are already in poor physical health. It will be these rapidly fatal conditions that appear on the death certificates rather than influenza itself. This may also explain partly the excess winter deaths due to stroke and heart attacks, although other factors such as the cold temperatures may also be attributable. To overcome this difficulty, the GRO(S) report describes excess deaths compared to that expected for each season.

In September this year, the Chief Medical Officer Dr Harry Burns issued a letter to NHS Boards setting out instructions and providing national guidance to those responsible for certifying death certificates. Dr Burns requested that death certificates should record the whole sequence of conditions and events leading up to death, which in future will provide better understanding when establishing the number of deaths where seasonal influenza has been a contributory factor.

If you are unhappy with this response to your request, you may ask us to carry out an internal review, by writing to Dr Kevin Woods, Director General - Health, Floor 1E.07 - St Andrews House, Regent Road, Edinburgh, EH1 3DG. Your request should explain why you wish a review to be carried out, and should be made within 40 working days of receipt of this letter, and we will reply within 20 working days of receipt. If you are not satisfied with the result of the review, you then have the right to make a formal complaint to the Scottish Information Commissioner.

Yours sincerely

RONA WATTERS

Health Protection Team