Capture-recapture analysis and pneumococcal meningitis estimates in England

To improve estimates of disease incidence and deaths from pneumococcal meningitis among adults in England, we performed a capture-recapture analysis for 1996 through 1999. We compared data from Hospital Episode Statistics (HES) and the Public Health Laboratory Services (PHLS) for incidence estimates and from HES and the Office for National Statistics (ONS) for estimates of deaths. Estimated sensitivities for the examined systems were 46% (95% confidence interval [CI] 42% to 50%) for HES and 40% [95% CI 37% to 44%] for PHLS. Sensitivities for mortality rates were found to be similar, 48% [95% CI 41% to 55%] for HES and 49% [95% CI 42% to 56%] for ONS. Stratification analysis showed that the sensitivity in those > 85 years of age was significantly lower than the sensitivity for other ages. The estimated case-fatality rate was 24% [95% CI 21% to 26%]. These estimates indicate that a cost-benefit analysis of adult pneumococcal vaccination programs is required.