Vibrio vulnificus infection reporting on death certificates: the invisible impact of an often fatal infection

This study assessed accuracy of (a) recording Vibrio vulnificus infection on death certificates and (b) International Classification of Disease (ICD)-9 codes for V. vulnificus. Patients with microbiologically confirmed V. vulnificus infection were identified as part of co-ordinated surveillance in four USA Gulf Coast states between 1989 and 1993. Of 60 deaths, 51 death certificates were reviewed and V. vulnificus was recorded as the immediate cause of death on 11 (22%). There was no ICD-9 code for V. vulnificus infection, thus no patients had an ICD-9 code indicating V. vulnificus infection. Of 23 certificates where V. vulnificus was recorded on the death certificate, only 5 (22%) were coded for Gram-negative, septicaemia. This study highlights the importance of teaching physicians how to provide epidemiologically meaningful data on death certificates and the need for accurate ICD mortality codes.