{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:02:09Z","timestamp":1791385329761,"version":"4.3.3"},"reference-count":54,"publisher":"eLife Sciences Publications, Ltd","license":[{"start":{"date-parts":[[2019,8,27]],"date-time":"2019-08-27T00:00:00Z","timestamp":1566864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,8,27]],"date-time":"2019-08-27T00:00:00Z","timestamp":1566864000000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,8,27]],"date-time":"2019-08-27T00:00:00Z","timestamp":1566864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["FDN154277"],"award-info":[{"award-number":["FDN154277"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01TW05991-01"],"award-info":[{"award-number":["R01TW05991-01"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elifesciences.org"],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>\n                    Control of pneumonia and diarrhea mortality in India requires understanding of their etiologies. We combined time series analysis of seasonality, climate region, and clinical syndromes from 243,000 verbal autopsies in the nationally representative Million Death Study. Pneumonia mortality at 1 month-14 years was greatest in January (Rate ratio (RR) 1.66, 99% CI 1.51\u20131.82; versus the April minimum). Higher RRs at 1\u201311 months suggested respiratory syncytial virus (RSV) etiology. India\u2019s humid subtropical region experienced a unique summer pneumonia mortality. Diarrhea mortality peaked in July (RR 1.66, 1.48\u20131.85) and January (RR 1.37, 1.23\u20131.48), while deaths with fever and bloody diarrhea (indicating enteroinvasive bacterial etiology) showed little seasonality. Combining mortality at ages 1\u201359 months with prevalence surveys, we estimate 40,600 pneumonia deaths from\n                    <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                    , 20,700 from RSV, 12,600 from influenza, and 7200 from\n                    <jats:italic>Haemophilus influenzae<\/jats:italic>\n                    type b and 24,700 diarrheal deaths from rotavirus occurred in 2015. Careful mortality studies can elucidate etiologies and inform vaccine introduction.\n                  <\/jats:p>","DOI":"10.7554\/elife.46202","type":"journal-article","created":{"date-parts":[[2019,8,27]],"date-time":"2019-08-27T08:00:21Z","timestamp":1566892821000},"update-policy":"https:\/\/doi.org\/10.7554\/elife.46202","source":"Crossref","is-referenced-by-count":28,"title":["Seasonal variation and etiologic inferences of childhood pneumonia and diarrhea mortality in India"],"prefix":"10.7554","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7823-1912","authenticated-orcid":true,"given":"Daniel S","family":"Farrar","sequence":"first","affiliation":[{"name":"Centre for Global Health Research, St. Michael\u2019s Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shally","family":"Awasthi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, King George's Medical University, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2336-6254","authenticated-orcid":true,"given":"Shaza A","family":"Fadel","sequence":"additional","affiliation":[{"name":"Centre for Global Health Research, St. Michael\u2019s Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anju","family":"Sinha","sequence":"additional","affiliation":[{"name":"Division of Reproductive Biology, Maternal and Child Health, Indian Council of Medical Research, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4890-9339","authenticated-orcid":true,"given":"Sze Hang","family":"Fu","sequence":"additional","affiliation":[{"name":"Centre for Global Health Research, St. Michael\u2019s Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Wahl","sequence":"additional","affiliation":[{"name":"International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun K","family":"Morris","sequence":"additional","affiliation":[{"name":"Centre for Global Child Health, Division of Infectious Diseases, Hospital for Sick Children and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7067-8341","authenticated-orcid":true,"given":"Prabhat","family":"Jha","sequence":"additional","affiliation":[{"name":"Centre for Global Health Research, St. Michael\u2019s Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4374","published-online":{"date-parts":[[2019,8,27]]},"reference":[{"key":"bib1","doi-asserted-by":"publisher","first-page":"1616","DOI":"10.1099\/jmm.0.011304-0","article-title":"Comparative evaluation of real-time PCR and conventional RT-PCR during a 2 year surveillance for influenza and respiratory syncytial virus among children with acute respiratory infections in Kolkata, India, reveals a distinct seasonality of infection","volume":"58","author":"Agrawal","year":"2009","journal-title":"Journal of Medical Microbiology"},{"key":"bib2","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.1128\/JCM.02509-09","article-title":"Multisite study of cryptosporidiosis in children with diarrhea in India","volume":"48","author":"Ajjampur","year":"2010","journal-title":"Journal of Clinical Microbiology"},{"key":"bib3","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-12-21","article-title":"Performance criteria for verbal autopsy-based systems to estimate national causes of death: development and application to the indian million death study","volume":"12","author":"Aleksandrowicz","year":"2014","journal-title":"BMC Medicine"},{"key":"bib4","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1007\/s13312-016-0889-x","article-title":"Ready to measure impact? 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