Vital statistics

This section contains data extracted from the Clinical and Health Outcomes Knowledge Base. This is produced by the National Centre for Health Outcomes Development (NCHOD).

When appropriate, comparisons are made with the corresponding variables for the South West region and England & Wales.

Table 8.01 – Estimates of resident population: mid-2013

Age Devon England & Wales
Males Females Persons Males Females Persons
No. % No. % No. % No. % No. % No. %
0-4 19.9 5.4 18.6 4.8 38.5 5.1 1840.5 6.6 1752.4 6.1 3592.9 6.3
5-14 39.8 10.8 37.3 9.6 77.1 10.2 3330.1 11.9 3174.2 11.0 6504.3 11.4
15-24 46.3 12.6 42.7 11.0 89.1 11.7 3710.5 13.2 3557.9 12.3 7268.4 12.8
25-34 38.2 10.4 37.8 9.7 76.1 10.0 3858.7 13.8 3879.0 13.4 7737.7 13.6
35-44 41.2 11.2 44.0 11.3 85.2 11.2 3742.1 13.3 3789.0 13.1 7531.1 13.2
45-54 54.4 14.2 44.9 14.4 108.3 14.3 3943.7 14.1 4030.2 13.9 7973.8 14.0
55-64 49.0 13.3 53.2 13.7 102.2 13.5 3166.0 11.3 3268.3 11.3 6434.2 11.3
65-74 46.7 12.7 50.1 12.9 96.8 12.8 2578.6 9.2 2774.5 9.6 5353.1 9.4
75-84 26.1 7.1 31.9 8.2 58.0 7.7 1434.2 5.1 1803.4 6.2 3237.6 5.7
85+ 9.0 2.4 17.8 4.6 26.8 3.5 444.9 1.6 870.2 3.0 1315.2 2.3
Total 368.7 100 389.3 100 758.1 100 28049.2 100 28899.0 100 56948.2 100

Notes: (1) These figures are ONS population estimates for mid-2013. They are based on ONS final mid-2011 population estimates derived from the 2011 census with allowance for subsequent births, deaths, migration and ageing of population (2) Population numbers represented in thousands

Table 8.02 – Population projections: mid-2018

Age Devon
Males Females Persons
Number % % Change Number % % Change Number % % Change
00 to 04 20.1 0.5 0.1 19.2 4.8 3.2 39.4 5.1 2.3
05 to 14 42.5 1.1 0.7 40.0 10.1 7.2 82.5 10.6 7.0
15 to 24 42.5 1.1 -0.8 38.5 9.7 -9.8 80.9 10.4 -9.2
25 to 34 40.7 1.1 0.7 38.6 9.7 2.1 79.3 10.2 4.2
35 to 44 38.8 1.0 -0.6 41.4 10.4 -5.9 80.2 10.3 -5.9
45 to 54 51.4 1.4 -0.2 55.3 13.9 -1.1 106.7 13.7 -1.5
55 to 64 51.5 1.4 0.5 55.6 14.0 4.5 107.2 13.8 4.9
65 to 74 51.2 1.3 1.0 55.2 13.9 10.2 106.4 13.7 9.9
75 to 84 29.7 0.8 1.4 34.5 8.7 8.2 64.2 8.3 10.7
85 plus 11.1 0.3 2.3 19.5 4.9 9.6 30.8 4.0 14.9
Total 379.5 100.0 2.9 397.8 100.0 2.2 777.6 100.0 2.6

Notes: (1) These figures are based on interim ONS sub-national population projections for the years 2012 to 2037, which are based on the ONS mid-year estimate for 2012, with assumptions for future trends in births, deaths, migration and ageing in the population. (2) The percentage change represents the increase or decrease in population by 2018 compared with 2013 (figures in Table 1). (3) Population numbers represented in thousands

Table 8.03 – Live births by maternal age: 2007-13

Age Devon England & Wales
2007 2008 2009 2010 2011 2012 2013 2013
No. % No. % No. % No. % No. % No. % No. % No. %
11-15 15 0.2 14 0.2 8 0.1 8 0.1 10 0.1 6 0.1 6 0.1 784 0.1
16-19 434 6.1 428 6.0 448 6.1 411 5.6 371 4.9 347 4.6 318 4.4 28,344 4.1
20-24 1,186 16.8 1,232 17.2 1,271 17.3 1,293 17.5 1,381 18.4 1,369 18.0 1,243 17.3 119,683 17.1
25-34 3,808 53.9 3,876 54.0 4,022 54.6 4,049 54.9 4,222 56.1 4,297 56.7 4,141 57.6 408,854 58.6
35-39 1,323 18.7 1,313 18.3 1,307 17.7 1,278 17.3 1,187 15.8 1,258 16.6 1,166 16.2 111,458 16.0
40+ 301 4.3 309 4.3 310 4.2 333 4.5 349 4.6 308 4.1 311 4.3 29,141 4.2
Total 7,067 100.0 7,172 100.0 7,366 100.0 7,372 100.0 7,520 100.0 7,585 100.0 7,185 100.0 698,264 100.0

Notes: (1) These figures are the number of live births to mothers resident in Devon

Table 8.04 – Stillbirths and rates (per 1,000 live births) by maternal age: 2007-13

Age Devon England & Wales
2007 2008 2009 2010 2011 2012 2013 2013
No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate
11-15 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 100 0 0.0 6 7.7
16-19 3 6.9 3 7.0 5 11.0 2 4.8 2 5.4 2 5.4 3 9.4 166 5.9
20-24 5 4.2 9 7.3 4 3.1 4 3.1 4 2.9 6 4.3 7 5.6 564 4.7
25-34 16 4.2 10 2.6 15 3.7 14 3.4 20 4.7 13 3.1 13 3.1 1,743 4.3
35-39 4 3.0 7 5.3 4 3.1 6 4.7 4 3.4 1 0.8 7 6.0 600 5.4
40+ 2 6.6 6 19.4 3 9.6 1 3.0 4 11.5 6 17.2 0 0.0 177 6.1
Total 30 4.2 35 4.9 31 4.2 27 3.6 34 4.5 29 3.9 30 4.2 3,256 4.7

Notes: (1) Still births are defined as late fetal deaths (those occurring after 24 weeks)

Table 8.05 – Live births in NHS hospitals and low birth weights: 2007-13

 

 

 

Year

Live Births occuring in NHS Hospitals Births (Live and Still) under 2,500 grams
Devon England & Wales Devon England & Wales
No. % No. % No. % No. %
2007 6,603 93.4 665,861 96.5 438 6.3 51,577 7.5
2008 6,741 94.0 683,889 96.5 456 6.4 52,954 7.5
2009 6,943 94.3 682,922 96.7 439 6.0 52,740 7.5
2010 6,998 94.9 700,821 96.9 433 5.9 52,638 7.3
2011 7,179 95.5 702,465 97.1 483 6.5 53,234 7.4
2012 7,266 95.8 709,096 97.2 492 6.5 53,207 7.3
2013 6888 95.9 679132 97.3 493 6.9 51,136 7.4

Notes: (1) Still births are defined as late fetal deaths (those occurring after 24 weeks). (2) Birthweight is obtained from NHS birth notifications. (3) Birthweight is not always available from NHS birth notifications.

Table 8.06 – Legal abortions and rates (per 1,000 women) by maternal age: 2012 and 2013

 

 

 

Age

2012 2013
 

Devon

 

England & Wales

NHS North East and West Devon NHS South Devon and Torbay  

England & Wales

Number Rate Number Rate Number Rate Number Rate Number Rate
Under 18 164 13.0 12,873 12.9 171 11.9 65 14.2 11,679 11.8
18 to 19 183 20.0 18,507 26.5 211 17.9 125 44.9 17,332 25.3
20 to 24 435 21.0 54,558 28.8 579 19.2 219 34.9 54,038 28.7
25 to 29 291 16.0 41,882 21.7 380 15.5 147 22.3 43,578 22.5
30 to 34 220 12.0 30,353 16.0 289 11.9 107 16.2 31,377 16.2
35+ 230 5.0 26,949 7.0 248 4.8 124 7.8 27,327 7.2
Total 1,523 12.9 185,122 16.4 1,878 12.0 787 18.5 185,331 16.5

Notes: (1) Figures for abortions were derived from notification forms returned to the Chief Medical Officer. (2) Total includes those with age not stated. (3) Figures from 2013 onwards are reported on a clinical commissioning group basis.

Table 8.07 – Abortions by gestational age and abortions in the NHS: 2013

NHS North East and West Devon NHS South Devon and

Torbay

England &

Wales

Percentage of all Abortions where gestational age was 0 to 9 weeks 73.9 73.2 79.2
Percentage of all Abortions where gestational age was 10 to 12 weeks 18.1 16.5 12.4
Percentage of all Abortions where gestational age was 13 weeks plus 8.0 10.3 8.5
Percentage of all Abortions which were performed by the NHS 88.2 88.8 33.6
Percentage of all Abortions which were performed by a NHS agency 10.2 10.8 64.1
Percentage of all Abortions which were NHS funded 98.3 99.6 97.6
Percentage of all Abortions which were performed outside the NHS 1.7 0.4 2.4

Notes: (1) Figures for abortions were derived from notification forms returned to the Chief Medical Officer. (2) Figures from 2013 onwards are reported on a clinical commissioning group basis

Table 8.08 – Mortality in infancy and childhood: 2006-12

 

 

Age

Devon England & Wales
2007 2008 2009 2010 2011 2012 2013 2013
No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate
Early neonatal  

23

 

3.4

 

21

 

3.1

 

11

 

1.5

 

16

 

2.2

 

19

 

2.5

 

22

 

2.9

 

14

 

1.9

 

1,424

 

2.0

Neonatal 26 3.8 26 3.9 17 2.3 23 3.1 25 3.3 28 3.7 17 2.4 1,881 2.7
Infant 34 5.1 34 5.1 23 3.1 32 4.3 34 4.5 34 4.5 24 3.3 2,733 3.9
1-4 years 7 15.6 6 17.6 6 19.6 7 19.4 4 13.4 5 16.3 3 9.6 485 16.8
5-14 years 8 6.8 6 6.9 11 10.3 4 8.7 2 2.6 8 10.4 7 9.1 554 8.5

Notes: (1) Early neonatal rate is the number of deaths of infants aged less than seven days per 1,000 births. (2) Neonatal rate is the number of deaths of infants aged less than 28 days per 1,000 births. (3) Infant mortality rate is the number of deaths within one year of birth per 1,000 live births. (4) Mortality rates for 1-14 age groups are the number of deaths per 100,000 in the age group

Table 8.09 – Deaths from selected causes by age and sex: 2013

 

Cause of Death

 

ICD Code

 

Sex

 

1-4

 

5-14

15-

34

35-

64

65-

74

 

75+

 

All

All Malignant Neoplasms C00-C97 Males 0 0 5 212 313 719 1,249
Females 0 0 3 194 222 667 1,086
Malignant Neoplasm of Small intestine, Colon, Rectum & Anus C17-C21 Males 0 0 0 27 25 74 126
Females 0 0 0 17 14 93 124
Malignant Neoplasm of Trachea, Bronchus and Lung C33-C34 Males 0 0 0 37 83 128 248
Females 0 0 0 35 47 90 172
Malignant Melanoma of Skin C43 Males 0 0 0 13 7 17 37
Females 0 0 0 4 6 5 15
Malignant Neoplasm of Female Breast C50 Females 0 0 0 51 28 83 162
Malignant Neoplasm of Cervix Uteri C53 Females 0 0 0 6 1 2 9
Malignant Neoplasm of Prostate C61 Males 0 0 0 9 34 141 184
Diabetes E10-E14 Males 0 0 0 3 4 27 34
Females 0 0 0 2 2 40 44
All Circulatory Diseases I00-I99 Males 0 0 4 151 203 807 1,165
Females 0 0 2 47 95 1,107 1,251
Coronary heart disease I20-I25 Males 0 0 0 94 124 390 608
Females 0 0 0 15 43 387 445
Cerebrovascular disease I60-I69 Males 0 0 0 16 27 200 243
Females 0 0 1 15 28 413 457
Asthma J45-J46 Males 0 0 0 0 0 7 7
Females 0 0 1 2 0 5 8
Bronchitis, Emphysema and other COPD J40-J44 Males 0 0 0 9 47 126 182
Females 0 0 0 12 24 130 166
Chronic liver disease including cirrhosis K70, K73-K74 Males 0 0 0 16 16 8 40
Females 0 0 0 11 6 5 22
Chronic renal failure N18 Males 0 0 0 1 0 4 5
Females 0 0 0 2 1 6 9
Land transport accidents V01-V89 Males 0 0 9 6 3 7 25
Females 0 1 1 2 0 2 6
Accidental falls W00-W19 Males 0 0 1 5 4 36 46
Females 0 0 1 1 2 58 62
Suicide, Self inflicted injury and Injury of undetermined intent X60-X84, Y10-Y34 (exc Y33.9) Males 10 34 5 4 53
Females 3 11 3 1 18
 

ALL CAUSES

Males 3 1 47 536 712 2,667 3966
Females 0 6 20 342 445 3,539 4352

Notes: (1) The all cause of death totals include causes not identified separately in the table

Table 8.10 – Standardised mortality ratio (SMR) for selected causes of death: 2011-13

 

 

Cause of Death

Devon South West GOR
 

ICD Code

 

Sex

 

No.

 

SMR

Confidence Interval  

SMR

Confidence Interval
All Malignant Neoplasms C00-C97 Males 3,762 94 91-97 95 94-96
Females 3,409 96 93-99 95 93-96
Malignant Neoplasm of Small intestine, Colon, Rectum & Anus C17-C21 Males 383 91 82-100 96 93-100
Females 374 102 92-113 101 97-105
Malignant Neoplasm of Trachea, Bronchus and Lung C33-C34 Males 721 80 75-87 85 82-87
Females 553 77 70-83 80 77-82
Malignant Melanoma of skin C43 Males 79 134 106-167 125 114-137
Females 45 102 75-137 116 104-129
Malignant Neoplasm of Female Breast C50 Females 525 98 89-106 99 95-102
Malignant Neoplasm of Cervix Uteri C53 Females 32 84 58-119 102 89-115
Malignant Neoplasm of Prostate C61 Males 622 113 104-122 104 101-108
Diabetes E10-E14 Males 123 97 81-116 94 87-101
Females 118 80 66-96 92 86-98
All Circulatory Diseases I00-I99 Males 3,565 94 90-97 93 92-95
Females 3,823 95 92-98 95 94-96
Coronary heart disease I20-I25 Males 1,844 91 87-95 92 90-94
Females 1,331 89 84-93 91 89-93
Cerebrovascular disease I60-I69 Males 790 100 93-107 97 94-100
Females 1,348 109 104-115 106 104-109
Asthma J45-J46 Males 17 94 55-151 75 60-93
Females 29 69 46-99 82 71-93
Bronchitis, Emphysema and other COPD J40-J44 Males 536 72 66-78 88 85-91
Females 456 65 60-72 79 76-82
Chronic liver disease including cirrhosis K70, K73-K74 Males 116 65 54-78 87 82-93
Females 71 67 52-85 83 76-90
Chronic renal failure N18 Males 29 89 60-128 91 78-105
Females 30 98 66-140 100 86-115
Land transport accidents V01-V89 Males 58 125 95-162 116 105-128
Females 13 79 42-134 119 100-142
Accidental falls W00-W19 Males 130 121 101-144 94 87-102
Females 157 141 120-165 96 89-104
Suicide, Self inflicted injury and Injury of undetermined intent X60-X84, Y10-Y34 (exc Y33.9) Males 164 142 121-166 117 110-125
Females 44 137 100-184 132 118-149
ALL CAUSES Males 11,860 92 90-93 94 93-95
Females 13,172 92 90-93 94 94-95

Notes: (1) The all causes of death totals also include causes not identified separately in the table. (2) Deaths are pooled over a three year period, 2011-13

Table 8.11 – Standardised average annual years of life lost (per 10,000 resident population aged under 75) by selected causes of death: 2011-13

Males Females Persons
Cause of Death ICD Code Devon SW E&W Devon SW E&W Devon SW E&W
Infectious and Parasitic Diseases A00-B99 5.69 5.96 7.24 3.39 3.31 4.90 4.56 4.62 6.06
Tuberculosis A15-A19 0.66 0.30 0.57 0.05 0.04 0.25 0.35 0.17 0.41
Malignant Neoplasm of Small intestine, Colon, Rectum & Anus  

C17-C21

 

12.88

 

15.69

 

17.28

 

10.46

 

12.07

 

11.81

 

11.63

 

13.83

 

14.49

Malignant Neoplasm of Trachea, Bronchus and Lung  

C33-C34

 

30.27

 

31.98

 

36.50

 

22.92

 

24.46

 

27.94

 

26.46

 

28.11

 

32.12

Malignant Melanoma of Skin C43 5.35 5.46 4.35 2.48 3.19 3.01 3.86 4.31 3.67
Malignant Neoplasm of Female Breast C50  

33.75

 

33.52

 

33.85

Malignant Neoplasm of Cervix Uteri C53 5.43 5.03 4.77
Malignant Neoplasm of Prostate C61 8.59 8.04 7.78
Hodgkin’s Disease C81 0.06 0.40 0.78 0.71 0.63 0.55 0.39 0.51 0.66
Leukaemia C91-C95 4.97 5.23 6.04 4.11 3.78 4.13 4.52 4.49 5.07
Diabetes E10-E14 4.07 4.03 4.71 2.35 2.23 2.83 3.18 3.12 3.76
Epilepsy G40-G41 4.96 5.54 4.97 2.10 3.04 3.09 3.54 4.28 4.02
Hypertensive Disease I10-I15 2.82 2.93 3.85 0.44 1.06 1.89 1.59 1.98 2.86
Coronary heart disease I20-I25 59.78 61.85 72.57 11.89 14.77 19.35 34.99 37.81 45.51
Cerebrovascular disease I60-I69 12.54 13.88 17.24 11.99 11.83 13.07 12.23 12.81 15.12
Pneumonia J12-J18 6.94 8.04 9.31 6.09 4.41 6.08 6.48 6.19 7.67
Bronchitis, Emphysema and other COPD  

J40-J44

 

10.94

 

13.19

 

15.04

 

7.08

 

9.21

 

11.84

 

8.94

 

11.15

 

13.4

Asthma J45-J46 1.14 0.76 1.31 2.26 1.76 1.39 1.73 1.26 1.35
Gastric, Duodenal & Peptic Ulcers K25-K27 1.45 2.05 2.65 0.97 1.06 1.23 1.20 1.55 1.93
Chronic liver disease including cirrhosis K70, K73-K74  

14.37

 

23.97

 

28.15

 

10.31

 

11.54

 

14.95

 

12.24

 

17.65

 

21.47

Chronic renal failure N18 0.29 0.26 0.51 0.86 0.31 0.42 0.58 0.28 0.46
Land transport accidents V01-V89 17.14 16.48 13.59 4.80 4.69 3.53 11.10 10.64 8.58
Accidental falls W00-W19 5.64 3.77 5.01 1.55 1.93 2.14 3.54 2.83 3.56
 

Suicide, Self inflicted injury and Injury of undetermined intent

X60-X84, Y10-Y34

(exc Y33.9)

 

 

57.56

 

 

54.73

 

 

50.61

 

 

17.2

 

 

17.06

 

 

13.57

 

 

37.08

 

 

35.86

 

 

32.03

All Causes 461.72 502.33 543.91 304.07 311.4 343.23 381.25 405.7 442.34

Notes: (1) Years of life lost are up to age 75. (2) The all causes of death totals also include cases not identified separately in the table

Table 8.12 – Standardised mortality ratios (SMR) for ‘Avoidable’ and other potentially reducible causes of death: 2011-13

Devon South West GOR
 

Cause of Death

 

ICD Code

 

Age

 

Sex

 

Deaths

 

SMR

Confidence Interval  

SMR

Confidence Interval
Tuberculosis A15-A19 5 to

64

Males 2 91 11-330 52 23-103
Females 0 0 0-462 18 0-101
Malignant Neoplasm of Female Breast C50 50 to

64

Females  

125

 

110

 

92-131

 

99

 

92-107

Malignant Neoplasm of Cervix Uteri C53 15 to

64

Females  

17

 

100

 

58-160

 

101

 

83-120

Hodgkin’s Disease C81 5 to

64

Males 0 0 0-156 59 28-108
Females 3 187 39-547 115 61-196
Chronic Rheumatic Heart Disease I05-I09 5 to

44

Males 0 0 0-1559 0 0-194
Females 0 0 0-1357 48 1-266
Cerebrovascular Disease I60-I69 35 to

64

Males 58 74 56-96 80 72-88
Females 46 78 57-105 82 73-92
Acute Myocardial Infarction I21-I22 35 to

64

Males 90 73 59-90 87 81-94
Females 18 54 32-86 80 68-93
Other Ischaemic Heart Disease I20, I23-I25 35 to

64

Males 169 95 81-110 85 80-91
Females 34 72 50-100 77 67-87
Asthma J45-J46 5 to

44

Males 2 134 16-483 86 41-158
Females 4 286 78-733 150 86-244

Notes: (1) Deaths are pooled over a three year period, 2011-13. (2) The list of ‘avoidable’ and other potentially reducible causes of death is from the paper by Charlton JRH, Bauer R, Lakhani A, Outcome measures for district and regional health care planning Community Medicine, 1984, 6:306-315

Table 8.13 – Standardised registration (SRR) ratios for selected cancers: 2011-13

Devon South West GOR
 

Cause of Death

 

ICD Code

 

Sex

 

Number

 

SRR

Confidence Interval  

SRR

Confidence Interval
Malignant Neoplasm of the Oesphagus C15 Males 226 86 75-98 92 87-96
Females 125 94 79-112 100 93-107
Malignant Neoplasm of the Stomach C16 Males 162 76 65-89 89 84-94
Females 91 80 64-98 84 77-91
Malignant Neoplasm of Small intestine, Colon, Rectum & Anus  

C17-C21

Males 1,127 101 95-107 101 99-104
Females  

998

 

111

 

104-118

 

108

 

106-111

Malignant Neoplasm of Trachea, Bronchus and Lung C33-C34 Males 843 77 72-82 86 84-88
Females 668 75 69-80 82 79-84
Malignant Melanoma of Skin C43 Males 449 161 147-177 139 133-144
Females 440 156 142-171 135 130-140
Other Malignant Neoplasm of Skin C44 Males 4,477 166 161-171 150 148-152
Females 3,436 164 159-170 154 152-156
Malignant Neoplasm of Female Breast C50 Females  

2,272

 

104

 

100-108

 

105

 

103-107

Malignant Neoplasm of Cervix Uteri C53 Females  

104

 

100

 

81-121

 

111

 

103-119

Malignant Neoplasm of Prostate C61 Males  

2,237

 

109

 

105-114

 

108

 

106-110

Malignant Neoplasm of Bladder C67 Males 307 83 74-93 99 95-104
Females 129 90 75-107 92 85-98

 Table 8.14 – Immunisation Rates for Selected Age Groups: 2013-14

 

District

Aged 1 Aged 2 Aged 5
DTaP/IPV/Hib MMR Hib/MenC PCV MMR DTaP/IPV
East Devon 97.6% 95.8% 94.0% 96.1% 92.6% 94.4%
Exeter 95.2% 96.4% 93.2% 95.6% 91.2% 92.5%
Mid Devon 95.4% 93.2% 92.7% 94.3% 92.6% 93.7%
North Devon 96.2% 95.7% 95.0% 95.3% 91.9% 92.5%
South Hams 92.1% 85.2% 86.1% 86.9% 81.7% 83.0%
Teignbridge 93.2% 94.1% 93.5% 94.5% 89.8% 92.3%
Torridge 97.9% 95.3% 95.1% 96.6% 93.6% 95.3%
West Devon 94.7% 94.1% 92.1% 93.5% 85.4% 86.5%
Devon 96.0% 94.1% 92.8% 94.3% 89.9% 91.5%

Notes: Aged 1 DTaP/IPV/Hib –Percentage of children who have been immunised for Diphtheria, Tetanus, Polio, Pertussis, Haemophilus influenza type B by their first birthday. Aged 2 MMR – Percentage of children who have been immunised for Measles, Mumps and Rubella by their second birthday. Aged 2 Hib/MenC – Percentage of children who have been immunised for Haemophilus influenza type B and Meningitis C by their second birthday. Aged 2 PCV – Percentage of children who have been immunised for pneumococcal disease by their second birthday. Aged 5 MMR – Percentage of children aged 5 who have been fully immunised for measles, mumps and rubella (second dose). Aged 5 DTaP/IPV – Percentage of children aged five who have been immunised for Diphtheria, Tetanus, Polio and Pertussis