EuroMOMO: Five years of mortality monitoring in Europe

Transcription

1 EuroMOMO: Five years of mortality monitoring in Europe Kåre Mølbak On behalf of all partners Department of Infectious Disease Epidemiology, Statens Serum Institut, Denmark 6 th European Public Health Conference, Brussels/Belgium 14 November 2013

2 Vital statistics are essential indicators of health and development Life expectancy Under-five mortality Maternal mortality Hospital standardised mortality rates And so on. These indicators are calculated with delays

3 What and why: mortality monitoring? Using available vital statistics data (all-cause mortality) for routine public health surveillance On a real-time basis, or as timely as possible For situational awareness or reassurance: The impact of an epidemic or a pandemic? Who is in particular affected? Impact of environmental events Changes in mortality? Basic principle: Excess deaths = Observed Expected deaths Statistical model to determine expected death

4 Foundation & Objective Workshop 2006: National public health centres in 13 European countries, ECDC, WHO Europe Consensus that a common methodology to monitor mortality across Europe was needed To develop and operate timely mortality monitoring across Europe using standardised methods To assess and monitor impact of public health threats To enable comparison between countries.

5 System Modelling of national weekly all-cause mortality using a common algorithm across Europe National outputs for national bulletins European coordination at SSI, Copenhagen Weekly EuroMOMO bulletin: pooled and individual country outputs Integration in ECDC s WISO and WHO s EuroFlu bulletins Weekly European monitoring in operation uninterrupted since mid-2009

6 Reporting countries/regions 2013 Belgium Denmark Estonia Finland France Germany Berlin, Hesse Greece (parts) Hungary Ireland Netherlands Portugal Spain Sweden Switzerland United Kingdom England, Northern Ireland, Scotland and Wales 15 countries 19 reporting partners

7 Friday early pm Thursday am Data flow and weekly procedures National Statistics MOMO hub SSI Denmark Partner Institutes EuroMOMO.eu EuroMOMO algorithm Pooled Analysis Numbers, total, age-group Z-scores, total, age-group National results Data sets Graphs Tables EuroMOMO input Data set MOMO restricted Website Comparative Graphs by country Numbers, total, age-group Z-scores, total, age-group Assessment Forum

8 Baseline estimation Multiplicative Poisson model (link=log) allowing for overdispersion ISO-week as underlying time-unit For each age group: E(log(N)) = trend(wk)+sin(2π(365.25/7)*wk)+cos(2π(365.25/7)*wk) N = #deaths in a week (wk) trend(wk) = constant, a linear trend or a 3-point spline sin + cos = seasonal variation Estimated on periods (assumed) to have no or limited effect of influenza and/or excess ambient temperatures: Spring: week 16 to 25, both included Autumn: week 37 to 44, both included

9 Adjusted for variation between the included countries and for differences in the local delay in reporting

10 Response to the 2009 influenza A H1N1 pandemic

11 Unprecedented but modest excess mortality in children 5-14 years of age

12 Rapid communications Excess mortality among the elderly in 12 European countries, February and March 2012 A Mazick (maz@ssi.dk) 1, B Gergonne 2, J Nielsen 1, F Wuillaume 3, M J Virtanen 4, A Fouillet 5, H Uphoff 6, T Sideroglou 7, A Paldy 8, A Oza 9, B Nunes 10, V M Flores-Segovia 11, C Junker 12, S A McDonald 13, H K Green 14, R Pebody 14, K Mølbak 1 1. Statens Serum Institut, Copenhagen, Denmark 2. The National Board of Health and Welfare, Stockholm, Sweden 3. Scientific Institute of Public Health, Brussels, Belgium 4. National Institute for Health and Welfare, Helsinki, Finland 5. French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France 6. Hesse State Health Office, Dillenburg, Germany 7. Hellenic Centre for Disease Control and Prevention, Athens, Greece 8. Hungary National Institute of Environmental Health, Budapest, Hungary 9. Health Protection Surveillance Centre, Dublin, Ireland 10. Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal 11. Instituto de Salud Carlos III, Madrid, Spain 12. Federal Statistical Office, Neuchâtel, Switzerland 13. National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands 14. Health Protection Agency, Colindale, United Kingdom Citation style for this article: Mazick A, Gergonne B, Nielsen J, Wuillaume F, Virtanen MJ, Fouillet A, Uphoff H, Sideroglou T, Paldy A, Oza A, Nunes B, Flores-Segovia VM, Junker C, McDonald SA, Green HK, Pebody R, Mølbak K. Excess mortality among the elderly in 12 European countries, February and March Euro Surveill. 2012;17(14):pii= Available online: Article published on 5 April 2012

13 Excess mortality in the winter of

14 Winter season 2012/13 All-cause mortality Winter season = week 40 week 20 Pooled analysis Data from 16 countries/regions Underlying population: 258 million EuroMOMO algorithm run on pooled weekly number of deaths from week Linear trend (all age groups) and sine curve (15-64, 65+, total) Analysed using week 35 database Cumulative excess mortality Sum of the weekly positive and negative variations around the baseline of expected deaths

15 Pooled European mortality

16 Pooled weekly total number of all-cause deaths, expected deaths (baseline), z-scores levels,

17 Pooled weekly total number of all-cause deaths, expected deaths (baseline), z-scores levels, Shaded: Influenza season weeks in Europe Source ECDC reports

18 Cumulative pooled winter excess mortality (w40-w20) by season and age group

19 Number (N) of excess deaths, upper & lower 95% confidence limits (95% CI), by winter season ( /13) and by age group. Total excess mortality rate/10 5 Age 0to4 5to14 15to64 65P Total Season N 95%CI N 95%CI N 95%CI N 95%CI N 95%CI Rate/ / ,7 2009/ ,2 2010/ ,6 2011/ ,1 2012/ ,8 US R&C deaths, multivariate model, : Average annual rate of flu-associated deaths: 9 deaths per (range: ) MMWR, 2010

20 Excess mortality in z-scores Individual countries and pooled week Duration: Individual week 50/ /2013 Pooled: week 1/ /2013 Heterogeneous pattern

21 Influenza activity in Europe

22 Conclusions The winter season 2012/13 Long duration, heterogeneous pattern in individual countries Temporal fit with overall influenza activity Diversity of circulating influenza viruses across Europe Other factors, e.g other respiratory viruses, cold weather, may have contributed to excess. EuroMOMO demonstrated usefulness for early impact assessment of public health treats: Comparison of mortality patterns and influenza activity Temporal pattern, both pooled and individual countries Magnitude Detection and assessment of sustained shifts, e.g age shift in pandemic

23 Priority tasks 2014 Main priority: Geographical expansion: Country visits from the EuroMOMO hub as well as technical support Support and encouragement to join EuroMOMO to countries from WHO, ECDC, DG Sanco Participation of countries with less timely data in summary reports, e.g. end-of-winter season estimations Promotion of EuroMOMO by including EuroMOMO data or a link to EuroMOMO in national flu surveillance bulletins, by improving output for WISO and EUROFLU by scientific publications and presentation at conferences and relevant meetings by collaborative studies.

24 Acknowledgement Anne Mazick, Bernadette Gergonne, Jens Nielsen BELGIUM Dept. of Epidemiology, Scientific Institute of Public Health (IPH) DENMARK Dept. of Epidemiology, Statens Serum Institut (SSI) ESTONIA Health Protection Inspectorate (TRVSK) FINLAND Dept. of Infectious Disease Epidemiology and Control, National Public Health Institute (KTL) FRANCE Cellule de Coordination des Alertes (CCA), Institut de Veille Sanitaire (InVS) GERMANY Robert Koch Institut (RKI) GERMANY Zentrum für Gesundheitsschutz, Hessisches Landesprüfungs- und Untersuchungsamt im Gesundheitswesen - Standort Dillenburg (HLPUG) GREECE Greek CDC (KEELPNO) HUNGARY National Institute of Environmental Health IRELAND Health Service Executive Health Protection Surveillance Centre (HPSC) THE NETHERLANDS Centre for Infectious Disease Control National Institute of Public Health and the Environment (RIVM) PORTUGAL Observatório National de Saúde, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA) SPAIN Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII) SWEDEN Communicable Disease Prevention and Control, Swedish National Board of Health and Welfare (SoS) SWEDEN Dept. of Epidemiology, Swedish Institute for Infectious Diseases Control (SMI) SWITZERLAND Federal Office of Public Health (BFS) UNITED KINGDOM England, Wales, Scotland Centre for Infections, Health Protection Agency (HPA)

25 Publications Nicoll A, Ammon A, Amato Gauci A, Ciancio B, Zucs P, Devaux I, Plata F, Mazick A, Mølbak K, Asikainen T, Kramarz P Experience and lessons from surveillance and studies of the 2009 pandemic in Europe. Public Health. 2010;124(1): Mazick A, Gergonne B, Wuillaume F, Danis K, Vantarakis A, Uphoff H, Spiteri G, van 't Klooster T, Junker C, Holmberg M, Molbak K. Higher all-cause mortality in children during autumn 2009 compared with the three previous years: pooled results from eight European countries. Euro Surveill Feb 4;15(5). doi:pii: Mazick A, Gergonne B, Nielsen J, Wuillaume F, Virtanen MJ, Fouillet A, Uphoff H, Sideroglou T, Paldy A, Oza A, Nunes B, Flores-Segovia VM, Junker C, McDonald SA, Green HK, Pebody R, Mølbak K. Excess mortality among the elderly in 12 European countries, February and March Euro Surveill Apr 5;17(14). doi:pii: Nielsen J, Mazick A, Andrews N, Detsis M, Fenech TM, Flores VM, Foulliet A, Gergonne B, Green HK, Junker C, Nunes B, O'Donnell J, Oza A, Paldy A, Pebody R, Reynolds A, Sideroglou T, Snijders BE, Simon-Soria F, Uphoff H, VAN Asten L, Virtanen MJ, Wuillaume F, Mølbak K. Pooling European all-cause mortality: methodology and findings for the seasons 2008/2009 to 2010/2011. Epidemiol Infect Nov 27:1-15 Collaboration with country specific assessments of influenza related mortality or establishment of MoMo systems Collaboration with international networks on estimation of influenza-related mortality (CDC, Glamor)