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The curious case of 600 extra deaths a week

BMJ 2013; 347 doi: (Published 09 August 2013) Cite this as: BMJ 2013;347:f5014

Rapid Response:

Re: The curious case of 600 extra deaths a week

The Belgian Scientific Institute for Public Health reported 10% excess mortality in June 2013 (corresponding to 700 additional deaths a month) in those aged 65 and older [1]. No likely cause was identified since climatological circumstances, air pollution levels and physician visits were influenza-like illnesses were unremarkable. However, it was expected that the heat wave of July would further contribute to excess mortality.

Belgium is one of the 18 European countries which monitors excess mortality for public health action in the so-called Euro-MOMO project [2]. Excess mortality has been noted in this surveillance system from the last weeks of 2012 all through the first 4 months of 2013, but has returned to normal since week 17.

Inspection of results graphs clearly demonstrates that overall mortality is dominated by people aged 65 and older. The finding reported by Nigel Hawkes that "Up to 65 years of age there are no changes [in mortality], but in older age groups there are sharp increases, especially marked in those aged over 85" is entirely non-specific and consistent with the higher mortality risk with age.

A Danish analysis showed that the influenza activity was remarkably prolonged this winter and associated with higher mortality than in the past 3 seasons, possibly because it was one of the few countries in which H3N2 and influenza B were the main circulating strains, whereas elderly may exhibit some immunity against H1N1 influenza which have been dominant in Denmark since 2009 [3].

Further analyses at the European level is required to investigate recent excess mortality trends. A combination of infectious diseases and climate influences seem a plausible candidate explanation as in previous investigations [4].


  4. Mazick A, Gergonne B, Nielsen J et al. Excess mortality among the elderly in 12 European countries, February and March 2012. Euro Surveill. 2012 Apr 5;17(14). pii: 20138.

Competing interests: No competing interests

12 August 2013
Michaël R Laurent
Geriatrics Registrar
University Hospitals Leuven, Belgium
Herestraat 49, 3000 Leuven