Excess mortality in Europe coincides with peaks of COVID-19, influenza and respiratory syncytial virus (RSV), November 2023 to February 2024.

Since the end of November 2023, the European Mortality Monitoring Network (EuroMOMO) has observed excess mortality in Europe. During weeks 48 2023-6 2024, preliminary results show a substantially increased rate of 95.3 (95% CI:  91.7-98.9) excess all-cause deaths per 100,000 person-years for all ages. This excess mortality is seen in adults aged 45 years and older, and coincides with widespread presence of COVID-19, influenza and respiratory syncytial virus (RSV) observed in many European countries during the 2023/24 winter season.

High average daily temperature in summer and the incidence of thrombolytic treatment for acute ischemic stroke.

INTRODUCTION: Meteorological factors can increase stroke risk; however, their impact is not precisely understood. Heat waves during summer increase total mortality. Therefore, we hypothesized that the average daily temperature in summer may correlate with the incidence of thrombolytic treatment for acute ischemic stroke in Budapest and Pest County, Hungary. METHODS: We analyzed the relationship between the average daily temperature in summer months and the daily number of thrombolytic treatments (TT) performed with the indication of acute ischemic stroke between 1st June and 31st August each year from 2007 to 2016. The analysis was also performed after the omission of the data of the last day of the months due to possible psychosocial impact reported in our previous study. Spearman's correlation was used for statistical analysis. RESULTS: No significant correlation was found between the average summer daily temperature and the number of TT in the entire sample of the 10-year period. When omitting the data of the last day of each month, positive correlations were suspected in 2014 (r=0.225, P=0.034) and 2015 (r=0.276, P=0.009). CONCLUSION: Our findings did not confirm an association between the average daily temperature in summer and the daily number of TT throughout the examined 10-year period. However, importantly, in 2014 and 2015, the years with the highest average daily temperatures in this period, a positive correlation was found. The level of correlation is modest, indicating that risk factors, both meteorological and non-meteorological, other than the average temperature, play equally important roles in determining the incidence of thrombolytic treatment for acute ischemic stroke on the population level.

Real-time monitoring shows substantial excess all-cause mortality during second wave of COVID-19 in Europe, October to December 2020.

The European monitoring of excess mortality for public health action (EuroMOMO) network monitors weekly excess all-cause mortality in 27 European countries or subnational areas. During the first wave of the coronavirus disease (COVID-19) pandemic in Europe in spring 2020, several countries experienced extraordinarily high levels of excess mortality. Europe is currently seeing another upsurge in COVID-19 cases, and EuroMOMO is again witnessing a substantial excess all-cause mortality attributable to COVID-19.

Excess all-cause mortality during the COVID-19 pandemic in Europe - preliminary pooled estimates from the EuroMOMO network, March to April 2020.

A remarkable excess mortality has coincided with the COVID-19 pandemic in Europe. We present preliminary pooled estimates of all-cause mortality for 24 European countries/federal states participating in the European monitoring of excess mortality for public health action (EuroMOMO) network, for the period March-April 2020. Excess mortality particularly affected ≥ 65 year olds (91% of all excess deaths), but also 45-64 (8%) and 15-44 year olds (1%). No excess mortality was observed in 0-14 year olds.

Excess all-cause and influenza-attributable mortality in Europe, December 2016 to February 2017.

Since December 2016, excess all-cause mortality was observed in many European countries, especially among people aged ≥ 65 years. We estimated all-cause and influenza-attributable mortality in 19 European countries/regions. Excess mortality was primarily explained by circulation of influenza virus A(H3N2). Cold weather snaps contributed in some countries. The pattern was similar to the last major influenza A(H3N2) season in 2014/15 in Europe, although starting earlier in line with the early influenza season start.

Modelling the introduction and spread of non-native species: international trade and climate change drive ragweed invasion.

Biological invasions are a major driver of global change, for which models can attribute causes, assess impacts and guide management. However, invasion models typically focus on spread from known introduction points or non-native distributions and ignore the transport processes by which species arrive. Here, we developed a simulation model to understand and describe plant invasion at a continental scale, integrating repeated transport through trade pathways, unintentional release events and the population dynamics and local anthropogenic dispersal that drive subsequent spread. We used the model to simulate the invasion of Europe by common ragweed (Ambrosia artemisiifolia), a globally invasive plant that causes serious harm as an aeroallergen and crop weed. Simulations starting in 1950 accurately reproduced ragweed's current distribution, including the presence of records in climatically unsuitable areas as a result of repeated introduction. Furthermore, the model outputs were strongly correlated with spatial and temporal patterns of ragweed pollen concentrations, which are fully independent of the calibration data. The model suggests that recent trends for warmer summers and increased volumes of international trade have accelerated the ragweed invasion. For the latter, long distance dispersal because of trade within the invaded continent is highlighted as a key invasion process, in addition to import from the native range. Biosecurity simulations, whereby transport through trade pathways is halted, showed that effective control is only achieved by early action targeting all relevant pathways. We conclude that invasion models would benefit from integrating introduction processes (transport and release) with spread dynamics, to better represent propagule pressure from native sources as well as mechanisms for long-distance dispersal within invaded continents. Ultimately, such integration may facilitate better prediction of spatial and temporal variation in invasion risk and provide useful guidance for management strategies to reduce the impacts of invasion.

Effects of heat waves on mortality: effect modification and confounding by air pollutants.

BACKGROUND: Heat waves and air pollution are both associated with increased mortality. Their joint effects are less well understood. METHODS: We explored the role of air pollution in modifying the effects of heat waves on mortality, within the EuroHEAT project. Daily mortality, meteorologic, and air pollution data from nine European cities for the years 1990-2004 were assembled. We defined heat waves by taking both intensity and duration into account. The city-specific effects of heat wave episodes were estimated using generalized estimating equation models, adjusting for potential confounders with and without inclusion of air pollutants (particles, ozone, nitrogen dioxide, sulphur dioxide, carbon monoxide). To investigate effect modification, we introduced an interaction term between heat waves and each single pollutant in the models. Random effects meta-analysis was used to summarize the city-specific results. RESULTS: The increase in the number of daily deaths during heat wave episodes was 54% higher on high ozone days compared with low, among people age 75-84 years. The heat wave effect on high PM10 days was increased by 36% and 106% in the 75-84 year and 85+ year age groups, respectively. A similar pattern was observed for effects on cardiovascular mortality. Effect modification was less evident for respiratory mortality, although the heat wave effect itself was greater for this cause of death. The heat wave effect was smaller (15-30%) after adjustment for ozone or PM10. CONCLUSIONS: The heat wave effect on mortality was larger during high ozone or high PM10 days. When assessing the effect of heat waves on mortality, lack of adjustment for ozone and especially PM10 overestimates effect parameters. This bias has implications for public health policy.

A temporally and spatially explicit, data-driven estimation of airborne ragweed pollen concentrations across Europe.

Ongoing and future climate change driven expansion of aeroallergen-producing plant species comprise a major human health problem across Europe and elsewhere. There is an urgent need to produce accurate, temporally dynamic maps at the continental level, especially in the context of climate uncertainty. This study aimed to restore missing daily ragweed pollen data sets for Europe, to produce phenological maps of ragweed pollen, resulting in the most complete and detailed high-resolution ragweed pollen concentration maps to date. To achieve this, we have developed two statistical procedures, a Gaussian method (GM) and deep learning (DL) for restoring missing daily ragweed pollen data sets, based on the plant's reproductive and growth (phenological, pollen production and frost-related) characteristics. DL model performances were consistently better for estimating seasonal pollen integrals than those of the GM approach. These are the first published modelled maps using altitude correction and flowering phenology to recover missing pollen information. We created a web page (http://euragweedpollen.gmf.u-szeged.hu/), including daily ragweed pollen concentration data sets of the stations examined and their restored daily data, allowing one to upload newly measured or recovered daily data. Generation of these maps provides a means to track pollen impacts in the context of climatic shifts, identify geographical regions with high pollen exposure, determine areas of future vulnerability, apply spatially-explicit mitigation measures and prioritize management interventions.

Mortality amenable to health care and its relation to socio-economic status in Hungary, 2004-08.

BACKGROUND: Recently, research focus has returned to amenable mortality to health care, despite the decreasing trend, as it remains a significant contributor to social and economic loss due to premature death. This article assesses the trends of amenable mortality over time and, its spatial inequalities with respect to deprivation, in Hungary. METHODS: An ecological analysis of mortality amenable to health care was carried out using smoothed indirectly standardized mortality ratios, calculated by full hierarchical Bayesian methods, at municipality level. The association between the spatial distribution of amenable mortality and deprivation was also assessed using a Hungarian specific deprivation index. RESULTS: Trends of mortality amenable to health care were characterized by a decreasing pattern across the studied period, 1996-2008. Areas of significantly high risk of amenable mortality were identified in the North-eastern, Eastern and South-western parts of Hungary. A statistically significant association was found between amenable mortality and deprivation status in both genders. After correcting for bias due to socio-economic confounders, the patterns of areas with excess risks significantly changed. CONCLUSION: Differences in deprivation alone cannot explain the spatial distribution of mortality amenable to health care. This study highlights the importance of exploring other factors (e.g. health-care system and individual life style) beyond socio-economic status, which affect health inequalities particularly for health policy makers, who are responsible for the mitigation of health disparities.

The influence of air pollution on respiratory allergies, asthma and wheeze in childhood in Hungary.

BACKGROUND: Higher exposure to air pollution may contribute to the increased prevalence of allergic diseases in children. The study investigated the associations between the prevalence of childhood respiratory diseases and long-term exposure to NO2, SO2, PM10, especially some surrogates in schoolchildren in Hungary. We also analyzed the possible modification effects of some confounders by interaction analysis. METHODS: A total of 6771 children aged 8-9-year-old residing at their current addresses since their births with air pollution monitoring stations were selected into this analysis. Health outcomes and their possible determinants, as well as surrogates of air pollution were surveyed by using a standardized questionnaire. Long-term exposure to PM10, NO2, and SO2 was calculated at settlement level derived from daily average concentrations of pollutants. Descriptive and analytical statistical methods were applied. RESULTS: NO2 levels were positively associated with respiratory allergies and asthma. Decreased risk for ragweed, any other pollen, house dust mite and animal fur allergy was detected with PM10 level. There were significant associations between respiratory allergies to ragweed, any other pollen, house dust mite, animal fur, wheeze symptoms and living or attending school nearby a factory, power station or bus station as well as living in a home with intensive noise or vibration. Gender, parental atopy, home mold and early respiratory infection were significant effect modifiers in some cases. CONCLUSIONS: The results of this study indicate that respiratory health in children is adversely affected by air pollutants.

Survival and growth of microscopic fungi derived from tropical regions under future heat waves in the Pannonian Biogeographical Region.

Warming and heat waves are predicted by different climate models in the near future in the Pannonian Biogeographical Region (PBR). These climatic effects may have impact on the prevalence and distribution of certain fungal species of this area. In this study the effects of predicted climate scenarios were tested on fungi being endemic or unintentionally introduced by global trade from regions of warm temperate climate. Common fungal species were selected for the study and exposed to heat waves during 7 days according to two climate scenarios: one moderately (RCP 4.5, Tavg = 27 °C, Tmax = 35 °C, RH: 100%) and one strongly pessimistic (RCP 8.5, Tavg = 30 °C, Tmax = 40 °C, RH: 100%) that include predictions for the Central Hungarian Region for July 2050. According to our results, Aspergillus flavus, Aspergillus niger, Aspergillus tubingensis and Fusarium strains introduced from tropical regions tolerated heat waves, unlike Penicillium and Talaromyces spp. and endemic Cladosporium spp. which were unable to grow under the RCP 8.5 treatment. The effects of climate change on fungi raise new issues not only from economic and health perspectives, but also in relation with plant protection and environment. Our results suggest that heat waves driven by climate change promote the colonization and growth of the tested strains of non-native fungi more likely than that of the native ones.

Parental education and lung function of children in the PATY study.

Studies of the relationships between low socio-economic status and impaired lung function were conducted mainly in Western European countries and North America. East-West differences remain unexplored. Associations between parental education and lung function were explored using data on 24,010 school-children from eight cross-sectional studies conducted in North America, Western and Eastern Europe. Parental education was defined as low and high using country-specific classifications. Country-specific estimates of effects of low parental education on volume and flow parameters were obtained using linear and logistic regression, controlling for early life and other individual risk factors. Meta-regressions were used for assessment of heterogeneity between country-specific estimates. The association between low parental education and lung function was not consistent across the countries, but showed a more pronounced inverse gradient in the Western countries. The most consistent decrease associated with low parental education was found for peak expiratory flow (PEF), ranging from -2.80 to -1.14%, with statistically significant associations in five out of eight countries. The mean odds ratio for low PEF (<75% of predicted) was 1.34 (95% CI 1.06-1.70) after all adjustments. Although social gradients were attenuated after adjusting for known risk factors, these risk factors could not completely explain the social gradient in lung function.

The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project.

BACKGROUND: The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity. METHODS: Heat waves were defined considering both maximum apparent temperature and minimum temperature and classified by intensity, duration and timing during summer. The effect was estimated as percent increase in daily mortality during heat wave days compared to non heat wave days in people over 65 years. City specific and pooled estimates by gender, age and cause of death were calculated. RESULTS: The effect of heat waves showed great geographical heterogeneity among cities. Considering all years, except 2003, the increase in mortality during heat wave days ranged from + 7.6% in Munich to + 33.6% in Milan. The increase was up to 3-times greater during episodes of long duration and high intensity. Pooled results showed a greater impact in Mediterranean (+ 21.8% for total mortality) than in North Continental (+ 12.4%) cities. The highest effect was observed for respiratory diseases and among women aged 75-84 years. In 2003 the highest impact was observed in cities where heat wave episode was characterized by unusual meteorological conditions. CONCLUSIONS: Climate change scenarios indicate that extreme events are expected to increase in the future even in regions where heat waves are not frequent. Considering our results prevention programs should specifically target the elderly, women and those suffering from chronic respiratory disorders, thus reducing the impact on mortality.

High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities.

RATIONALE: Episode analyses of heat waves have documented a comparatively higher impact on mortality than on morbidity (hospital admissions) in European cities. The evidence from daily time series studies is scarce and inconsistent. OBJECTIVES: To evaluate the impact of high environmental temperatures on hospital admissions during April to September in 12 European cities participating in the Assessment and Prevention of Acute Health Effects of Weather Conditions in Europe (PHEWE) project. METHODS: For each city, time series analysis was used to model the relationship between maximum apparent temperature (lag 0-3 days) and daily hospital admissions for cardiovascular, cerebrovascular, and respiratory causes by age (all ages, 65-74 age group, and 75+ age group), and the city-specific estimates were pooled for two geographical groupings of cities. MEASUREMENTS AND MAIN RESULTS: For respiratory admissions, there was a positive association that was heterogeneous between cities. For a 1 degrees C increase in maximum apparent temperature above a threshold, respiratory admissions increased by +4.5% (95% confidence interval, 1.9-7.3) and +3.1% (95% confidence interval, 0.8-5.5) in the 75+ age group in Mediterranean and North-Continental cities, respectively. In contrast, the association between temperature and cardiovascular and cerebrovascular admissions tended to be negative and did not reach statistical significance. CONCLUSIONS: High temperatures have a specific impact on respiratory admissions, particularly in the elderly population, but the underlying mechanisms are poorly understood. Why high temperature increases cardiovascular mortality but not cardiovascular admissions is also unclear. The impact of extreme heat events on respiratory admissions is expected to increase in European cities as a result of global warming and progressive population aging.

Heat effects on mortality in 15 European cities.

BACKGROUND: Epidemiologic studies show that high temperatures are related to mortality, but little is known about the exposure-response function and the lagged effect of heat. We report the associations between daily maximum apparent temperature and daily deaths during the warm season in 15 European cities. METHODS: The city-specific analyses were based on generalized estimating equations and the city-specific results were combined in a Bayesian random effects meta-analysis. We specified distributed lag models in studying the delayed effect of exposure. Time-varying coefficient models were used to check the assumption of a constant heat effect over the warm season. RESULTS: The city-specific exposure-response functions have a V shape, with a change-point that varied among cities. The meta-analytic estimate of the threshold was 29.4 degrees C for Mediterranean cities and 23.3 degrees C for north-continental cities. The estimated overall change in all natural mortality associated with a 1 degrees C increase in maximum apparent temperature above the city-specific threshold was 3.12% (95% credibility interval = 0.60% to 5.72%) in the Mediterranean region and 1.84% (0.06% to 3.64%) in the north-continental region. Stronger associations were found between heat and mortality from respiratory diseases, and with mortality in the elderly. CONCLUSIONS: There is an important mortality effect of heat across Europe. The effect is evident from June through August; it is limited to the first week following temperature excess, with evidence of mortality displacement. There is some suggestion of a higher effect of early season exposures. Acclimatization and individual susceptibility need further investigation as possible explanations for the observed heterogeneity among cities.

An ecological time-series study of heat-related mortality in three European cities.

BACKGROUND: Europe has experienced warmer summers in the past two decades and there is a need to describe the determinants of heat-related mortality to better inform public health activities during hot weather. We investigated the effect of high temperatures on daily mortality in three cities in Europe (Budapest, London, and Milan), using a standard approach. METHODS: An ecological time-series study of daily mortality was conducted in three cities using Poisson generalized linear models allowing for over-dispersion. Secular trends in mortality and seasonal confounding factors were controlled for using cubic smoothing splines of time. Heat exposure was modelled using average values of the temperature measure on the same day as death (lag 0) and the day before (lag 1). The heat effect was quantified assuming a linear increase in risk above a cut-point for each city. Socio-economic status indicators and census data were linked with mortality data for stratified analyses. RESULTS: The risk of heat-related death increased with age, and females had a greater risk than males in age groups > or =65 years in London and Milan. The relative risks of mortality (per degrees C) above the heat cut-point by gender and age were: (i) Male 1.10 (95%CI: 1.07-1.12) and Female 1.07 (1.05-1.10) for 75-84 years, (ii) M 1.10 (1.06-1.14) and F 1.08 (1.06-1.11) for > or = or =85 years in Budapest (> or =24 degrees C); (i) M 1.03 (1.01-1.04) and F 1.07 (1.05-1.09), (ii) M 1.05 (1.03-1.07) and F 1.08 (1.07-1.10) in London (> or =20 degrees C); and (i) M 1.08 (1.03-1.14) and F 1.20 (1.15-1.26), (ii) M 1.18 (1.11-1.26) and F 1.19 (1.15-1.24) in Milan (> or =26 degrees C). Mortality from external causes increases at higher temperatures as well as that from respiratory and cardiovascular disease. There was no clear evidence of effect modification by socio-economic status in either Budapest or London, but there was a seemingly higher risk for affluent non-elderly adults in Milan. CONCLUSION: We found broadly consistent determinants (age, gender, and cause of death) of heat related mortality in three European cities using a standard approach. Our results are consistent with previous evidence for individual determinants, and also confirm the lack of a strong socio-economic gradient in heat health effects currently in Europe.

Impacts of long-term ragweed pollen load and other potential risk factors on ragweed pollen allergy among schoolchildren in Hungary.

INTRODUCTION AND OBJECTIVE: Hungary is one of the areas in Europe most infected with ragweed (Ambrosia artemisiifolia L.) and its pollen, and is the most important cause of seasonal allergic rhinoconjunctivitis in the country. The aim of the study was to investigate the association between ragweed pollen allergy and long-term ragweed pollen load, as well as analysis of the the impacts of additional potential risk factors on health outcomes. MATERIAL AND METHODS: A modified version of standardized questionnaires, based on the International Study of Asthma and Allergy in Childhood, were completed by the parents of schoolchildren aged 8 - 9 attending 3rd grade classes throughout the country. Pollen load was calculated for each settlement from daily ragweed pollen concentrations monitored by 19 monitoring stations in the country. Descriptive and analytical statistical methods were applied. RESULTS: At national level there was a significant inverse association between prevalence of ragweed allergy and its pollen load, but significance was lost after excluding data from Budapest, the capital city, due to the impact of urbanization. In the adjusted model, parental atopic disease was the strongest risk factor (either parent had atopic disease aOR=2.60; 95% CI=2.31-2.93 or both parents had atopic disease aOR=4.56; 95% CI=3.71-5.60). Further significant risk factors were male gender (aOR=1.52; 95% CI=1.36-1.71), lower respiratory infection in the first two years of life (aOR=1.91; 95% CI=1.70-2.16), and unshared children's room (aOR=1.22; 95% CI=1.09-1.37). Allergy was significantly less common among children whose parents received social aid (aOR=0.83; 95% CI=0.72-0.97) and whose mother smoked during pregnancy (aOR=0.80; 95% CI=0.64-0.99). CONCLUSIONS: Higher ragweed pollen exposure was not found to be associated with higher risk of ragweed allergy.

Synergistic Effects of Ambient Temperature and Air Pollution on Health in Europe: Results from the PHASE Project.

We studied the potential synergy between air pollution and meteorology and their impact on mortality in nine European cities with data from 2004 to 2010. We used daily series of Apparent Temperature (AT), measurements of particulate matter (PM10), ozone (O3), and nitrogen dioxide (NO2) and total non-accidental, cardiovascular, and respiratory deaths. We applied Poisson regression for city-specific analysis and random effects meta-analysis to combine city-specific results, separately for the warm and cold seasons. In the warm season, the percentage increase in all deaths from natural causes per °C increase in AT tended to be greater during high ozone days, although this was only significant for all ages when all causes were considered. On low ozone days, the increase in the total daily number of deaths was 1.84% (95% CI 0.87, 2.82), whilst it was 2.20% (95% CI 1.28, 3.13) in the high ozone days per 1 °C increase in AT. Interaction with PM10 was significant for cardiovascular (CVD) causes of death for all ages (2.24% on low PM10 days (95% CI 1.01, 3.47) whilst it is 2.63% (95% CI 1.57, 3.71) on high PM10 days) and for ages 75+. In days with heat waves, no consistent pattern of interaction was observed. For the cold period, no evidence for synergy was found. In conclusion, some evidence of interactive effects between hot temperature and the levels of ozone and PM10 was found, but no consistent synergy could be identified during the cold season.

Paediatric environmental health in Hungary.

A review is given on the state of activities regarding environmental health in Hungary, with special respect to present and future health of children.

[Increase in prevalence of childhood asthma in Budapest between 1995 and 2003: correlation with air pollution data and total pollen count]. / A gyermekkori asztma prevalenciájának növekedése Budapesten 1995 és 2003 között a (változatlan) légszennyezettségi és pollen adatok tükrében.

INTRODUCTION: According to the data of the Hungarian pulmonological network, the prevalence of asthma in the last 15 years has increased (almost linearly) in Hungary. In 2004 it was 1.8%. There are only a few data about the prevalence of childhood asthma. AIMS: The aim of the authors was to measure the prevalence of bronchial asthma in childhood in Budapest in 1995, 1999 and 2003, using questionnaires directed to district pediatricians. METHODS: There were only two questions in these questionnaires: how many children are in their districts, and how many are suffering from asthma? Besides of this survey the dust, CO, NO(2) and SO(2) concentrations in the air were measured on-line at 8 points in Budapest, while ozone level measurements were also made at 2 stations. The counts of pollen and of fungal elements in the air were calculated separately for Buda and for Pest. RESULTS: In 1995, replies were received from 118 pediatricians in 11 districts, who were responsible for the supervision of 104,060 children, out of these 1.88+/-0.87% had been diagnosed as having asthma. In 1999 replies were sent by 153 physicians in 22 of the 23 districts, who had a total of 142,679 children under their care. These included 3228 asthmatics, i.e. a prevalence of 2.26+/-0.95%. In 2003 the authors received answers from all of the 23 districts of Budapest. The 204 pediatricians were responsible for the supervision of 176 049 children. The number of patients with the diagnosis of asthma was 4712 (corresponding for a prevalence of 2.68+/-1.3%). The increase between 1995 and 1999, and between 1999 and 2003 was highly significant (p < 0.0001). This significant increase was valid even when the authors analysed only those 11 districts, which answered already in 1995. The level of air pollution in Budapest did not deteriorate in the period in question, and the concentration of pollen grains of plants causing allergy did not increase compared to previous years. CONCLUSIONS: On the basis of the results of more than 100 thousand children, the authors conclude that between 1995 and 2003 the proportion of asthmatic children increased by 50% in Budapest, while the air pollution did not deteriorate and the pollen concentration from sensitizing plants did not increase.