Excess mortality in Guadeloupe and Martinique, islands of the French West Indies, during the chikungunya epidemic of 2014

Rev. Soc. Bras. Med. Trop.

Medeiros

Frutuoso

et al. 2020

Self Cite

Introduction: In March 2020, the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic. In Brazil, 110 thousand cases and 5,901 deaths were confirmed by the end of April 2020. The scarcity of laboratory resources, the overload on the service network, and the broad clinical spectrum of the disease make it difficult to document all the deaths due to COVID-19. The aim of this study was to assess the mortality rate in Brazilian capitals with a high incidence of COVID-19. Methods: We assessed the weekly mortality between epidemiological week 1 and 16 in 2020 and the corresponding period in 2019. We estimated the expected mortality at 95% confidence interval by projecting the mortality in 2019 to the population in 2020, using data from the National Association of Civil Registrars (ARPEN-Brasil). Results: In the five capitals with the highest incidence of COVID-19, we identified excess deaths during the pandemic. The age group above 60 years was severely affected, while 31% of the excess deaths occurred in the age group of 20-59 years. There was a strong correlation (r = 0.94) between excess deaths and the number of deaths confirmed by epidemiological monitoring. The epidemiological surveillance captured only 52% of all mortality associated with the COVID-19 pandemic in the cities examined. Conclusions: Considering the simplicity of the method and its low cost, we believe that the assessment of excess mortality associated with the COVID-19 pandemic should be used as a complementary tool for regular epidemiological surveillance.

Section: Discussionmentioning

confidence: 99%

Section: /8mentioning

confidence: 99%

Tracking excess deaths associated with the COVID-19 epidemic as an epidemiological surveillance strategy-preliminary results of the evaluation of six Brazilian capitals

Rev. Soc. Bras. Med. Trop.

Medeiros

Frutuoso

et al. 2020

Self Cite

“…This is not an unexpected finding, since other viruses such as influenza and chikungunya are also characterized by a mortality burden that is often greater than that measured through the etiological investigation of each patient. Mortality associated with these viruses can be better assessed by calculating the excess mortality that occurs in periods of epidemic [13,14]. Using a similar methodology, it is possible to estimate that in New York City the excess of deaths in the first four weeks was 12547 and, however, conventional epidemiological surveillance was able to identify 7186 deaths from COVID-19, 57% of the excess deaths in the same period [15].…”

Section: Discussionmentioning

confidence: 99%

“…We emphasize that this limitation is restricted to the analysis of the excess of deaths from respiratory causes, since the cause of death does not interfere in the assessment of mortality from all causes. Another limitation related to the use of data from the registry offices is that in this system only data are available for the years 2019 and 2020, therefore, it was not possible to use an average mortality rate of several years as would be the most appropriate [14,15]. Even with these limitations, the results were quite consistent, showing the most affected ages and there was a strong correlation between the mortality found in the official surveillance system and excess mortality, in addition, the period of increase in mortality was coincident with the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Excess mortality is a tool already used to assess mortality associated with climatic events, earthquakes and epidemics with good temporal definition such as those caused by the influenza virus, respiratory syncytial virus and chikungunya [13,14,20]. Like the CDC in the USA, the EuroMOMO Project tracks mortality data from some European countries weekly to assess excess mortality and monitor the impact of influenza epidemics, these systems are managing to capture the excess mortality associated with the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

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Use of excess mortality associated with the COVID-19 epidemic as an epidemiological surveillance strategy - preliminary results of the evaluation of six Brazilian capitals

Medeiros

Frutuoso

et al. 2020

Preprint

Self Cite

In early 2020, the World Health Organization (WHO) recognized the pandemic situation of the new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), which causes Coronavirus Disease-2019 (COVID-19). In Brazil by the end of April 2020, another 110 thousand cases and 5,000 deaths had been confirmed. The scarcity of laboratory resources and overload of the care network, added to the broad clinical spectrum of the disease, can make it difficult to capture all mortality from this disease through epidemiological surveillance based on individual notification of cases. The aim of this study was to evaluate the excess of deaths in Brazilian capitals with the highest incidence of COVID-19, as a way of validating the method, we also evaluated a capital with low incidence. We assessed weekly mortality from all causes during the year 2020, up to the epidemiological week 17, compared with the previous year. The data were obtained through the National Civil Registry Information Center (CNIRC, acronym in Portuguese). We estimate the expected mortality and the 95% confidence interval by projecting the observed mortality in 2019 for the population of 2020. In the five capitals with the highest incidences it was possible to identify excess deaths in the pandemic period, the age group most affected were those over 60 years old, 31% of the excess deaths occurred in the population between 20 and 59 years old. There was a strong correlation (r = 0.94) between the excess of deaths in each city and the number of deaths confirmed by epidemiological surveillance. There was no excess of deaths in the capital with the lowest incidence, nor among the population under 20 years old. We estimate that epidemiological surveillance managed to capture only 52% of all mortality associated with the COVID-19 pandemic in the cities studied. Considering the simplicity of the method, its low cost and reliability for assessing the real burden of the disease, we believe that the assessment of excess mortality associated with the COVID-19 pandemic should be widely used as a complementary tool to regular epidemiological surveillance and its use should be encouraged by WHO.

Excess deaths associated with the 2014 chikungunya epidemic in Jamaica

Pathogens and Global Health

Gérardin

Kassar

et al. 2019

Although traditionally chikungunya virus is considered non-fatal, recent studies suggest that there may be in fact underreporting of deaths in some situations. A major chikungunya epidemic hit Jamaica in 2014 but no chikungunya-associated deaths were reported. We assessed the excess of all-cause deaths during this epidemic. Excess deaths were estimated by difference between observed and expected mortality based on the average age-specific mortality rate of 2012-2013, using the 99% confidence interval. There was an excess of 2,499 deaths during the epidemic (91.9/100,000 population), and a strong positive correlation between the monthly incidence of chikungunya and the excess of deaths (Rho = 0.939, p < 0.005). No significant concomitant epidemiological or climatic phenomenon occurred. Chikungunya is a major contributor to morbidity during epidemics and may be an unrecognized cause of death. Thus, it is urgent to review clinical protocols and improve the investigations of specific-cause deaths during chikungunya epidemics. Excess deaths could be a strategic tool for epidemiological surveillance.