Several European countries have timely all-cause mortality monitoring. However, small changes in mortality may not give rise to signals at the national level. Pooling data across countries may overcome this, particularly if changes in mortality occur simultaneously. Additionally, pooling may increase the power of monitoring populations with small numbers of expected deaths, e.g. younger age groups or fertile women. Finally, pooled analyses may reveal patterns of diseases across Europe. We describe a pooled analysis of all-cause mortality across 16 European countries. Two approaches were explored. In the ‘summarized’ approach, data across countries were summarized and analysed as one overall country. In the ‘stratified’ approach, heterogeneities between countries were taken into account. Pooling using the ‘stratified’ approach was the most appropriate as it reflects variations in mortality. Excess mortality was observed in all winter seasons albeit slightly higher in 2008/09 than 2009/10 and 2010/11. In the 2008/09 season, excess mortality was mainly in elderly adults. In 2009/10, when pandemic influenza A(H1N1) dominated, excess mortality was mainly in children. The 2010/11 season reflected a similar pattern, although increased mortality in children came later. These patterns were less clear in analyses based on data from individual countries. We have demonstrated that with stratified pooling we can combine local mortality monitoring systems and enhance monitoring of mortality across Europe.

Emergence and re-emergence of arboviral disease in new areas of southern Europe is becoming a public health problem. Since Aedes albopictus was first detected in 2004 in Catalonia, it has spread along the Spanish Mediterranean coast. Results of an entomological surveillance carried out by the Spanish Ministry of Health to monitor the expansion of Ae. albopictus along the Spanish Mediterranean coast between 2009 and 2012 are presented. Besides the new locations in Valencia and Murcia regional communities, it was identified in five municipalities in the Balearic Islands in 2012. A comprehensive plan aiming the control of invasive vector-borne diseases including entomological surveillance should be considered.

ResumenLas altas temperaturas experimentadas en Europa durante el verano de 2003 tuvieron un efecto en la mortalidad en varios países, incluido el nuestro. En este capítulo se describe la mortalidad registrada durante el período comprendido entre el 1 de junio al 31 de agosto de 2003, y se comenta el impacto de las olas de calor sufridas.El número de defunciones se obtuvo de los registros civiles de las capitales de provincia y de una muestra aleatoria de 107 municipios rurales. Esto se comparó con la mortalidad esperada, estimada mediante un modelo de regresión de Poisson sobre series históricas de defunciones, corregido por la tendencia ascendente y la estacionalidad de la mortalidad. La información meteorológica la proporcionó el Instituto Nacional de Meteorología.España experimentó tres períodos de temperaturas elevadas. El exceso de defunciones asociado fue del 8% (43.212 observadas por 40.046 esperadas). El exceso de mortalidad afectó exclusivamente a las personas mayores de 65 años (15%). Este incremento también se observó en el medio rural.Este fenómeno es un problema de salud pública emergente por su riesgo atribuible creciente debido al envejecimiento de la población. Frente a ello, se pueden plantear sistemas de alerta y respuesta basados en el control de riesgos naturales, las demandas médicas de urgencia y las defunciones, así como en el fortalecimiento de la capacidad de respuesta de los servicios sociales y sanitarios. Palabras clave: Calor/efectos adversos. Humanos. España/epidemiología. Europa/epidemiología. Factores meteorológicos. Mortalidad. Estaciones. AbstractThe effect of the elevated temperatures experimented in Europe during the summer 2003 on mortality was observed in several countries. This study, carried out in Spain, describes the mortality between the 1 st June and the 31 st August and evaluates the effect of the heat wave on mortality.Observed deaths were obtained from official vital Registers of the capital city of the 50 provinces. Deaths from 107 randomly selected rural villages were also obtained from the same source. Observed deaths were compared with expected estimated applying a Poisson regression model to historical mortality series adjusting for the upwards trend and seasonality observed. Meteorological information was provided by the National Institute of Meteorology.Spain experienced three heat waves. Total excess deaths associated was 8% (43212 observed compared with 40046 expected). Excess deaths were only observed among 65 years old and over (15%). The increased mortality was also observed in rural villages.This phenomenon is becoming an emerging public health problem because of its increasing attributable risk because of the aging of Spanish population. Alert and response systems based on monitoring of climate related risks, emergency rooms activity and mortality and the strengthening of social and health services response capacity should be considered.

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