Chikungunya Fever: A Killer Epidemic in Ahmedabad City, India

Background The Chikungunya virus is an alphavirus native to tropical Africa and Asia and is transmitted to humans by the bite of infected Aedes mosquitoes. The symptoms of Chikungunya include sudden onset of fever, severe arthralgia, and maculopapular rash. Thirty percent of the population on the French R�union Island was afflicted with Chikungunya in the past year. They reported 237 deaths. India on the other hand reported 1.39 million cases of Chikungunya but no deaths. Methods Mortality data from 2002-2006 was obtained from the Ahmedabad Municipal Corporation (AMC). Actual mortality rate of 2006 was compared to the mortality rate of 2002-05 and its statistical significance tests were carried out. Findings Mortality data obtained from the Ahmedabad Municipal Corporation (AMC) suggests that 3112 excess deaths occurred in August-November (epidemic period) compared to the average deaths in the same months during the previous four years. These differences in deaths were found to be highly statistically significant. A peak in excess mortality is seen in the month of September when 1489 additional deaths were recorded. Case fatality rates for Ahmedabad also turn out to be much higher than that of the Reunion Island. Interpretation The Chikungunya epidemic was raging when the excess deaths occurred. There were no other adverse events or other epidemics that took place could explain this excess mortality. Government authorities, WHO and other international public health agencies should take these findings of excess mortality seriously and investigate into this occurrence of excess deaths to understand this reemerging disease and prevent future epidemics and mortality.

Excess Mortality in a Nephrology Clinic during First Months of Coronavirus Disease-19 Pandemic: A Pragmatic Approach

BACKGROUND: Excess mortality is defined as mortality above what would be expected based on the non-crisis mortality rate in the population of interest. AIM: In this study, we aimed to access weather the coronavirus disease (COVID)-19 pandemic had impact on the in-hospital mortality during the first 6 months of the year and compare it with the data from the previous years. METHODS: A retroprospective study was conducted at the University Clinic of Nephrology Skopje, Republic of Macedonia. In-hospital mortality rates were calculated for the first half of the year (01.01–30.06) from 2015 until 2020, as monthly number of dead patients divided by the number of non-elective hospitalized patents in the same period. The excess mortality rate (p-score) was calculated as ratio or percentage of excess deaths relative to expected average deaths: (Observed mortality rate–expected average death rate)/expected average death rate *100%. RESULTS: The expected (average) overall death mortality rate for the period 2015–2019 was 8.9% and for 2020 was 15.3%. The calculated overall excess mortality in 2020 was 72% (pscore 0.72). CONCLUSION: In this pragmatic study, we have provided clear evidence of high excess mortality at our nephrology clinic during the 1st months of the COVID-19 pandemic. The delayed referral of patients due to the patient and health care system-related factors might partially explain the excess mortality during pandemic crises. Further analysis is needed to estimate unrecognized probable COVID-19 deaths

Altitude and COVID-19 in Colombia : an updated analysis accounting for potential confounders

Q4Q2Pacientes con COVID-19We assessed the relationship between the altitude of municipalities and the incidence, mortality, and fatality from COVID-19 and excess of mortality in Colombia between 2020 and 2022. We conducted an ecologic study including all 1122 municipalities in Colombia and used categories of altitude as main independent variable. We fit multivariable regression models for incidence, mortality, fatality rates, and excess of mortality controlling for several variables at municipality level. There was a higher incidence rate, similar mortality rate and lower case-fatality rate for COVID-19 during 2020–2022 in municipalities in the upper category of altitude (>=2500 masl) compared to the lower category (<1000 masl). The excess of mortality was lower but not statistically different in municipalities in the upper category of altitude, and significantly lower in the intermediate altitude category compared to the lowlands. Our findings provide evidence that municipalities with high altitude had similar mortality rate, and lower case-fatality rate and excess of mortality for COVID-19 compared to lowlands in Colombia.https://orcid.org/0000-0002-0100-1940Revista Internacional - IndexadaA2N

Global Mortality Impact of the 1957–1959 Influenza Pandemic

Background. Quantitative estimates of the global burden of the 1957 influenza pandemic are lacking. Here we fill this gap by modeling historical mortality statistics. Methods. We used annual rates of age- and cause-specific deaths to estimate pandemic-related mortality in excess of background levels in 39 countries in Europe, the Asia-Pacific region, and the Americas. We modeled the relationship between excess mortality and development indicators to extrapolate the global burden of the pandemic. Results. The pandemic-associated excess respiratory mortality rate was 1.9/10 000 population (95% confidence interval [CI], 1.2–2.6 cases/10 000 population) on average during 1957–1959. Excess mortality rates varied 70-fold across countries; Europe and Latin America experienced the lowest and highest rates, respectively. Excess mortality was delayed by 1–2 years in 18 countries (46%). Increases in the mortality rate relative to baseline were greatest in school-aged children and young adults, with no evidence that elderly population was spared from excess mortality. Development indicators were moderate predictors of excess mortality, explaining 35%–77% of the variance. Overall, we attribute 1.1 million excess deaths (95% CI, .7 million–1.5 million excess deaths) globally to the 1957–1959 pandemic. Conclusions. The global mortality rate of the 1957–1959 influenza pandemic was moderate relative to that of the 1918 pandemic but was approximately 10-fold greater than that of the 2009 pandemic. The impact of the pandemic on mortality was delayed in several countries, pointing to a window of opportunity for vaccination in a future pandemic. Keywords. mortality rates; pandemic influenza; historical studies; vital statistics; severity; models; global disease burden; development indicators; health indicators; pandemic planning

Excess Mortality Rate During Adulthood Among Danish Adoptees

BACKGROUND AND OBJECTIVE: Adoption studies have been used to disentangle the influence of genes from shared familial environment on various traits and disease risks. However, both the factors leading to adoption and living as an adoptee may bias the studies with regard to the relative influence of genes and environment compared to the general population. The aim was to investigate whether the cohort of domestic adoptees used for these studies in Denmark is similar to the general population with respect to all-cause mortality and cause-specific mortality rates. METHODS: 13,111 adoptees born in Denmark in 1917, or later, and adopted in 1924 to 1947 were compared to all Danes from the same birth cohorts using standardized mortality ratios (SMR). The 12,729 adoptees alive in 1970 were similarly compared to all Danes using SMR as well as cause-specific SMR. RESULTS: The excess in all-cause mortality before age 65 years in adoptees was estimated to be 1.30 (95% CI 1.26-1.35). Significant excess mortality before age 65 years was also observed for infections, vascular deaths, cancer, alcohol-related deaths and suicide. Analyses including deaths after age 65 generally showed slightly less excess in mortality, but the excess was significant for all-cause mortality, cancer, alcohol-related deaths and suicides. CONCLUSION: Adoptees have an increased all-cause mortality compared to the general population. All major specific causes of death contributed, and the highest excess is seen for alcohol-related deaths

Six-year mortality in a street-recruited cohort of homeless youth in San Francisco, California.

Objectives. The mortality rate of a street-recruited homeless youth cohort in the United States has not yet been reported. We examined the six-year mortality rate for a cohort of street youth recruited from San Francisco street venues in 2004. Methods. Using data collected from a longitudinal, venue-based sample of street youth 15-24 years of age, we calculated age, race, and gender-adjusted mortality rates. Results. Of a sample of 218 participants, 11 died from enrollment in 2004 to December 31, 2010. The majority of deaths were due to suicide and/or substance abuse. The death rate was 9.6 deaths per hundred thousand person-years. The age, race and gender-adjusted standardized mortality ratio was 10.6 (95% CI [5.3-18.9]). Gender specific SMRs were 16.1 (95% CI [3.3-47.1]) for females and 9.4 (95% CI [4.0-18.4]) for males. Conclusions. Street-recruited homeless youth in San Francisco experience a mortality rate in excess of ten times that of the states general youth population. Services and programs, particularly housing, mental health and substance abuse interventions, are urgently needed to prevent premature mortality in this vulnerable population

Building a Multivariate model to estimate and prospectively monitor excess mortality associated with influenza epidemics and extreme temperature

Background As observed in several European countries, in the winter of 2011/12 the Portuguese mortality surveillance system detected an excess mortality in elderly population that was concomitant with an influenza epidemic and a cold spell. In order to estimate the impact of specific event contribution a multivariate model was developed. Methods We used an additive Poisson regression model, with mortality rate as the outcome and season specific ILI rate above baseline, extreme temperatures events (cold wave: less then 5ºC; heat wave: above 30ºC), trend and season components as the independent variables. All cause mortality data (week 26/2007 to week 20/2012) was extracted from the national mortality surveillance system. Excess mortality associated to influenza epidemic and cold spell was obtained by respectively summing specific events components of the model during the excess period. Results We observed a mortality excess period between weeks 2 to11/2012. Within this period the total estimated mortality excess was 3994, 97% of them due to influenza epidemics (AH3) and extreme cold event. Looking into specific event contribution, 75% (2978; CI95%: 2773-3185) was associated to influenza epidemic, 22% to extreme cold (889; CI95%: 801-978) and 3% unexplained. Results also showed that the multivariate model can be used for prospectively monitoring excess mortality, by setting the extreme temperatures and influenza epidemics covariates at zero and projecting the baseline for the future. Conclusion An excess 3994 deaths was observed during 2012 winter, 75% of these was attributable to influenza and 22% to extreme cold temperatures. The multivariate model allowed us to estimate excess mortality associated to different events but also to project a baseline for mortality monitoring. This approach may be a more suitable method to build baselines to prospectively detect excess mortality since no data is removed from the mortality time serie

An analysis of the excess mortality profile during the 2006 Chikungunya Fever epidemic in Mauritius

The Island of Mauritius was affected by a large scale epidemic outbreak ofChikungunya Fever (CHIKF) from February to April 2006. It was observed that this epidemic was associated with an excess mortality during the months of March to May 2006 in Mauritius. This study was aimed to analyze the gender and age group distribution of the excess mortality. Population and mortality data were obtained from the Mauritius Central Statistics Office for the years 2000 to 2006. The excess monthly mortality was computed for 2006 and the distribution of excess mortality according to gender and age groups was analyzed. For both genders combined, the excess mortality was 91.5% in the age group &ge; 50 years. For the &ge; 50-year age group, the total male excess death rate (EDR) exceeded the total female EDR by 66%. Our results indicate that CHIKF is associated withan increased mortality particularly in the &ge; 50-year age group with males being more vulnerable than females to mortality. Although there have been reports of CHIKF related deaths in other studies, the profile of the excess mortality during a CHIKF outbreak has not been previously described.KEY WORDS: Chikungunya Fever; Distribution of excess mortality; Gender; Age group