European all-cause excess and influenza-attributable mortality in the 2017/18 season: should the burden of influenza B be reconsidered?

J. Nielsen*, L. S. Vestergaard, L. Richter, D. Schmid, N. Bustos, T. Asikainen, R. Trebbien, G. Denissov, K. Innos, M. J. Virtanen, A. Fouillet, T. Lytras, K. Gkolfinopoulou, M. an der Heiden, L. Grabenhenrich, H. Uphoff, A. Paldy, J. Bobvos, L. Domegan, J. O'DonnellM. Scortichini, A. de Martino, J. Mossong, K. England, J. Melillo, L. van Asten, M. MA de Lange, R. Tønnessen, R. A. White, S. P. da Silva, A. P. Rodrigues, A. Larrauri, C. Mazagatos, A. Farah, A. D. Carnahan, C. Junker, M. Sinnathamby, Richard Pebody, Nicholas Andrews, A. Reynolds, J. McMenamin, C. S. Brown, C. Adlhoch, P. Penttinen, K. Mølbak, T. G. Krause

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

78 Citations (Scopus)


Objectives: Weekly monitoring of European all-cause excess mortality, the EuroMOMO network, observed high excess mortality during the influenza B/Yamagata dominated 2017/18 winter season, especially among elderly. We describe all-cause excess and influenza-attributable mortality during the season 2017/18 in Europe. Methods: Based on weekly reporting of mortality from 24 European countries or sub-national regions, representing 60% of the European population excluding the Russian and Turkish parts of Europe, we estimated age stratified all-cause excess morality using the EuroMOMO model. In addition, age stratified all-cause influenza-attributable mortality was estimated using the FluMOMO algorithm, incorporating influenza activity based on clinical and virological surveillance data, and adjusting for extreme temperatures. Results: Excess mortality was mainly attributable to influenza activity from December 2017 to April 2018, but also due to exceptionally low temperatures in February-March 2018. The pattern and extent of mortality excess was similar to the previous A(H3N2) dominated seasons, 2014/15 and 2016/17. The 2017/18 overall all-cause influenza-attributable mortality was estimated to be 25.4 (95%CI 25.0-25.8) per 100,000 population; 118.2 (116.4-119.9) for persons aged 65. Extending to the European population this translates into over-all 152,000 deaths. Conclusions: The high mortality among elderly was unexpected in an influenza B dominated season, which commonly are considered to cause mild illness, mainly among children. Even though A(H3N2) also circulated in the 2017/18 season and may have contributed to the excess mortality among the elderly, the common perception of influenza B only having a modest impact on excess mortality in the older population may need to be reconsidered.

Original languageEnglish
Pages (from-to)1266-1276
Number of pages11
JournalClinical Microbiology and Infection
Issue number10
Publication statusPublished - Oct 2019

Bibliographical note

Funding Information:
The EuroMOMO network has received financial support from the European Centre for Disease Prevention and Control (ECDC) , contract number ECDC/2016/041 , but not specifically to this study. The corresponding author had full access to all data and had final responsibility for the decision to submit for publication.

Publisher Copyright:
© 2019 The Authors


  • B/Yamagata
  • EuroMOMO
  • FluMOMO
  • Influenza
  • Mortality


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