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.

Excess mortality in Israel associated with COVID-19 in 2020-2021 by age group and with estimates based on daily mortality patterns in 2000-2019

Background

We aimed to build a basic daily mortality curve in Israel based on 20-year data accounting for long-term and annual trends, influenza-like illness (ILI) and climate factors among others, and to use the basic curve to estimate excess mortality during 65 weeks of the COVID-19 pandemic in 2020–2021 stratified by age groups.

Methods

Using daily mortality counts for the period 1 January 2000 to 31 December 2019, weekly ILI counts, daily climate and yearly population sizes, we fitted a quasi-Poisson model that included other temporal covariates (a smooth yearly trend, season, day of week) to define a basic mortality curve. Excess mortality was calculated as the difference between the observed and expected deaths on a weekly and periodic level. Analyses were stratified by age group.

Results

Between 23 March 2020 and 28 March 2021, a total of 51 361 deaths were reported in Israel, which was 12% higher than the expected number for the same period (expected 45 756 deaths; 95% prediction interval, 45 325–46 188; excess deaths, 5605). In the same period, the number of COVID-19 deaths was 6135 (12% of all observed deaths), 9.5% larger than the estimated excess mortality. Stratification by age group yielded a heterogeneous age-dependent pattern. Whereas in ages 90+ years (11% excess), 100% of excess mortality was attributed to COVID-19, in ages 70–79 years there was a greater excess (21%) with only 82% attributed to COVID-19. In ages 60–69 and 20–59 years, excess mortality was 14% and 10%, respectively, and the number of COVID-19 deaths was higher than the excess mortality. In ages 0–19 years, we found 19% fewer deaths than expected.

Conclusion

The findings of an age-dependent pattern of excess mortality may be related to indirect pathways in mortality risk, specifically in ages <80 years, and to the implementation of the lockdown policies, specifically in ages 0–19 years with lower deaths than expected.

The effects of biostimulation and bioaugmentation on crude oil biodegradation in two adjacent terrestrial oil spills of different age, in a hyper-arid region

This study deals with two adjacent terrestrial oil spills, with similar properties, located in a hyper-arid region in Israel, one from 1975 and the other from 2014. It tests the effect of biostimulation on crude oil degradation in both spills and whether biostimulated sediments from the 1975 spill can bioaugment crude oil degradation in the 2014 spill. Soil hydrophobicity, expressed as Water Drop Penetration Time (WDPT), and Gasoline Range Organics (GRO) and Diesel Range Organics (DRO) content in sediments were measured in one-month ex-situ experiments. No significant reduction in hydrophobicity and GRO + DRO content was observed in non-biostimulated controls. A combined treatment of mineral fertilization at t₀ and maintaining 50% water saturation, significantly accelerated the decrease in hydrophobicity and GRO + DRO content in sediments of both spills. The addition of biostimulated sediments from the 1975 spill failed to accelerate the reduction of GRO + DRO content and hydrophobicity in the 2014 spill. Surprisingly, the GRO + DRO degradation rate in biostimulated sediments from the 2014 spill was 36% higher than in biostimulated sediments from the 1975 spill. Crude oil composition in both spills changes during its degradation and is characterized by an increase in the GRO fraction. To a certain range, WDPT was found to serve as a reliable indicator for oil content in the soil. We conclude that even in a hyper-arid region, oil bio-degradation capabilities develop in a relatively short time. Moreover, while biostimulation was effective in accelerating biodegradation, bioaugmentation with biostimulated sediments from a nearby older spill was found ineffective.

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.

Excitatory and inhibitory synaptic mechanisms at the first stage of integration in the electroreception system of the shark

High impulse rate in afferent nerves is a common feature in many sensory systems that serve to accommodate a wide dynamic range. However, the first stage of integration should be endowed with specific properties that enable efficient handling of the incoming information. In elasmobranches, the afferent nerve originating from the ampullae of Lorenzini targets specific neurons located at the Dorsal Octavolateral Nucleus (DON), the first stage of integration in the electroreception system. Using intracellular recordings in an isolated brainstem preparation from the shark we analyze the properties of this afferent pathway. We found that stimulating the afferent nerve activates a mixture of excitatory and inhibitory synapses mediated by AMPA-like and GABA_A receptors, respectively. The excitatory synapses that are extremely efficient in activating the postsynaptic neurons display unusual voltage dependence, enabling them to operate as a current source. The inhibitory input is powerful enough to completely eliminate the excitatory action of the afferent nerve but is ineffective regarding other excitatory inputs. These observations can be explained by the location and efficiency of the synapses. We conclude that the afferent nerve provides powerful and reliable excitatory input as well as a feed-forward inhibitory input, which is partially presynaptic in origin. These results question the cellular location within the DON where cancelation of expected incoming signals occurs.

The impact of prenatal diagnosis and termination of pregnancy on the relative incidence of malformations at birth among Jews and Muslim Arabs in Israel

BACKGROUND

Ultrasound examination of the fetus enables diagnosis of many major malformations during pregnancy, providing the possibility to consider termination of the pregnancy. As a result, in many cases the incidence of malformations at birth does not represent their true incidence.

OBJECTIVES

To determine the impact of prenatal diagnosis and pregnancy termination on the relative incidence of malformations at birth among Jews and Muslim Arabs in Israel.

METHODS

Data on selected major malformations in 2000-2003 were collected from the two large central databases of the Ministry of Health and the Central Bureau of Statistics which contain information regarding births, stillbirths and terminations of pregnancies.

RESULTS

For many malformations the total incidence was much higher than the incidence at birth. For almost all of the malformations studied, the total incidence was higher in Muslims than in Jews and the differences were further accentuated among the liveborn because of the differences in the rate of pregnancy terminations.

CONCLUSIONS

In order to detect possible influences of environmental or genetic factors on major malformations in Israel, it is critical to look at data including pregnancy terminations, stillbirths and live births.

The functional architecture of the shark's dorsal-octavolateral nucleus: an in vitro study

Learning to predict the component in the sensory information resulting from the organism's own activity enables it to respond appropriately to unexpected stimuli. For example, the elasmobranch dorsal octavolateral nucleus (DON) can apparently extract the unexpected component (i.e. generated by nearby organisms) from the incoming electrosensory signals. Here we introduce a novel and unique experimental approach that combines the advantages of in vitro preparations with the integrity of in vivo conditions. In such an experimental system one can study, under control conditions, the cellular and network mechanisms that underlie cancellation of expected sensory inputs. Using extracellular and intracellular recordings we compared the dynamics and spatiotemporal organization of the electrosensory afferent nerve and parallel fiber inputs to the DON. The afferent nerve has a low threshold and high conduction velocity; a stimulus that recruits a small number of fibers is sufficient to activate the principal neurons. The excitatory postsynaptic potential in the principal cells evoked by afferent nerve fibers has fast kinetics that efficiently reach the threshold for action potential. In contrast, the parallel fibers have low conduction velocity, high threshold and extensive convergence on the principal neurons of the DON. The excitatory postsynaptic response has slow kinetics that provides a wide time window for integration of inputs. The highly efficient connection between the afferent nerve and the principal neurons in the DON indicates that filtration occurring in the DON cannot be mediated simply by summation of the parallel fibers' signals with the afferent sensory signals. Hence we propose that the filtering may be mediated via secondary neurons that adjust the principal neurons' sensitivity to afferent inputs.

Infant mortality in Israel during 1950-2000: rates, causes, demographic characteristics and trends

We evaluated the trends and risk factors in infant mortality in Israel over five decades (1950-2000), based on data obtained from the official notifications of live births, and death certificates. Until the 1960s the main cause of infant mortality was infectious disease; this was replaced by congenital anomalies in Moslems and Druzes, and preterm birth in Jews and Christians. In 2000, there were 746 infant deaths, and the national infant mortality rate (IMR) was 5.4 per 1000 live births (Jews 3.9; [95% CI 3.5, 4.3]; Moslems 9.2 [8.3, 10.3]; Christians 3.6 [1.4, 5.8]; Druzes 6.3 [3.6, 9.0]). Between 1955 and 2000 the overall IMR declined sevenfold (absolute declines of 56.8, 56.3, 45.0 and 28.3 per 1000 live births, in Moslems, Druzes, Christians and Jews, respectively). The reduction in IMRs between 1990 and 2000 in all religious groups (>45%) exceeded the goal set by the World Summit for Children in 1990 of 33%. In 2000, the main risk factors were birthweight < 1500 g [relative risk (RR) = 69], major congenital malformations (RR = 22.0 [18.8, 25.7], and multiple births (RR of 9.3 and 4.2 in triplets and twins respectively). We conclude that the marked decline in IMRs in Israel over five decades reflects a major improvement in population health. Today, infant mortality in Israel represents a unique combination of high rate of congenital malformations among Moslems, where consanguineous marriages are common, and medical termination of pregnancy of malformed fetuses are infrequent; and relatively high IMRs from preterm birth in Jews, associated with high rates of assisted reproduction.

Differences in infant mortality rates between Jews and Arabs in Israel, 1975-2000

BACKGROUND

The infant mortality rate is a health status indicator.

OBJECTIVES

To analyze the differences in infant mortality rates between Jews and Arabs in Israel between 1975 and 2000.

METHODS

Data were used from the Central Bureau of Statistics and the Department of Mother, Child and Adolescent Health in the Ministry of Health.

RESULTS

The IMR in 2000 was 8.6 per 1,000 live births in the Israeli Arab population as compared to 4.0 in the Jewish population. Between 1970 and 2000 the IMR decreased by 78% among Moslems, 82% among Druze, and 88% among Christians, as compared to 79% in the Jewish population. In 2000, in the Arab population, 40% of all infant deaths were caused by congenital malformations and 29% by prematurity, compared to 23% and 53%, respectively, in the Jewish population. Between 1970 and 2000 the rate of congenital malformations declined in both the Arab and Jewish populations. In the 1970s the rate was 1.4 times higher in the Arab community than in the Jewish community, and in 2000 it was 3.7 times higher.

CONCLUSION

As in the Jewish population, the IMR in the Arab community has decreased over the years, although it is still much higher than that in the Jewish community. Much remains to be done to reduce the incidence of congenital malformations among Arabs, since this is the main cause of the high IMR in this population.

Relative prevalence of malformations at birth among different religious communities in Israel

The aim of this research was to determine the relative prevalence at birth of major malformations among the different religious communities in Israel as a way to better understand their causes. We collected data on malformations present among liveborn infants in a 10-year period from the national registry of birth defects according to the religious affiliation. In a total of 1,203,763 liveborn infants, the prevalence of major malformations was in a similar range among Jews and Christians and much higher among Muslim and Druze. These observations may be explained by differences between these communities, in particular, the rates of consanguinity and of therapeutic abortions. The Muslim and Druze communities in Israel are those with the highest consanguinity rates and the lowest rates of termination of pregnancies when a malformation is diagnosed. Analysis of the differences in the rate of malformations at birth in different communities is important for Public Health planning. It may also help to delineate causes and serve as the basis for research.

Experimental tongue cancer in desalivated rats

A group of 39 rats underwent excision of the submandibular and sublingual glands and ligation of the parotid ducts through the midventral incision of the neck, while the control group (41 rats) underwent a sham operation. All rats were administered 4NQO in a final concentration of 0.001% in drinking water. At 7, 14, 22 and 28 weeks after administering 4NQO, both groups of rats were killed and their tongues dissected, inspected and then fixed in 10% buffered formalin for histopathological examination. Clinical examination during the first 14 weeks revealed that rats in both groups looked healthy and no differences in body weight were noticed. Afterwards, the average weight gain of the desalivated rats was lower than in the control group (P < 0.01). The number of macroscopic oral lesions increased with time in both groups. However, in the desalivated rats, the first identifiable lesions were seen as early as week 7, whereas in the control group macroscopic lesions were seen only after 22 weeks. Histological examination revealed more affected rats in the desalivated group in the first 14 weeks after administering the carcinogen; lesions showed more severe pathological changes including two cases with evidence of squamous cell carcinoma. The differences between the desalivated groups and control decreased after 22 weeks with almost no differences at the end of the experiment.

Induction of urokinase-type plasminogen activator by UV light in human fetal fibroblasts is mediated through a UV-induced secreted protein

Plasminogen activator was previously shown to be induced by UV light in human cells with low capacity to repair UV-induced DNA lesions. We now show that in human fetal fibroblasts UV light enhanced the two mRNA species coding for the urokinase-type plasminogen activator (uPA) and the tissue-type plasminogen activator, but immunological analysis revealed exclusively uPA activity. Several independent and complementary experiments indicated that induction of uPA was mediated, apparently entirely, through a UV-induced, secreted protein (UVIS) in the growth medium of irradiated cells. First, elevation of uPA mRNA after irradiation was severely blocked by cycloheximide. Second, replacement of conditioned medium in irradiated cells while the rate of plasminogen activator induction was maximal rapidly and completely stopped any further increase in uPA activity. Third, addition of the same removed conditioned medium to nonirradiated cells mimicked UV light in enhancing the level of uPA activity as well as that of uPA mRNA. Fourth, UVIS activity was completely lost by treating the conditioned medium with trypsin but not with nucleases. Kinetic measurements indicated that the accumulation of UVIS rather than the induction of uPA by UVIS conferred the rate-limiting step in the overall process of uPA induction. Both UV light and UVIS acted synergistically with inhibitors of DNA repair for uPA induction. Based on these results, a model is proposed implicating relaxation of DNA torsional stress of an as yet undefined DNA sequence(s) in the induction of UVIS, which is then responsible for activation of the uPA gene.