title: Monitoring of all-cause mortality in Belgium (Be-MOMO): a new and automated system for the early detection and quantification of the mortality impact of public health events.
abstract: OBJECTIVE
  Be-MOMO is the monitoring of all-cause death registry data in Belgium. The new methods are described and the detection and quantification of outbreaks is presented for the period April 2006-March 2007. Sensitivity, specificity and timeliness are illustrated by means of a temporal comparison with known health events.
  
  
  METHODS
  Relevant events are identified from important mortality risks: climate, air pollution and influenza. Baselines and thresholds for deaths by gender, age group, day and week are estimated by the method of Farrington et al. (J R Stat Soc Ser A, 159:547-563, 1996). By adding seasonal terms to the basic model, a complete 5-year reference period can be used, while a reduction of noise allows the application to daily counts.
  
  
  RESULTS
  Ignoring two false positives, all flags could be classified into five distinct outbreaks, coinciding with four heat periods and an influenza epidemic. Negative deviations from expected mortality in autumn and winter might reflect a displacement of mortality by the heat waves. Still, significant positive excess was found during five influenza weeks. Correcting for the delay in registration of deaths, outbreaks could be detected as soon as 1-2 weeks after the event.
  
  
  CONCLUSIONS
  The sensitivity of Be-MOMO to different health threats suggests its potential usefulness in early warning: mortality thresholds and baselines might serve as rapid tools for detecting and quantifying outbreaks, crucial for public health decision-making and evaluation of measures.
authors.affiliation: Unit of Epidemiology, Scientific Institute of Public Health, Brussels, Belgium. b.cox@iph.fgov.be
authors.forename: Bianca
authors.initials: B
authors.lastname: Cox
authors.forename: Françoise
authors.initials: F
authors.lastname: Wuillaume
authors.forename: Herman
authors.initials: H
authors.lastname: Van Oyen
authors.forename: Sophie
authors.initials: S
authors.lastname: Maes
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000397:Air Pollution / Q000706:statistics & numerical data*; D001530:Belgium / Q000453:epidemiology; D002980:Climate; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012307:Risk Factors; D018571:Sentinel Surveillance; D013696:Temperature