Excess mortality in Europe estimated by EuroMOMO during the COVID-19 pandemic and previous influenza seasons

Sarah K Nørgaard; Jens Nielsen; Christel B Schjørring; Albert S Kalnæs; Lukas Richter; Alena Chalupka; Toon Braeye; Serge Nganda Mekogo; Maria Athanasiadou; Theodore Lytras; Gleb Denissov; Oskari Luomala; Isabelle Pontais; Benedikt Zacher; Matthias An der Heiden; Kassiani Mellou; Ioannis Panagoulias; Anna Paldy; Tibor Malnasi; Eva Kelly; Naama Rotem; Francesca K de'Donato; Chiara Di Blasi; Joël Mossong; Anne Vergison; Kathleen England; Neville Calleja; Liselotte van Asten; Jan van de Kassteele; Christian Madsen; Susana Silva; Ana Paula Rodrigues; Natalija Kranjec; Inmaculada León-Gómez; Diana Gomez-Barroso; Ilias Galanis; Ahmed Farah; Rolf Weitkunat; Nick Andrews; Tom Clare; Magda Bucholc; Declan T Bradley; Naoma William; Mark Hamilton; Pernille Jorgensen; Richard G Pebody; Nick Bundle; Bolette Søborg; Tyra G Krause; Lasse S Vestergaard; Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark

doi:10.1038/s41467-025-67981-1

Excess mortality in Europe estimated by EuroMOMO during the COVID-19 pandemic and previous influenza seasons

Sarah K Nørgaard^*, Jens Nielsen, Christel B Schjørring, Albert S Kalnæs, Lukas Richter, Alena Chalupka, Toon Braeye, Serge Nganda Mekogo, Maria Athanasiadou, Theodore Lytras, Gleb Denissov, Oskari Luomala, Isabelle Pontais, Benedikt Zacher, Matthias An der Heiden, Kassiani Mellou, Ioannis Panagoulias, Anna Paldy, Tibor Malnasi, Eva KellyNaama Rotem, Francesca K de'Donato, Chiara Di Blasi, Joël Mossong, Anne Vergison, Kathleen England, Neville Calleja, Liselotte van Asten, Jan van de Kassteele, Christian Madsen, Susana Silva, Ana Paula Rodrigues, Natalija Kranjec, Inmaculada León-Gómez, Diana Gomez-Barroso, Ilias Galanis, Ahmed Farah, Rolf Weitkunat, Nick Andrews, Tom Clare, Magda Bucholc, Declan T Bradley, Naoma William, Mark Hamilton, Pernille Jorgensen, Richard G Pebody, Nick Bundle, Bolette Søborg, Tyra G Krause, Lasse S Vestergaard, Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark

^*Corresponding author for this work

1 Citation (Scopus)

Abstract

Important questions remain regarding differences in geographical and age-specific mortality patterns as the COVID-19 pandemic evolved in consecutive waves, and how COVID-19 mortality compares to seasonal influenza. In a pandemic situation, excess all-cause mortality provides a more complete and robust measure than cause-specific mortality. Data submitted by 26 countries participating in the European Mortality Monitoring (EuroMOMO) network between 2020 and 2023 was analysed to quantify excess all-cause mortality during the COVID-19 pandemic. Excess mortality from this period was compared to previous influenza seasons from 2014 to 2019. Pooled estimates of excess mortality showed four main waves during the COVID-19 pandemic period, most markedly in people aged 65 years and above, with timing and magnitude that varied between countries. Here we show that prior to implementation of control measures and COVID-19 vaccination, excess mortality greatly exceeded typical seasonal influenza mortality, but later during the pandemic was at levels comparable to influenza.

Original language	English
Article number	1356
Journal	Nature Communications
Volume	17
Issue number	1
Pages (from-to)	1356
ISSN	2041-1722
DOIs	https://doi.org/10.1038/s41467-025-67981-1
Publication status	Published - 15 Jan 2026
Externally published	Yes

Keywords

Humans
COVID-19/mortality
Europe/epidemiology
Influenza, Human/mortality
Seasons
Aged
SARS-CoV-2
Pandemics
Female
Male
Middle Aged
Adult
Aged, 80 and over
Child
Adolescent
Young Adult
Child, Preschool
Infant
Mortality/trends

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Cite this

Nørgaard, S. K., Nielsen, J., Schjørring, C. B., Kalnæs, A. S., Richter, L., Chalupka, A., Braeye, T., Mekogo, S. N., Athanasiadou, M., Lytras, T., Denissov, G., Luomala, O., Pontais, I., Zacher, B., An der Heiden, M., Mellou, K., Panagoulias, I., Paldy, A., Malnasi, T., ... Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark (2026). Excess mortality in Europe estimated by EuroMOMO during the COVID-19 pandemic and previous influenza seasons. Nature Communications, 17(1), 1356. Article 1356. https://doi.org/10.1038/s41467-025-67981-1

Nørgaard, SK, Nielsen, J, Schjørring, CB, Kalnæs, AS, Richter, L, Chalupka, A, Braeye, T, Mekogo, SN, Athanasiadou, M, Lytras, T, Denissov, G, Luomala, O, Pontais, I, Zacher, B, An der Heiden, M, Mellou, K, Panagoulias, I, Paldy, A, Malnasi, T, Kelly, E, Rotem, N, de'Donato, FK, Di Blasi, C, Mossong, J, Vergison, A, England, K, Calleja, N, van Asten, L, van de Kassteele, J, Madsen, C, Silva, S, Rodrigues, AP, Kranjec, N, León-Gómez, I, Gomez-Barroso, D, Galanis, I, Farah, A, Weitkunat, R, Andrews, N, Clare, T, Bucholc, M, Bradley, DT, William, N, Hamilton, M, Jorgensen, P, Pebody, RG, Bundle, N, Søborg, B, Krause, TG, Vestergaard, LS & Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark 2026, 'Excess mortality in Europe estimated by EuroMOMO during the COVID-19 pandemic and previous influenza seasons', Nature Communications, vol. 17, no. 1, 1356, pp. 1356. https://doi.org/10.1038/s41467-025-67981-1

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title = "Excess mortality in Europe estimated by EuroMOMO during the COVID-19 pandemic and previous influenza seasons",

abstract = "Important questions remain regarding differences in geographical and age-specific mortality patterns as the COVID-19 pandemic evolved in consecutive waves, and how COVID-19 mortality compares to seasonal influenza. In a pandemic situation, excess all-cause mortality provides a more complete and robust measure than cause-specific mortality. Data submitted by 26 countries participating in the European Mortality Monitoring (EuroMOMO) network between 2020 and 2023 was analysed to quantify excess all-cause mortality during the COVID-19 pandemic. Excess mortality from this period was compared to previous influenza seasons from 2014 to 2019. Pooled estimates of excess mortality showed four main waves during the COVID-19 pandemic period, most markedly in people aged 65 years and above, with timing and magnitude that varied between countries. Here we show that prior to implementation of control measures and COVID-19 vaccination, excess mortality greatly exceeded typical seasonal influenza mortality, but later during the pandemic was at levels comparable to influenza.",

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doi = "10.1038/s41467-025-67981-1",

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AU - Nørgaard, Sarah K

AU - Nielsen, Jens

AU - Schjørring, Christel B

AU - Kalnæs, Albert S

AU - Richter, Lukas

AU - Chalupka, Alena

AU - Braeye, Toon

AU - Mekogo, Serge Nganda

AU - Athanasiadou, Maria

AU - Lytras, Theodore

AU - Denissov, Gleb

AU - Luomala, Oskari

AU - Pontais, Isabelle

AU - Zacher, Benedikt

AU - An der Heiden, Matthias

AU - Mellou, Kassiani

AU - Panagoulias, Ioannis

AU - Paldy, Anna

AU - Malnasi, Tibor

AU - Kelly, Eva

AU - Rotem, Naama

AU - de'Donato, Francesca K

AU - Di Blasi, Chiara

AU - Mossong, Joël

AU - Vergison, Anne

AU - England, Kathleen

AU - Calleja, Neville

AU - van Asten, Liselotte

AU - van de Kassteele, Jan

AU - Madsen, Christian

AU - Silva, Susana

AU - Rodrigues, Ana Paula

AU - Kranjec, Natalija

AU - León-Gómez, Inmaculada

AU - Gomez-Barroso, Diana

AU - Galanis, Ilias

AU - Farah, Ahmed

AU - Weitkunat, Rolf

AU - Andrews, Nick

AU - Clare, Tom

AU - Bucholc, Magda

AU - Bradley, Declan T

AU - William, Naoma

AU - Hamilton, Mark

AU - Jorgensen, Pernille

AU - Pebody, Richard G

AU - Bundle, Nick

AU - Søborg, Bolette

AU - Krause, Tyra G

AU - Vestergaard, Lasse S

AU - Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark

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N2 - Important questions remain regarding differences in geographical and age-specific mortality patterns as the COVID-19 pandemic evolved in consecutive waves, and how COVID-19 mortality compares to seasonal influenza. In a pandemic situation, excess all-cause mortality provides a more complete and robust measure than cause-specific mortality. Data submitted by 26 countries participating in the European Mortality Monitoring (EuroMOMO) network between 2020 and 2023 was analysed to quantify excess all-cause mortality during the COVID-19 pandemic. Excess mortality from this period was compared to previous influenza seasons from 2014 to 2019. Pooled estimates of excess mortality showed four main waves during the COVID-19 pandemic period, most markedly in people aged 65 years and above, with timing and magnitude that varied between countries. Here we show that prior to implementation of control measures and COVID-19 vaccination, excess mortality greatly exceeded typical seasonal influenza mortality, but later during the pandemic was at levels comparable to influenza.

AB - Important questions remain regarding differences in geographical and age-specific mortality patterns as the COVID-19 pandemic evolved in consecutive waves, and how COVID-19 mortality compares to seasonal influenza. In a pandemic situation, excess all-cause mortality provides a more complete and robust measure than cause-specific mortality. Data submitted by 26 countries participating in the European Mortality Monitoring (EuroMOMO) network between 2020 and 2023 was analysed to quantify excess all-cause mortality during the COVID-19 pandemic. Excess mortality from this period was compared to previous influenza seasons from 2014 to 2019. Pooled estimates of excess mortality showed four main waves during the COVID-19 pandemic period, most markedly in people aged 65 years and above, with timing and magnitude that varied between countries. Here we show that prior to implementation of control measures and COVID-19 vaccination, excess mortality greatly exceeded typical seasonal influenza mortality, but later during the pandemic was at levels comparable to influenza.

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KW - Europe/epidemiology

KW - Influenza, Human/mortality

KW - Seasons

KW - Aged

KW - SARS-CoV-2

KW - Pandemics

KW - Female

KW - Male

KW - Middle Aged

KW - Adult

KW - Aged, 80 and over

KW - Child

KW - Adolescent

KW - Young Adult

KW - Child, Preschool

KW - Infant

KW - Mortality/trends

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VL - 17

SP - 1356

JO - Nature Communications

JF - Nature Communications

IS - 1

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ER -

Excess mortality in Europe estimated by EuroMOMO during the COVID-19 pandemic and previous influenza seasons

Abstract

Keywords

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