Measures of mortality are among the most important indicators for public health. All European Union member states collect all-cause mortality data in order to facilitate planning, monitoring annual trends of diseases and evaluating public health interventions. However, there is little tradition of conducting timely monitoring of mortality. This lack of timely collection, analysis and interpretation is a limitation when it comes to the assessment of the health impact of events that may lead to sudden changes in mortality such as major epidemics, extreme temperatures as well as deliberate or accidental release of biological or chemical agents.
In the DG Sanco supported project EuroMOMO we developed a coordinated approach to real-time mortality monitoring across Europe. This system is ready to apply among countries that are able to meet the minimal requirements for mortality monitoring. Currently, the weekly output (the mortality bulletin at www.euromomo.eu) is based on data submitted from 15 countries.
The EuroMOMO network demonstrated how a timely, standardised and coordinated approach to mortality monitoring increases the European capacity to assess the impact of events with a potential impact on public health, including the 2009/10 influenza A(H1N1) pandemic. Without EuroMOMO, Europe would have been less well prepared for the pandemic
In addition, EuroMOMO was pivotal to facilitate country-specific in-depth analyses of influenza-associated mortality in general or the impact of the pandemic more specifically.
Our mission is to reinforce the EU`s preparedness to respond to potential risk by a continued operation of the EuroMOMO network. The vision is further to extent the collaboration by adding new countries to the network. By training activites, partners will learn and exchange best practice on how to apply data from real-time mortality monitoring for risk assessment, in particular as regards cross-border threats and the management of the public health response to emergencies.

The general aim of this project is to operate coordinated real-time mortality monitoring and analysis across as many European countries as possible, in order to improve the capacity to assess risks associated with major health threats, including pandemic influenza and other infectious or non-infectious public health events with a severe impact.
Routine activities address the following specific objectives
To produce quality checked weekly reports of weekly a)crude mortality, b)expected mortality, c)delays in reporting, d)sustained excess mortality patterns for each studied country and age group and e)to compare European mortality patterns with influenza- and climate-related patterns.
Specific objectives for work year 2013 are,
f) to train member state officials in the operation of mortality monitoring
g) to train member state officials in the use of mortality monitoring outputs for preparedness and crisis management. The emphasis will be on cross-border threats and the management of the public health response to European emergencies.

Managerial objectives include
To monitor progress of operation, to ensure that objectives and deliverables are met and to maintain the network (for details, page 18, nr 9-13).

To meet the objectives a-e) we use the previously developed EuroMOMO algorithm and procedures that have been applied as a common tool for producing weekly indicators, including: Observed number of all-cause deaths, expected number of deaths (baseline), number of deaths corrected for delay in data transmission, deviations from the baseline: Difference between observed and expected number of death, expressed in numbers and as standard deviation scores (z-scores) for instant comparison.
The indicators are reported by total population and by age group (<5, 5 - 14, 15 - 64, >=65 years), reflecting the same age groups that are used by the European Influenza Surveillance Network. The EuroMOMO algorithm is furter detailed in the 2013 workplan.

Partners run the common algorithm on their mortality data to compute the agreed indicators and sent the weekly results to the network hub, where they are stored in a central database. At the hub all received results will be quality checked. For the countries where the statistical software Stata is not available, the algorithm may be run for the country by the hub and results then sent back to the partner institute. The hub is responsible for maintenance of the algorithm as well as for technical support and guidance for the participating countries and to those intending to participate.
The hub pooles data from participating countries every week and produces a estimation of the crude number of deaths and expected baseline for all partner institutes participating in that specific week, adjusted for heterogeneities between participating counties.
At the hub level mortality outputs are compared with prevailing influenza- and climate-related patterns when necessary. When there are excess mortality signals the hub invites partners to carry out and report in depth analysis of their national data and facilitates communication wth risk assessment at ECDC.
The hub maintains a website where weekly European mortality reporta are published (www.euromomo.eu). The mortality report is updated every week on Friday afternoon. The results from the participating countries and pooled analysis are accessible to the participating institutes and the European international public health counterparts. In accordance with country requests, only pooled results are released for public viewing. Details on the reporting are described in the annexed workplan 2013
To ensure sustainability of the network and long term operation of the mortality reporting system at EU level, the hub will, in collaboration with the Advisory Board and Coordination team, consider opportunities related to the outcome of the EuroMOMO evaluation from ECDC (2011-12), the ECDC surveillance strategy 2012-20 (under preparation), the revised health security initiative of the commission and other aspects of the EU health information framework

Apart from the routine network activities the following activities are planned for the year 2013:
To meet objectives f+g the network hub will offer member state officials training in the operation of the common EuroMOMO algorithm used for mortality monitoring as well as in the use of mortality monitoring outputs for risk assessment. The training will be conducted during the annual network meeting, by weekly application of the MOMO algorithm and analysis of national data (learning-by-doing), and by individual long-distance training via email and telephone communication where necessary.

Training by weekly application of the MOMO algorithm, analysis and communication of outputs
A very important method for member states of acquiring expertise in mortality monitoring is to actually engage in regular mortality monitoring activities and to analyse outputs repeatedly and in evolving contexts (learning-by-doing). Using all-cause mortality from vital statistics for public health monitoring purposes is a new concept and comprehensive knowledge about the meaning of mortality patterns is not yet available. Therefore, participation in weekly EuroMOMO mortality monitoring, with the effective use of its IT tools, is the cornerstone of increasing the member states knowledge of cross-border risks and management of the public health response to these.

Training during the annual network meeting 2013
The annual network meeting invites both, existing network partners as well as participants from countries not yet represented in the network. The meeting is scheduled to be held in Denmark.
During the meeting training courses will be held both for existing and for new partners addressing the following topics
- Technical aspects of the EuroMOMO algorithm: Principle, applications, maintenance, standard operations, problem solution
- Assessment of mortality monitoring outputs (both national and European)
- Using all-cause mortality outputs for preparedness and crisis management
A detailed curriculum will be developed in the months prior to the training courses by network experts under the lead of the network hub and in consultation with the networks coordination team. Training will be conducted by the network hub and volunteering network experts.

Individual long distance training
The network hub will offer support on an individual basis to any EuroMOMO partner should the need arise. The support includes advice and training in the analysis and assessment of mortality outputs as well as facilitate risk communication between member states and relevant European agencies, such as ECDC and WHO Europe.