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Volume 27, Number 2—February 2021

Excess Deaths during Influenza and Coronavirus Disease and Infection-Fatality Rate for Severe Acute Respiratory Syndrome Coronavirus 2, the Netherlands

Liselotte van AstenComments to Author , Carel N. Harmsen, Lenny Stoeldraijer, Don Klinkenberg, Anne C. Teirlinck, Marit M.A. de Lange, Adam Meijer, Jan van de Kassteele, Arianne B. van Gageldonk-Lafeber, Susan van den Hof, and Wim van der Hoek
Author affiliations: National Institute for Public Health and the Environment, Bilthoven, the Netherlands (L. van Asten, D. Klinkenberg, A.C. Teirlinck, M.M.A. de Lange, A. Meijer, J. van de Kassteele, A.B. van Gageldonk-Lafeber, S. van den Hof, W. van der Hoek); Statistics Netherlands, the Hague, the Netherlands (C.N. Harmsen, L. Stoeldraijer)

Main Article

Table 2

Excess deaths during influenza epidemics and the COVID-19 epidemic, the Netherlands*

Influenza strains†
Influenza vaccine match‡
Vaccinated, % of target group§
Epidemic duration, weeks
Excess deaths
No. (range)¶
% Above expected deaths
2010–2011 A(H1N1)pdm09 dominance followed by B Victoria dominance Match 69 7 416 (−722 to 1,555) 2
2011–2012 A(H3N2) dominance Mismatch 66 2 600 (308–892) 11
2012–2013 Mixed A(H1N1)pdm09 and A(H3N2) dominance followed by mixed B Yamagata and Victoria dominance Mismatch 62 18 6,318 (3,790–8,846) 13
2013–2014 Mixed dominance with slightly more A(H3N2) than A(H1N1)pdm09 Mismatch 60 11 −581 (−1,927 to –765) −2.1
2014–2015 A(H3N2) dominance followed by B Yamagata dominance Mismatch 57 21 8,574 (5,831–11,316) 15
2015–2016 A(H1N1)pdm09 dominance followed by B Victoria dominance Match 56 11 3,883 (2,390–5, 375) 13
2016–2017 A(H3N2) Match 54 15 7,527 (5,236–9,817) 18
2017–2018 B Yamagata dominance; at end of season mixed AH3N2 and A(H1N1)pdm09 dominance Mismatch; match# 50 18 9,373 (6,439–12,306) 18
2018–2019 Mixed A(H1N1)pdm09 and AH3N2 dominance Match 51 14 2,858 (499–5,217) 7
2019–2020 Mixed A(H1N1)pdm09 and AH3N2 dominance Match 53 3** 404 (−97 to –905) 4
2019–2020 Mixed Influenza and COVID-19 epidemic (weeks 10 and 11, 2020) Match NA 2 213 (−115 to −541) 4
2019–2020 COVID-19 (selected weeks: 12–19, 2020) NA NA 8†† 9,554 (8,271–10,838) 41
2010–2020 Influenza seasonal average NA NA 12 3,995 10

*COVID-19, coronavirus disease; NA, not applicable; pdm, pandemic.
†COVID-19 or influenza epidemic (influenza strains as reported in the Annual report: surveillance of influenza and other respiratory infections in the Netherlands).
‡Vaccine match with the dominant influenza strain(s).
§Persons >60 years of age or with concurrent conditions and increased risk for influenza complications, % as reported previously (1619).
¶Number of deaths above expected baseline number of deaths (observed minus expected deaths). The range is approximated by the lower limit minus observed and the upper limit minus observed.
#Mismatch: Yamagata was not included in the vaccine; match: for both influenza A H1 and H3 strains.   
**Excluding weeks 10 and 11 in 2020, which were both COVID-19 and influenza epidemic weeks (COVID-19: week 12–19: Thursday March 12–Wednesday May 6). 
††Weeks with high excess deaths in the first wave of the COVID-19 epidemic.

Main Article

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