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The current issue of Eurosurveillance updates and provides additional context to the report in early 2004 of an estimated 22 080 excess deaths in England and Wales, France, Italy and Portugal during and immediately after the heat waves of the summer of 2003 [1]. While estimates for England and Wales [2], France [3], and Portugal [4], are largely unchanged from those reported earlier, to these should be added 6595-8648 excess deaths in Spain [5], of which approximately 54% or 3574-4687 occurred in August, and 1400-2200 in the Netherlands [6], of which an estimated 500 occurred during the heat wave of 31 July-13 August. Data for Italy, provided here for the cities of Bologna, Milan, Rome, and Turin, are compatible with the earlier estimate that 3134 excess deaths occurred in the 21 Italian regional capitals during the period 1 June-15 August [1,7]; the Italian National Institute of Statistics however, reported an excess of 19 780 deaths country-wide during June-September 2003 as compared to 2002 [8]. Reports elsewhere indicate that approximately 1250 heat-related deaths occurred in Belgium during the summer of 2003 [9], that there were 975 excess deaths during June-August in Switzerland [10] and 1410 during the period August 1-24 in Baden-Württemberg, Germany [11]. At this point, it seems reasonable to speculate that with evidence of heat wave-associated deaths beyond England and Wales, France, Italy, and Portugal, the previously published estimate of 22 080 early August excess deaths should be revised upward by at least 50% for all of western Europe, and by 100% or more if heat events that occurred during June and July 2003 are also taken into account.


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