Summary
Influenza virus infections are slowly increasing and the first RSV infections have been detected. SARS-CoV-2 activity is currently stable after the wave in September.
Since the last radar, over five hundred more cases of pertussis/pertussis have been added, bringing the total number of reported cases this year to 15,125 (as of 17 December 2024).
Internationally, we look at the cases of the disease in the Democratic Republic of the Congo. We also report on the closure of schools in Germany due to two cases of Mpox and the high number of cases of Mycoplasma pneumoniae in Europe. In the USA, a national milk testing strategy is launched to monitor the outbreak of avian influenza, which has been ongoing since March, more closely.
This month's topic deals with noroviruses and provides a motto for the festive season: wash your hands - prevent infections!
In the medical practices selected for monitoring (sentinel), seven out of 237 samples tested positive for influenza in the week between 9 and 15 December. The number of flu cases is therefore on the rise. AGES influenza surveillance estimates the incidence of influenza-like illnesses in Austria in calendar week (CW) 49 at 1,909/100,000 inhabitants, which is lower than in previous years.
As part of the public influenza vaccination programme, everyone living in Austria can be vaccinated against influenza free of charge for the first time this season. This still makes sense in December and beyond. Vaccination is possible at participating surgeries and public vaccination centres. You can find more information on this at Influenza | Vaccination simply protects and Influenza vaccination 2024/2025: Vaccination centres.
The influenza vaccination shortly before the flu epidemic remains the best preventive measure to reduce the risk of influenza.
The Robert Koch Institute in Germany calculated good effectiveness of the influenza vaccination against seasonal influenza A for the past 2023/2024 season. The vaccination was particularly effective against infection with influenza in the age groups of 0 to 17-year-olds and over 60-year-olds. The results also indicate that an influenza vaccination protects against severe courses of the disease with hospitalisation.
Information on the vaccination programme and participating vaccination centres: https://impfen.gv.at/impfungen/influenza.
After peaking in September, the SARS-CoV-2 viral load in Austrian wastewater monitoring had fallen significantly by mid-November. Since then, the overall Austrian viral load has risen again slightly, with varying degrees of severity in the individual federal states.
The situation regarding COVID-19-related admissions to Austrian hospitals remains stable. This stable trend, or decline, can also be seen in other European countries. The European Centre for Disease Prevention and Control(ECDC) points out that people aged 65 and over are at the highest risk of a severe course of COVID-19 infection.
The COVID-19 vaccination is offered free of charge in Austria and is available to everyone from the age of 6 months. Vaccination is generally recommended from the age of 12. The vaccines are constantly being adapted to current virus variants. Variant vaccines directed against JN.1 and KP.2 are currently available. It is assumed that both vaccines offer good protection against severe courses of the currently circulating virus variants.
Further information on the vaccination programmes offered by the individual federal states can be found at COVID-19 | Vaccination simply protects.
So far, six RSV infections have been detected in the sentinel samples for this season, so the viral load is currently still considered to be low. In Europe, RSV activity has been increasing for several weeks, with 8% of tests in primary care being RSV-positive. In Europe, 83% of people hospitalised with RSV are children under the age of 5. (As of 16 December 2024, ECDC)
Last season, the viral load in Austria peaked at the beginning of February 2024.
An illness triggered by RSV can progress in very different ways. In infants, young children and older people in particular, the disease can be associated with complications and even fatal outcomes. Vaccination against RSV is therefore strongly recommended for these risk groups. The following options are available:
- At the beginning of December, 14,000 doses of the RSV prophylaxis Beyfortus arrived in Austria. Immunisation is available free of charge for newborns in hospitals. In a next step, the offer is to be extended to other age groups up to the age of one. The organisation is already in preparation.
- It is also possible to vaccinate pregnant women (24 to 36 weeks of pregnancy) for the passive protection of newborn babies. The mother's antibodies are passed on to the child. Pregnant women can be vaccinated once on request in accordance with the authorisation if their due date is between September and March.
- Vaccination for active immunisation is generally recommended forpeople over the age of 60 to prevent severe, sometimes life-threatening cases. Corresponding vaccines have been available since 2023.
The newly arrived RSV prophylaxis for newborns, infants and young children involves monoclonal antibodies, i.e. artificially produced antibodies that help the immune system to fight the virus in the event of an infection. In contrast to vaccinations (active immunisation), in which the immune system is stimulated to produce its own antibodies by components of pathogens, protective antibodies are available to the body very quickly in so-called passive immunisation.
RSV prophylaxis is generally recommended for all children aged 1 year between September and March, so that they are protected in their first RSV season.
Current information on immunisation against RSV can be found at https://impfen.gv.at/impfungen/rsv
The number of pertussis cases in Austria and many European countries rose massively in 2024. We have provided details on this in the AGES Radar of 28 March 2024.
While 2,791 cases were reported in Austria in the previous year as a whole, there have been 15,125 cases of pertussis so far this year (as of 17 December 2024; last radar: 14,542). The cases per 100,000 inhabitants for each province for 2024 are shown in Figure 1. The age distribution (Figure 2) shows how infants are particularly affected.
In order to protect infants in the first months of life, pregnant women in particular are advised to be vaccinated in the last trimester of pregnancy, regardless of the interval between the last pertussis vaccination. This provides newborn babies with protection through maternal antibodies.
Further information on the pertussis vaccination can be found in the vaccination plan Austria 2023/2024 version 1.0 (sozialministerium.at).
Whooping cough (pertussis) - AGES
Between 24 October and 9 December 2024, 527 cases of undiagnosed disease were registered in the Panzi health zone (an administrative area of the Congolese health service) in the province of Kwango, Democratic Republic of Congo (DRC). Symptoms include fever, headache, cough, runny nose and aching limbs. 32 deaths were reported by the health facilities. Differing, higher death figures at community level are still being investigated. Malnourished children under the age of five are mainly affected.(ECDC, Africa CDC, as of 12/12/2024)
Response teams have been deployed to collect samples, analyse clinical characteristics, investigate transmission dynamics and identify additional cases(Africa CDC, as of 08.12.2024). Due to the limited laboratory capacity of the district, the samples were transported to the national reference laboratory in Kinshasa.
Ten of the 12 samples originally taken tested positive for malaria. However, as these initial samples had not survived the long transport to Kinshasa well, they were difficult to analyse. According to media reports, the DRC Ministry of Health announced on 17 December 2020 that the analysis of further samples confirmed the original diagnosis. According to this, the cases are said to be severe cases of malaria in the form of respiratory diseases. This is exacerbated by malnutrition in the affected region.
As recently as September, the World Health Organisation (WHO) upgraded the food security assessment of Kwango province from IPC 1 (minimal food insecurity) to IPC 3 (crisis situation); IPC stands for Integrated Food Security Phase Classification, and phase 3 refers to acute hunger. Malnutrition can lead to more complicated courses of malaria infections.
The epicentre of the outbreak, the Panzi health zone, is very remote, which made it difficult to respond quickly and assess the situation. Around 200,000 people live in this region, which covers an area of 7,377 square kilometres, comparable to the size of the federal state of Salzburg. Panzi is located around 700 kilometres south-east of Kinshasa, the capital of the Democratic Republic of the Congo. It takes three days to get there, and the current rainy season makes the journey even more difficult. As the diagnostic possibilities on site are limited, the final identification of the cause has been delayed.
The ECDC estimates the risk for the EU/EEA countries as low(ECDC, as of 13.12.2024).
Undiagnosed disease - Democratic Republic of the Congo
WHO Director-General's opening remarks at the media briefing - 10 December 2024
Communicable disease threats report, 7-13 December 2024, week 50
A school in Rösrath, a town near Cologne, Germany, switched to distance learning on Monday evening (15.12.2024) as a precautionary measure until the start of the holidays due to two cases of Mpox. The two infected children and their families, who have also been diagnosed with Mpox, are in quarantine. The course of the disease is currently mild.
The family probably contracted the disease from a family member who had close contact with the local population while travelling in Africa. The first case of Mpox in Cologne was detected in mid-October.
These cases are clade Ib. Due to the increase in Mpox cases in 2024 triggered by clade I, the WHO declared a public health emergency of international concern (PHEIC) in August.
Within Europe, cases of clade Ib have so far only been detected in Sweden (August), the UK (November) and Germany. All European cases have been linked to travel to Africa. The ECDC estimates the risk for the European population to be low. When travelling to affected regions and having contact with affected persons, the risk is classified as moderate(ECDC, as of 13.12.2024).
You can find more information on Mpox in the AGES radar from 29/08/2024.
Some European countries have recorded an increase in Mycoplasma pneumoniae infections in recent months. Denmark reported 1,915 new cases per week in mid-November, while 541 new cases were registered in 2023 at the same time. Sweden has also reported unusually high numbers of infections since August. The cases hospitalised so far for the 2024/2025 season are already higher than in the last ten years. Norway experienced the peak in case numbers in mid-October, but the incidence of Mycoplasma pneumoniae cases is still high. 17% of the samples taken are attributable to Mycoplasma pneumoniae, with children aged 5 to 14 years being most frequently affected.
Mycoplasma pneumoniae is a bacterium that can cause infections of the respiratory tract. Most infections are mild. In some cases, however, a protracted and severe infection of the lungs can occur, which must be treated with an antibiotic. In English, the disease is referred to as "walking pneumoniae" or "atypical pneumonia", as the patient appears to be better than you would expect someone with pneumonia to be. The term comes from the fact that many with mild symptoms do not stay at home or in bed. The bacterium is transmitted through the air (aerogenic) when an infected person excretes it when coughing or sneezing, among other things.
In most European countries, including Austria, Mycoplasma pneumoniae is not notifiable. As a result, the data available is limited. European media report increasing numbers of atypical pneumonia and hospital admissions with Mycoplasma pneumoniae.
An increase in cases was also observed in the USA this year between March and October. The increase is particularly noticeable in children between the ages of 2 and 4, as Mycoplasma pneumoniae infections were previously highest in the 5 to 17 age group.
Mycoplasma pneumoniae epidemics typically occur every one to three years. The decline in immunity in the population (recently exacerbated by contact reductions during the COVID-19 pandemic) and the emergence of new variants contribute to this cycle.
The ECDC is monitoring the situation and is calling on member states to monitor the emergence of atypical or serious diseases, the development of resistance to antibiotics and the pressure on the healthcare system.
Communicable disease threats report, 30 November - 6 December 2024, week 49
Mycoplasma Pneumoniae Infections Have Been Increasing | NCIRD | CDC
Avian influenza A(H5N1) in the USA
On 6 December 2024, the US Department of Agriculture (USDA) announced the launch of a national milk testing strategy . The testing of milk cooling tanks at milk processing plants should enable the USDA to localise the virus, monitor trends and find potentially affected herds. Shortly before this, the California Department of Public Health (CDPH) published a voluntary recall of raw milk (products). These tested positive for the avian influenza virus in supermarkets, warehouses and also at the bottling station of a manufacturer. Consumption of raw milk is generally not recommended, also due to other possible pathogens. Pasteurised milk is still considered safe.
The outbreak of avian influenza A(H5N1) in dairy cows in the USA has been ongoing since March 2024. This is the first time the virus has been detected in cows. A total of 860 cases of A(H5N1) have been detected in dairy cows in 16 states so far this year(USDA, as of 17 December 2024). 60 humans have also tested positive for the virus. Most of these human cases were previously in contact with cows or poultry, with only two cases where the source of infection has not yet been determined(CDC, as of 16 December 2024). Prior to 2024, only one other infection had been detected in a human, an employee of a poultry farm, in the USA.
The A(H5N1) virus was also detected for the first time in a pig in Oregon at the end of October. As pigs have both human and avian receptors, they are seen as a kind of "mixed vessel" for the virus. Due to this characteristic, the infection caused concern among scientists.
In addition to the planned milk samples, the situation in the USA is also being monitored via wastewater. Genetic virus material in wastewater can be an indicator of an affected herd in the vicinity or draw attention to a possible increase in infections in the area. At present, subtype A(H5) is mainly detected in California, where most cases are currently being reported.
In Austria and Europe, no A(H5N1) cases have yet been reported in humans or cattle. The ECDC estimates the risk for the general European population to be low. For people with contact to infected animals or a contaminated environment, the risk is low to moderate.
On behalf of the ministry, AGES has produced information videos for hobby poultry farmers that provide information on signs of illness and measures to be taken. Information on current outbreaks can be found in the AGES animal disease radar.
Noroviruses are found all over the world and are one of the most common causes of gastrointestinal infections. They are known to quickly lead to large outbreaks, especially where people are together in a confined space. This applies to communal facilities such as nurseries or care homes, but also cruise ships and hotels. This year in particular, there have been an unusually high number of cases of norovirus infections in Austria and other European countries.
What happens in the event of an infection?
A norovirus infection usually causes nausea, profuse vomiting, diarrhoea and abdominal pain a few hours to two days after infection. In addition, there may be a general feeling of illness with muscle aches and headaches as well as a slight fever. In most cases, the disease is self-limiting, meaning that an improvement occurs on its own, without specific therapy, after a few days. The severe diarrhoea and vomiting can lead to dehydration, which can be severe in very young or very old people. Despite the often mild illness, there are an estimated 136,000 to 278,000 deaths from norovirus worldwide every year. Sufficient fluid intake is therefore particularly important during the illness.
Highly contagious!
Noroviruses are small viruses that belong to the Calcidiviridae family. They are only found in humans and are highly contagious. There are several reasons for this: on the one hand, a very small amount of virus particles (10-100) is sufficient to cause an infection (so-called "infectious dose"). During the illness, the viruses are excreted in large quantities in the vomit and faeces. Even after the symptoms have improved, virus particles can still be present and lead to infection. On the other hand, noroviruses are very resistant to environmental influences. They can survive on inanimate surfaces for a long time and are resistant to many disinfectants. When selecting disinfectants, care should therefore always be taken to ensure that they are also effective against noroviruses. It is assumed that noroviruses can survive both freezing temperatures and temperatures of up to 60 °C, at least for a certain period of time.
Most norovirus infections occur through human-to-human transmission, on the one hand through direct contact with the faeces of infected persons: A special feature of noroviruses is that the virus particles can also be transmitted via droplets in the air caused by gushing vomit. On the other hand, indirect transmission is possible, e.g. via contaminated hands or contaminated surfaces and objects. In addition to infected people, contaminated food (e.g. frozen berries or shellfish) or water can also serve as a source of infection.
Outbreaks can therefore occur in different ways: For example, a contaminated dish in a canteen or restaurant can infect many people at once. A single person can then pass this infection on to their school class, family members or other close contacts.
Seasonal fluctuations
Norovirus infections are likely to be severely underreported, so the true extent of the spread is unknown. This is because patients with mild cases either do not go to the doctor or the doctor does not arrange for further stool diagnostics for noroviruses. In addition, only food-related norovirus cases are notifiable in Austria.
Usually, most cases of norovirus infections occur in winter (so-called "winter vomiting disease"). This year, however, there was not the expected drop in cases in the warmer months after the peak in winter: In spring, 53% more cases were reported in Austria than in the same period in previous years. A similar pattern was seen in Germany, Finland, Ireland, the Netherlands and the USA. An increase was also recorded in the United Kingdom: There were 75% more cases there in April than in previous years.
One of the reasons for this is the dominant genotype GII. 17, which is circulating in Austria and Europe. This genotype was responsible for half (six out of twelve) of all norovirus outbreaks in Austria from July 2023 to June 2024, while it only accounted for around 10% of outbreaks in previous years. A total of 3,309 norovirus cases have been reported in Austria so far in 2024 (as at 17 December 2024, see Figure 1). By comparison: In 2023 there were 2,134 cases, in 2022 1,945 cases were registered and in 2021 there were 1,322 cases (see Figure 2). In general, most norovirus infections occur in young children and older people. In 2024, 40% of reported cases were people over 65 years of age.
How can I protect myself from a norovirus infection?
There is currently no vaccination or suitable treatment against noroviruses. It is therefore particularly important to observe hygiene measures to prevent the spread of the virus. This means first and foremost: hand hygiene! Regardless of whether you are healthy or ill, you should always wash your hands thoroughly with (warm) water and soap, especially after using the toilet and before handling food. This is particularly important in food processing companies and in communal facilities such as schools, nurseries, care homes and hospitals.
If you contract a norovirus infection yourself, other measures are necessary in addition to strict adherence to hand hygiene:
- Surfaces soiled by faeces or vomit must be cleaned and disinfected immediately
- Wash clothing, bed linen and towels at 60 °C (or higher)
In households shared by sick and non-ill people, the following must also be observed:
- Sick people should not prepare food for other people
- Do not share hygiene articles or eating utensils
- Avoid physical contact, such as shaking hands
- Daily cleaning and disinfection of shared surfaces and objects
- When caring for sick people: wear a face mask or FFP2 mask
As already mentioned, when selecting disinfectants, care should always be taken to ensure that they are also effective against noroviruses. In communal facilities, additional measures may also be necessary, such as a ban on visits or physical segregation of infected persons. If possible, sick people should stay away from communal facilities for two days after the end of symptoms. It is important to know that there is no long-term immunity after a norovirus infection. This means that you can repeatedly contract the virus and fall ill with it. As the viruses can continue to be excreted for one to two weeks after the end of the illness, it is particularly important to continue to observe strict hand hygiene after the illness.
So: wash your hands - prevent infection!
The International Day of Universal Health Coverage has been celebrated annually on 12 December since 2014. It aims to draw attention to Universal Health Coverage (UHC) for all people, which focuses on three issues: 1) equity in access to health services, 2) sufficient quality of services and 3) protecting people from financial ruin due to health expenses. Unfortunately, 4.5 billion people worldwide still do not have universal access to health services.
In Austria, the ten health goals are intended to ensure that all people living in Austria have the same opportunities for health, regardless of age, income, origin or gender: Health goals and working groups - Health goals Austria.
https:// universalhealthcoverageday.org/
https:// www.who.int/campaigns/universal-health-coverage-day/2024
The WHO published the World Malaria Report 2024 on 11 December 2024. It is estimated that around 2.2 billion cases of malaria and 12.7 million deaths have been prevented since 2000. This has been possible thanks to a combination of education, insecticide-treated mosquito nets, preventative medication, rapid diagnostic tests and malaria vaccinations. Nevertheless, malaria is still a global health threat, especially in the WHO region of Africa.
New HIV drug prevents infections
World AIDS Day is celebrated annually on the first of December to raise awareness and draw attention to the ongoing challenges. In 2023, an estimated 39.9 million people worldwide were living with HIV. Approximately 630,000 people died last year from HIV-related causes. And an estimated 1.3 million people were infected with HIV in 2023.
The journal "Science" has named the injectable HIV drug lenacapivir the "Breakthrough of the Year 2024", and many HIV/AIDS researchers are confident that lenacapivir as pre-exposure prophylaxis (PrEP) will greatly reduce global infection rates.
A large efficacy study in young African women showed 100% efficacy: not a single woman who was given the drug became infected with HIV. In another study conducted on four continents on people who have sex with men, only 2 out of more than 2,000 people were infected, which also showed a very high efficacy of 99.9 %.
As PrEP, lenacapivir only needs to be injected every six months and therefore has the potential to prevent millions of future infections.
In Austria, lenacapivir has yet to be authorised as a long-acting PrEP. The active ingredient combination emtricitabine/tenofovir disoproxil fumarate is currently available in Austria as oral PrEP. When taken correctly, this also offers highly effective protection against HIV infection. Since April 2024, the costs have been reimbursed by social insurance.
The seven AIDS service centres in Austria offer anonymous and free HIV laboratory tests; appointments can be made online: AIDS-Hilfen Österreichs.
Virulence describes how "toxic" or harmful the effect of an infectious agent is on a particular host. It depends on many individual, acquired and variable abilities of the pathogen that determine how effectively it can infect someone and make them ill. Virulence is assessed on the basis of a pathogen's ability to invade and multiply in living tissue and the degree of damage it causes. The sensitivity of the pathogen to therapy and its ability to evade the immune system also play a role.
Virulence and pathogenicity interact in an infection. Pathogenicity describes the genetic basis of a pathogen to trigger a disease in a specific host in the first place. Apathogenic bacteria, for example, cannot cause disease.
Pathogenicity = Can the pathogen cause disease at all?
Virulence = How serious is the disease?
In the course of the COVID-19 pandemic, for example, the question often arose as to whether a new variant has a higher virulence, i.e. causes more severe disease than older variants.
The AGES Radar for Infectious Diseases is published monthly. The aim is to provide the interested public with a quick overview of current infectious diseases in Austria and the world. The diseases are briefly described, the current situation is described and, where appropriate and possible, the risk is assessed. Links lead to more detailed information. The "Topic of the month" takes a closer look at one aspect of infectious diseases.
How is the AGES radar for infectious diseases compiled?
Who: The radar is a co-operation between the AGES divisions "Public Health" and Risk Communication.
What: Outbreaks and situation assessments of infectious diseases:
- National: Based on data from the Epidemiological Reporting System (EMS), outbreak investigation and regular reports from AGES and the reference laboratories
- International: Based on structured research
- Topic of the week (annual planning)
- Reports on scientific publications and events
Further sources:
Acute infectious respiratory diseases occur more frequently in the cold season, including COVID-19, influenza and RSV. These diseases are monitored via various systems, such as the Diagnostic Influenza Network Austria (DINÖ), the ILI (Influenza-like Illness) sentinel system and the Austrian RSV Network (ÖRSN). The situation in hospitals is recorded via the SARI (Severe Acute Respiratory Illness) dashboard.
Austrian laboratories send SARS-CoV-2 samples to AGES for sequencing. The sequencing results are regularly published on the AGES website.
For the international reports, health organisations (WHO, ECDC, CDC, ...) specialist media, international press, newsletters and social media are monitored on a route-by-route basis.
For infectious diseases in Austria, the situation is assessed by AGES experts, as well as for international outbreaks for which no WHO or ECDC assessment is available.
Disclaimer: The topics are selected according to editorial criteria, there is no claim to completeness.
Suggestions and questions to:wima@ages.at
As the response to enquiries is also coordinated between all parties involved (knowledge management, INFE, risk communication), please be patient. A reply will be sent within one week.
Last updated: 19.12.2024
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