AGES radar for infectious diseases - 13.03.2025

Summary

The flu epidemic has probably peaked, but the number of infections is still high. The RSV season is much milder than the last one and there have also been fewer hospital admissions so far. SARS-CoV-2 activity remains stable at a very low level.

The source of the outbreak of Legionnaires' disease in Vorarlberg was found and measures against further spread were thus possible.

Pertussis cases reached a new high last year, with a total of 15,465 cases reported. This year there are 700 as of 10 March 2025.

In the USA, a child died of measles at the end of February, the first measles death there in ten years. There are currently outbreaks in several states with a total of at least 222 cases and two deaths.

To mark International Women's Day on 8 March, our Topic of the Month looks at how gender differences play a role in infectious diseases.

The following annual reports from AGES projects were published: Mosquito Alert App, Ovitrap Monitoring, West Nile Virus Monitoring and Tick Monitoring.

Situation in Austria

The surveillance systems suggest that the current flu epidemic has passed its peak but is still at a high level. According to reporting medical practices (sentinel), infections with influenza A have decreased, but those with influenza B have not. The positivity rate among those tested remains very high at just under 38%, with influenza B accounting for 66% of the most recent detections. The SARI dashboard shows an overall decline in hospital admissions due to influenza. Strong influenza activity continues to be recorded across Europe. After predominantly influenza A activity at the beginning of the season, more EU countries are now reporting an increase in influenza cases caused by influenza B. The remaining weeks of the flu season are likely to be largely determined by the level of influenza B infections. Transmission of influenza B occurs predominantly in younger age groups, especially children and adolescents, favoured by attendance at schools and kindergartens.

AGES influenza surveillance estimates the incidence of influenza-like illnesses in Austria in calendar week (CW) 10 at 2,059/100,000 inhabitants, which is comparable to previous years. Influenza activity is also at a high level in the rest of the EU/EEA, even though the number of hospital admissions has fallen in some countries (ERVISS).

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. Vaccination is possible at participating surgeries and public vaccination centres. Timely influenza vaccination remains the best preventive measure to reduce the risk of influenza.

You can find more information on this at: Influenza | Vaccination simply protects

Influenza - AGES

You can also listen to more information on influenza in the AGES podcast "Courage to take risks": Episode 003 - Influenza & Co: How do I surf safely through the flu wave?

The detection of SARS-CoV-2 remains stable at a low level both in Austrian wastewater monitoring and in the sentinel samples. The positivity rate in the sentinel system is 3.1 %. COVID-19-related admissions to Austrian hospitals have also decreased. There was no increase in cases in other EU/EEA countries this winter.

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 against JN.1 and KP.2 are currently available. It is assumed that these vaccines offer good protection against severe courses of the currently circulating virus variants.

Information on the vaccination programmes of the individual federal states can be found under COVID-19 | Vaccination.

Coronavirus - AGES

 

Based on the detections in the sentinel system, a mild RSV season can be assumed in Austria so far this year. The positivity rate in week 10 was 6.8% and thus slightly above the current Europe-wide average, which was 9.5% at its peak in week 52/2024 and has remained stable at a higher level since then. Overall, the picture in Europe is mixed, as the epidemic is not progressing simultaneously in different countries.

Compared to previous weeks, the proportion of confirmed RSV infections in Austria is stable with a slight downward trend. For comparison: in the previous season, a positivity rate of over 20% was detected at the peak of the wave; overall, there is almost three times less evidence of RSV this year. In terms of severe cases, there were also significantly fewer hospital admissions due to RSV this season. Children under the age of 4 are most affected by severe RSV infections.

An illness triggered by RSV can progress in very different ways. In infants, young children and older people in particular, the disease can lead to severe infections of the lower respiratory tract and even to lung failure with a fatal outcome.

Last season, the RSV season in Austria peaked at the beginning of February 2024.

Current information on immunisation against RSV can be found at https://impfen.gv.at/impfungen/rsv

RSV - AGES

 

From the end of 2024 to the end of February, an increased number of cases of Legionnaires' disease were detected in Vorarlberg. 37 cases could be attributed to an outbreak with certainty, plus three probable and three possible cases. As all of the Legionella bacteria from patient samples that could be cultivated were genetically linked, it is assumed that most of the cases have a common source. The local health authorities took several hundred water samples, which were then analysed for the Legionella pneumophila serogroup 1 bacterium by colleagues at AGES in Vienna. Following the detection of the bacterium in environmental samples from a cooling tower, appropriate measures were introduced to prevent the risk of further infections from the suspected source. The fact that no new cases were subsequently detected after the incubation period expired indicates that the outbreak was successfully clarified

Legionnaires' disease is a severe pneumonia caused by Legionella bacteria and mainly affects people over the age of 50. It is caused by inhaling very fine water droplets (aerosol particles) contaminated with legionella, for example when showering. Legionella bacteria are very widespread in the environment and multiply particularly well in hot water supply systems or cooling towers in large buildings.

Consumers can reduce the risk by not leaving the water in the pipes for too long.

You can find more information on legionella at: Legionella - AGES and National Reference Centre for Legionellosis - AGES

In the AGES Radar for Infectious Diseases of 25 July 2024, we dealt with legionella in the topic of the month.

A total of 2,791 cases were reported in Austria in 2023, 15,465 in 2024 and 700 this year (as at 10 March 2025).

The cases per 100,000 inhabitants for each federal state for 2025 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.

A study from the end of January suggests that there could be a link between whooping cough and sudden infant death syndrome. A comparison between the former West Germany, with a low pertussis vaccination rate at the time, and the former GDR, with a very high vaccination rate, shows that sudden infant death syndrome and hospitalisations due to pertussis infections correlated in both countries. Both occurred less frequently in the population group with a high immunisation rate.

Further information on the pertussis vaccination can be found at Whooping cough (pertussis) | Vaccination simply protects.

Whooping cough (pertussis) - AGES

International outbreaks

A child died of measles in Texas, USA, at the end of February. It was the first measles death in the USA for ten years. Another death has since been reported. There have been at least three outbreaks with 222 cases in the USA so far this year (as of the CDC's last update on 7 March 2025). The CDC has published corresponding travel information emphasising the importance of vaccination. Although the new US Secretary of Health and Human Services Robert F. Kennedy recommended the measles vaccination after the death, according to CNN he also advises vitamin A, cod liver oil and antibiotics. Vitamin A only makes sense if there is a clear deficiency and can be overdosed, antibiotics are not effective against viruses.

Measles was eliminated in large parts of North America, with only isolated imported cases. Due to falling vaccination rates in the USA, there is an increasing likelihood that these imported cases will lead to local outbreaks, examples of which can currently be found not only in the USA but also in Canada (227 cases, as of 6 March 2025).

In Austria, there were 542 cases of measles in 2024. The number also remained high at the turn of the year, with 56 cases reported this year (as of 12 March 2025), although only a few have been added in recent weeks. It is advisable to check your own immunisation status and update your vaccinations if necessary.

Following the outbreak of the Sudan virus in Uganda on 30 January 2025, the Ugandan Ministry of Health reported a total of 14 cases (12 confirmed and 2 suspected cases) on 1 March. Of these, eight people have recovered, two others are currently undergoing treatment and two people have died. The deaths include the index case and a child under the age of 5.

The Sudan virus belongs to the same family as the Ebola virus. There is no vaccine or medication against the Sudan virus.

The Federal Ministry for European and International Affairs recommends checking the necessity of travelling to Kampala.

More details on the Sudan virus outbreak in Uganda can be found in the RADAR of 28 November 2024.

Sudan virus disease - Uganda

On 9 February, a cluster of unknown deaths was reported in the province of Equateur in the Democratic Republic of the Congo (DRC). As of 25 February, a total of 1,318 cases of febrile illness and 53 deaths have been recorded. The disease affects all age groups, especially adolescents and young adults, particularly men.

The disease usually progresses very quickly, often taking just one day from the onset of symptoms to death. The exact cause of the disease remains unclear and further investigations, including toxicological environmental analyses, are underway. Symptoms of the disease include fever, chills, headache, muscle aches, joint pain, neck pain, vomiting, abdominal pain, shortness of breath and restlessness. Due to this wide range of symptoms, it is suspected to be either a rapid outbreak of bacterial meningitis or chemical poisoning, possibly in combination with malaria and other infectious diseases common in the region. According to the World Health Organisation (WHO), around 50% of tests were positive for malaria, although the high positivity among cases tested in the area is not unusual.

The WHO currently assesses the international health risk as low. General travel information and warnings can be found on the website of the Ministry of Foreign Affairs.

 

Topic of the month

A heart attack can look different in women than in men. This can lead to the symptoms being recognised later. This is now a recognised gender-specific aspect in medicine. We are using International Women's Day on 8 March as an opportunity to show that gender can also play a role in infectious diseases.

Sex? Gender?

Sex differences can be discussed on numerous levels, from the biological definition of the sexes (sex) to the size of germ cells and socio-cultural role models (gender). The WHO emphasises that every form of gender difference in infectious diseases can be significant - from the risk of being exposed to a pathogen to treatment and social consequences. Biological factors can also lead to medical differences, as can gender aspects, which include role models, socio-cultural behaviour, traditional social norms, forms of expression or even identities. Wherever differences in infectious diseases are recognised, it is important to raise awareness and identify the causes in order to find targeted measures. Gender medicine is a building block of individualised medicine.

Biological gender influences the immune response

The immune systems of men and women differ in their ability to react to pathogens due to genetic and hormonal factors; depending on age and hormone status, these differences can also change over the course of a lifetime. In general, women tend to have a somewhat stronger immune response, and this is already the case in infants. In this early phase of life, boys and girls are exposed to roughly the same pathogens and the weaker immune system of boys means that they die more frequently from infectious diseases. Nevertheless, there are also infectious diseases to which women are more susceptible. And: women can become pregnant, physiological changes in the immune system, the respiratory tract and the cardiovascular system during pregnancy can lead to particularly severe courses of some infectious diseases (WHO).

Some infectious diseases pose a risk to the unborn child during pregnancy. One example of this is listeriosis. Listeria are bacteria that can hardly cause any damage in young and healthy adults, an infection occurs largely through food and proceeds without symptoms or only with some diarrhoea.

Pregnant women have a significantly increased risk of infection. Due to the somewhat down-regulated immune system, the probability of the pathogens spreading in the body is also increased; invasive listeriosis can occur, with meningitis or other severe courses. Pregnant women are also at risk of infecting their unborn child, which increases the risk of premature birth or stillbirth. Sepsis and meningitis can develop in infected newborns.

To prevent listeriosis, it is therefore important to avoid raw milk products and to cook meat and fish dishes thoroughly.

Different structures, different decisions

The risk of contracting an infectious disease also depends on lifestyle. The biological factor of gender usually plays a lesser role here than differences in the world of work, leisure activities or everyday family life. Significantly more women are employed in patient care; they carry out the majority of nursing activities, often without having much influence on the general conditions. The constant proximity to patients also means that they are more likely to be exposed to viruses and bacteria, often without the opportunity to take the necessary protective measures. The same applies in the private sphere, where women perform the majority of unpaid care work and are also exposed to an increased risk of contact with diseases.

On the other hand, occupations such as fishing, mining, agriculture and livestock farming, which in many societies are predominantly carried out by men, can expose them to an increased risk. For example, they are increasingly exposed to vectors, i.e. disease carriers such as mosquitoes or ticks. Mosquito-borne diseases such as dengue or malaria affect significantly more men in some regions of the world.

Lifestyle choices are often responsible for gender differences in infectious diseases. Smoking habits, outdoor activities and diet differ on average between men and women. The latter are more likely to eat fruit and vegetables, which would generally be a healthy choice, but more often leads to salmonella infections.

In Europe, infectious diseases affect slightly more men than women. In a study of 16 infectious diseases analysed, the overall difference is small, but individual diseases such as malaria, HIV or chlamydia affect significantly more men. On the one hand, the higher prevalence of sexually transmitted diseases in men has led to campaigns and measures focussing on men who have sex with men. On the other hand, the risks for women have been underestimated and their access to help and information has not been promoted. The risk of a woman becoming infected during sexual intercourse with an HIV-positive partner is higher than that of a man with an HIV-positive partner. The risk increases with sexual assault and rape, as injuries can occur that favour infection.

Infectious diseases with social consequences

Differences in the immune system lead to a different course, differences in socio-cultural roles and economic factors result in a different risk of being exposed to a pathogen and also have an influence on how well care is provided in the event of an illness. It is often women who are more affected by poverty and have less access to the healthcare system.

However, the interactions between infectious diseases and society are even more complex, as the COVID-19 pandemic has also shown: Vulnerable population groups suffered disproportionately more from the pandemic than socially well-protected groups, and in many cases this affected girls and women in particular. Domestic violence increased in some countries. Whether this also applies to Austria is difficult to prove. In times of lockdowns and social restrictions, it was also more difficult to seek help.

Precise observation, effective action

In order to combat infectious diseases effectively, all risk factors must be known as precisely as possible: Who is exposed to the pathogen? How does it spread? Who is at risk of dangerous progressions? For surveillance, monitoring and the implementation of measures, it is also important to record gender. Everyone benefits from measures that are better adapted to individuals; knowing the importance of gender leads to a better understanding of the spread of infectious diseases and to a better strategy in combating them.

Sources and tips for further reading:

untitled (who.int) Taking sex and gender into account in emerging infectious disease programmes

Eurosurveillance | Differences between males and females in infectious diseases notifications in the EU/EEA, 2012 to 2021

Addressing sex and gender in epidemic-prone infectious diseases

Infectious Diseases Are More Closely Linked to Sex and Gender Than We Think - Society for Women's Health Research

Society for Women's Health Research

 

Messages

Annual report Mosquito Alert App

The citizen science project "Mosquito Alert" offers citizens the opportunity to report tiger mosquitoes via an app. The "Mosquito Alert" 2024 annual report was published on 7 March 2025.

In 2024, 4,577 adult mosquitoes were reported, which was significantly more than in previous years (comparison 2023: 2,932). Most reports came from Styria, followed by Vienna, Lower Austria and Upper Austria, with the highest number reported from mid-July to mid-September.

Experts identified the following mosquitoes from the reports:

1,517 Asian tiger mosquitoes (comparison 2023: 568),

251 Japanese bush mosquitoes and

105 reports were domestic house mosquitoes.

Almost 90 % of the findings were concentrated in urban areas. In Vienna, Graz and Linz, where tiger mosquitoes are already known to occur from previous years, the reports from the Mosquito Alert app increased and showed a significant expansion of the tiger mosquito population compared to the previous year 2023.

The annual report 2024 "Ovitrap monitoring of alien mosquito species in Austria" was published on 3 March 2025.

In cooperation with the provincial health directorates of Upper Austria, Lower Austria, Burgenland, Styria, Salzburg, Carinthia and Tyrol, the distribution of alien and potentially invasive mosquito species in Austria is recorded using ovitrap traps. These traps are set up at several locations throughout Austria from the beginning of May to the end of October.

In 2024, a total of 7,148 samples were collected, and 2,056 of these samples (30.4 %) were found to contain eggs of container-breeding gnats of the genus Aedes. The ratio of positive samples (comparison 2023: 30.5 %) and the average number of eggs per day and location is very similar to the previous year 2023.

In 2024, Aedes eggs were detected for the first time at all 65 survey locations.

Eggs of the Asian tiger mosquito(Ae. albopictus) were found at 37 sites (comparison 2023: 21). The spatial spread of the Asian tiger mosquito in Graz, Linz and Vienna has increased significantly compared to the previous year 2023, as can also be seen from the reports made by the population using the Mosquito Alert App.

The Japanese bush mosquito(Ae. japonicus) was by far the most common species in the Ovitraps. It can now be found in all of Austria's federal states and is particularly widespread in the south. It will no longer be possible to eliminate this species in Austria.

The Korean bush mosquito(Ae. koreicus) has so far only been found sporadically and could not be detected in 2024.

The annual report 2024 "Austria-wide West Nile virus monitoring in mosquitoes" was published on 3 March 2025.

The occurrence of West Nile virus (WNV) in mosquitoes has been monitored for the first time since 2024 as part of the EU-funded OH SURVector project and in cooperation with the provincial health directorates.

To this end, traps were set up twice a month at 68 locations from May to October. The mosquitoes caught were identified by species and analysed for the presence of WNV. A total of 7,927 mosquitoes were caught, most of which were Cx. pipiens/torrentium, the most important vector of WNV in Europe. The mosquitoes were summarised in 1,364 pools. WNV was detected in three pools. The positive samples came from Burgenland and Styria.

In 2024, 36 cases of West Nile fever were reported in humans infected in Austria, as well as 59 cases in horses and 22 in birds. This is the highest number reported to date for all three groups. The reports came from the east of Austria, as in previous years.

 

Annual report tick monitoring

The Annual Report 2024 Tick Monitoring in Austria was published on 10 March 2025. Over the course of the year, AGES received a total of 1,420 ticks from all over Austria.

The most common tick genus was Ixodes, led by the tick species Ixodes ricinus. The second most common genus was Dermacentor ticks.

Native shield ticks were analysed for borrelia, the causative agent of Lyme borreliosis. Borrelia was detected in a total of 20 % of the ticks.

In 2024, there were eleven confirmed findings of "giant ticks"(Hyalomma ticks). Almost all of them were imported ticks. Rickettsia aeschlimannii, the causative agent of rickettsiosis, was detected in 37.5 % of the "giant ticks". Of the eight Hyalomma ticks received by AGES, all were negative for the Crimean-Congo haemorrhagic fever virus.

The most common diseases transmitted to humans by ticks in Austria are Lyme borreliosis and tick-borne encephalitis (TBE). A vaccination is available against TBE. No federal state in Austria is TBE-free, so the vaccination is recommended for all people living in Austria.

You can find more information at: Tick information - AGES

Technical term epidemiology

The reproduction number (R value) is a central concept in epidemiology and indicates whether an infectious disease can spread in a population. It indicates the average number of people infected by an infected person and is crucial for assessing the possible spread of an epidemic. The reproduction number is also used to calculate the proportion of the population that needs to be immunised through vaccination in order to contain and possibly eradicate the disease.

If the R value is above 1, each existing infection causes more than one new infection and the disease spreads. A value of 1 indicates a stable infection situation, while a value below 1 indicates a declining spread. The higher the R-value, the more difficult it is to bring an infectious disease under control.

Measles has a very high R-value of 15, meaning that it spreads quickly and with certainty in an unvaccinated group. The COVID-19 pandemic has shown how important the reproduction number is for guiding public health measures, as factors such as immunity through infection or vaccination can influence the R-value.

About the radar

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), we ask for your patience. A reply will be sent within one week.

The next AGES-Radar will be published on 13 March 2025.

Data on notifiable diseases

Case numbers of notifiable diseases according to the Epidemics Act, the figures are shown for the previous month and, in each case for the period from the beginning of the year to the end of the previous month, the figures for the current year, for the previous year, as well as the median of the last 5 years for comparison (Epidemiological Reporting System, as of 12.03.2025).

Pathogens 2025 2024 2020-2024 (median)
Feb Jan-Feb Jan-Feb Jan-Feb
Amoebic dysentery (amoebiasis) 0 0 2 1
Botulism b 0 0 0 0
Brucellosis 1 1 2 2
Campylobacteriosis b 263 755 940 867
Chikungunya fever 0 0 2 0
Cholera 0 0 0 0
Clostridioides difficile infection, severe course 85 184 134 111
Dengue fever 15 22 39 17
Diphtheria 1 1 0 1
Ebola fever 0 0 0 0
Echinococcosis due to fox tapeworm 3 4 4 2
Echinococcosis caused by dog tapeworm 3 4 6 6
Spotted fever (rickettsiosis caused by R. prowazekii) 0 0 0 0
Tick-borne encephalitis (TBE) 0 1 1 0
Yellow fever 0 0 0 0
Haemophilus influenzae, invasive a 17 35 27 11
Hantavirus disease 2 5 6 7
Hepatitis A 6 14 12 8
Hepatitis B 99 172 239 162
Hepatitis C 92 185 205 169
Hepatitis D 0 0 2 2
Hepatitis E 9 12 12 8
Whooping cough (pertussis) 214 670 1.554 44
Polio (poliomyelitis) 0 0 0 0
Lassa fever 0 0 0 0
Legionnaires' disease (legionellosis) d 40 66 37 28
Leprosy 0 0 0 0
Leptospirosis 1 1 7 1
Listeriosis b 1 5 12 6
Malaria 5 9 9 9
Marburg fever 0 0 0 0
Measles 6 54 248 9
Meningococcus, invasive c 8 9 2 2
Middle East respiratory syndrome (MERS) 0 0 0 0
Anthrax 0 0 0 0
Mpox e 4 5 6 0
Norovirus gastroenteritis b 667 1.231 1.051 516
Paratyphoid fever 0 0 0 0
Plague 0 0 0 0
Pneumococcus, invasive c 141 270 250 152
Smallpox 0 0 0 0
Psittacosis 0 0 1 1
Rotavirus gastroenteritis b 92 185 130 58
Glanders (Malleus) 0 0 0 0
Rubella 0 0 0 0
Relapsing fever 0 0 0 0
STEC/VTEC b 57 104 64 39
Salmonellosis b 48 99 126 116
Scarlet fever 38 59 124 1
Severe acute respiratory syndrome (SARS) 0 0 0 0
Shigellosis b 17 44 32 13
Other viral meningoencephalitis 7 23 15 16
Rabies 0 0 0 0
Trachoma (grain disease) 0 0 0 0
Trichinellosis 0 0 1 1
Tuberculosis 32 59 80 63
Tularemia 1 4 17 4
Typhoid fever 0 0 0 0
Bird flu (avian influenza) 0 0 0 0
West Nile virus disease 0 0 0 0
Yersiniosis b 5 15 22 22
Zika virus disease 0 0 4 0

 

a The diseases are evaluated according to the case definition. Diseases for which a case definition exists are shown, with the exception of transmissible spongiform encephalopathies. As a rule, confirmed and probable cases are counted. Subsequent notifications or entries may result in changes.

b Bacterial and viral food poisoning, in accordance with the Epidemics Act.

c Invasive bacterial disease, in accordance with the Epidemics Act.

d Includes only cases with pneumonia.

e Mpox has been notifiable since 2022; the median is only calculated for the years in which notification is mandatory.

 

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Last updated: 13.03.2025

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