Summary
A low-level increase in SARS-CoV-2 is being observed in wastewater and in the sentinel system.
New measles cases are still being reported sporadically in Austria, with a total of 453 already reported this year. AGES updates the case numbers and information on hospitalisations on a weekly basis.
In the first half of 2024, more than twice as many cases of whooping cough were reported in Austria as in the whole of 2023. There is a particular health risk for the vulnerable group of infants aged 0 to 6 months.
The number of norovirus infections rose sharply in the first half of 2024. The spread of a new genotype could be partly responsible for this.
In this month's topic , we explore infectious diseases in Austria's favourite travel destinations.
Another human case of avian influenza of the H5N1 subtype has been reported in the USA, for the first time with respiratory symptoms. Several EU/EEA member states are jointly procuring a vaccine to protect exposed occupational groups.
Outbreaks of parvovirus B19 and the Oropouche virus have attracted international attention.
In recent weeks, there has been a slight increase in the SARS-CoV-2 concentration in Austrian wastewater. The virus concentration in wastewater remains very low. A slight increase in COVID-19 cases has been observed in the sentinel monitoring system for a few weeks. The positivity rate in the sentinel samples in calendar week 25 is just under 10%. This increase is not reflected in inpatient hospital admissions, which are stable at a low level.
An increase in SARS-CoV-2 activity can also be observed in other European countries. In Germany, for example, analyses of the FluWeb portal show a slight increase in COVID-19 cases(RKI, as at 21 June 2024). In Spain, the proportion of SARS-CoV-2-positive samples in the sentinel system reached over 30% at the beginning of June. Since calendar week 24, the figure appears to be falling again(SiVIRA, as of 26/06/2024).
In the USA, the proportion of positive SARS-CoV-2 tests and visits to the emergency room have also increased slightly in recent weeks, starting from a low level(CDC, as of 21 June 2024).
The JN.1 variant and its sublines are currently dominant worldwide. The KP.2 and KP.3 variants have been increasing for several weeks. The increase in wastewater and other indicators cannot currently be directly linked to these variants. Declining immunity and the bad weather in some regions in recent weeks may also be influencing factors.
The situation is being closely monitored by European countries. It is currently not considered to be a cause for concern.
The pertussis figures are rising significantly in Europe, details of which can be found in the AGES Radar of 23 May 2023. The chart (see below), in which the incidence is divided into six-month periods, illustrates the extent of the increase in Austria.
While 2,791 cases were reported in the entire previous year, this year there were already 6,625 in the first half of the year (as of 26 June 2024).
There are probably several reasons for the sharp increase: for example, pertussis occurs periodically in waves in Europe; the proportion of fully vaccinated people (including booster vaccinations) is not optimal, which influences the severity of the wave.
The vaccination is included in the free vaccination programme in Austria. Basic immunisation in infancy should be refreshed at primary school age. In order to maintain immunisation protection, the vaccination should also be boostered regularly in adulthood, every ten years up to the age of 60 and every five years from the age of 60. The pertussis vaccination is recommended for everyone.
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 means that newborn babies are protected from infection by maternal antibodies.
Further information on the pertussis vaccination can be found in the Austria 2023/2024 vaccination plan (sozialministerium.at).
In 2024, 453 cases of measles have been registered so far. AGES updates the data here on a weekly basis. The number of new infections has only been low for a few weeks now, but reports must still be expected. Many of the new cases have been imported from other European countries.
Information on the measles-mumps-rubella vaccination can be found in the Austria 2023/2024 vaccination plan (sozialministerium.at).
In the first half of 2024, almost as many norovirus cases were reported in Austria as in the whole of 2023, namely over 2,000. This means that the rising trend that was already observed before the COVID-19 pandemic will continue and is likely to be exceeded this year.
Overall, the figures for noroviruses represent a large underreporting, partly because the Epidemics Act only requires viral food poisoning to be reported.
Most reports are made by children under the age of 10 and people over the age of 60.
Noroviruses are one of the most common causes of viral infections of the gastrointestinal tract worldwide and are transmitted directly from person to person or indirectly via contaminated surfaces, objects, food or water. Noroviruses are very contagious and even small quantities (10-100 virus particles) can lead to illness.
A new genotype is likely to be partly responsible for the significant increase. The variant with the designation GII.17 is demonstrably responsible for four out of eleven outbreaks in Austria. According to the National Reference Centre for Noroviruses in Graz, 30% of all sequenced noroviruses are of the GII.17 genotype, which was rarely detected in previous years. Higher incidences than usual are also reported in other European countries, for example in Germany, Finland and Ireland.
There is no vaccine that protects against noroviruses. The most important preventive measure is personal hand hygiene: thorough hand washing before eating and after every visit to the toilet.
In the current outbreak of avian influenza A(H5N1) in dairy cows in the USA, 126 herds in twelve states are currently affected (as of 26 June 2024).
Since the publication of the last AGES radar for infectious diseases (23 May 2024), a third human case has been reported in connection with an outbreak in dairy cows. This patient is again an employee of a dairy farm and shows respiratory symptoms (cough without fever) in addition to eye complaints(CDC, as of 30 May 2024). The CDC continues to assess the health risk to the general US population from A(H5N1) as low (as of 14 June 2024). The risk to occupationally or otherwise exposed groups is considered low to moderate.
Since March 2024, the health status of at least 690 people has been monitored in connection with the outbreak in dairy cows in the USA and at least 51 people have been tested for influenza A(CDC, as at 24/06/2024).
In addition to dairy cows, the H5N1 virus has also been detected in other mammal species in the USA, including goats, alpacas, mice and cats. So far, at least 19 cats have tested positive for the H5N1 virus in connection with the outbreak in the USA, in states where the virus has also been found in dairy cows. Transmission through the consumption of raw milk is suspected. In cats, the disease was severe and manifested itself in neurological symptoms, ocular discharge and a high mortality rate(AVMA, as of 24 June 2024). Birds are also still affected in the USA: In May, 14 outbreaks in poultry (with 5.8 million animal losses) were reported in five states and some cases in wild birds(Highly Pathogenic Avian Influenza H5 (HPAI H5) clade 2.3.4.4B risk assessment (openagrar.de)). The wide distribution in birds and the increased spread to mammals enables the viruses to change and adapt to new hosts.
In Europe, there are no cases of A(H5N1) in cattle or humans. The developments in the USA do not currently change the ECDC's risk assessment for the EU/EEA: the risk of transmission of the virus from animals to the general EU/EEA population is considered low , and a low to moderate risk is assumed for occupationally exposed groups.
Preventive measures
The USA is currently developing vaccines against the avian influenza A(H5N1) virus to protect exposed groups of people(CDC, as of 21/06/2024). In Europe, fifteen EU/EEA member states, including Austria, are participating in the procurement of a vaccine to be used to protect poultry farm and dairy workers, veterinarians and laboratory technicians(European Commission, as of 21 June 2024). Finland is the first country to launch a vaccination campaign for people at high risk of infection, including poultry farmers, veterinarians, scientists working with the virus and workers on fur farms.
The virus genome has been detected in samples of pasteurised milk from US retailers. The viruses are no longer infectious after pasteurisation. Consumption of unpasteurised milk is not recommended, also with regard to other pathogens. It is generally recommended to adhere to the basic rules of kitchen hygiene, to heat meat and eggs sufficiently and not to consume raw milk: Cook safely - AGES.
Further information on avian influenza in Austria can be found in the Animal Disease Radar.
H5N1 Bird Flu: Current Situation Summary | Avian Influenza (Flu) (cdc.gov)
Risk assessment for highly pathogenic avian influenza H5 (HPAI H5) clade 2.3.4.4B (openagrar.de)
Surveillance systems in 14 EU/EEA countries have observed an increase in cases of infection with parvovirus B19 in pregnant women since the end of 2023. In Austria, cases of parvovirus B19 are not notifiable. This virus is the causative agent of ringworm. Ringworm is usually harmless and once an infection has been contracted, it produces lifelong immunity. However, if a pregnant woman is infected, this can be life-threatening for the unborn child.
Both the RKI and experts in Austria assume that the measures taken in the course of the COVID-19 pandemic have greatly reduced the number of infections and that the number of cases is therefore now rising across Europe. If fewer people have had an infection, more people are susceptible to it.
The European Centre for Disease Prevention and Control (ECDC) therefore published a risk assessment on 5 June:
For the general public , the risk is low. For pregnant women up to 20 weeks, the risk is low to moderate. But even here, the majority of infections have no negative consequences for the unborn child; less than 10% of maternal B19 virus infections in the first 20 weeks of pregnancy lead to complications.
What can pregnant women do? It is not so easy to reduce the risk of infection in everyday life. Infected people are often already contagious before they have symptoms and often the symptoms are so mild that they go unnoticed. This makes it difficult to avoid contact with infected people. Good hand hygiene is easy to implement: wash your hands regularly with soap and water! Hand sanitisers containing alcohol are not enough. Pregnant women without immunity or with unresolved immunity should not have any professional contact with children of pre-school age.
Risks posed by reported increased circulation of human parvovirus B19 in the EU/EEA (europa.eu)
Italy reported Europe's first imported case of Oropouche in June. It was a patient who had probably been infected while travelling in Cuba. After his return at the end of May, he developed severe symptoms and was hospitalised, where he finally tested positive for the Oropouche virus (OROV).
Cuba has been experiencing the first Oropouche outbreak in the country's history since May. A total of 74 cases have been reported in the provinces of Santiago de Cuba and Cienfuegos as of 5 June 2024. No deaths have been recorded so far.
The Oropouche virus is an arbovirus that is transmitted by midges, small mosquitoes. The virus circulates in Central and South America and was previously native to the Amazon basin. This year, OROV cases are rising sharply: Brazil has already reported over 5,000 cases in 2024; compared to 836 reported cases in 2023, this represents a six-fold increase(Science.org, as of 24/06/2024). Increases in OROV cases are also being observed in Bolivia, Colombia and Peru. OROV cases have recently been recorded in areas where no OROV transmissions had previously taken place(PAHO, as at 24/06/2024).
The ongoing dengue epidemic in South America (see AGES radar issues February and March 2024) could contribute to the fact that so many Oropouche cases are being detected. In the past, only laboratories in the Amazon region tested for the disease, but in January Brazil ordered 10% of samples nationwide to be tested from patients whose symptoms were consistent with Oropouche fever but tested negative for Zika, Chikungunya and dengue. The Pan American Health Organisation (PAHO) is also encouraging other countries in the WHO Region of the Americas to intensify surveillance and implement recommendations for the diagnosis of OROV.
The symptoms of an oropouchevirus infection are similar to those of dengue: fever, headache, chills, among others. Most patients recover without permanent damage. There is no specific medication or vaccination.
Deforestation of the rainforest and climate change appear to favour the spread of these vectors and thus the disease. The vectors of the Oropouche virus are not native to Europe.
Summer and relaxation at last - off to the most popular holiday destinations! Unfortunately, various infectious diseases can lurk there, often transmitted by little pests. This should not diminish the anticipation, but a little information can help to reduce one or two risks.
The infectious diseases listed are not necessarily those with the highest risk, but an editorial selection. Further information on the situation in your destination country can be found on the website of the Federal Ministry for European and International Affairs, for example, or you can seek advice from your doctor.
Austria
In Austria, there is a risk of contracting diseases such as Lyme disease or tick-borne encephalitis (TBE) . Especially if you are on holiday in Austria during the tick season and are out and about in nature.
A current research project by AGES is analysing ticks handed in by the population for pathogens. As of 21 June 2024, just under a quarter (24.9%) of the 282 ticks examined tested positive for Borrelia. A typical symptom of Lyme disease is the ring-shaped, red skin rash that often, but not always, occurs. There is currently no vaccination against Lyme disease; the disease is treated with antibiotics. The most important preventative measure is protection against tick bites. Removing the tick quickly can reduce the risk of Lyme disease transmission.
Apart from Lyme disease, tick-borne encephalitis is the most common tick-borne disease in Austria. Austria is one of the countries most affected by TBE in Central Europe. Vaccination is therefore recommended for all people living and travelling in Austria.
Croatia
The same applies to the forests in the north of Croatia as to Austria: they are a TBE risk area. Anyone travelling in the countryside there should make sure they have an up-to-date vaccination.
Prevention is essential to protect against tick bites: wear long clothing and check your body regularly for ticks.
You can find more information at Tick information - AGES
Italy
In northern Italy, there were a total of 14 dengue cases in August last year, in which the infection actually occurred locally(AGES-Radar 05.10.2023). This means that mosquitoes infected with dengue viruses are already present in Italy. The same applies to some areas in France. Vaccination is not recommended across the board for travellers, but good protection against mosquitoes is advisable: Long clothing, mosquito nets and anti-mosquito repellent. This also reduces the risk of other mosquito-borne diseases, such as West Nile fever, of which there were cases in 2023, at least in the regions of Piedmont, Lombardy, Veneto, Emilia-Romagna, Puglia, Sicily and Sardinia.
Dengue and West Nile virus are also present in some regions of the popular summer holiday destinations of Spain and France. It can be assumed that both pathogens and their vectors will continue to spread as a result of climate change.
Greece
Seasonal outbreaks of West Nile fever can occur in Greece during the summer months. In 2023, 162 cases of West Nile virus (WNV) were reported in Greece, including 23 deaths(ECDC, as of 13 December 2023) WNV is transmitted through the bite of infected mosquitoes. Around 80 % of human cases are asymptomatic. There is no preventive protection or virus-specific treatment for WNV infection in humans, only treatment of the symptoms. Therefore, avoiding gels bites is the best way to prevent infection.
The ECDC monitors West Nile virus cases in Europe and updates the numbers on the dashboard weekly: Surveillance of West Nile virus infections in humans, weekly report (europa.eu) and WNV Dashboard (europa.eu)
Greece: Travel and safety advice - Federal Foreign Office (auswaertiges-amt.de)
Thailand
The ECDC registered an increased number of Zika virus cases among travellers returning from Thailand in Europe in 2023. The finding of a relatively high number of imported cases in recent months likely indicates continued transmission of Zika virus in Thailand. In 2024, eight out of nine Zika virus sufferers in Austria had previously been to Thailand. The Zika virus is primarily transmitted by diurnal Aedes mosquitoes, but sexual transmission is also possible. Most cases are mild, but there is a risk of malformations and premature birth or miscarriage if infected during pregnancy. There is no vaccination. As a preventative measure, mosquito bites should be avoided, details of which can be found in the tips below. The use of a condom is recommended for sexual contact, also with regard to other sexually transmitted diseases.
Epidemiological bulletin 20-21/2024 (rki.de)
Communicable disease threats report, 21-27 January 2024, week 4 (europa.eu)
Turkey
Turkey is considered a high-risk area for rabies. It is recommended to avoid contact with street dogs and cats in particular. The rabies virus is transmitted through the saliva of infected animals, in most cases through a bite, and almost always leads to death within 14 days of the onset of the disease. Travellers should therefore enquire in advance about the current rabies situation in their destination country. The Austrian vaccination plan recommends pre-exposure rabies vaccination for travellers to countries with a high rabies risk, especially for travelling pet addicts and children. The doctor will inform you about the vaccination, the appropriate vaccine and the corresponding vaccination schedule.
AGES was appointed as a rabies advice centre in 2005. The doctors at AGES are available 365 days a year to answer questions about rabies: Rabies advice centre - AGES
Tips:
If you are bitten(or stung) on holiday and then fall ill, you should also consider the mosquito(or tick) as a possible cause, so tell your doctor where and when you were bitten. If you also know exactly what bit you, all the better.
Vaccination protection when travelling | Health portal
Information on mosquitoes and mosquitoes and how to avoid them can be found here: Information on mosquitoes & mosquitoes - AGES
In many countries, protection against mosquitoes is an effective preventive measure against diseases. In addition to long clothing and mosquito nets, correctly applied insect repellents are effective in preventing bites: Effective products contain either the active ingredient diethyltoluamide (= DEET) or icaridin in varying concentrations. In both cases, the concentration in the insect repellent should be at least 20 %; lower concentrations do not help. DEET has already been used successfully for some time. Icaridin has the advantage of being absorbed less through the skin and not attacking plastic. Care should be taken with both DEET and Icaridin to ensure that they do not get into the water, as they are toxic to amphibian larvae. It is important to read the package leaflet and seek medical advice if in doubt.
The repellent should also be chosen according to the occasion. When travelling in the tropics, where there is a high risk of mosquito-borne pathogens, a repellent with very high efficacy should be used. In Austria, mainly for protection against annoying bites, a weaker but somewhat better tolerated repellent is normally sufficient.
The only recommended active ingredient of natural origin is found in lemon eucalyptus oil, which can also be produced artificially. It is somewhat weaker in its effect, but well tolerated.
Encounters with mosquitoes increase in summer. The free Mosquito Alert app makes it possible to turn these rather undesirable encounters into something positive. The Citizen Science project, which has been running throughout Europe since 2020, allows the public to report tiger mosquitoes and other mosquitoes via the app. This makes it possible to keep an eye on the populations of mosquito species and act quickly in the event of new discoveries.
You can find more information about the project at Mosquito Alert - AGES and Mosquito Alert
The European Football Championship has been taking place in Germany since 14 June 2024. At such major events, such as the Hajj (the Islamic pilgrimage to Mecca) or the Olympic Games taking place in France in the summer, the situation is also monitored by local health institutes in collaboration with the ECDC and WHO. The gathering of large numbers of people increases the risk of transmission of infectious diseases. Non-communicable health risks, such as those caused by heat, drugs and alcohol, also increase during such events. To date, no relevant events in connection with communicable diseases have been identified during UEFA EURO 2024(ECDC, as at 24 June 2024).
The WHO and ECDC, together with the German Federal Centre for Health Education (BZgA), have published recommendations for the current UEFA EURO 2024: Public health advice UEFA EURO 2024 (europa.eu) These include recommendations for action to protect against heat, as well as a list of important emergency telephone numbers in Germany.
If it is not possible to stop the spread of a viral disease, containment (see AGES Infection Radar issue of 23 May 2024) is not sufficient as a strategy, then the aim is to cushion the consequences of the epidemic as much as possible: The mitigation strategy attempts to slow down the pace of further spread in the event of an epidemic or pandemic. This can be achieved through lockdown measures, such as closing schools or restricting large events. However, measures such as social distancing or masks are also part of the mitigation strategy.
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: 27.06.2024
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