In recent weeks, there has been an increase in the concentration of SARS-CoV-2 in Austrian wastewater. The virus concentration in wastewater remains low compared to previous waves. A slight increase in COVID-19 cases has been observed in the sentinel monitoring system since mid-June. The positivity rate in the sentinel samples has been above 10% since calendar week 26. The positivity rate indicates how many of the samples recorded in the system from patients with acute respiratory infections test positive for SARS-CoV-2. There has also been a slight increase in inpatient hospital admissions in recent weeks, albeit still at a low level.

An increase in SARS-CoV-2 activity has also been observed in other European countries since May, with a slight decline in the positivity rate in July (as of 22 July 2024).

The JN.1 variant and its sublines are currently dominantworldwide. Of these sublines, KP.3 and LB.1 are increasing worldwide. The European Centre for Disease Prevention and Control (ECDC) does not believe that the increase in these variants will affect the severity of infection or the effectiveness of the vaccine.

The situation is being closely monitored by European countries. It is currently not considered to be a cause for concern.

Due to the increasing SARS-CoV-2 activity, wearing a mask is recommended if close contact with many people indoors cannot be avoided, e.g. at the airport or on an aeroplane. At the Tour de France in mid-July, a mask requirement was reintroduced in certain areas due to several COVID-19 cases.

The vaccine adapted to the JN.1 variant has arrived in Austria and can already be ordered and vaccinated by vaccination centres. A single vaccination is recommended, preferably in autumn. As in the previous year, vaccination is particularly recommended for people at risk and people aged 60 and over. Details on COVID-19 vaccination can be found in the updated recommendation dated 18 July 2024.

Coronavirus - AGES

erviss.org

Vaccination schedule Austria (sozialministerium.at)

In the current outbreak of avian influenza A(H5N1) in dairy cows in the USA, 168 herds in 13 states are currently affected (as of 23 July 2024).

In connection with these outbreaks in dairy cows, a fourth person tested positive for H5N1 in early July. After cases in Texas and Michigan, this is the first official human H5N1 case in Colorado. It is also a worker on a dairy farm where cows have already tested positive for the virus. The person had conjunctivitis and has recovered.

In addition to this new case linked to dairy cows, six workers on a poultry farm in Colorado also tested positive for H5N1 in July with mild symptoms. They were involved in the removal of infected birds following an outbreak of highly pathogenic avian influenza (HPAI). These are the first cases among poultry workers in the US since 2022.

The US Centers for Disease Control and Prevention (CDC) estimates that the risk to the general public in the US from these outbreaks is low and is expected to remain low. However, developments in recent weeks emphasise the importance of protective measures for people in close contact with infected animals.

There have been no reported cases of A(H5N1) in humans or cattle in Europe. HPAI viruses in birds are circulating at a very low level, the total number of detections in Europe is the lowest since 2019/2020. In Austria , there are currently no reported cases of HPAI in wild birds, poultry or captive birds (as of 3 July 2024). So far, the genetic analyses of the cases found in Europe have not shown any changes that indicate that the virus has adapted to humans.

The ECDC considers the risk to the public in the EU/EEA countries to be low. The risk for occupationally exposed groups, such as farmers, is classified as low to medium. It is generally recommended to avoid contact with sick or dead birds and dead wild animals. Exposed persons are recommended to wear personal protective equipment such as masks, goggles and overalls when handling sick animals.

Preventive measures

In Europe, fifteen EU/EEA member states, including Austria, are participating in the procurement of a vaccine that is to be used to protect occupationally exposed persons, including employees of poultry farms. In Finland, risk groups will soon be able to be vaccinated against avian influenza (details can be found in the AGES Radar of 27 June 2024).

The avian influenza virus has been genetically 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.

Avian influenza is notifiable in Austria and is monitored. In order to correctly classify the rare event of a human infection with avian influenza as quickly as possible, doctors are advised to ask patients with unclear or flu-like symptoms about contact with birds or other animals in the last two weeks.

Further information on avian influenza in Austria can be found in the Animal Disease Radar.

CDC Reports Fourth Human Case of H5 Bird Flu Tied to Dairy Cow Outbreak | CDC Online Newsroom | CDC

CDC Confirms Human Cases of H5 Bird Flu Among Colorado Poultry Workers | CDC Online Newsroom | CDC

AI Report XXIX_journal publication_0.pdf (europa.eu)

Rapid Risk assessment for highly pathogenic avian influenza H5 (HPAI H5) (openagrar.de)

Communicable disease threats report, 6-12 July 2024, Week 28 (europa.eu)

After Italy recorded the first imported case of Oropouche in Europe in June (see AGES radar from 27/06/2024), further reports have been added: As of 12 July 2024, three cases of Oropouche have been reported in Italy and three in Spain. All six people had returned from Cuba(ECDC). In the three Spanish cases, the clinical symptoms were mild and all have since recovered. There is no connection between the cases, except that they were all in Cuba.

Oropouche virus (OROV) is an arbovirus that is transmitted by midges. These small mosquitoes are the main carriers or vectors of the virus. OROV circulates in Central and South America and was previously mainly native to the Amazon basin. This year, OROV cases are rising sharply, even in regions that were previously unaffected. Deforestation of the rainforest and climate change appear to be favouring the spread of the vectors and thus the disease. Cuba has been experiencing the first Oropouche outbreak in the country's history since May. You can find more information in the AGES Radar from 27/06/2024.

The symptoms of an OROV infection are similar to those of dengue: fever, headache, chills, etc. Most patients recover without permanent damage. There is no specific medication or vaccination.

Since June, Brazil has reported several cases of miscarriages, stillbirths and neurological defects in newborns who were probably infected with OROV in the womb. To investigate a possible link, the Pan American Health Organisation (PAHO) is urging member states to closely monitor and report the occurrence of similar events.

The ECDC considers the risk of infection for EU/EEA citizens travelling to Cuba or the Americas to be low. It is recommended to protect yourself against mosquito bites. As midges are smaller than mosquitoes and can therefore penetrate mosquito nets, particularly close-meshed mosquito nets impregnated with insect repellents are recommended as protection when travelling to affected areas The vectors of the Oropouche virus do not occur in continental Europe. Should a case of Oropouche be imported to Europe, the probability of secondary transmission in continental Europe is therefore considered to be very low. So far, the disease is limited to the American continent. The ECDC continues to expect imported cases among travellers returning from outbreak areas.

Oropouche virus disease - Cuba (who.int)

Communicable disease threats report, 6-12 July 2024, Week 28 (europa.eu)

It's a hot year, some bathing waters are barely refreshing and even the drinking water from the tap is rather warm to the body. Many bacteria are happy when the cool water is only wet; they multiply better in warm water. This also applies to legionella. These bacteria can cause pneumonia, especially in people whose immune system is already weakened. Legionella bacteria are very widespread in the environment. They multiply particularly well in hot water supply systems or cooling towers in large buildings.

Infection occurs via inhalation of very fine water droplets (aerosols) contaminated with legionella, for example when showering. Drinking water contaminated with legionella is harmless as long as the water does not enter the windpipe. Legionella is not transmitted from person to person.

In addition to showers, such aerosols are also produced in evaporative cooling systems and whirlpools. To reduce the risk, water systems in hospitals, nursing homes and swimming pools are routinely checked and sanitisation measures are taken if necessary. Hotels and residential complexes should also be checked regularly. However, absolute protection is not possible.

At temperatures above 70 °C, legionella die in a few seconds, which is why the legionella circuit can be effective. It ensures that the water system is heated to over 70 °C every week. Other measures include permanently heating the central drinking water storage tank to at least 60 °C, electrolytic disinfection, UV disinfection and copper-silver disinfection, as well as improving the water circulation.

Consumers should ensure that water does not stand in the pipes for too long, especially during the holiday season. Ideally, someone should run the water regularly when you are away for a longer period of time. If this is not possible, the pipes should be thoroughly flushed after returning home.

AGES has been collecting samples of legionella since 2014 and analysing their relationships based on genomic data. This data should help to clarify where an infection may have occurred, as Legionella is very widespread and it is often not clear where patients may have become infected. The genome comparison can be used, for example, to find out whether the infection took place in the shower at home or via a cooling tower in a hospital.

From Legionella to Legionnaires' disease

Legionnaires' disease is a pneumonia caused by Legionella bacteria that mainly affects older people and those with a weakened immune system. The disease got its name from the circumstances of its discovery: in 1976, following a meeting of the US war veterans' association American Legion in a hotel, there were around 200 cases of pneumonia with a cause that was still unknown at the time. After intensive research, Legionella pneumophila was identified as the pathogen the following year. The bacteria had colonised the hotel's air conditioning system and spread through it. 34 people died.

The numbers are rising

The number of cases has roughly doubled in the last decade. In 2022, there were 305 reported cases of legionella infections in Austria, twelve of which were fatal. In 2024, 144 cases were reported in the first half of the year. As most cases are normally reported in August and September, there could be an increase again this year.

Warming due to climate change could play a role in this; legionella benefit from warmer and more humid air and can then multiply more easily. Other reasons for the increase are currently being investigated by AGES at the Institute for Infection Epidemiology.

Legionella - AGES

The AGES Annual Report 2023 on gonococci was published on 25 July 2024. In 2023, 419 samples from 398 patients tested positive for gonococci at the National Reference Centre for Gonococci. The majority of the strains came from urethral swabs. Almost three quarters of the samples that tested positive for N. gonorrhoeae came from men. Overall, most gonococcal infections were confirmed in the 25 to 34 age group.

No multi-resistance or extensive resistance to antibiotics was identified in the analysis of 403 isolates. All isolates tested at the reference centre for gonococci were sensitive to the antibiotics ceftriaxone and cefixime, which are routinely used in the treatment of gonorrhoea. Resistance to azithromycin, which is also used in combination to treat gonorrhoea, was found in 22.9% of the isolates. High resistance rates were recorded to ciprofloxacin, tetracycline and penicillin.