ONWARD: a #OneHealth, pan - #European multidisciplinary #network advancing #surveillance, #research, clinical management and control of zoonotic #hepeviruses

 

Highlight

• HEV remains the leading cause of acute viral hepatitis in Europe

• Surveillance and diagnostics for HEV are heterogeneous across EU/EEA

• Zoonotic HEV circulates widely in pigs, wildlife and food chains

• Rat HEV expands the zoonotic spectrum and clinical burden in Europe

• ONWARD integrates One Health surveillance, research and capacity building

Abstract

Zoonotic hepeviruses, particularly hepatitis E virus (HEV, species Paslahepevirus balayani) represent a major yet underestimated public health challenge in Europe. Despite being the leading cause of acute viral hepatitis, surveillance, diagnostic practices and prevention strategies remain heterogeneous across EU/EEA countries, limiting comparability and hindering accurate burden estimates. Underdiagnosis is further compounded by extrahepatic manifestations and the growing impact of chronic HEV infection in immunocompromised patients. At the human–animal–environment interface, zoonotic HEV circulates widely in domestic pigs, wildlife and food products, while coordinated surveillance and control measures remain inconsistently implemented. The recent recognition of ratHEV (species Rocahepevirus ratti) as a cause of acute and chronic hepatitis in Europe further expands the spectrum of zoonotic hepevirus infections and underscores the need for integrated One Health approaches. To address these challenges, the One Health Zoonotic Hepevirus Network (ONWARD; COST Action CA24140) was launched in 2025 as a pan-European, multidisciplinary collaboration uniting experts across human, veterinary, food safety and environmental health sectors. ONWARD aims to harmonise diagnostic tools, strengthen clinical research, integrate multisectoral surveillance, promote capacity building and support evidence-based policy development. By fostering coordination with European stakeholders ONWARD provides a structured framework to strengthen preparedness, surveillance and response to zoonotic hepevirus threats across Europe.

Source: 

Link: https://www.sciencedirect.com/science/article/pii/S1386653226000338?dgcid=rss_sd_all

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#Potential and #challenges for sustainable #progress in human #longevity

 

Abstract

Decelerating gains in life expectancy (e0) in high-income countries have raised concerns about the future of human longevity. To enhance our understanding of these developments, we examine subnational (N = 450) mortality trends in Western Europe in the period 1992-2019. Between 1992 and 2005, gains in life expectancy were both substantial and widespread. Laggard regions experienced the fastest improvements, yielding rapid regional convergence. Between 2005 and 2019, however, gains in these regions decelerated, while remaining remarkably stable in vanguard regions, suggesting that it remains possible to continue extending longevity. The observed slowing of e0 gains is strongly associated with mortality at ages 55-74, which increased in this period across large areas of Western Europe, particularly in Germany and France. In this work, we show that monitoring mortality trends at a fine geographical level is crucial for revealing both the potential for, and challenges to, sustainable progress in human longevity.

Source: 

Link: https://www.nature.com/articles/s41467-026-68828-z

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#Ecology and #environment predict spatially stratified #risk of #H5 highly pathogenic avian #influenza clade 2.3.4.4b in wild #birds across #Europe

 

Abstract

Highly pathogenic avian influenza (HPAI) represents a threat to animal and human health, with the ongoing H5N1 outbreak within the H5 2.3.4.4b clade being one of the largest on record. However, it remains unclear what factors have contributed to its intercontinental spread. We use Bayesian additive regression trees, a machine learning method designed for probabilistic modelling of complex nonlinear phenomena, to construct species distribution models (SDMs) for HPAI clade 2.3.4.4b presence. We identify factors driving geospatial patterns of infection and project risk distributions across Europe. Our models are time-stratified to capture both seasonal changes in risk and shifts in epidemiology associated with the succession of H5N6/H5N8 by H5N1 within the clade. While previous studies aimed to model HPAI presence from physical geography, we explicitly consider wild bird ecology by including estimates of bird species richness, abundance of specific taxa, and “abundance indices” describing total abundance of birds with high-risk behavioural traits. Our projections of HPAI clade 2.3.4.4b indicate a shift in persistent, year-round risk towards cold, low-lying regions of northwest Europe associated with H5N1. Methodologically, we demonstrate that while most variation in risk can be explained by climate and physical geography, adding host ecology is a valuable refinement to SDMs of HPAI.

Source: 

Link: https://www.nature.com/articles/s41598-025-30651-9

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Unprecedented high level of highly pathogenic avian #influenza in wild #birds in #Europe during the 2025 autumn #migration

 

Abstract

Between 6 September and 14 November 2025, 1,443 highly pathogenic avian influenza (HPAI) A(H5) virus detections were reported in wild birds across 26 countries in Europe. This number was four times higher than in the same period in 2024 and the highest overall for those weeks since at least 2016. Almost all the detections (99%) were due to HPAI A(H5N1) viruses, and most of them belonged to EA-2024-DI.2.1, a new sub-lineage of the EA-2024-DI.2 genotype. These HPAI virus detections in wild birds involved increasing numbers of waterfowl species (ducks, geese and swans) that were found positive in large parts of Europe. In addition, high numbers of common cranes were affected across a wide band stretching from northeast to southwest Europe. Given the unprecedented high circulation of HPAI virus in the wild bird population compared to previous years, and the associated high environmental contamination, strict biosecurity measures and early detection of infected poultry establishments are urgently needed to prevent introductions from wild to domestic birds and further spread among poultry establishments. Prompt removal of wild bird carcasses is indicated to reduce the risk of infection for other wild and domestic birds and mammals.

Source: 

Link: https://efsa.onlinelibrary.wiley.com/doi/abs/10.2903/j.efsa.2025.9811

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#Vectors on the Move: How #Climate Change Fuels the Spread of #Arboviruses in #Europe

 

Abstract

Climate change is increasingly recognized as a major driver of emerging infectious diseases, particularly vector-borne diseases (VBDs), which are expanding in range and intensity worldwide. Europe, traditionally considered low-risk for many arboviral infections, is now experiencing autochthonous transmission of pathogens such as dengue, chikungunya, Zika virus, West Nile virus, malaria, and leishmaniasis. Rising temperatures, altered precipitation patterns, and milder winters have facilitated the establishment and spread of competent vectors, including Aedes, Anopheles, Phlebotomus, and Culex species, in previously non-endemic areas. These climatic shifts not only impact vector survival and distribution but also influence vector competence and pathogen development, ultimately increasing transmission potential. This narrative review explores the complex relationship between climate change and VBDs, with a particular focus on pediatric populations. It highlights how children may experience distinct clinical manifestations and complications, and how current data on pediatric burden remain limited for several emerging infections. Through an analysis of existing literature and reported outbreaks in Europe, this review underscores the urgent need for enhanced surveillance, integrated vector control strategies, and climate-adapted public health policies. Finally, it outlines research priorities to better anticipate and mitigate future disease emergence in the context of global warming. Understanding and addressing this evolving risk is essential to safeguard public health and to protect vulnerable populations, particularly children, in a rapidly changing climate.

Source: Microorganisms, https://www.mdpi.com/2076-2607/13/9/2034

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Incidence of #healthcare-associated #infections in long-term #care #facilities in nine #European countries: a 12-month, prospective, longitudinal cohort study

Summary

Background

The number of older people in need of long-term care is increasing, and health-care-associated infections (HAIs) are a major cause of morbidity and mortality for residents of long-term care facilities (LTCFs). This study, organised by the European Centre for Disease Prevention and Control (ECDC), provided data on the incidence of HAIs and related adverse outcomes in LTCFs in European countries, supplementing the available estimates from repeated point prevalence surveys conducted by the ECDC.

Methods

In this longitudinal, prospective cohort study, we analysed all HAIs collected in a convenience sample of residents from 65 LTCFs (including general nursing homes, residential homes, and mixed facilities) in nine EU or European Economic Area (EEA) countries (Belgium, Finland, France, Italy, Lithuania, Luxembourg, the Netherlands, Poland, and Spain) over 12 months. Eligible residents were those expected to stay in the LTCF for at least the entire study period. Data were collected with three questionnaires: an institutional questionnaire, a residents' questionnaire, and an HAI questionnaire. HAIs were defined according to standard ECDC criteria. The primary outcome was HAI incidence. Incidence measures, estimated using generalised estimating equation models to account for sample heterogeneity, were percentages of each type of HAI, numbers of HAIs per 100 LTCF residents (ratio), and numbers of HAIs per 1000 resident-days (incidence rate).

Findings

HAIs were analysed in 3029 residents of LTCFs between Jan 1–May 4, 2022, and Jan 1–May 12, 2023. The mean age of study participants was 80·9 years (SD 14·6), including 960 (31·7%) men and 2069 (68·3%) women. 3763 HAIs were recorded, with at least one HAI identified in 1717 (57%) of 3029 residents. There were 124·2 HAIs (95% CI 118·6–129·9) per 100 residents and 1·8 HAIs (0·9–3·3) per 1000 resident-days. 160 (4·3% [95% CI 3·9–5·4]) HAIs led to hospitalisation, and 154 (4·5% [2·5–4·8]) were associated with death. Respiratory tract infections (RTIs) were the most frequent type of infection (n=1080, 28·9% [95% CI 27·3–30·5]), including pneumonia (n=279, 7·3% [6·4–8·3]) and other lower RTIs (n=394, 10·7% [9·6–11·8]), followed by urinary tract infections (UTIs; n=743, 18·7% [17·2–20·3]). RTIs showed the highest incidence of mortality (n=85, 2·3% [95% CI 1·8–2·8] of all HAIs). Severe cases of COVID-19 (n=72, 1·9% [95% CI 1·5–2·4] of all HAIs) were less frequent than mild or moderate cases (n=615, 16·0% [14·9–17·1] of all HAIs).

Interpretation

This study shows the high incidence of HAIs among LTCF residents in EU or EEA countries, with more than one in two residents experiencing at least one HAI, and with RTIs and UTIs accounting for almost half of all observed HAIs.

Source: Lancet Infectious Diseases, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00217-8/fulltext?rss=yes#fig1

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Multiple introductions of #equine #influenza virus into the #UK resulted in widespread #outbreaks and #lineage #replacement

Abstract

Influenza A viruses (IAVs) are prime examples of emerging viruses in humans and animals. IAV circulation in domestic animals poses a pandemic risk as it provides new opportunities for zoonotic infections. The recent emergence of H5N1 IAV in cows and subsequent spread over multiple states within the USA, together with reports of spillover infections in humans, cats and mice highlight this issue. The horse is a domestic animal in which an avian-origin IAV lineage has been circulating for >60 years. In 2018/19, a Florida Clade 1 (FC1) virus triggered one of the largest epizootics recorded in the UK, which led to the replacement of the Equine Influenza Virus (EIV) Florida Clade 2 (FC2) lineage that had been circulating in the country since 2003. We integrated geographical, epidemiological, and virus genetic data to determine the virological and ecological factors leading to this epizootic. By combining newly-sequenced EIV complete genomes derived from UK outbreaks with existing genomic and epidemiological information, we reconstructed the nationwide viral spread and analysed the global evolution of EIV. We show that there was a single EIV FC1 introduction from the USA into Europe, and multiple independent virus introductions from Europe to the UK. At the UK level, three English regions (East, West Midlands, and North-West) were the main sources of virus during the epizootic, and the number of affected premises together with the number of horses in the local area were found as key predictors of viral spread within the country. At the global level, phylogeographic analysis evidenced a source-sink model for intercontinental EIV migration, with a source population evolving in the USA and directly or indirectly seeding viral lineages into sink populations in other continents. Our results provide insight on the underlying factors that influence IAV spread in domestic animals.

Author summary

Influenza causes significant disease burden in animals, including wild birds, sea lions, pigs, horses, dogs, and more recently, cows. Outbreaks and epizootics of influenza in agricultural species are a threat to food security and the economy whereas in wild animals they could affect biodiversity and conservation efforts. Given the zoonotic nature of influenza viruses and the high levels of contact between domestic animals and humans, animal influenza is also a public health concern. Here, we combined geographical, epidemiological, and virus sequence data to determine key factors that led to one of the largest epizootics of equine influenza in the United Kingdom in decades. We show that an American equine influenza virus lineage was introduced into Europe and replaced the virus lineage that had been circulating in the United Kingdom for nearly 20 years. We also analysed a global dataset of virus genomes and propose a model of equine influenza virus intercontinental migration, in which USA is the main source of viruses to other countries. Our results provide important information concerning the basic principles of influenza virus circulation in animal populations. This is central to devise effective measures of disease control that would increase animal health while reducing zoonotic risk.

Source: PLoS Pathogens, https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1013227

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#Corynebacterium diphtheriae #Outbreak in #Migrant Populations in #Europe

Abstract

Background

A surge of cases of Corynebacterium diphtheriae infection was observed in reception centers for migrants in Europe beginning in the summer of 2022. Most of the cases were cutaneous, although some respiratory cases as well as one death were reported. A pan-European consortium was created to assess the clinical, epidemiologic, and microbiologic features of this outbreak.

Methods

We assessed cases of toxigenic C. diphtheriae infection that were reported in 10 European countries from January through November 2022. Data regarding countries of origin and transit routes were obtained from interviews with the patients. Whole-genome sequencing and antimicrobial-susceptibility testing were performed on bacterial isolates that were obtained from the patients. The phylogenetic relationships of the isolates and their antimicrobial-resistance genes were evaluated.

Results

A total of 363 toxigenic C. diphtheriae isolates were identified among 362 patients during the study period. Clinical data were available for 346 patients (95.6%): 268 (77.5%) had cutaneous diphtheria, 53 (15.3%) had respiratory diphtheria (11 [3.2%] had a pseudomembrane), and 9 (2.6%) had both respiratory and cutaneous symptoms. Four major genetic clusters were identified, which indicated the multiclonal nature of the outbreak. The ermX gene (which codes for erythromycin resistance) and the pbp2m and blaOXA-2 genes (which code for beta-lactam resistance) were detected in a subgroup of isolates. Isolates that carried ermX were resistant to erythromycin, and isolates that carried pbp2m were resistant to penicillin but were susceptible to amoxicillin. On the basis of the genomic variation within the four genetic clusters, their most recent common ancestors were estimated to have existed between 2017 and 2020.

Conclusions

The distribution of each genetic cluster of C. diphtheriae isolates across multiple countries in Europe showed repeated cross-border spread. The large number of C. diphtheriae infections among migrants is a cause for concern, particularly given that antimicrobial-resistance phenotypes threaten the efficacy of first-line treatments. (Funded by the Bavarian State Ministry of Health, Care, and Prevention and others.)

Source: The New England Journal of Medicine, https://www.nejm.org/doi/full/10.1056/NEJMoa2311981?query=TOC

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Quantifying the #zoonotic #risk profile of European #influenza A viruses in #swine from 2010 to 2020 inclusive

ABSTRACT

H1 and H3 influenza A viruses (IAVs) circulating in European pigs are markedly distinct from those circulating in other global swine populations. These viruses exhibit significant genetic diversity, further expanded by periodic interspecies transmission of IAVs from humans into pigs, followed by sustained circulation. Several zoonotic IAV infections in humans in Europe have been associated with the 1C lineage of H1 IAVs. Given the predominance of H1 detections in pigs and their zoonotic potential, we quantified antigenic evolution of H1 viruses in European pigs using ferret and pig models and assessed diversity relative to swine IAV vaccine strains. Ferret and swine antisera comparisons revealed no significant differences in antibody responses. Viruses of the 1A.3.3.2 clade exhibited reduced cross-reactivity to human seasonal vaccine strains from 2009. Viruses of the 1B.1.2.2 clade showed no cross-reactivity to the 1978 human seasonal influenza viruses nor to candidate vaccine viruses (CVVs). Clades 1C.2.1 and 1C.2.2 human variant strains had variable cross-reactivity to the tested 1C lineage CVVs, and 1C.2.4 and 1C.2.5 clade viruses exhibited rapid genetic diversification. Many viruses tested were antigenically distant from swine influenza vaccine-representative strains, highlighting the need for updated vaccine formulations. Importantly, age-stratified human serum panels revealed limited population cross-protection to tested viruses, particularly for antigenically heterogenous viruses. These findings quantify the genetic and antigenic diversity of co-circulating IAV lineages and identify specific groups of viruses that may represent a greater risk to animal and public health. These results can be used to inform future pre-pandemic preparedness efforts.

Source: Journal of Virology, https://journals.asm.org/doi/full/10.1128/jvi.00306-25?af=R

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Investigating Factors Driving Shifts in Subtype #Dominance within #H5Nx Clade 2.3.4.4b High-Pathogenicity Avian #Influenza viruses

Abstract

H5Nx clade 2.3.4.4b high-pathogenicity avian influenza viruses (HPAIVs) have decimated wild bird and poultry populations globally since the autumn of 2020. In the United Kingdom (UK) and in continental Europe, the H5N8 subtype predominated during the first epizootic wave of 2020/21, with few detections of H5N1. However, during the second (2021/22) and third (2022/23) epizootic waves, H5N1 was the dominant subtype. The rapid shift in dominance from H5N8 to H5N1 was likely driven by a combination of virological, immunological, and/or host-related factors. In this study, we compared viral fitness and immunological responses in ducks, a key reservoir species, using dominant genotypes of H5N1 (genotype AB) and H5N8 (genotype A) from the second wave. While viral shedding dynamics were similar for both viruses, H5N8 was more pathogenic. Antigenic analysis of post-infection duck sera revealed that the haemagglutinin (HA) protein was antigenically similar across clade 2.3.4.4b H5 HPAIVs, but neuraminidase (NA) proteins displayed different patterns of cross-reactivity. We also modelled a scenario where ducks were pre-exposed to H5N1 (genotype C) or H5N8 (genotype A) from the first wave and subsequently challenged with either homologous or heterologous subtypes from the second wave (genotype AB or A). Despite the absence of seroconversion, pre-exposure to different subtypes resulted in varying clinical outcomes following challenge. These findings indicate that both viral and immunological factors likely played significant roles in the emergence and spread of H5Nx HPAIVs in wild bird populations.

Source: BioRxIV, https://www.biorxiv.org/content/10.1101/2025.04.23.650244v2

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Genesis and Spread of Novel Highly Pathogenic Avian #Influenza A(#H5N1) Clade 2.3.4.4b Virus #Genotype EA-2023-DG #Reassortant, Western #Europe

Abstract

In Europe, highly pathogenic avian influenza (HPAI) virus circulates in avian wildlife, undergoing frequent reassortment, sporadic introductions in domestic birds, and spillover to mammals. An H5N1 clade 2.3.4.4b reassortant, EA-2023-DG, affecting wild and domestic birds was detected in western Europe in November 2023. Six of its RNA segments came from the EA-2021-AB genotype, but the polymerase basic 2 and polymerase acidic segments originated from low pathogenicity avian influenza viruses. Discrete phylogeographic analyses of concatenated genomes and single polymerase basic 2 and polymerase acidic segments suggested reassortment in summer 2023 near the southwestern Baltic Sea. Subsequent continuous phylogeographic analysis of all concatenated EA-2023-DG genomes highlighted circulation in northwestern Europe until June 2024 and long-distance dispersal toward France, Norway, England, Slovakia, Switzerland, and Austria. Those results illustrate the value of phylodynamic approaches to investigate emergence of novel avian influenza virus variants, trace their subsequent dispersal history, and provide vital clues for informing outbreak prevention and intervention policies.

Source: US Centers for Disease Control and Prevention, https://wwwnc.cdc.gov/eid/article/31/6/24-1870_article

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#Ecology and #environment predict spatially stratified #risk of #H5 highly pathogenic avian #influenza clade 2.3.4.4b in wild #birds across #Europe

Abstract

Highly pathogenic avian influenza (HPAI) represents a threat to animal and human health, with the ongoing H5N1 outbreak within the H5 2.3.4.4b clade being the largest on record. However, it remains unclear what factors have contributed to its intercontinental spread. We use Bayesian additive regression trees, a machine learning method designed for probabilistic modelling of complex nonlinear phenomena, to construct species distribution models (SDMs) for HPAI clade 2.3.4.4b presence. We identify factors driving geospatial patterns of infection and project risk distributions across Europe. Our models are time-stratified to capture both seasonal changes in risk and shifts in epidemiology associated with the succession of H5N6/H5N8 by H5N1 within the clade. While previous studies aimed to model HPAI presence from physical geography, we explicitly consider wild bird ecology by including estimates of bird species richness, abundance of specific taxa, and "abundance indices" describing total abundance of birds with high-risk behavioural traits. Our projections of HPAI clade 2.3.4.4b indicate a shift in persistent, year-round risk towards cold, low-lying regions of northwest Europe associated with H5N1. Methodologically, we demonstrate that while most variation in risk can be explained by climate and physical geography, adding host ecology is a valuable refinement to SDMs of HPAI.

Source: BioRxIV, https://www.biorxiv.org/content/10.1101/2024.07.17.603912v2

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Sustained circulation of #enterovirus D68 in #Europe in 2023 and continued #evolution of #EVD68 B3-lineages associated with distinct amino acid substitutions in VP1 protein

Highlights

• Enterovirus D68 (EV-D68) was circulating in Europe in 2023

• Most EV-D68 cases were captured through clinical EV surveillance

• Phylogenetic analysis of the VP1 region revealed a distinct B3-derived lineage

• The identified B3 lineage presented a previously undescribed residue change, D554E

Abstract

Background

Enterovirus D68 (EV-D68) causes respiratory disease ranging from mild to severe and in rare cases a paralytic syndrome, called acute flaccid myelitis (AFM). Since the global EV-D68 outbreak in 2014, the virus has mainly circulated in biennial epidemic cycles with peaks detected during even years. However, following the COVID-19 pandemic, the seasonal pattern of EV-D68 has been characterized by large yearly upsurges. Here, we describe the circulation of EV-D68 in Europe in 2023 and track its genetic evolution.

Study design

Data was compiled from members of the European Non-Polio Network (ENPEN). This included monthly data on the total number of EV samples tested, EV positive samples, EV-D68 positive samples and cases, and other EV positive samples detected in 2023. Information on sample types and surveillance system was recorded. Sequence data from the VP1 gene was used for phylogenetic and amino acid sequence analysis.

Results

EV was detected in 13585 out of 203622 diagnostic samples tested (6.7%), of which 402 (3.0%) were determined as EV-D68, representing 386 cases. EV-D68 infections peaked in October 2023 (136/386; 35.2%). 267/386 (69.2%) of EV-D68 cases were captured through clinical EV surveillance, almost all of which (202/204 of positive samples with sample type information) were detected in respiratory specimens. Phylogenetic analysis performed on 99 VP1 sequences revealed a distinct B3-derived lineage with a previously undescribed residue change, D554E, in Europe.

Conclusions

The study documents sustained circulation of EV-D68 in Europe in 2023, the evolution of B3-derived lineages, and appearance of previously undescribed amino acid substitutions in Europe. This stresses the need for continuous EV-D68 surveillance and harmonization of EV-D68 detection practices towards better data comparability across countries.

Source: Journal of Clinical Virology, https://www.sciencedirect.com/science/article/abs/pii/S1386653225000277?dgcid=rss_sd_all

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Direct and indirect #impacts of #COVID19 #pandemic on #life #expectancy and person-years of life lost with & without #disability: A systematic analysis for 18 European countries, 2020–22

Abstract

Background

The direct and indirect impacts of the COVID-19 pandemic on life expectancy (LE) and years of life lost with and without disability remain unclear. Accounting for pre-pandemic trends in morbidity and mortality, we assessed these impacts in 18 European countries, for the years 2020–2022.

Methods and Findings

We used multi-state Markov modeling based on several data sources to track transitions of the population aged 35 or older between eight health states from disease-free, combinations of cardiovascular disease, cognitive impairment, dementia, and disability, through to death. We quantified separately numbers and rates of deaths attributable to COVID-19 from those related to mortality from other causes during 2020–2022, and estimated the proportion of loss of life expectancy and years of life with and without disability that could have been avoided if the pandemic had not occurred. Estimates were disaggregated by COVID-19 versus non-COVID causes of deaths, calendar year, age, sex, disability status, and country. We generated the 95% uncertainty intervals (UIs) using Monte Carlo simulations with 500 iterations. Among the 289 million adult population in the 18 countries, person-years of life lost (PYLL) in millions were 4.7 (95% UI 3.4–6.0) in 2020, 7.1 (95% UI 6.6–7.9) in 2021, and 5.0 (95% UI 4.1–6.2) in 2022, totaling 16.8 (95% UI 12.0–21.8) million. PYLL per capita varied considerably between the 18 countries ranging between 20 and 109 per 1,000 population. About 60% of the total PYLL occurred among persons aged over 80, and 30% in those aged 65–80. If the pandemic were avoided, over half (9.8 million (95% UI 4.7–15.1)) of the 16.8 million PYLL were estimated to have been lived without disability. Of the total PYLL, 11.6–13.2 million were due to registered COVID-19 deaths and 3.6–5.3 million due to non-COVID mortality. Despite a decrease in PYLL attributable to COVID-19 after 2021, PYLL associated with other causes of death continued to increase from 2020 to 2022 in most countries. Lower income countries had higher PYLL per capita as well as a greater proportion of disability-free PYLL during 2020–2022. Similar patterns were observed for life expectancy. In 2021, LE at age 35 (LE-35) declined by up to 2.8 (95% UI 2.3–3.3) years, with over two-thirds being disability-free. With the exception of Sweden, LE-35 in the studied countries did not recover to 2019 levels by 2022.

Conclusions

The considerable loss of life without disability and the rise in premature mortality not directly linked to COVID-19 deaths during 2020–2022 suggest a potential broader, longer-term and partially indirect impact of the pandemic, possibly resulting from disruptions in healthcare delivery and services for non-COVID conditions and unintended consequences of COVID-19 containment measures. These findings highlight a need for better pandemic preparedness in Europe, ideally, as part of a more comprehensive global public health agenda.

Source: PLoS Medicine, https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004541

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Prevalence, clinical #management, and #outcomes of #adults hospitalised with endemic #arbovirus illness in southeast #Europe (MERMAIDS-ARBO): a prospective observational study

Summary

Background

Arboviruses have expanded into new regions in Europe, yet data indicate gaps in disease notifications and a risk of further spread. We aimed to report on prevalence, clinical management, and outcomes of endemic arbovirus infections in southeast Europe.

Methods

In this prospective observational study (MERMAIDS-ARBO), we enrolled adults (age ≥18 years) hospitalised with an arbovirus-compatible disease syndrome within 21 days of symptom onset across 21 hospitals in seven countries in southeast Europe over four arbovirus seasons (May 1–Oct 31, during 2016–19). We obtained data from case report forms completed by site investigators on admission and discharge. Participants were excluded if they had non-infectious CNS disorders, symptoms of another confirmed cause, an identified focal source of infection, or symptoms caused by recurrence of a pre-existing condition. The primary outcome was the proportion of participants with confirmed or probable acute infections with West Nile virus (WNV), tick-borne encephalitis virus (TBEV), Crimean–Congo haemorrhagic fever virus (CCHFV), or Toscana virus (TOSV), per reference laboratory criteria. Secondary outcomes were the proportions of patients treated with antivirals, antibiotics, or corticosteroids; the proportion of patients requiring intensive care; hospital length of stay; and mortality.

Findings

Of 2896 adults screened for eligibility, 929 were recruited and 913 met protocol-defined eligibility criteria (median age 43·1 years [IQR 29·5–59·7]; 550 [60%] men, 361 [40%] women, and two [<1%] with missing data). 530 (58%) participants presented with suspected meningitis, encephalitis, or both, and 318 (35%) with fever plus myalgia, fever plus arthralgia, or both. 820 (90%) reported no international travel within 21 days before symptom onset. 727 (80%) were administered antibiotics, 379 (42%) corticosteroids, and 222 (24%) antivirals. The median length of hospital stay was 9 days (IQR 6–14), and 113 (12%) required intensive care. Of 847 participants with a reference laboratory sample who met full eligibility criteria for analysis, 110 (13%) were diagnosed with 114 confirmed or probable acute arbovirus infections (four had coinfections or cross-reactivity): one (<1%) with CCHFV, 16 (2%) with TBEV, 44 (5%) with TOSV, and 53 (6%) with WNV. There was one death (<1%) of an individual with WNV. Of the 110 participants, 49 (45%) had a local clinician-attributed arbovirus discharge diagnosis.

Interpretation

Our data highlight the need to strengthen arbovirus surveillance systems for the early detection of emerging and re-emerging outbreaks, including investments to increase awareness of arbovirus infections among clinicians, to improve access to specialist diagnostics, and to develop effective and accessible vaccines and treatments to protect populations and health systems in southeast Europe.

Source: Lancet Infectious Diseases, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00655-8/fulltext?rss=yes

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Avian #influenza: increased spread in #poultry-dense areas at end 2024

 {Excerpt}

Abstract 

Between 21 September and 6 December 2024, 657 highly pathogenic avian influenza (HPAI) A(H5N1) and A(H5N5) virus detections were reported in domestic (341) and wild (316) birds across 27 countries in Europe. Many HPAI outbreaks in domestic birds were clustered in areas with high poultry density and characterised by secondary farm-to-farm spread. Waterfowl, particularly the mute swan, were primarily affected during this reporting period, with HPAI virus detections focused on south-eastern Europe. Notably, A(H5N5) viruses expanded their geographic and host range, resulting in a surge in detections and mortality events described in gulls and crows. No new HPAI virus detections in mammals were reported in Europe during this reporting period, but the number of dairy cattle farms reportedly affected in the United States of America (USA) rose to > 800 in 16 States, and HPAI virus was identified in two pigs in a mixed-species farm. Between 21 September and 11 December 2024, 56 new human cases with avian influenza virus infection were reported from North America (45 A(H5N1) cases), Viet Nam (one A(H5)) and China (ten A(H9N2) cases). Most of the A(H5) human cases in North America (95.6%, n = 43/45) had reported exposure to poultry, live poultry markets, or dairy cattle prior to avian influenza virus detection or onset of illness. Human infections with avian influenza viruses remain rare and no evidence of human-to-human transmission has been documented in the reporting period. The risk of infection with currently circulating avian A(H5) influenza viruses of clade 2.3.4.4b in Europe remains low for the general public in the European Union/European Economic Area (EU/EEA). The risk of infection remains lowto-moderate for those occupationally or otherwise exposed to infected animals or contaminated environments. 

©2025 European Food Safety Authority, European Centre for Disease Prevention and Control, European Union Reference Laboratory for Avian Influenza. EFSA Journal published by Wiley-VCH GmbH on behalf of European Food Safety Authority. 

Source: European Food Safety Authority, https://www.efsa.europa.eu/sites/default/files/2024-12/9204.pdf

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