BACKGROUND Increasing incidence rates of invasive Streptococcus dysgalactiae subspecies equisimilis (iSDSE) have been detected worldwide. AIM We aimed to investigate iSDSE infection incidence rates in Denmark during 2014–2024, and characterise the genomic population structure of a subset of iSDSE isolates and their antimicrobial resistance (AMR). METHODS Using national register data, we estimated overall and sex-/age-stratified iSDSE incidences during 2014–2024, by retrospectively identifying cases of invasive infections with group C and G streptococci or S. dysgalactiae (including specified as subspecies equisimilis). From the voluntary national beta-haemolytic streptococci laboratory surveillance system, whole-genome-sequenced isolates from August 2020−September 2022 were used to investigate the iSDSE genomic population structure. Susceptibility to penicillin, erythromycin and clindamycin was determined and AMR genes identified. RESULTS During 2014–2024, iSDSE incidence rates increased significantly (linear trend analysis p < 0.001) with mean annual incidence ranging between 10.3 and 16.4 per 100,000, peaking in 2023. Incidence was higher in males, increasing with older age. Nearly 75% of the 1,223 iSDSE isolates belonged to four of 14 genetic clusters. Sequence types (STs) ST20 and ST17 were most prevalent, while emm-type stG62647, a variant associated internationally with higher virulence, dominated. All isolates were phenotypically susceptible to penicillin but approximately 10% were respectively erythromycin and clindamycin resistant. High erythromycin resistance prevalence (57%; 39/68), coinciding with gene ermA, occurred in one genetic cluster. CONCLUSION The findings illustrate the need for national registry-based surveillance to detect epidemiological changes and potential outbreaks. Further, continuous genomic surveillance can monitor the occurrence and expansion of genetic clades and AMR genes.
We report an ongoing outbreak of invasive Haemophilus influenzae type b (Hib) disease among people who use drugs (PWUD) and people experiencing homelessness (PEH) in Hamburg, Germany. Between 1 September 2024 and 31 August 2025, 20 adult Hib cases were reported. The cases were either residents of Hamburg (16/20) or stayed in Hamburg during the exposure period (4/20). Whole genome sequencing identified a link between 18 cases (median age 50 years (range 26–77); six female, 12 male, three died). An epidemiological link (i.e. drug consumption in the open drug scene) could be established for 15 of the 18 cases. Control measures included post-exposure chemoprophylaxis for close contacts (n = 4), vaccination offers (n = 69 doses administered by 31 August 2025) and an information campaign targeting PWUD, PEH and staff members of addiction support centres. We describe the first Hib outbreak among adults in Europe and document drug use and homelessness as suspected risk factors. Based on these findings, national vaccination recommendations issued by the Standing Committee on Vaccination in Germany (STIKO) were updated to include vaccination and post-exposure prophylaxis recommendations in outbreak settings for PWUD and PEH. Control measures are currently being evaluated and expanded.
During Spain’s 2025/26 RSV season, three children were infected with RSV-B viruses carrying the F protein N201T substitution. Two who received nirsevimab that season were hospitalised (one required intensive care); the third was treated previously. Recombinant expression studies confirmed reduced nirsevimab recognition. Genomic data indicated sporadic emergence across distinct RSV-B backgrounds rather than expansion of a single lineage. Findings highlight the importance of combining genomic surveillance with antigenic characterisation to detect and interpret variants with reduced susceptibility to antibody-based prevention.
INTRODUCTION Field epidemiology training programmes (FETPs) strengthen public health workforce capacity for infectious disease surveillance and outbreak response. The Postgraduate Training for Applied Epidemiology (PAE) is a 2-year FETP aligned with European and global training standards. AIM We evaluated the contribution of PAE to a strengthened public health workforce for infection protection in Germany. METHODS Our evaluation consisted of three components: a semi-structured desk review of programme outputs (1996–2025), an online graduate survey (cohorts 1996–2023), and an online workshop with experts from local, federal state and national health authorities. We analysed quantitative data descriptively, and qualitative data through a simplified content analysis. RESULTS By December 2025, PAE had 126 graduates with the following outputs: 197 peer-reviewed publications, 193 accepted conference abstracts, and 205 conducted outbreak investigations. In total, 72% (91/126) graduates responded to the survey. Most respondents remained in the German public health workforce (70%; 64/91), reported high satisfaction (90%; 82/91), and would recommend the programme (96%; 87/91). Graduates reported roles in crisis and outbreak management (70%; 64/91), holding leadership roles (59%; 54/91), and engaging in knowledge dissemination (86%; 78/91). Qualitative findings highlighted shared methodological approaches and technical language, and strong networks as key facilitators of collaboration across all levels of the German public health service. CONCLUSION We found that PAE contributes to strengthening and sustaining an infection protection workforce in Germany that regularly applies and disseminates learnt skills. Most graduates have held or currently hold leadership roles and frequently contribute to outbreak and public health crisis management.
BACKGROUND Congenital syphilis is a potentially serious, but preventable infection. Several European countries have recently reported increasing trends. AIM This study assessed national incidence and temporal trends of congenital syphilis and prevalence of pregnancies with active syphilis in Denmark between 2010 and 2024. METHODS Using nationwide individual-level data linked through civil registration numbers across Danish health and population registers, we identified all maternal and congenital syphilis cases among live-born children born in Denmark from 2010 to 2024. We calculated annual incidence per 10,000 live births and analysed temporal trends and annual percent change (APC) with 95% confidence intervals (CI), using Poisson or negative binomial regression models. RESULTS Five infants with confirmed congenital syphilis were recorded among 894,345 live births, corresponding to an incidence of 0.6 per 100,000 (95% CI: 0.2–1.4). No infants with congenital syphilis were identified after 2016. For each infant, a plausible explanation for screening failure was identified: two women arrived in Denmark late in pregnancy, two were infected late in pregnancy. None of these events reflected failure of the first-trimester screening algorithm itself. One event was due to a reporting irregularity. Poisson regression showed a decreasing trend (APC = −21.7%; 95% CI: −43.4 to −1.0). Active syphilis infection occurred in 172 pregnancies, amounting to 20.0 per 100,000 live births (95% CI: 17.2–23.2) with no temporal changes. CONCLUSIONS Congenital syphilis is now eliminated in Denmark. The incidence of pregnancies with active syphilis infection remained stable despite increasing syphilis prevalence in the general population, confirming the continued effectiveness of the Danish national antenatal syphilis screening programme.
BACKGROUND Antimicrobial resistance is highly correlated with inappropriate antimicrobial use. Urinary tract infections (UTIs) are the main infections treated with antibiotics in the population ≥ 70 years. AIM We aimed to investigate antibiotic prescribing patterns for UTIs treatment among older people in Denmark and resistance trends to assess impact of antibiotic stewardship interventions and quality improvement strategies. METHODS This national register-based surveillance study included people ≥ 70 years in Danish primary healthcare and assessed consumption of pivmecillinam, trimethoprim, nitrofurantoin and sulfamethizole from 1999 to 2023 and resistance levels from 2018 to 2023. Consumption data were obtained from the Register of Medicinal Product Statistics and resistance data from the Danish Microbiology Database. A review of quality improvement strategies from 2005 to 2020 was conducted to provide context for the study. RESULTS The highest level of antibiotic consumption for UTIs in older people was in 2014 (447 prescriptions/1,000 people ≥ 70 years) and gradually decreased by 28.4% in 2023. Resistance to pivmecillinam, trimethoprim, sulfamethizole and nitrofurantoin in Escherichia coli and Klebsiella pneumoniae decreased significantly from 2018 to 2023, alongside the decline in antibiotic consumption. Focus on antibiotic stewardship was intensified after 2013, with several quality improvement initiatives and updated treatment guidelines aiming at improving diagnosis and antibiotic treatment. CONCLUSION Antibiotic consumption for UTIs in people ≥ 70 years decreased notably, accompanied by a decrease in resistance levels, reflecting a positive impact of antibiotic stewardship programmes to improve diagnosis and treatment. However, a growing older population could place a strain on healthcare resources in the future.
In June 2026, acute fever, diarrhoea, lethargy and marked reduction of milk yield were reported in dairy cattle in eastern France. Unbiased Nanopore metagenomics on pooled plasma from affected cows detected Simbu serogroup Orthobunyavirus, provisionally named European Shamonda Virus, and recovered complete genomes. Segments L and M clustered with Nigerian Shamonda virus, whereas S showed a distinct clustering pattern, suggesting high mutation rate or reassortment. Similar findings in neighbouring countries indicate cross-border emergence requiring coordinated surveillance.
Mosquito-borne diseases such as dengue, chikungunya and West Nile virus infection become increasingly frequent in Europe. These developments require preparedness and coordinated response mechanisms across countries and sectors. Vector control is a central component of public health response, both for containing outbreaks and for reducing the risk of disease emergence. While mosquito control is important, evidence on the cost-effectiveness of most methods remains limited, complicating the design of evidence-based vector management strategies. In addition, the range of authorised vector control products is narrow and increasingly compromised by insecticide resistance. Mosquito control in European countries involves a diverse set of actors, and work on mosquito-borne diseases at European Union level spans several institutions with complementary mandates. Europe should therefore promote cross-sectoral collaboration through a One Health approach that brings together public health, environmental health, veterinary health and urban planning sectors, while engaging communities in mosquito surveillance and control. Continued investment in research to assess the cost-effectiveness, safety and ecological impact of existing and new vector control methods is needed to develop sustainable, science-based, integrated mosquito control strategies that protect public health, animal health and ecosystems. Regulatory clarity and flexibility, for biocidal, non-biocidal and innovative control approaches, would support this effort.
BACKGROUNDWith improvements in test sensitivity and testing frequency, more people in Europe are diagnosed during the HIV acute/seroconversion phase, when their CD4+ T-cell count can be temporarily low.AIMWe piloted a revised definition of late HIV diagnosis for surveillance which considers laboratory markers, evidence of HIV test negativity in the past year and clinical evidence of recent HIV acquisition, to better distinguish between people diagnosed late and those diagnosed during the acute/seroconversion phase.METHODSWe collected pseudonymised HIV diagnosis records for 2022 and 2023 from nine European countries (Belgium, Czechia, Denmark, Germany, Greece, Italy, the Netherlands, Portugal and Sweden). We applied the revised definition to reclassify those with evidence of recently acquired HIV as 'not late' and calculated the corresponding correction factor by country and demographic group. Individuals with a previous diagnosis were excluded from the analysis.RESULTSAmong 10,220 individuals with a CD4+ T-cell count at diagnosis, 56% (5,689/10,220) had a CD4+ T-cell count < 350 cells/µL or an AIDS-defining event at diagnosis. Applying the revised definition reduced the late diagnosis proportion from 56% to 50%, a correction factor of 9% (535/5,689). The correction factor ranged between 3% and 25% across countries and was higher for younger ages and for gay, bisexual and other men who have sex with men, compared with other groups.CONCLUSIONSWithout reclassification, late HIV diagnosis proportions are overestimated. We provide recommendations and validity considerations for countries intending to use the revised definition.
BACKGROUND In European countries, including France, the incidence and costs of whooping cough in people with chronic conditions remains understudied. AIM We aimed to estimate cumulative incidence and costs of whooping cough hospitalisations in children, adolescents and adults with chronic conditions in France. METHODS We extracted data from patients hospitalised with whooping cough with or without underlying chronic conditions, asthma, chronic obstructive pulmonary disease (COPD), diabetes and immunocompromising conditions between 2008 and 2020 using the Système National des Données de Santé (SNDS). RESULTS Among the 10,893 patients hospitalised with whooping cough in 2008–2020, asthma and/or COPD were the most common chronic conditions. Of the 7,212 children and adolescents hospitalised, 1,263 (17.5%) had asthma and 68 (0.9%) had an immunocompromising condition. Of the 3,681 adults, 2,297 (62.4%) had asthma and/or COPD, 594 (16.1%) had an immunocompromising condition and 454 (12.3%) had diabetes. In children and adolescents, the highest cumulative incidence ratio (CIR) was among patients with an immunocompromising condition (adjusted CIR = 3.6; 95% confidence interval (CI): 2.8–4.6) whereas in adults, patients with asthma and/or COPD had the highest adjusted CIR (18.6; 95% CI: 17.4–19.9). Median hospitalisation costs were the highest for patients with an immunocompromising condition (EUR 4,401). No significant changes in healthcare resource utilisation were observed before and after whooping cough hospitalisation in adults. CONCLUSION Chronic conditions are associated with higher cumulative incidence of whooping cough-related hospitalisation in France. This highlights the importance of reducing whooping cough circulation, through strengthening vaccination programmes, particularly for those with chronic conditions.
This Perspective discusses how European Union (EU)-level action could support public health laboratories in preparing for future threats from respiratory infectious diseases. It draws extensively from a study that looked at the experience of public health laboratories in EU/ European Economic Area (EEA) countries during the COVID-19 pandemic. This study included a literature review and consultation with stakeholders from public health laboratories in EU/EEA countries and from EU institutions. We discuss how to address the challenges faced by public health laboratories during the COVID-19 pandemic, focusing particularly on the role of EU institutions. The Perspective concludes by discussing the importance of improving public health laboratory preparedness for future health threats when there is no ongoing public health emergency, instead of during a health emergency.
Between October 2025 and May 2026, 28 patients with cutaneous leishmaniasis caused by Leishmania major were identified at Toulouse University Hospital, France, contrasting with fewer than three cases diagnosed annually in 2019–2024. Epidemiological investigations linked 24 cases to recent travel to Tunisia, with 19 reporting exposure in the governorate of Sidi Bouzid, endemic for zoonotic cutaneous leishmaniasis. These findings suggest increased transmission in central Tunisia and reinforce the need for surveillance of imported leishmaniasis in Europe.
BACKGROUND Because of climate change, the frequency of extreme weather events, including heavy rainfall and flooding, is increasing in Europe. It is important to understand how such events affect infectious disease incidence to inform preparedness and response activities. AIM We aimed to gather evidence of associations between heavy rainfall and flooding and infectious disease incidence in humans in Europe, as well as report preparedness and response measures. METHODS In this rapid review, PubMed, Embase and the Cochrane Library were searched using a combination of keywords relevant to infectious diseases as well as to heavy rainfall and flooding to identify published literature and preprints. Articles published between 1 January 2018 and 15 June 2025 were eligible for inclusion. RESULTS From 897 records identified, 14 articles were included in the review. In particular, outbreaks of campylobacteriosis and cases of leptospirosis were reported following heavy rainfall and flooding events in Europe. Public health communication on awareness and hygienic practices was among the most commonly reported preparedness and response measure, while structural measures such as sanitary infrastructure and One Health surveillance systems were suggested. CONCLUSION While heavy rainfall and flooding have been associated with outbreaks of infectious diseases in different parts of Europe, relatively few studies investigating these associations were identified in Europe despite wide search criteria, highlighting the need for further research to strengthen European preparedness and response measures.
In June 2026, an intensive care physician deployed in the Democratic Republic of the Congo and previously vaccinated against Ebola virus developed fatigue, nausea and headaches while returning to France. Bundibugyo virus was identified with RT-PCR. The patient was treated with remdesivir and recovered fully. Contact tracing identified five low-risk contacts and no secondary cases. Stringent infection prevention and control measures and multidisciplinary collaboration are important when managing suspected or confirmed Ebola disease cases, even with low viral loads.
BACKGROUNDDoxycycline post-exposure prophylaxis (doxy-PEP) has been shown to reduce the incidence of chlamydia and syphilis among men who have sex with men (MSM) at high risk of sexually transmitted infections (STIs). However, doxy-PEP adds antibiotic exposure and may select for tetracycline resistance in both target and bystander bacteria, raising concerns about antimicrobial resistance (AMR). Quantifying additional antibiotic consumption from doxy-PEP is important for assessing its potential AMR impact at population level.AIMWe estimated the potential increase in doxycycline consumption attributable to doxy-PEP among MSM using HIV pre-exposure prophylaxis (PrEP) in the European Union and European Economic Area (EU/EEA) and compared it with overall doxycycline and tetracycline-class consumption.METHODSWe used Monte Carlo simulation to estimate annual doxycycline use from doxy-PEP among MSM using PrEP. We estimated population size from the 2024 European MSM Internet Survey and derived doxy-PEP uptake and prescribing frequency from expert elicitation. Estimated consumption in defined daily doses (DDD) per year was compared with tetracycline-class and doxycycline antibiotic use reported by the European Surveillance of Antimicrobial Consumption Network.RESULTSDoxy-PEP among MSM using PrEP in the EU/EEA could result in an estimated 4.4 million DDDs of doxycycline annually (95% credible interval (CrI): 0.5–18.1 million), corresponding to a 1.9% increase (95% CrI: 0.2–7.7) relative to 2023 doxycycline consumption.CONCLUSIONThe estimated Doxy-PEP use constitutes a non-negligible share of total doxycycline consumption in the EU/EEA. Monitoring doxy-PEP uptake and AMR indicators will be essential as more countries consider integrating this intervention into STI prevention strategies.
BACKGROUNDThe ongoing panzootic of highly pathogenic avian influenza A(H5N1) presents a risk to human health both from infections resulting from exposure to infected birds or mammals, and from potential mutations enabling human-to-human transmission of a virus to which there is little or no population immunity.AIMThis cohort study was designed with the aim of informing assessments of the risk of avian influenza to human health and the public health management of influenza A(H5N1) exposures.METHODSWe recruited 428 individuals at 34 highly pathogenic avian influenza A(H5N1) outbreak sites between April 2023 to March 2025, throughout England. Through nasopharyngeal samples and questionnaires, we investigated risk factors including exposure periods and usage of personal protective equipment (PPE), and characteristics of influenza A(H5N1) infection.RESULTSThe median participant age was 37 years (interquartile range: 28–51 years), 296 (69%) were male. Most participants (85%) reported full PPE use when exposed, and 82 (19%) were vaccinated against seasonal influenza. Six persons tested PCR-positive for influenza A(H5N1), of whom three (< 1%) met the case definition for infection (two confirmed, one unclear) attributable to exposure periods. No severe illness was reported; no secondary cases were identified. None of the six cases with positive detections were vaccinated against seasonal influenza; two of them reported not wearing full PPE when exposed.CONCLUSIONWe recommend continued conscientious PPE use and the resumption of enhanced surveillance following detection of an increased risk of animal-human transmission, with a One Health focus, to mitigate pandemic risk of influenza A(H5N1).
Following an outbreak of Andes hantavirus (ANDV) infections on a cruise ship in May 2026, a healthcare worker not directly involved in caring for an imported ANDV case in the Netherlands had a single low-positive ANDV PCR result. The healthcare worker remained asymptomatic, showed no seroconversion, and all subsequent samples tested negative. We describe a retrospective investigation, including detailed reconstruction of potential transmission routes. Our finding may indicate that asymptomatic ANDV infections with low-level viraemia can occur after indirect exposure.
BACKGROUND Community-acquired pneumonia by Mycoplasma pneumoniae is often complicated by co-infections with other respiratory pathogens. AIM We describe through a sentinel respiratory surveillance system in Scotland, M. pneumoniae infection occurrence in patients presenting to general practitioners with acute respiratory infection (ARI) (October 2022−May 2025) and the co-detection frequency of other respiratory pathogens. METHODS Upper respiratory tract swabs from a representative community sample of 65,798 ARI patients were laboratory-tested for 10 respiratory pathogens, including M. pneumoniae. Positivity for M. pneumoniae was monitored over time. Single or multiple joint pathogen detections were assessed and stratified by demographic characteristics. Proportions hospitalised within 14 days after their M. pneumoniae positive test were determined. RESULTS Of 65,798 patients (40,158 female, 25,534 male, 106 sex unknown; median age: 35 years, interquartile range (IQR): 17–59), 3,031 (4.6%) were M. pneumoniae positive (1,686 female, 1,340 male, five sex unknown; median age: 18 years, IQR: 9–39). Positivity was elevated in October 2023−October 2024, particularly in 5–14-year-olds, and peaked at 47.7% (31/65) in week 1, 2024. Among M. pneumoniae cases viably tested for all pathogens, 26.0% (728/2,799) had co-detections of another pathogen, with rates in 0–4-year-olds (61.3%; 122/199) and 5–14-year-olds (31.3%, 321/1,024) reflecting those reported elsewhere in hospitalised paediatric cases. Co-detections involving rhinovirus (47.5%; 346/728) predominated, otherwise varying by pathogen and age. Of 3,031 M. pneumoniae cases, 1.8% (n = 55) were admitted. CONCLUSION Sentinel surveillance of respiratory pathogens in the community was helpful to characterise an M. pneumoniae epidemic, revealing frequent respiratory-pathogen co-detections in ≤ 14-year-olds, as prior reported in hospitalised M. pneumoniae paediatric cases.
