Public health action needed to mitigate the impact of respiratory pathogens for 2023-24 winter season in Europe

In an epidemiological update released today, the European Centre for Disease Prevention and Control (ECDC) urges EU/EEA Member States to strengthen vaccination campaigns and prepare for the possible need to increase emergency department and ICU capacity, as well as to consider a number of public health measures to reduce the impact of respiratory pathogens circulating this winter.

The recommendations come as primary care consultations for respiratory illness have gradually increased since September, and several respiratory pathogens are co-circulating at variable levels, contributing to increased morbidity and mortality.

SARS-CoV-2 is currently predominating while respiratory syncytial virus (RSV), seasonal influenza and other viruses co-circulate at lower levels but with an increasing trend. Severe disease related to SARSCoV-2 currently impacts mainly those aged 65 years and above; increases in RSV activity have resulted in increasing hospital admissions, particularly among young children. Although currently low, influenza activity can be expected to further increase during the winter months. Seasonal outbreaks of various other pathogens causing respiratory symptoms that occur every few years (like Mycoplasma pneumoniae) also contribute to the increased numbers of patients presenting to primary and secondary care. 

ECDC recommendations include:

• Vaccinating the most vulnerable against SARS-CoV-2 and influenza (as well as RSV in the countries that are introducing this vaccine) in order to prevent infection from progressing to severe disease.
• Increasing emergency department and ICU capacity (as needed in terms of adequate staffing and bed capacity) for both adult and paediatric hospitals.
• Ensuring healthcare staff are trained to implement appropriate infection prevention and control (IPC) measures to assist in reducing the burden in healthcare settings and avoid outbreaks within these settings, including long-term care facilities (LTCFs).
• Raising awareness among healthcare professionals to ensure timely diagnosis of cases and enhance hospital preparedness to manage increased patient load in emergency and intensive care units (ICU), in both paediatric and adult hospitals.
• Performing rapid testing to facilitate early diagnosis and management decisions, appropriate treatment and implementation of public health measures when appropriate.
• Reminding clinicians that when indicated, the early use of antiviral treatments for COVID19 and influenza, may prevent progression to severe disease in vulnerable groups, and that RSV prophylaxis for infants can be considered (in accordance with national guidelines). Use of antibiotics for bacterial respiratory infections should follow a medical assessment as antibiotics do not treat viral infections. 
• Implementing risk communication activities for the public, including strengthening the promotion of vaccination against seasonal influenza, COVID-19 and RSV according to national recommendations. Messaging should also promote good hand- and respiratory hygiene, encourage people to stay home when ill, and ensure appropriate ventilation of indoor spaces.
• Recommending the use of a face mask in crowded public spaces to people with high risk for severe disease. 
• Considering the use of ECDC ‘5Cs diagnostic model for vaccination’ (addressing Confidence, Complacency, Constraints, Collective Responsibility and Calculation via their risk communication activities) for more effective promotion of vaccination uptake of the recommended vaccines.