Joint statement by the World Health Organisation declares yet another wave of viral illness is crashing on a health system already stretched to a breaking point by COVID-19 and, more recently, RSV.

The worst flu outbreak in more than a decade has left nearly every state with high or very high levels of flu activity, underscoring how pandemic precautions may have left us more vulnerable to seasonal respiratory diseases.

The 2022-2023 influenza (flu) season epidemic is off to an early start in the European region as concerns over Respiratory syncytial virus (RSV) rise and COVID-19 is still being a threat.

The region is currently experiencing increasing circulation of influenza and RSV. Together with COVID-19, these viruses are expected to have a high impact on our health services and populations this winter. This highlights how important it is for vulnerable groups to get vaccinated against influenza and COVID-19 as well as for everyone to protect themselves and others from infections.

We are already seeing influenza viruses (A and B) circulating in different parts of the region. While circulating among all age-groups and particularly in children of school-age, influenza A viruses usually cause severe disease mostly for older people and those with chronic conditions.

An increasing number of people is being admitted to hospitals due to influenza, with hospital admissions rising since October. Our populations, 55 years and older, account for almost half of reported influenza hospital admissions.

In 23 countries reporting Severe Acute Respiratory Infection (SARI) data, hospitalised patients have been diagnosed mostly with type B viruses (85%), with children aged four years and younger being the most often affected.

RSV has also been on the rise since October, with some 20 countries and areas experiencing intensified RSV activity.

COVID-19 case rates, hospital and intensive care unit (ICU) admissions, and death rates are currently low compared to the past 12 months, but this situation could change as new variants emerge, and the disease continues to strain healthcare resources.

With the continued impact of the COVID-19 pandemic and the circulation and health impact of other respiratory pathogens, it is challenging to predict how the new winter period will develop.

In view of this, we cannot afford to become complacent. We must step up vaccination programmes and preparedness measures across the region. The need to protect our populations’ health, especially the most vulnerable, is as strong as ever.

We continue to encourage the most vulnerable – older people, pregnant women, people with underlying health conditions such as heart disease, and health workers – to get vaccinated against seasonal influenza and COVID-19.

We cannot say it enough: Vaccination saves lives. It decreases the chances of being infected and reduces the risk of severe illness from COVID-19 and seasonal influenza.

Personal protective measures also help us keep all respiratory viruses – seasonal influenza, COVID-19 and RSV – at bay. We continue to urge everyone to protect themselves by taking simple but effective measures – from cleaning hands regularly, wearing well-fitting masks, particularly when in crowded, closed settings with inadequate ventilation, to staying away from others when ill with a respiratory virus.

It is also important for countries to monitor not only SARS-CoV-2, but also how influenza and RSV viruses are spreading and affecting people and health care systems. Reporting these findings to WHO/Europe and ECDC will help better understand the impact of several respiratory viruses co-circulating widely, and to further strengthen our prevention and control measures.

We also recommend clinicians to consider early antiviral treatments and prophylaxis for influenza, RSV and COVID-19, according to national guidance, for those who are at risk of severe disease, to prevent severe outcomes and reduce the burden on healthcare systems.

Only by being prepared, staying vigilant and continuing to do what we know works will we be able to overcome this winter’s challenge.

Flu-connected hospital admissions over Thanksgiving week almost doubled over the previous week and were the highest seen for that period since the 2010-2011 season, per the CDC in the US.

Adults 65 and older and kids 4 and under have been hit particularly hard during the unusually early surge, especially if they had underlying health conditions.
But about 4 in 10 Americans say they don't plan to get a flu shot this season, largely over concerns the vaccines don't work well or have side effects.

The Biden administration is promising resources and personnel to help local health systems cope but isn’t considering declaring a public health emergency, CNN reported.
Go deeper: Public health experts say that masking and other pandemic precautions largely kept influenza at bay over the past two years and disrupted its seasonal spread. But the return to pre-pandemic life has left us "immunologically naïve" and more susceptible to infections.

Normally, "we might get exposed to a small bit of virus and your body fights it off," John Tregoning, an immunologist at Imperial College London, told Nature. But, he added, "that kind of asymptomatic boosting maybe hasn't happened in the last few years."
One research team last year predicted strong epidemic rebounds in children once personal protection measures were lifted and urged robust "catch-up vaccination programs."
But experts caution they still don't know a lot about seasonal viruses and continue to grapple with questions like how much COVID-19 weakened the public's immunity.
The flu outbreak comes as other respiratory diseases are circulating, including respiratory syncytial virus, or RSV, and emerging COVID variants.

The CDC estimates that so far this season, there have been at least 8.7 million illnesses, 78,000 hospitalizations and 4,500 deaths from the flu.

"We can't let up our guard. We have to take the precautions that we need to prevent the spread of these viruses, like washing our hands, wearing masks in crowded indoor spaces, and like making sure that we're staying home if we're sick. And of course, again, with COVID and flu [to] get vaccinated as soon as you can," U.S. Surgeon General Vivek Murthy told ABC's "Good Morning America."

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