In 2024 and as of 2 October 2024, 18 countries in Europe have reported 1’202 locally acquired human cases of West Nile Virus (WNV) infection with known place of infection. The earliest and latest date of onset were respectively on 1 March 2024 and 26 September 2024.
Locally acquired cases were reported by Italy (422), Greece (202), Spain (114), Albania (102), Hungary (101), Romania (71), Serbia (53), Austria (34), Türkiye (30), France (27), Croatia (20), Germany (8), Slovenia (5), Kosovo (4), Slovakia (4), Bulgaria (2), North Macedonia (2) and Czechia (1).
In Europe, 88 deaths were reported by Greece (31), Italy (16), Albania (13), Romania (10), Spain (10), Bulgaria (2), Serbia (2), Türkiye (2), France (1) and North Macedonia (1).
Case numbers reported this year are above the mean monthly case count for the past 10 years. During the same period in 2023, 681 cases had been reported. However, numbers are lower than in 2018, when 1 728 cases had been reported by this time of year.
Distribution of locally acquired human West Nile virus infections in 2024 till 2 October 2024:
Of note, further regions of infection were reported in 2023.
The following precautions are recommended:
On 8 August 2024, three additional autochthonous cases of dengue have been reported in the Pyrénées, Orientales, Lozère and Gard departments.
On 2 August 2024, an autochthonous case of dengue in a person living in La Colle-sur-Loup, Alpes-Maritimes department, Provence-Alpes-Côte d'Azur region. This is the first locally acquired dengue case in the region in 2024. Recently, a second case was reported from the same region.
Overall, France has reported six locally acquired dengue cases in 2024.
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
On 31 July 2024, France reported a confirmed, autochthonous case of chikungunya virus (CHIKV) disease in Île-de-France with suspected exposure in Paris (Paris Department) and Gennevilliers (Hauts-de-Seine Department). The case had the onset of symptoms on 18 July 2024. Since 1 May and as of 30 July 2024, nine imported chikungunya cases have been reported in France.
On 2 August 2024, the Alpes-Maritimes department reported its first locally acquired case of dengue in France for the 2024 season.
General precautions:
Recommended vaccinations and other health risks:
Diseases transmitted by mosquitoes and ticks:
This tragic case demonstrates the importance of being informed about rabies and acting quickly in the event of a bite or scratch by a mammal in a rabies-endemic country.
Prevention: Avoid contact with animals! Do not feed animals either! Pre-exposure vaccination (2 injections and a booster after 1 year) is recommended especially for travelers with increased individual risk (traveling with two-wheelers, to remote areas, long-term stays, small children, cave explorers, contact with bats, etc.).
Behavior after exposure: After an animal bite/scratch: Immediately wash the wound with running water and soap for 15 minutes, then disinfect and in any case visit a good medical facility as soon as possible for follow-up vaccination!
For more information: see flyer rabies.
An outbreak of 4 autochthonous (locally transmitted) cases of dengue fever was detected in Gardanne in the department of Bouches-du-Rhône. Symptoms of the cases occurred between the second half of July and early August 2023.
At least 47 autochthonous cases were recorded in France in 2022. The affected regions were Occitania (9 cases) and Provence-Alpes-Cote d'Azur (36 cases).
Protect yourself against ticks during outdoor activities (see Mosquito Protection Factsheet). Vaccination is recommended when staying in endemic areas. Complete basic immunization requires three doses of vaccine. Temporary protection exists after only two doses of vaccination. These first two vaccinations are usually given one month apart. The third vaccination is given 5-12 months after the second dose, depending on the vaccine. A booster vaccination is indicated after 10 years.
After recreational activities: Always examine their body for ticks or tick bites. If redness occurs after tick bite: Consult a physician to rule out Lyme disease, which would require antibiotic treatment.
All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.
All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.
Travellers should be immune to chickenpox. Persons between 13 months and 39 years of age who have not had chickenpox and who have not received 2 doses of chickenpox vaccine should receive a booster vaccination (2 doses with minimum interval of 4 weeks), see Swiss vaccination schedule, LINK.
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
There is a risk of arthropod-borne diseases other than malaria, dengue, chikungunya or zika in sub-/tropical regions, and some areas of Southern Europe. These include the following diseases [and their vectors]:
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
EKRM_Factsheet_Layperson_EN_Dengue.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
CDC Map: Distribution of dengue
Dengue fever is the most common insect-borne infectious disease worldwide. There are 4 known serotypes of dengue virus, so it is possible to be infected with dengue more than once. Approximately 1 in 4 infected individuals develop symptoms of dengue, resulting in high fever, muscle and joint pain, and skin rash. In rare cases, most often after a second infection, life-threatening bleeding and shock (severe drop of blood pressure) may occur.
In 3 out of 4 cases, an infection with the virus remains asymptomatic. After a short incubation period (5-8 days), 1 out of 4 infected people present an abrupt onset of fever, headache, joint, limb and muscle pain, as well as nausea and vomiting. Eye movement pain is also typical. A rash usually appears on the 3rd or 4th day of illness. After 4 to 7 days, the fever finally subsides but fatigue may persist for several days or weeks.
In rare cases, severe dengue can occur. Particularly susceptible are local children and seniors as well as people who have experienced a prior dengue infection. Tourists extremely rarely present with severe dengue. In the first days, the disease resembles the course of classic dengue fever, but on the 4th/5th day, and usually after the fever has subsided, the condition worsens. Blood pressure drops, and patients complain of shortness of breath, abdominal discomfort, nosebleeds, and mild skin or mucosal hemorrhages. In the most severe cases, life-threatening shock may occur.
There is no specific treatment for dengue virus infection. Treatment is limited to mitigation and monitoring of symptoms: fever reduction, relief of eye, back, muscle and joint pain, and monitoring of blood clotting and blood volume. Patients with severe symptoms must be hospitalised.
For treatment of fever or pain, paracetamol or acetaminophen are recommended (e.g. Acetalgin® Dafalgan®). Drugs containing the active ingredient acetylsalicylic acid (e.g. Aspirin®, Alcacyl®, Aspégic®) must be avoided.
Effective mosquito protection during the day and especially during twilight hours (i.e. sunset) is the best preventive measure:
For further information, please refer to the factsheet on "Mosquito and tick bite protection".
Note on the dengue vaccine Qdenga®:
Consistent mosquito protection during the day (see above) is still considered the most important preventive measure against dengue!
Of note
EKRM_Factsheet_Layperson_EN_Chikungunya.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
CDC Map: Distribution for Chikungunya
The infection may present with some or all of the following symptoms: sudden onset of high-grade fever, chills, headache, redness of eyes, muscle and joint pain, and rash. The rash usually occurs after the onset of fever and typically involves the trunk and extremities, but can also include the palms, soles of the feet, and the face.
Often fever occurs in two phases of up to one week duration, with an interval of one to two fever-free days in between. The second phase may present with much more intense muscle and joint pain, which can be severe and debilitating. These symptoms are typically bilateral and symmetric and mainly involve hands and feet, but may also involve the larger joints, such as the knees or shoulders.
About 5-10% of infected people continue to experience severe joint pain even after the fever has subsided, in some cases lasting up to several months or, albeit rare, even years.
Wichtig: Eine STI kann auch ohne oder mit nur leichten Symptomen auftreten. Auch wenn Sie sich dessen nicht bewusst sind, können Sie andere anstecken. Deshalb ist es wichtig sich testen zu lassen.
Durch Bakterien oder Parasiten hervorgerufen
Alle diese Krankheiten können geheilt werden. Wichtig ist dabei, frühzeitig zu testen und umgehend zu therapieren, um Komplikationen und v.a. weitere Übertragungen zu vermeiden.
Durch Viren hervorgerufen
The incubation period (time between infection and onset of symptoms) ranges from a 2 to 21 days (usually 5 to 10 days). The onset of MVD is usually abrupt, with initially non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhoea. As the disease advances, clinical manifestations can become more severe and include liver failure, delirium, shock, bleeding (hemorrhaging), multi-organ dysfunction and death.
In case of symptoms
If think that you have had an exposure at risk and develop fever with nonspecific symptoms such as chills, headache, muscle pain, malaise or abdominal pain:
The risk for travellers is very low if the below precautions are followed, but it is high for family members and caregivers who have contact with sick people.
General precautions during travel to affected areas:
Mpox has been commonly found in West and Central Africa for many years where the suspected reservoir - small mammals - is endemic. There are two types of Monkeypox virus called ‘clades’ that cause the disease mpox - clade I in Central Africa and clade II in West Africa. Since the end of smallpox vaccination campaigns in the early 1980’s, cases of mpox have increased, slowly at first and significantly in the last 5-10 years, especially in the Democratic Republic of Congo (DRC).
In 2022, a new emerging subclade of clade II was responsible for a global epidemic that spread mainly through sexual contact among men who have sex with men. It resulted in the first public health emergency of international concern (PHEIC) declared by the WHO until 2023. Although the clade II epidemic is now under control, this virus variant continues to circulate worldwide.
In 2024, the continued spread of mpox clade I in endemic regions of Central Africa, particularly in the DRC, and the emergence of a new subclade Ib in Eastern DRC and neighboring countries have raised global concern and prompted the WHO to declare a PHEIC for the second time in two years. The current geographical spread of the mpox clade Ib variant occurs via commercial routes through sexual contact (e.g. sex workers), followed by local transmission in households and other settings (which is becoming increasingly important).
Animal to human transmission
Mpox can spread from animal to human when they come into direct contact with an infected animal (rodents or primates).
Human to human transmission
Mpox can be spread from person to person through close physical contact (sexual and non-sexual contact) with someone who has symptoms of mpox. Skin and mucous membrane lesions, body fluids, and scabs are particularly infectious. A person can also become infected by touching or handling clothing, bedding, towels, or objects such as eating utensils/dishes that have been contaminated by contact with a person with symptoms. Household members, family caretakers, and sexual partners of a confirmed case of mpox are at higher risk for infection as are health care workers who treat a case without adequate personal protection.
The incubation period (time between infection and onset of symptoms) ranges from a few days up to 3 weeks. Mpox causes a rash / skin eruption that can be painful associated with swollen lymph nodes and fever. Fever may start already before the rash phase. Other symptoms include muscle aches, back pain, and fatigue. The rash may be localized or generalized, with few or hundreds of skin lesions. It mainly affects the face, the trunk and the palms of hand and soles of the feet. It can also be present in genital areas and on mucous membranes such as in the mouth and throat. Symptoms usually last 2 to 4 weeks and the person remains contagious until all lesions have healed (once the cabs have fallen off).
Complications include secondary bacterial infections, infections of the lung and brain and involvement of other organs, still birth and others. Children, pregnant women, and people with weak immune systems are at higher risk to develop a severe form of mpox.
The majority of person with mpox recovers spontaneously and do not need specific antiviral treatment. Care management consists of relieving pain and other symptoms and preventing complications (e.g., superinfection). Several antiviral treatments are studied in various countries and may be used in trials or in clinical situations according to the recommendations of national medical societies.
In case of symptoms:
General precautions:
Vaccination:
There are several vaccines against mpox (e.g. Jynneos®, manufacture Bavarian Nordic). The Bavarian Nordic vaccine was originally developed to fight against smallpox, but offers a cross-protection against mpox. In Switzerland, the Jynneos® vaccine has been licensed by Swissmedic since 2024. Groups at risk (e.g., men who have sex with men or transgender people with multiple sex partners) are eligible for vaccination since 2022 and this recommendation remains unchanged (see FOPH recommendations). In light of the epidemiological situation in Africa in 2024, the Swiss Expert Committee for Travel Medicine recommends vaccination against mpox for professionals who are / will be in contact with suspect mpox patients or animals in endemic/epidemic regions or who work in a laboratory with the virus (for updates, see news).
The risk to the general population and travelers (tourists) is considered extremely low if the above-mentioned general precautions are followed and vaccination is not recommended.
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