Fighting a triple health threat this winter in Europe and Central Asia

Across Europe and Central Asia, vulnerable populations and health workers face a triple threat — influenza, respiratory syncytial virus (RSV) and COVID-19.

In the 2022/23 winter season, the influenza season epidemic started early, and influenza cases and hospital admissions have been increasing since November. RSV has also been on the rise, and COVID-19 is still a threat.

This is of concern as when influenza, RSV and COVID-19 co-circulate, the risk to vulnerable populations increases, and health services may come under severe pressure.

From Kyrgyzstan, Georgia, Albania and North Macedonia to Denmark, Spain and Portugal, those at risk are protecting themselves by getting vaccinated against influenza and COVID-19. Across the region, people also continue to practice measures such as covering sneezes and coughs with a tissue or bent elbow, cleaning hands regularly or wearing a mask when needed to keep respiratory infections at bay.

Older people, people with underlying health conditions, such as heart or lung disease, pregnant women as well as health workers are at risk of influenza and COVID-19. Children under the age of 5 years are also at risk of influenza. The most affected by RSV-associated severe disease are children under the age of five years (and in particular infants under six months), older people and people with specific comorbidities. Images of residents at a long-term care facility and patients at a clinic in Kyrgyzstan’s capital. ©WHO/Maxime Fossat

From mid-November 2022 onwards, a number of countries in WHO’s European Region, including Kyrgyzstan, have been reporting increasing rates of influenza transmission.

Emil, 62, receives an influenza vaccine at the Nijnaya Serafimovka Centre for the Elderly and Disabled in Kyrgyzstan. ©WHO/Maxime Fossat

Health workers across the region have been busy rolling out influenza and COVID-19 vaccination campaigns, and preparing for a challenging winter.

But health workers themselves are highly susceptible to COVID-19 and influenza infections due to their profession. They risk both getting ill and spreading these diseases to vulnerable patients. Also, as health workers are a primary and trusted source of information, if they are positive about vaccination, their patients might be more likely to get vaccinated too.

Eliso Matcharashvili, a nurse, is getting vaccinated against influenza at Botchorishvili Clinic in Tbilisi, Georgia. ©WHO/Hedinn Halldorsson

“Every autumn I look forward to the arrival of influenza vaccines so that I can get vaccinated and protect myself and my patients. The vaccine provides a high level of protection for all health workers, and especially for health workers working in large hospitals, like myself,” says Eliso Matcharashvili.

Dr Sylvia Hazañas Ruiz, Director of the Limonar Health Centre, in Málaga, Spain. ©WHO/Adel Sarkozi

“I was the first to get the COVID-19 vaccine in the Centre, and the first to get the fourth COVID-19 vaccine dose. And this year, I was the first to get vaccinated against influenza. I wanted to set an example to my staff. They all followed suit. They are vaccinated…I felt ok after the vaccines. And I’ve never caught COVID-19,” says Dr Sylvia Hazañas Ruiz.

In many countries, including Portugal, Denmark, Spain and Albania, vulnerable people can get vaccinated against influenza and COVID-19 at the same time.

1) 23-year-old Vasco Sousa, a nurse, at the Social Services Centre of Lisbon City Council in Portugal. 2) Antonio Pina, 85 receives his COVID-19 third booster shot at the vaccination centre in Lisbon, Portugal. 3) David Santos, 81, and his wife Elvira Santos, 75, at the vaccination centre in Lisbon, where they received their influenza and COVID-19 second booster shot. 4) Maria Jose Pacheco, 86, receives her influenza and COVID-19 third booster shots at the vaccination centre in Lisbon. ©WHO/Khaled Mostafa

“At the moment, I am seeing around 100 people or more every day. And almost all of them are getting the COVID-19 and influenza vaccines,” says nurse Vasco Sousa.

75-year-old Lucilia Santos says she is getting the COVID-19 booster and, for the first time in her life, the influenza vaccine. She is getting older, she explains, and she realizes that the influenza vaccine is important to keep her protected especially as this winter may be harsher than previous winters. ©WHO/Khaled Mostafa

1) Antonio Perez Ciezar, from Spain, is getting his fourth COVID-19 vaccine and the influenza vaccine at the same time. ©WHO/Adel Sarkozi 2) Per Jensen, from Denmark, shows his arm after getting his COVID-19 and influenza vaccines. ©WHO/Uugangerel Davaasuren

“I have nine grandchildren. Being in good health means being able to spend time with them, and with my whole family,” says Antonio Perez Ciezar.

For precaution, he adds, he always takes a mask with him, and puts it on in places where there are a lot of people.

In Albania, 270 000 doses of influenza vaccine have arrived so far in the country and are being distributed to health centres. Albania is also expecting to administer around 700 000 doses of the new bivalent COVID-19 vaccines to boost protection against the latest variants of the virus.

Health workers in Albania have been working hard over the last few years to ensure a high uptake of influenza vaccinations in the country, particularly among vulnerable groups. ©WHO/Florion Goga

“As we’re seeing increasing numbers of people receiving the influenza vaccine every year, thanks to successful awareness-raising campaigns, I think it is safe to say that the vaccination programme is going very well in Albania,” says Mimoza Kote, a 58-year-old nurse from Albania.

Elsewhere in the WHO European region, in North Macedonia, a ‘caravan’ has travelled across the country, reaching 24 communities in cities and villages in October 2022.

Under the slogan “Protected Together — Vaccines Work”, the information and vaccination caravan brought trusted information on seasonal influenza, COVID-19 and all routine childhood vaccines and offered on-the-spot vaccination against COVID-19. The caravan was an initiative of North Macedonia’s Ministry of Health, World Health Organization (WHO) and UNICEF (the United Nations Children’s Fund).

1) A factsheet on influenza on display at one of the caravan’s events ©UNICEF/Tomislav Georgiev. 2) Jordan Risteski was vaccinated against COVID-19 in Ohrid, North Macedonia, as part of the caravan’s activities ©UNICEF/ Tamara Mihajlovska. 3) Community outreach events such as the caravan help bring to local communities the vaccination information they need, from people they trust. ©WHO/ Zdravko Mitic

WHO/Europe hopes to see more and more vulnerable people take up their COVID-19 and influenza vaccines across the region, given concerns that far too many people remain unvaccinated in many countries.

Anne-May Fabricius, a midwife, vaccinates vulnerable people, including pregnant women, against influenza and COVID-19 at the Baldersgade Vaccination Centre in Copenhagen, Denmark. ©WHO/Uugangerel Davaasuren

“After some shifts you go home with the feeling that you have done something that was really, really important today,” says Anne-May Fabricius.