Bacterial and viral respiratory infections contribute to morbidity and mortality every winter.

Those over the age of 65 years have historically been at an increased risk of experiencing adverse effects from infection. Additionally, non-pharmaceutical prevention measures adopted during the Covid-19 pandemic might have had an unintentional negative knock-on effect; children ages 0-4 years with lessened prior exposure to respiratory infections, such as the influenza virus or respiratory syncytial virus (RSV), may now catch them more easily this winter.  

It is important for healthcare professionals to have a good idea of what the potential disease burden due to respiratory illness might be so the correct resources can be allocated in preparation for a potential surge or outbreak.

GlobalData epidemiologists forecast that by the end of 2023, there will be just over 45 million cases in men and women of all ages infected with influenza-like illness (ILI) in the seven major pharmaceutical markets (7MM: US, France, Germany, Italy, Spain, UK, and Japan).

ECDC respiratory infections report

The European Centre for Disease Prevention and Control (ECDC) has summarized data collected from sentinel surveillance systems in the EU/European Economic Area (EEA) and produced a report documenting the epidemiology of respiratory infections as of week 48 in 2023.

Since September 2023, primary care consultations for respiratory illnesses were increasing in the 23 participating EU/EEA countries, although the level of respiratory pathogens in circulation is still considered low to medium. ILIs were above a standardized threshold level in five countries (Belgium, Denmark, Greece, Latvia, and Luxembourg). The acute respiratory infection (ARI) rates were above baseline levels in three countries (Estonia, Latvia, and Lithuania).

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While RSV infection rates have been increasing, they intensified later in the year during the 2023 winter season. In the EU/EEA, the pooled test positivity in primary care settings was 1% in week 48 in 2023, which is less than half of the maximum reached in 2022.

The pooled test positivity in primary care settings was 4% in week 48 in 2023 in Estonia, Greece, and Lithuania. All three influenza virus subtypes are co-circulating, but no dominant virus has been detected. Thus, it is difficult to tell if the 2023–24 influenza season has officially begun.

Coronavirus 2

It is also important to note that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is circulating at increasing rates. The initial symptoms of Covid-19 and influenza and can be easily confused, making it difficult for individuals to distinguish between the two illness.

Severe acute respiratory infection (SARI) rates have remained relatively unchanged compared to the same period in 2022. An increase in SARI rates was found in the 0–4 years age group in Germany and Spain; however, it is important to note that data availability is limited, reporting is resource-intensive, and information only becomes available after discharge, so there will be a delay in reporting.

Out of the four countries that reported RSV test positivity from SARI systems, Germany and Spain reported increasing RSV test positivity in the latter part of 2023. The 0-4 years age group had the highest test positivity at a rate of 60%. Overall, the key recommendation given by the ECDC is still to get vaccinated against seasonal influenza and RSV if possible, especially for those who are in high-risk groups.