An infectious expert from Ausservillgraten (Infectiology Tyrol) provided us with information on the current infection situation in the Lienz district.
Every year, Christmas is a critical phase for infectious disease: the spectrum of pathogens changes due to more travel, family gatherings and more intensive leisure interactions during these days. After Epiphany, the situation can be better assessed until the semester break in February. Therefore, the time is good for an epidemiologic update on the situation in East Tyrol and neighboring regions.
First: Comparisons with previous seasons are only possible to a limited extent. This year, powerful and cost-effective array and multiplex methods are available for the first time, enabling rapid and comprehensive elucidation of viral and atypical pathogens or pathogens that are difficult to grow in standard media. Until last year, it was necessary to search for individual pathogens, but now it is possible to test more than 30 germs simultaneously from a single swab – within hours, at the beginning of the cost of a corona PCR, an international spread. A little downer: Health insurance companies do not cover the cost of such specialized medical tests. This is unlikely to change in the near future.
Current infection situation in East Tyrol
Evaluation of more than 200 swabs from symptomatic patients since December 1 shows a colorful picture: in about 75% of cases, the cause of infection can be determined; Combined with conventional culture, the clearance rate increases to about 85%. Infections with several pathogens active at the same time are also recorded – and this is surprisingly frequent, especially in severe cases: 28% of all clarified cases, but more than half of the cases classified as severe by the doctor are multiple infections: 15% due to this interaction between a virus and a bacterium, 6% with two bacteria, 3% with two viruses, and 4% with 3 or more pathogens. This result puts into perspective the diagnostic value of individual rapid tests, which inevitably overlook such co-infections and therefore cannot be taken into account in treatment.
The pathogen currently most commonly detected in symptomatic patients in East Tyrol is Haemophilus influenzae, a bacterium that, despite its name, has nothing to do with influenza. It can cause serious and previously feared inflammation of the epiglottis in children, which has disappeared in recent years thanks to vaccination. A six-fold vaccination may have prevented some suffering here this year. However, the vaccine does not protect against classic pharyngitis with fever. Additionally, many people carry the germ on their mucous membranes, but it becomes active only as a result of another, usually viral, infection. It is difficult to grow in conventional culture and is easily overlooked, especially in the early stages of infection. It works very well with new detection techniques.
They were followed by influenza (17.5%), pneumococci (17%), SARS-CoV2 (13.7%), enteroviruses (10.8%), Mycoplasma pneumoniae (5.7%) and classic respiratory coronaviruses before the pandemic (3.3%). While the number of corona cases has been declining since early December, the number of people infected with the influenza virus has risen sharply since Christmas. This is mainly due to influenza A H1N1v (this derivative of the 2009 swine flu currently accounts for 90% of cases), with 10% due to influenza A H3N2.
Influenza B has not yet appeared. Positive: The flu vaccine offers more reliable protection this year, but vaccine breakthroughs have yet to be recorded. Among the group of enteroviruses, human rhinoviruses dominate with 95%. These are generally considered less pathogenic and malignant, but severe courses are possible, especially in association with another pathogen. Whooping cough infections have decreased significantly (currently only <1% of cases), indicating that control measures taken in the fall have been effective.
In addition to influenza, the ascending branch includes respiratory coronaviruses (70% of the OC43 type that had already spread in the fall), parainfluenza viruses (20% of genotype 2, 40% each of genotype 3 and genotype 4), and Mycoplasma pneumoniae. RSV continues to play a minor role; Human metapneumonia virus infections occur only late in the season.
What does this mean for the next few months?
Overall, the picture is one of a “normal” winter and a heterogeneous one characterized by interactions between multiple pathogens, requiring careful clarification in individual cases.
The next few weeks will see further declines in influenza, human metapneumonia virus, adenoviruses and classic and/or SARS-CoV2. Anticipated Corona Viruses. The importance of Haemophilus influenzae will continue for some time; Gram-positive pathogens such as streptococci should regain the upper hand only in late spring. In severe or persistent cases, a targeted search should be made for co-infections, i.e. multiple culprits. A certain degree of caution and responsible behavior is recommended, but actions that go beyond the normal scope are not required.
This is now the main exposure phase for staff in medical facilities; Of course elaborate precautions are required when dealing with infectious patients. If the patient inquires over the phone or tells reception immediately that they have a cold, flu or something like that, it certainly helps and reduces the risk of transmission.
Anyone with a fever or productive infection (cough, sneeze) should get it checked out by a doctor and keep the risk of infection to those around them as low as possible – by taking sick leave if necessary, otherwise it's best to keep your distance. Hand hygiene and, especially in case of production infections, a well-sealed mask by wearing it properly. A temporary job in a home office can also make sense. Symptomatic people should avoid public gatherings and under no circumstances engage in activities involving people at risk or high risk of transmission.
Text: Author, Photo: Martin Lucker