Eurosurveillance - Volume 31, Issue 31, 06 August 2026

The ongoing panzootic of highly pathogenic avian influenza A(H5N1) presents a risk to human health both from infections resulting from exposure to infected birds or mammals, and from potential mutations enabling human-to-human transmission of a virus to which there is little or no population immunity.

This cohort study was designed with the aim of informing assessments of the risk of avian influenza to human health and the public health management of influenza A(H5N1) exposures.

We recruited 428 individuals at 34 highly pathogenic avian influenza A(H5N1) outbreak sites between April 2023 to March 2025, throughout England. Through nasopharyngeal samples and questionnaires, we investigated risk factors including exposure periods and usage of personal protective equipment (PPE), and characteristics of influenza A(H5N1) infection.

The median participant age was 37 years (interquartile range: 28–51 years), 296 (69%) were male. Most participants (85%) reported full PPE use when exposed, and 82 (19%) were vaccinated against seasonal influenza. Six persons tested PCR-positive for influenza A(H5N1), of whom three (< 1%) met the case definition for infection (two confirmed, one unclear) attributable to exposure periods. No severe illness was reported; no secondary cases were identified. None of the six cases with positive detections were vaccinated against seasonal influenza; two of them reported not wearing full PPE when exposed.

We recommend continued conscientious PPE use and the resumption of enhanced surveillance following detection of an increased risk of animal-human transmission, with a One Health focus, to mitigate pandemic risk of influenza A(H5N1).

Doxycycline post-exposure prophylaxis (doxy-PEP) has been shown to reduce the incidence of chlamydia and syphilis among men who have sex with men (MSM) at high risk of sexually transmitted infections (STIs). However, doxy-PEP adds antibiotic exposure and may select for tetracycline resistance in both target and bystander bacteria, raising concerns about antimicrobial resistance (AMR). Quantifying additional antibiotic consumption from doxy-PEP is important for assessing its potential AMR impact at population level.

We estimated the potential increase in doxycycline consumption attributable to doxy-PEP among MSM using HIV pre-exposure prophylaxis (PrEP) in the European Union and European Economic Area (EU/EEA) and compared it with overall doxycycline and tetracycline-class consumption.

We used Monte Carlo simulation to estimate annual doxycycline use from doxy-PEP among MSM using PrEP. We estimated population size from the 2024 European MSM Internet Survey and derived doxy-PEP uptake and prescribing frequency from expert elicitation. Estimated consumption in defined daily doses (DDD) per year was compared with tetracycline-class and doxycycline antibiotic use reported by the European Surveillance of Antimicrobial Consumption Network.

Doxy-PEP among MSM using PrEP in the EU/EEA could result in an estimated 4.4 million DDDs of doxycycline annually (95% credible interval (CrI): 0.5–18.1 million), corresponding to a 1.9% increase (95% CrI: 0.2–7.7) relative to 2023 doxycycline consumption.

The estimated Doxy-PEP use constitutes a non-negligible share of total doxycycline consumption in the EU/EEA. Monitoring doxy-PEP uptake and AMR indicators will be essential as more countries consider integrating this intervention into STI prevention strategies.

Because of climate change, the frequency of extreme weather events, including heavy rainfall and flooding, is increasing in Europe. It is important to understand how such events affect infectious disease incidence to inform preparedness and response activities.

We aimed to gather evidence of associations between heavy rainfall and flooding and infectious disease incidence in humans in Europe, as well as report preparedness and response measures.

In this rapid review, PubMed, Embase and the Cochrane Library were searched using a combination of keywords relevant to infectious diseases as well as to heavy rainfall and flooding to identify published literature and preprints. Articles published between 1 January 2018 and 15 June 2025 were eligible for inclusion.

From 897 records identified, 14 articles were included in the review. In particular, outbreaks of campylobacteriosis and cases of leptospirosis were reported following heavy rainfall and flooding events in Europe. Public health communication on awareness and hygienic practices was among the most commonly reported preparedness and response measure, while structural measures such as sanitary infrastructure and One Health surveillance systems were suggested.

While heavy rainfall and flooding have been associated with outbreaks of infectious diseases in different parts of Europe, relatively few studies investigating these associations were identified in Europe despite wide search criteria, highlighting the need for further research to strengthen European preparedness and response measures.