Theflu has returned to Europe at a faster-than-expected pace this winter after almost disappearing last year, raising concerns of an unusually long flu season alongside COVID-19.
The lockdowns, use of protective masks and social distancing rules that became the norm in Europe during the COVID-19 pandemic banished the flu last winter, temporarily eliminating a virus that causes the deaths of about 650 people worldwide.000 people a year, according to EU figures.
But that has now changed as countries adopt less stringent measures to combat COVID-19 due to widespread vaccination.
Since mid-December, flu viruses have been circulating in Europe at a faster-than-expected rate, the European Centre for Disease Prevention and Control (ECDC) reported this month.
In December, the number of flu patients in European intensive care units rose steadily to 43 in the last week of the year, ECDC and World Health Organization (WHO) figures show.
This is well below pre-pandemic levels of COVID-19 - with flu intensive care inpatients rising, for example, to more than 400 during the same period in 2018, according to the data.
However, this is a big increase on the previous year, when only one flu ICU admission was recorded for the whole of December, again according to the data.
The return of the virus may be the start of an unusually long flu season, which could extend into the summer, ECDC's top flu expert Pussy Pedinen told Reuters.
"If we start lifting all the measures, the big concern I have about influenza is that because we have had such a long period of near-zero circulation in the European population, we may move away from normal seasonal patterns," he noted."
Lifting the restrictive measures in spring may extend the flu circulation well beyond the normal end of the European season in May, he explained.
A flu outbreak alongside the COVID-19 epidemic could put undue pressure on already stressed health systems, the ECDC said in its report.
In France three regions - including that of Paris - are facing an influenza epidemic, according to figures released by the French health ministry last week. Others are at pre-epidemic levels.
This season, France has so far recorded 72 severe cases of flu, with six deaths.
Dominant strain
Further complicating the situation, the dominant strain of flu circulating this year so far appears to be the H3 strain of the A virus, which usually causes the most severe cases among the elderly.
Pentinen said it is too early for a final evaluation of flu vaccines because larger numbers of sick people are needed for real-time analyses. But lab tests show that the vaccines available this year "will not be optimal" against H3.
This is mainly because the virus was circulating very little or not at all when the vaccine formulation was decided last year, making it harder for vaccine makers to predict which strain would be the dominant one in the coming flu season.
Vaccines Europe, which represents the leading vaccine manufacturers in the region, acknowledged that strain selection was made more difficult by the very low flu circulation last year, but noted that there is not yet sufficient data to assess the effectiveness of the vaccines for this flu season.
Flu vaccines are adapted each year to make them as effective as possible against the ever-changing flu viruses. Their formulation is decided six months before the flu season starts, based on the circulation of viruses in the other hemisphere. This gives drug manufacturers time to develop and make the vaccines.
There is still no data available on influenza vaccination at a pan-European level. However, national figures for France show that population coverage is not as widespread as authorities had hoped.
Officials there have extended the vaccination period by a month to the end of February to boost vaccination. According to figures released last week, 12 million people have been vaccinated so far, about 45% of the population targeted by the campaign.
"There is still much room for improvement to limit the impact of the flu epidemic," the health ministry said in a statement issued on 11 January. The target for this year is to vaccinate 75% of the population at risk.
Vaccines Europe said the industry has supplied large numbers of flu vaccines despite the pressures on production facilities posed by the pandemic of the new coronavirus.
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