The persistent presence of winter viruses serves as a reminder that health risks are still very much part of our reality. Additionally, COVID-19 remains a concern and is under continuous monitoring by health authorities. How can you safeguard your health as you prepare for expatriation? Here's a guide to the viruses currently under watch and tips for expatriates.
Antibiotic-resistant bacteria
The World Health Organization (WHO) identifies bacteria resistant to antibiotics as "the greatest threat to human health." This threat is significant because antimicrobial resistance (AMR) necessitates increasingly complex treatments to combat diseases. Antibiotic resistance represents a critical risk to global health. On May 17, 2024, WHO released a across 15 families, categorized by their resistance levels. A dated November 21, 2023, attributed 1.27 million deaths in 2019 directly to AMR. In Europe, antibiotic resistance claims approximately 35,000 lives annually, with Greece, Romania, Bulgaria, and France recording the highest rates of antibiotic consumption. However, the issue of antibiotic overuse is a concern for all countries.
Advice for expats
Antibiotic resistance typically stems from the improper use of antibiotics, complicating disease treatment and increasing vulnerability to serious infections. WHO emphasizes that antibiotics, primarily prescribed by general practitioners, are only effective against bacterial infections, such as bacterial pneumonia, bacterial sore throat, ear infections, and urinary tract infections, but are ineffective against viral illnesses like most sore throats, the flu, rhinopharyngitis, acute bronchitis, and gastroenteritis. When abroad, adhere to basic hygiene practices. If you fall ill, refrain from self-medication and using someone else's antibiotics. Always follow your doctor's advice. Often, rest, a nutritious diet, and basic medications like paracetamol and cough syrup are sufficient to manage the illness.
Flu
This winter has seen enhanced surveillance of influenza viruses due to a particularly severe flu season affecting many states. The A (H1N1)pdm09 virus is currently the most prevalent, with B-Victoria and A (H3N2) viruses also showing significant activity. In the United States, flu test positives have surged by nearly 20%, with the Centers for Disease Control and Prevention (CDC) reporting over 5.3 million cases, 63,000 hospitalizations, and 2,700 deaths. They recommend flu vaccinations starting at 6 months old. In Europe, there's a red alert as vaccination rates among those over 65 are declining despite the epidemic's peak. Denmark (78%) and Ireland (76%) exceed the 75% vaccination target, whereas countries like France and Italy see lower rates (54% and 53%, respectively), and Iceland at 47%. Poland and Slovakia have alarmingly low rates, barely over 10% each. Annually, the flu is responsible for more than 27,000 deaths in Europe.
Canada reported 4,495 positive cases in the first week of January, an increase of 11.3%. Australia, New Zealand, the United Arab Emirates, and Japan also experienced significant peaks in flu infections, with Japan nearing 320,000 cases by the end of December 2024. The WHO notes that flu affects approximately 1 billion people worldwide each year, with 3 to 5 million suffering from severe forms of the illness.
Advice for expats
For expatriates aged 65 and older, local health authorities likely recommend flu vaccination, which is also advised for pregnant women, those under 65 with chronic conditions, and obese individuals. Vaccinations are often free for these at-risk groups, but it's wise to verify the specific policies in your host country. Healthcare professionals and those in close contact with vulnerable individuals are also urged to get vaccinated. If you're moving abroad, check your vaccination eligibility with local health authorities, especially as this flu season has notably affected younger populations, including young adults and teenagers. Despite concerns about side effects from concurrent COVID-19 and flu vaccinations, getting both is recommended.
COVID-19 (Sars-CoV-2)
COVID-19 may not dominate headlines as it once did, but it persists, continually evolving with new variants. The latest variant, named XEC, was first identified in Germany and has since spread across Europe, the United States, and China. An offshoot of the Omicron variant, XEC is highly transmissible, yet current vaccines remain effective against it. Though Sars-CoV-2 has been downgraded from the "global emergencies" category, it continues to be a significant health concern. The World Health Organization (WHO) reports that COVID-19 has been responsible for over 7 million deaths, though this figure is likely underestimated by a factor of three. As of August 2024, the WHO noted that COVID-19 is present in all countries, with notable case increases in Canada, the United States, and France.
Advice for expats
Whether you're preparing to move abroad or already residing overseas, ensure you are up to date with your vaccinations, as vaccination campaigns continue globally. Verify whether COVID-19 vaccinations are included in your host country's healthcare coverage. Besides vaccination, maintain preventive measures: wash your hands frequently, carry hand sanitizer for situations where soap and water are unavailable, use disposable tissues, avoid close contact like hugs and handshakes, cough into your elbow, and ventilate indoor areas regularly. If you fall ill with COVID-19 or another illness, wear a mask, rest at home, and adhere to other recommended safety practices. Additionally, wear masks in crowded or poorly ventilated areas and note that some facilities, such as hospitals, may have reinstated mandatory mask-wearing. Stay informed about local guidelines and comply with any mandates.
MPOX
As of November 2024, the World Health Organization (WHO) continues to uphold its highest alert level concerning the mpox epidemic, initially triggered in 2022. Mpox is a zoonotic disease transmitted from animals to humans, manifesting as a milder form of human smallpox, typically featuring a rash accompanied or preceded by fever or swollen lymph nodes. Human-to-human transmission can occur through direct contact with bodily fluids or skin lesions, or indirectly via contact with contaminated objects. Most patients recover within 2 to 3 weeks. While mpox predominantly affects Central and West Africa—with over 20,000 cases reported in the Democratic Republic of the Congo alone—it has seen a global rise in cases since 2022. As of January 7, 2025, there are 117,663 cases across 122 countries, with 115 of those countries encountering the virus for the first time. A variant known as mpox clade 1b emerged in the summer of 2024, affecting at least five European countries including Germany, Belgium, the United Kingdom, Sweden, and France.
Advice for expats
A vaccine for mpox is available. In response to a surge in cases, the United States has initiated vaccination campaigns, with European health authorities urging similar measures due to nearly vanished global immunity following the cessation of smallpox vaccinations in the early 1980s. Expatriates are advised to get vaccinated if they are at "high risk of exposure to the virus." High-risk groups include men who have sex with men or multiple partners, women in relationships with men who have sex with other men, transgender individuals with multiple sexual partners, those who have casual sexual partners, or live with individuals highly exposed to the virus. Vaccination is recommended regardless of the country of expatriation. Immunocompromised individuals moving to areas where mpox is prevalent should also consider vaccination. However, pregnant or breastfeeding expatriates are advised against vaccination due to insufficient data on long-term effects, although no adverse effects on fertility have been noted.
Measles
The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) in the United States report a concerning increase in measles cases, with 10.3 million occurrences in 2023, marking a 20% increase from the previous year. This surge prompted WHO to renew its alert in November 2024. The resurgence of measles is largely attributed to declining vaccination rates globally. In 2023, WHO reported that over 22 million children missed their first measles vaccine dose, though two doses are required for full effectiveness. Measles outbreaks were recorded in 57 countries across most continents, except the Americas. Despite a slight decrease in fatalities, with more than 107,000 deaths recorded in 2023, down 8% from 2022, the death toll remains alarmingly high considering the availability of effective vaccines. Measles is extremely contagious, and there is no treatment to eliminate the virus, underscoring the critical importance of vaccination.
Advice for expats
While some parent associations campaign against mandatory vaccinations, health authorities stress the vital importance of immunizing infants and children. Measles can lead to brain damage or death, polio can cause permanent paralysis, and meningitis and mumps can result in permanent deafness, with meningitis also posing a risk of brain damage. When moving abroad with children, adhere to both your home and host country's vaccination requirem
Dengue
Dengue, often referred to as "tropical flu," is primarily spread through mosquito bites and is prevalent in tropical and subtropical regions. However, global warming is facilitating the virus's expansion into southern Europe. As of May 30, 2024, the World Health Organization (WHO) reported 7.6 million cases globally, including more than 16,000 severe cases and 3,000 deaths. WHO estimates that nearly half the world's population is at risk of exposure to dengue, with 100 to 400 million infections occurring annually, many of which are asymptomatic. Recent years have seen a sharp increase in cases, particularly in the Americas, where there were 4.5 million cases and 2,300 deaths in 2023. Other affected regions include France, Italy, Spain, Senegal, Burkina, Ghana, India, Nepal, China, Thailand, Indonesia, Vietnam, and Australia. Symptoms, lasting between 2 and 7 days, include high fever, nausea, and joint pain, though many cases are asymptomatic. Severe dengue, which can be life-threatening, often presents with symptoms such as fatigue, blood in stools or vomit, and persistent vomiting, usually after the initial fever has subsided.
Advice for expats
Currently, there is no vaccine or specific treatment for dengue. Expatriates residing in areas where dengue is prevalent should adhere strictly to health recommendations to prevent infection. Protect yourself from mosquito bites both day and night by eliminating breeding sources like standing water under pots or food remnants. Use mosquito nets treated with repellents and wear protective clothing. These preventive measures are also effective against chikungunya, another rising mosquito-borne disease. If you develop a fever, avoid self-medicating with non-steroidal anti-inflammatory drugs like ibuprofen or aspirin, which can increase bleeding risks associated with the disease. Instead, consult a healthcare provider promptly. Paracetamol may be recommended to manage pain. In cases of severe dengue, hospitalization is necessary. Be aware that a previous infection can increase the risk of severe outcomes in subsequent infections.
Other pathogens under surveillance
While some pathogens are not as virulent as the major viruses previously discussed, they still fall under the category of "common pathogens," such as Human Metapneumovirus (HMPV). Previously the subject of misinformation, HMPV is now better understood and resembles the seasonal flu. The current peak in cases, particularly noted in China, is within expected seasonal patterns. Another pathogen under close watch is the Respiratory Syncytial Virus (RSV). This highly contagious virus primarily affects the respiratory tract and is more commonly seen in children, though adults are susceptible as well. Despite being less well-known, RSV impacts millions globally each year. The strain on hospitals worldwide often intensifies due to the simultaneous surge of multiple viruses, including flu, RSV, and HMPV, challenging healthcare systems to manage the increased viral circulation effectively.
Should we fear an outbreak of Avian Flu (H5N1)
The H5N1 virus, commonly known as avian flu, is under close scrutiny by the World Health Organization (WHO) due to its potential to infect humans as well as animals. Infections typically occur through the respiratory route following contact with affected animals, involving exposure to feathers or secretions. While the symptoms largely mirror those of seasonal flu, including possible gastrointestinal issues, the virus can lead to severe complications and even death. Recent developments include a reported death in the United States on January 7, linked to the H5N1 virus. Just days prior, the outgoing Biden administration allocated $306 million to support research and combat efforts against this virus. In 2024, the U.S. reported 66 human cases of avian flu, with Canada recording its first human case on November 9, 2024. Additionally, Vietnam and Mexico have each reported human cases.
The ongoing spread of H5N1 among animals raises concerns among scientists about the possibility of the virus mutating in ways that could facilitate human-to-human transmission. Such a mutation could potentially bridge the gap between avian flu and seasonal flu, leading to more widespread transmission among humans. A notable case in the United States of a person infected without direct contact with animals has rekindled these concerns. However, despite the theoretical possibility of a more severe outbreak, there is currently no imminent catastrophic scenario. The scientific community continues to treat these risks as hypothetical, emphasizing the need for caution and ongoing vigilance.
How to protect your health when moving abroad
Health risks are often overlooked during the preparations for expatriation, yet they are crucial, particularly when relocating to a country with known health risks. To safeguard your health, ensure that your vaccinations are up to date. Consult with your doctor before you travel to discuss your health and possibly undergo a comprehensive health check-up. It's also important to familiarize yourself with the health insurance system of your host country. Depending on your personal health profile and the insurance system in the expatriation country, enrolling in private health insurance may be advisable. In the event of illness, adhere strictly to the prevailing health guidelines and recommendations.
