Infectious Diseases: Global Perspective
Respiratory and Droplet Transmission
Nipah Virus Disease — India and Bangladesh
Nipah virus (NiV; Henipavirus nipahense, family Paramyxoviridae) is a zoonotic paramyxovirus with Pteropus fruit bats as its primary reservoir. Human infection typically occurs through direct contact with infected bats or bat-contaminated foodstuffs—most commonly raw date palm sap in the Bangladeshi epidemiological context—or via nosocomial transmission from person to person. The incubation period ranges from 4 to 14 days. Clinical presentation spans febrile encephalitis to severe respiratory illness, with case fatality rates historically ranging from 40% to over 70% in Bangladesh.
Two geographically distinct NiV events were active during Week 7. In Bangladesh, WHO published a Disease Outbreak News on 6 February 2026 reporting a confirmed fatal case in a woman in her forties residing in Naogaon District, Rajshahi Division. She developed fever, headache, muscle cramps, anorexia, and vomiting on 21 January, progressing rapidly to hypersalivation, disorientation, and convulsions before death on 28 January. The exposure source was identified as repeated consumption of raw date palm sap between 5 and 20 January, consistent with the established seasonal transmission pattern in Bangladesh. Contact tracing identified 35 contacts; six symptomatic contacts were sampled and all tested negative by PCR and IgM ELISA. No secondary cases have been identified.
In India, two confirmed NiV infections were reported in healthcare workers—both nurses aged 20 to 30 years—at a private hospital in Barasat, North 24 Parganas district, West Bengal. Both individuals developed severe symptoms in late December 2025 and were admitted in early January 2026; one remains in critical care as of the reporting date. Laboratory confirmation was obtained at the National Institute for Virology in Pune using RT-PCR and ELISA. A total of 196 contacts were tested negative. Media reporting, though unconfirmed officially, suggests the nurses had cared for a patient with NiV-compatible symptoms, raising the possibility of nosocomial transmission. One nurse had recently visited a village in Nadia district near the Bangladesh border, where date palm sap consumption is common. India’s previous NiV outbreaks in West Bengal occurred in Siliguri (2001) and Nadia district (2007), and the geographic recurrence within this corridor is epidemiologically notable.
ECDC assesses the likelihood of importation to the EU/EEA as currently very low, given the limited geographic scope of both events and low case counts. Nevertheless, the co-occurrence of bat-to-human transmission in Bangladesh and probable nosocomial amplification in India within the same epidemiological week constitutes a high-consequence signal warranting active monitoring. EU/EEA travellers to affected areas should avoid raw date palm sap, contact with bats or their excreta, and unprotected exposure to febrile patients in healthcare settings.
Vector-Borne Transmission
Dengue — Global
In January 2026, over 100,000 dengue cases and more than 10 deaths were reported across 39 countries and territories globally. The epidemiological picture remains heterogeneous: the Americas continue to bear the highest burden, though current case counts are approximately 60% below the same period in 2025 and 44% below the five-year average, suggesting relative attenuation of the extraordinary 2025 season. A notable exception is Timor-Leste, where January 2026 cases exceeded December 2025 figures by more than fourfold (1,281 vs. 279). In Southeast Asia, Thailand and India reported 1,903 and 3,544 cases respectively in January 2026, with both countries below their 2025 reference levels. Sri Lanka reported 8,014 cases as of 1 February, with a declining weekly trend. Dengue remains absent from the EU/EEA mainland; French outermost territories (Martinique, Guadeloupe, Réunion, and French Guiana) continue to report cases at broadly expected seasonal levels, with Martinique sustaining elevated and stable transmission of approximately 36 cases per week.
Chikungunya — Global
Since the start of 2026 and through 31 January, approximately 2,882 chikungunya virus disease (CHIKVD) cases and one death have been reported across 11 countries. The most significant development is the emergence of autochthonous transmission in Suriname—the country’s first since 2016—with 327 laboratory-confirmed cases among 712 suspected cases reported between Week 51 of 2025 and Week 4 of 2026, including one death, during ongoing rainy season conditions. Seychelles is reporting a CHIKVD outbreak for the first time in 2026, with ECDC aware of imported cases in EU/EEA countries linked to travel to the archipelago since December 2025. Brazil continues to account for the largest case volume, with sustained transmission across all five macro-regions. French overseas territories of Mayotte (44 cases), Réunion (8), and French Guiana (4 autochthonous cases—the first since 2015) are also affected. The overall global case count is lower than the same period in 2025.
Avian Influenza — Human Cases
Two novel avian influenza strains with documented human spillover were reported to ECDC during Week 7. China reported two additional human cases of avian influenza A(H9N2)—a 73-year-old woman from Guangdong Province with symptom onset on 17 January and a 2-year-old boy from Hunan Province with onset on 29 December 2025—bringing the global total to 195 confirmed human cases since 1998, with two deaths (CFR: 1%). The infection causes predominantly mild respiratory illness; no sustained human-to-human transmission has been documented. Separately, a 34-year-old man in Guangdong Province, China was confirmed as a case of avian influenza A(H10N3), a subtype for which only seven human cases have been reported globally since 2021, all in China and all following exposure to live animals or contaminated environments. ECDC assesses the risk to EU/EEA human health from both subtypes as very low in the absence of evidence for human-to-human transmission.
Infectious Diseases: European Union / European Economic Area
Respiratory and Droplet Transmission
Influenza and Respiratory Syncytial Virus
Respiratory virus activity across the EU/EEA remains elevated but is showing a gradual decline in influenza-specific indicators. In Week 6, 18 countries reported influenza test positivity of 30% (median; IQR: 21–52%) in primary care settings, and 9 countries reported 27% (IQR: 19–37%) in hospitals—both slightly lower than Week 5 values of 21 and 11 reporting countries, respectively. Influenza A(H3) remains the dominant circulating subtype, representing 74% of typed specimens over the current season (Week 40, 2025 to Week 6, 2026), with subclade 2a.3a.1(K) accounting for 90% of A(H3) viruses. A(H1)pdm09 accounts for the remainder of typed influenza A, predominantly subclade 5a.2a.1(D.3.1). Influenza B/Victoria is minimal (0.4% of typed isolates). EuroMOMO is reporting elevated all-cause mortality, both overall and in individuals aged 45 years and above, consistent with the influenza and RSV burden on older age groups.
RSV circulation presents a contrasting and concerning trajectory. RSV test positivity is currently 12% (IQR: 9.9–14%) in primary care and 14% (IQR: 15–25%) in hospitals, with ECDC noting that the RSV season began later than in the two preceding seasons and that hospitalisation rates are showing an overall increasing trend. Children under five years of age account for the greatest proportion of SARI admissions due to RSV. This late-season intensification of RSV in the context of a still-elevated influenza wave creates compounding pressure on paediatric hospital capacity across the region. SARS-CoV-2 circulation remains low (3.3% IQR: 1.4–7.6% test positivity in primary care) and is not contributing substantially to hospitalisation burden. Circulating SARS-CoV-2 variants are dominated by NB.1.8.1 (52%, Variant Under Monitoring) and XFG (44%, Variant Under Monitoring).
Measles — Multi-country
Measles transmission within the EU/EEA is intensifying at both outbreak and country levels despite an expected seasonal decrease in aggregate case counts. Two epidemiologically distinct outbreak events are of immediate public health concern. In Alicante, Spain, a workplace-associated outbreak was reported on 6 February 2026 among employees of two companies in the same building: 16 laboratory-confirmed cases have been identified among 28 suspected cases, with nine remaining under investigation. Public health authorities have implemented isolation and targeted vaccination of contacts. In France, an ongoing cluster at Val Thorens ski resort in Auvergne-Rhône-Alpes involves four young adults (two unvaccinated, one vaccinated, one unknown status) with onset between 12 January and 4 February 2026, one of whom was hospitalised. The ski resort context has particular epidemiological relevance given the high population mixing and international attendance. Spain reported a total of 32 cases from 1 January to 8 February 2026, including three imported cases, while France reported 12 cases in January 2026 across three clusters.
The broader EU/EEA context is deeply concerning. Across the full calendar year 2025, 30 EU/EEA countries reported 7,655 measles cases, of which 79.9% occurred in unvaccinated individuals; eight deaths were reported (CFR: 0.105%), attributable to France (4), Romania (3), and the Netherlands (1). In January 2026, WHO formally announced that six countries in the European region—including the United Kingdom and Spain—have re-established endemic measles transmission based on 2024 reporting, representing a fundamental setback for regional elimination goals. Outside the EU/EEA, England has reported 96 laboratory-confirmed cases since the start of 2026, predominantly in children under 10 years old, driven by an ongoing outbreak in North London; Israel has reported 988 measles hospitalisations since 2025, including 14 deaths. In the Americas, 1,031 cases were reported in weeks 1–3 of 2026 alone—a 45-fold increase over the same period in 2025—with Mexico, the United States, and Canada accounting for the majority.
Cereulide Contamination in Infant Formula
ECDC and EFSA are jointly preparing a Rapid Outbreak Assessment on a multi-country foodborne incident caused by cereulide toxin linked to infant formula products, with publication expected on 19 February 2026. Cereulide is a heat-stable emetic toxin produced by Bacillus cereus strains; once formed, it cannot be eliminated by standard sterilisation or cooking. Its presence in infant formula represents a high-priority food safety concern given the vulnerability of the affected population and the severity of clinical effects. Full details of affected product batches and the geographic scope of the incident are expected in the forthcoming assessment.
Infectious Diseases: Bulgaria
Bloodborne Transmission
Fecal-Oral Transmission
Campylobacteriosis
While campylobacteriosis week-to-week case counts were stable in Week 7 (8 cases, unchanged from Week 6), the year-to-date cumulative total of 60 cases represents a 107% increase over the equivalent period in 2025 (29 cases). Campylobacter spp. are the most commonly reported bacterial cause of gastrointestinal illness in the EU/EEA, transmitted primarily through consumption of undercooked poultry, unpasteurised dairy products, or contaminated water. The doubling of cumulative incidence relative to 2025 constitutes a statistically and epidemiologically meaningful signal, particularly in the context of the ongoing acute viral hepatitis elevation, suggesting that conditions favouring enteric pathogen transmission may be more broadly operative in 2026.
Contact and Sexual Transmission
Gonorrhoea
Gonorrhoea reported a year-to-date cumulative total of 27 confirmed cases through Week 7, compared with 9 cases during the equivalent period in 2025—a 200% increase. Although absolute case numbers remain modest, the magnitude of the year-on-year increase is substantial and follows a pattern that has been observed in prior surveillance periods. Neisseria gonorrhoeae has demonstrated progressive antimicrobial resistance to multiple antibiotic classes, with cefixime-resistant and ceftriaxone-resistant strains now documented in Europe. The accelerating incidence trajectory in Bulgaria warrants enhanced sentinel surveillance for antimicrobial susceptibility patterns, as treatment failure with currently recommended regimens would have significant individual and public health consequences.
Urogenital Chlamydia
Year-to-date urogenital chlamydial infections reached 30 confirmed cases, compared with 20 in the same period of 2025—a 50% increase. While below the 20% week-over-week threshold used as the primary signal criterion, the cumulative trend is directionally consistent with the gonorrhoea increase and may reflect improved diagnostic capacity, changes in sexual behaviour patterns, or genuine increases in transmission. Both STIs warrant joint consideration within a broader STI surveillance framework.
Respiratory and Droplet Transmission
Varicella
Varicella registered 618 cases in Week 7—an increase of 55 cases (+9.8%) over Week 6—bringing the year-to-date cumulative total to 4,066 cases. Although the week-over-week change does not meet the 20% reporting threshold, the absolute weekly case volume is the highest of the current year and the geographic distribution is nationally widespread. The largest weekly case counts are concentrated in Sofia city (160), Plovdiv (58), Varna (54), Kyustendil (27), Blagoevgrad (44), and Pleven (30), together accounting for approximately 64% of national cases. Year-to-date cases remain below the 2025 reference level (4,604 cases), indicating that overall seasonal intensity is not exceeding prior experience, even as absolute weekly volumes are increasing. The current trajectory, if sustained, may approach or exceed 2025 levels in coming weeks.
Scarlet Fever
Scarlet fever registered 74 cases in Week 7, an increase of 11 cases (+17.5%) from Week 6 (63 cases). While marginally below the 20% reporting threshold, this increase is consistent with a broader upward trend observed across earlier weeks of 2026 and warrants monitoring. The year-to-date total of 416 cases is substantially below the 2025 reference period (666 cases, a 37.5% reduction), indicating that overall season severity remains considerably lower than the previous year despite the recent weekly uptick.
COVID-19
COVID-19 registered 15 confirmed cases in Week 7, a decrease of 7 cases (32%) from Week 6 (22 cases). The year-to-date cumulative total is 252 cases versus 205 in the same period of 2025. SARS-CoV-2 transmission in Bulgaria remains at a low and declining level, consistent with the EU/EEA trend.
Vaccine-Preventable Diseases
Measles
One confirmed measles case was reported in Bulgaria in Week 7, originating from Pazardzhik oblast according to the regional breakdown, with ECDC confirming this as Bulgaria’s first case of 2026 (Bulgaria reported two cases in all of 2025). The detection of an incident case in the context of active measles outbreaks in neighbouring European countries and sub-optimal vaccination coverage in several Bulgarian regions warrants rapid epidemiological investigation to determine source of exposure, vaccination history, and contact tracing requirements.