This epidemiological forecast for 2025 for Poland considers several key factors shaping the health landscape: climate change, increasing mobility of goods and people, rising migration, an aging population, and urbanization coupled with rural depopulation. The year 2025 is designated as the Year of Health Education and Prevention in Poland, coinciding with the implementation of a new law on civil protection and civil defense. Thus, public health security will ostensibly be a priority.
Introduction and Context
The „One Health” concept, recognizing the interconnectedness of human, animal, and environmental health, is central to this forecast. Climate change is expected to increase the frequency and intensity of extreme weather events, impacting health and ecosystems. Conversely, milder winters may improve air quality, as seen during pandemic lockdowns. Increased activity of sanitary, veterinary, and plant protection inspectors is anticipated to safeguard borders against highly infectious diseases. Lessons from managing African Swine Fever (ASF) in the port of Gdynia in 2024 highlight the importance of controlling epidemics and epizootics for economic stability.
Key Drivers of Epidemiological Risks:
- Climate Change: More frequent and intense heat waves, droughts, floods, and wildfires, negatively affecting human and animal health and ecosystems. Reduced heating in winter months may improve air quality.
- Increased Mobility: Increased movement of goods (e.g., through ports in Tricity and Świnoujście) and people (e.g., record numbers at regional airports) raises the risk of disease transmission.
- Migration: Influx of migrants (e.g., due to the war in Ukraine and migration from the Global South) poses challenges to public health systems, especially with regards to infectious disease control.
- Aging Population: An increasing elderly population will place greater strain on healthcare systems and increase susceptibility to certain diseases.
- Urbanization: Growing urban centers and shrinking rural populations create challenges for healthcare provision and disease surveillance across different regions.
Specific Disease Concerns – Respiratory and War-Related
COVID-19: The peak of COVID-19 infections in Poland likely occurred in late October 2024. Currently circulating variants do not appear to pose significant competition to other respiratory infections. No new variants are expected to significantly impact the current infection season. Special preventive measures beyond standard respiratory hygiene are likely unnecessary.
Pertussis (Whooping Cough): Following a peak in September and October 2024 (reaching 5,000 cases per month, a level unseen in decades), the situation is stabilizing due to the disease’s cyclical nature and increased uptake of DTP booster vaccinations. The 2025 infection level is expected to be lower than in 2024.
War in Ukraine and Associated Health Risks: While the tactic of weaponizing refugees through mass migration appears to have been abandoned by Russia, the potential for health risks associated with migration through Poland remains.
- Polio: Poliovirus has been detected in sewage in Podkarpacie, a region bordering Ukraine. While concerning, polioviruses are regularly found in European transport hubs. Interpretation requires caution.
- Antibiotic Resistance: The number of Ukrainian soldiers treated in Poland with broad-spectrum antibiotics is decreasing, suggesting a potential reduction in the spread of war-related antibiotic resistance.
- HIV: A sharp increase in HIV infections in 2022-2023 was observed, linked to the mixing of populations from post-Soviet regions. While the rate of new infections is slowing, a prevalence of 2% among sexually active individuals from eastern Ukraine necessitates continued high vigilance, with an estimated 2,000-2,500 new cases expected in 2025.
- Other STIs: A similar trend is expected for other sexually transmitted infections. Universities in major cities should renew inclusive safe sex programs.
- Tuberculosis: The situation is stabilizing after increases in 2022-2023. While cases of MDR tuberculosis from Ukraine remain a concern, transmission within Poland is expected to decrease.
- Viral Hepatitis: A rise in the incidence of viral hepatitis A, B, and C in 2024, particularly in areas with large immigrant populations (e.g., Wrocław and Warsaw), is concerning.
Bio-Geo-Politics, Vaccinations, and Avian Influenza
Regional Bio-Geo-Politics: Changes in US leadership may impact international approaches to infectious disease control, particularly regarding vaccination policy and bioterrorism. The new Polish law on civil protection emphasizes epidemiological surveillance and infectious disease control, necessitating improved coordination between services. Training for heads of relevant entities is mandated by March 31, 2025.
Vaccinations: The 2025 vaccination program includes new additions and updates:
- Pertussis: Free vaccination for selected adult groups, including pregnant women, which must be promoted.
- HPV: Universal vaccination program for children aged 9-14 (9-valent Gardasil vaccine). The restriction of Gardasil to those under 14 is debatable, with calls for considering sexual initiation age during qualification.
- InfluenzaL Depending on the design of the seasonal flu vaccine for the northern hemisphere in 2025, it is worth considering whether to extend free vaccination to workers in contact with livestock and meat
Avian Influenza (HPAI A/H5N1): Unprecedented cases of HPAI A/H5N1 in mammals (dairy cattle, cats, and humans) in the USA in 2024 are raising serious concerns. While human-to-human transmission remains unlikely, genetic drift or reassortment could change this. The spring 2025 bird migration will be crucial in determining the role of wild birds in spreading new variants. The risk of introduction to Europe exists through human activity and the transport of goods and animals. Endemic strains with tropism for mammals have been circulating in Europe, and the intensity of outbreaks in poultry in Poland has decreased since 2022. However, the global situation suggests an increasing risk of an avian influenza pandemic. Strategic planning and preparedness are crucial, especially given Poland’s significant poultry and egg exports.
Gastrointestinal hospital outbreaks, Borys Flood Aftermath, and Bioterrorism
Gastrointestinal and Hospital-Acquired Infections: 2024 saw a high number of outbreaks of gastrointestinal infections of various etiologies. Decreased hygiene practices post-COVID-19 and increased outdoor dining may contribute to this trend. Hot temperatures favor the growth of bacteria like Salmonella, Staphylococcus aureus, E. coli, and parasites like Giardia.
- Norovirus: An increasing trend in norovirus outbreaks in the second half of 2024 suggests a higher-than-average number of outbreaks in the winter of 2025.
- Clostridium difficile: Infections are steadily increasing, and this trend is expected to continue in 2025 due to the aging population.
- Antibiotic Resistance: While specific resistance genes fluctuate, no major revolution is expected in 2025. The OXA-244 variant, prominent in 2022-2023, appears to be under control.
Borys Flood Aftermath: The 2024 flood, caused by Cyclone Borys, affected the Oder River basin. While it did not significantly increase waterborne infections, further research is needed on the potential threat of bacteria in floodwater, soil, and well water. Technologies like NGS can facilitate such studies. Continuous monitoring of flowing water may be necessary in the future.
- Chemical residues found in post-flood soils are at trace levels and do not pose a threat to future crops or human/animal health.
- Experiences from the flood should inform a modern concept of responsibility and preparedness, with a focus on health communication.
- Coordination between services during the crisis was generally positive, but there is room for improvement at higher levels.
- Medical students, especially future nurses, show a lack of knowledge and interest in flood-related health risks, highlighting a need to review medical curricula.
Bioterrorism and Biological Negationism: AI advancements, particularly large language models (LLMs), pose new threats in bioterrorism and disinformation. Open-source models, like the Chinese DeepSeek v3, could potentially be used to generate instructions for creating biological weapons.
- AI can also be used to spread disinformation about biological threats, causing panic and hindering response efforts.
- Poland is considered particularly vulnerable to such attacks due to its civil defense system being under reconstruction and internal institutional conflicts.
- A cyberattack on the Wrocław sanitary-epidemiological station in 2024 highlights the vulnerability of sensitive data registries.
- Lack of clear regulations and guidelines for bio/cyber-terrorist threats, coupled with insufficient coordination between responsible services, are major concerns. The new civil protection law mandates education in this area, with 2025 being a year of training.
Other Zoonoses, Agricultural Concerns
Other Zoonoses:
- West Nile Virus: 2025 will reveal whether the virus has overwintered in Poland. Infections in birds, horses, and humans along migration routes in 2024 suggest its presence in multiple locations.
- Tick-borne Diseases: Lyme disease and tick-borne encephalitis (TBE) are increasing due to the extended activity period of ticks. Early spring and late autumn 2025 are expected to be high-risk periods.
- Rabies: Activity remains relatively high in eastern Poland since 2022, partly due to the war in Ukraine hindering rabies control in wild animal populations.
- Dirofilariasis: Canine heartworm disease is now present throughout Poland and will be diagnosed in 2025.
Animal Diseases without Zoonotic Potential:
- Bluetongue Disease: The appearance of Bluetongue disease in western Poland in autumn 2024 is unlikely to cause rapid spread in cattle due to the lack of vector activity in winter. However, high intensity in affected areas necessitates corrective plans before spring 2025 to prevent further spread and potential loss of export markets.
- African Swine Fever (ASF): The situation in 2025 is expected to be similar to 2024, with the virus endemic in most intensive pig farming areas. While the pressure is low, strict biosecurity measures remain necessary, impacting the profitability of the pig farming sector.
- Newcastle Disease: Likely to spread from east to west, posing a significant threat to the poultry industry.
Withdrawal of Plant Protection Products and Antibiotics in Animal Husbandry:
- Restrictions on the use of antibiotics in animal husbandry and plant protection products are a key element of the „From Farm to Table” strategy.
- 2025 will see significant limitations and withdrawals of active substances in plant protection products.
- Reporting of antibiotic use in animal husbandry will become mandatory from 2025. Monitoring is necessary to assess the impact on known bacterial infections and the emergence of other pests and diseases.
- Toxins in plant-based food may pose a significant challenge.
Conclusion
The year 2025 should be used to learn from the Borys flood, prepare for a potential avian influenza pandemic, and address hybrid threats from Russia, particularly in the context of AI advancements and bioterrorism. While COVID-19 poses less of a threat than in previous years, and pertussis is stabilizing, avian influenza remains a significant concern. The situation in other areas is relatively stable. The hope is that 2025 will be a year of effective health education, particularly in coordinating, monitoring, and combating biological threats, and that this knowledge will be minimally needed.
This is shorter version in English of original text in Polish