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Hoebel J, Michalski N, Diercke M, Hamouda O, Wahrendorf M, Dragano N, Nowossadeck E. Emerging socio-economic disparities in COVID-19-related deaths during the second pandemic wave in Germany. Int J Infect Dis 2021; 113:344-346. [PMID: 34757202 PMCID: PMC8558828 DOI: 10.1016/j.ijid.2021.10.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/24/2021] [Accepted: 10/21/2021] [Indexed: 01/04/2023] Open
Abstract
Over the course of the second pandemic wave in late 2020, new infections with severe acute respiratory syndrome coronavirus-2 shifted from the most affluent to the most deprived regions of Germany. This study investigated how this trend in infections played out for deaths due to coronavirus disease 2019 (COVID-19) by examining area-level socio-economic disparities in COVID-19-related mortality during the second pandemic wave in Germany. The analysis was based on nationwide data on notified deaths, which were linked to an area-based index of socio-economic deprivation. In the autumn and winter of 2020/2021, COVID-19-related deaths increased faster among residents in Germany's more deprived districts. From late 2020 onwards, the mortality risks of men and women in the most deprived districts were 1.52 (95% confidence interval [CI] 1.27-1.82] and 1.44 (95% CI 1.19-1.73) times higher than among those in the most affluent districts, respectively, after adjustment for age, urbanization and population density. To promote health equity in the pandemic and beyond, deprived populations should receive increased attention in pandemic planning, infection control and disease prevention.
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Affiliation(s)
- Jens Hoebel
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | - Niels Michalski
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Michaela Diercke
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Osamah Hamouda
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Morten Wahrendorf
- Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Enno Nowossadeck
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Wachtler B, Müters S, Michalski N, Koschollek C, Albrecht S, Haller S, Hamouda O, Hövener C, Hoebel J. Socioeconomic inequalities in the prevalence and perceived dangerousness of SARS-CoV-2 infections in two early German hotspots: findings from a seroepidemiological study. BMC Res Notes 2021; 14:375. [PMID: 34565448 PMCID: PMC8474907 DOI: 10.1186/s13104-021-05784-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/14/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Evidence on socioeconomic inequalities in infections with the novel coronavirus (SARS-CoV-2) is still limited as most of the available studies are ecological in nature and individual-level data is sparse. We therefore analysed individual-level data on socioeconomic differences in the prevalence and perceived dangerousness of SARS-CoV-2 infections in local populations. Data were obtained from a population-based seroepidemiological study of adult individuals in two early German SARS-CoV-2 hotspots (n = 3903). Infection was determined by IgG antibody ELISA, RT-PCR testing and self-reports on prior positive PCR tests. The perceived dangerousness of an infection and socioeconomic position (SEP) were assessed by self-reports. Logistic and linear regression were applied to examine associations of multiple SEP measures with infection status and perceptions of dangerousness. RESULTS We found no evidence of socioeconomic inequalities in SARS-CoV-2 infections by education, occupation, income and subjective social status. Participants with lower education and lower subjective social status perceived an infection as more dangerous than their better-off counterparts. In successfully contained local outbreaks of SARS-CoV-2 in Germany, infections may have been equally distributed across the socioeconomic spectrum. But residents in disadvantaged socioeconomic groups might have experienced a higher level of mental distress due to the higher perceived dangerousness of an infection.
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Affiliation(s)
- Benjamin Wachtler
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Stephan Müters
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Niels Michalski
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Carmen Koschollek
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Stefan Albrecht
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Sebastian Haller
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Osamah Hamouda
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Claudia Hövener
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
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Hövener C, Koschollek C, Schlaud M, Gößwald A, Hamouda O. Seroprävalenzstudie an besonders von der SARS-CoV-2-Pandemie betroffenen Orten: CORONA-MONITORING lokal. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C Hövener
- Robert Koch-Institut
- Robert Koch-Institut, Abteilung für Epidemiologie und Gesundheitsmonitoring
| | | | - M Schlaud
- Robert Koch-Institut, Abteilung für Epidemiologie und Gesundheitsmonitoring
| | - A Gößwald
- Robert Koch-Institut, Abteilung für Epidemiologie und Gesundheitsmonitoring
| | - O Hamouda
- Robert Koch-Institut, Abteilung für Infektionsepidemiologie
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Koppe U, Wilking H, Harder T, Haas W, Rexroth U, Hamouda O. [COVID-19 patients in Germany: exposure risks and associated factors for hospitalization and severe disease]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1107-1115. [PMID: 34327540 PMCID: PMC8320410 DOI: 10.1007/s00103-021-03391-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/01/2021] [Indexed: 02/07/2023]
Abstract
The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) spread worldwide in 2020. By the end of June 2021, over 3.7 million people had been infected in Germany. The spread of the infection, however, is not evenly distributed across all parts of the population. Some groups are at a higher risk for SARS-CoV‑2 infections or severe coronavirus disease 2019 (COVID-19) trajectories than others.This narrative review provides an overview of the parts of the population in Germany that are most affected by COVID-19. In addition, risk factors associated with hospitalization or severe courses of COVID-19 are identified.SARS-CoV‑2 transmission may occur in various locations and settings. Professional settings, e.g., in the meat-processing industry, but also leisure activities and large public events are particularly affected. In the course of the pandemic, certain comorbidities associated with an increased risk for hospitalization or severe courses of COVID-19 have been identified. These include preexisting pulmonary, cardiovascular, and metabolic diseases. Patients with organ transplants and people with Down syndrome (trisomy 21) have the highest risk for hospitalization after SARS-CoV‑2 infection.The identified settings that contribute to the spread of SARS-CoV‑2 and the knowledge about vulnerable groups with a higher risk for hospitalization or severe disease trajectories form an important evidence base for the planning of prevention strategies and the fight against the pandemic.
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Affiliation(s)
- Uwe Koppe
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland.
| | - Hendrik Wilking
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Thomas Harder
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Walter Haas
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Ute Rexroth
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Osamah Hamouda
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
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Ullrich A, Schranz M, Rexroth U, Hamouda O, Schaade L, Diercke M, Boender TS. Impact of the COVID-19 pandemic and associated non-pharmaceutical interventions on other notifiable infectious diseases in Germany: An analysis of national surveillance data during week 1-2016 - week 32-2020. Lancet Reg Health Eur 2021; 6:100103. [PMID: 34557831 PMCID: PMC8454829 DOI: 10.1016/j.lanepe.2021.100103] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic and associated non-pharmaceutical interventions (NPIs) affect healthcare seeking behaviour, access to healthcare, test strategies, disease notification and workload at public health authorities, but may also lead to a true change in transmission dynamics. We aimed to assess the impact of the pandemic and NPIs on other notifiable infectious diseases under surveillance in Germany. METHODS We included 32 nationally notifiable disease categories with case numbers >100/year in 2016-2019. We used quasi-Poisson regression analysis on a weekly aggregated time-series incorporating trend and seasonality, to compute the relative change in case numbers during week 2020-10 to 2020-32 (pandemic/NPIs), in comparison to week 2016-01 to 2020-09. FINDINGS During week 2020-10 to 2020-32, 216,825 COVID-19 cases, and 162,942 (-35%) cases of other diseases, were notified. Case numbers decreased across all ages and notification categories (all p<0•05), except for tick-borne encephalitis, which increased (+58%). The number of cases decreased most for respiratory diseases (from -86% for measles, to -12% for tuberculosis), gastro-intestinal diseases (from -83% for rotavirus gastroenteritis, to -7% for yersiniosis) and imported vector-borne diseases (-75% dengue fever, -73% malaria). The less affected infections were healthcare associated pathogens (from -43% infection/colonisation with carbapenem-non-susceptible Acinetobacter, to -28% for Methicillin-resistant Staphylococcus aureus invasive infection) and sexually transmitted and blood-borne diseases (from -28% for hepatitis B, to -12% for syphilis). INTERPRETATION During the COVID-19 pandemic a drastic decrease of notifications for most infectious diseases and pathogens was observed. Our findings suggest effects of NPIs on overall disease transmission that require further investigation. FUNDING The Robert Koch Institute is the National Public Health Institute of Germany, and is an institute within the portfolio of the Federal Ministry of Health.
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Affiliation(s)
- Alexander Ullrich
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
| | - Madlen Schranz
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
| | - Ute Rexroth
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
| | - Osamah Hamouda
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
| | - Lars Schaade
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Nordufer 20, 13353 Berlin, Germany
| | - Michaela Diercke
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
| | - T Sonia Boender
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
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Seifried J, Hoffmann A, Reda S, Böttcher S, Abu Sin M, Hofmann A, Noll I, von Laer A, Reuss A, Oh DY, Albrecht S, Stern D, Willrich N, Staat D, Zacher B, Schneider M, Feig M, Nitsche A, Rieck T, Rexroth U, Eckmanns T, Hamouda O. [Recording of SARS-CoV-2 laboratory tests in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:403-411. [PMID: 33856510 PMCID: PMC8047561 DOI: 10.1007/s00103-021-03307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/10/2021] [Indexed: 11/18/2022]
Abstract
Die Erfassung von Daten zu SARS-CoV-2-Testungen in Deutschland sind für die Einschätzung des Infektionsgeschehens im Rahmen der COVID-19-Pandemie von zentraler Bedeutung. Am Robert Koch-Institut (RKI) werden dazu die Daten aus verschiedenen Systemen zur Erfassung von Labortestungen zusammengeführt. In diesem Beitrag werden zunächst bedeutsame Aspekte der Testverfahren erläutert. Nachfolgend werden die unterschiedlichen Systeme zur Erfassung von Labortestungen erläutert und Testzahlen aus der RKI-Testlaborabfrage und der laborbasierten Surveillance SARS-CoV‑2 sowie die Abrechnungsdaten der kassenärztlichen Vereinigungen zu SARS-CoV-2-Labortestungen dargestellt. Mit der RKI-Testlaborabfrage und der laborbasierten Surveillance SARS-CoV‑2 stand früh in der Pandemie eine Surveillance zur Verfügung, mit der unter den teilnehmenden Laboren Daten zu durchgeführten Testungen und Testkapazitäten ausgewertet werden können. Durch die Erfassung von positiven und negativen Testergebnissen sind Aussagen zur Gesamtzahl der durchgeführten Testungen sowie dem Anteil der positiven Testergebnisse möglich. Während die aggregierten Testzahlen bundesweit weitestgehend repräsentativ sind, ist die Repräsentativität auf Bundesland- und Landkreisebene aber nicht immer gegeben. Die Abrechnungsdaten der Kassenärztlichen Vereinigungen können die Labordaten im Nachhinein ergänzen. Sie erlauben eine retrospektive Einschätzung der Gesamtzahl von SARS-CoV-2-Tests in Deutschland, da die Leistungen der vertragsärztlichen Versorgung aller gesetzlich Krankenversicherten (ca. 85 % der Bevölkerung) enthalten sind. Die verschiedenen Systeme zur Erfassung von Labortestungen ergänzen sich gegenseitig. Die Auswertungen fließen in die Maßnahmenempfehlungen zur Pandemiebewältigung ein.
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Affiliation(s)
- Janna Seifried
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Alexandra Hoffmann
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Sarah Reda
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Sindy Böttcher
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Muna Abu Sin
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Alexandra Hofmann
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Ines Noll
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Anja von Laer
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Annicka Reuss
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Djin-Ye Oh
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Stefan Albrecht
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Daniel Stern
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Berlin, Deutschland
| | - Niklas Willrich
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Doreen Staat
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Benedikt Zacher
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Marc Schneider
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Marcel Feig
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Andreas Nitsche
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Berlin, Deutschland
| | - Thorsten Rieck
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Ute Rexroth
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Tim Eckmanns
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Osamah Hamouda
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.
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Halm A, Grote U, An der Heiden M, Hamouda O, Schaade L, Rexroth U. [Crisis management at the Robert Koch Institute during the COVID-19 pandemic and the exchange between federal and state governments]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:418-425. [PMID: 33666683 PMCID: PMC7933910 DOI: 10.1007/s00103-021-03294-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/01/2022]
Abstract
Das Robert Koch-Institut (RKI) spielt in Deutschland eine zentrale Rolle bei der Bewältigung von Gesundheitsgefahren biologischen Ursprungs. Das Krisenmanagement des RKI hat das Ziel, dazu beizutragen, die Gesundheit der Menschen in Deutschland in epidemisch bedeutsamen Lagen zu schützen und die Arbeitsfähigkeit des RKI auch bei hoher Belastung über längere Zeit aufrechtzuerhalten. In diesem Artikel wird das Krisenmanagement des RKI generell und speziell während der COVID-19-Pandemie zum Stand 31.10.2020 dargestellt. Es werden die generischen RKI-Krisenmanagementstrukturen und der Aufbau des RKI-Lagezentrums, deren Operationalisierung im Rahmen der COVID-19-Pandemie sowie die aufgetretenen Herausforderungen beschrieben. Ebenso wird der Bund-Länder-Austausch während der bisherigen Pandemie dargestellt. Die COVID-19-Pandemie hat außergewöhnliche Umstände mit sich gebracht. Eine gute Kommunikation und Koordination während der Lage sind essenziell, sowohl RKI-intern als auch mit anderen Bundes- oder Länderbehörden und der Fachöffentlichkeit. Unter hohem Druck erstellt das RKI Empfehlungen, Stellungnahmen und Bewertungen zu verschiedenen Themen und aktualisiert diese regelmäßig. Für die operative Unterstützung aller Aktivitäten wurde am RKI ein Lagezentrum aktiviert. Während der COVID-19-Pandemie gibt es verschiedene sowohl personelle als auch strukturelle Herausforderungen. Es zeigte sich, dass eine gute Vorbereitung (z. B. bereits vorhandene Positionsbeschreibungen und Räumlichkeiten) das Krisenmanagement positiv beeinflusst.
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Affiliation(s)
- Ariane Halm
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.
| | - Ulrike Grote
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Maria An der Heiden
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Osamah Hamouda
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Lars Schaade
- Zentrum für Biologische Gefahren und Spezielle Pathogene (ZBS), Robert Koch-Institut, Berlin, Deutschland
| | - Ute Rexroth
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
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Schmidt D, Kollan C, Stoll M, Hamouda O, Bremer V, Kurth T, Bartmeyer B. Everything counts - a method to determine viral suppression among people living with HIV using longitudinal data for the HIV care continuum - results of two large, German, multi-center real-life cohort studies over 20 years (1999-2018). BMC Public Health 2021; 21:200. [PMID: 33482773 PMCID: PMC7825204 DOI: 10.1186/s12889-020-10088-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to develop a standardized method to reconstruct persons’ individual viral load (VL) courses to determine viral suppression and duration of viremia for the HIV care continuum in Germany using longitudinal cohort data. Methods We analyzed data from two large, multi-center German cohort studies under the direction of the Robert Koch Institute. We included data from 1999 to 2018 of all diagnosed people and of people who initiated antiretroviral treatment (ART). We developed a model generating virtual VL values and an individual VL course corresponding to real VL measurements with a maximum distance of 180 days, considering ART status and VL dynamics. If the distance between VL measurements was > 180 days, the time between was defined as gap time. Additionally, we considered blips, which we defined as a single detectable VL < 1000 copies/ml within 180 days. Results A total of 22,120 people (164,691 person-years, PY) after ART initiation were included in the analyses. The proportion of people with viral suppression (VL < 50 copies/ml) increased from 34% in 1999 to 93% in 2018. The proportion of people with VL < 200 copies/ml increased from 47% in 1999 to 96% in 2018. The proportion of people with viremia > 1000 copies/ml decreased from 37% in 1999 to 3% in 2018. The proportion of people with gap time fluctuated and ranged between 18 and 28%. An analysis of the first VL after gap time showed that 90% showed viral suppression, 5% VL between 50- < 1000 copies/ml and 5% VL > 1000 copies/ml. Conclusion We provide a method for estimating viral suppression and duration of viremia using longitudinal VL data. We observed a continuous and remarkable increase of viral suppression. Furthermore, a notable proportion of those with viremia showed low-level viremia and were therefore unlikely to transmit HIV. Individual health risks and HIV drug resistance among those with low-level viremia are problematic, and viral suppression remains the goal. In 2018, 93 and 96% of people after ART initiation showed VL < 50 copies/ml and VL < 200 copies/ml, respectively. Therefore, using the threshold of VL < 200 copies/ml, Germany reached the UNAIDS 95 target of viral suppression since 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10088-7.
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Affiliation(s)
- Daniel Schmidt
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. .,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Christian Kollan
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Matthias Stoll
- Clinic for Rheumatology and Immunology, Infectious Diseases Unit, Medical University Hannover, Hannover, Germany
| | - Osamah Hamouda
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Barbara Bartmeyer
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Poethko-Müller C, Prütz F, Buttmann-Schweiger N, Fiebig J, Sarganas G, Seeling S, Thamm R, Baumann J, Hamouda O, Offergeld R, Schaade L, Lampert T, Neuhauser H. German and international studies on SARS-CoV-2 seroprevalence. J Health Monit 2020; 5:2-15. [PMID: 35146294 PMCID: PMC8734155 DOI: 10.25646/7024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 06/14/2023]
Abstract
Since the beginning of the year 2020, the SARS-CoV-2 coronavirus has spread globally at a tremendous pace. Studies on the prevalence of SARS-CoV-2 antibodies in the population help estimate the number of people that have already been infected. They also allow an estimate of the number of undetected infections i.e. infections that do not appear in data on officially reported cases. The interpretation of study results needs to consider bias from selective sampling and the diagnostic test properties. To promote networking and co-operation between scientists, the Robert Koch Institute has compiled an overview of the seroepidemiological studies conducted in Germany on its website, which is regularly updated. The RKI conducts searches, for example of press releases, study registry entries or preprint server publications, and contacts the lead investigators of these studies. Of the 40 studies contacted so far, 24 have already provided information (as of 25.06.2020). We can differentiate between studies of the general population, of selected population groups such as healthcare workers, or of ongoing cohorts. This article provides an overview of such studies from Germany, but also of selected international studies. A special focus is set on studies of children and adolescents, which are now of particular interest due to the planned reopening of childcare facilities and schools.
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Affiliation(s)
| | - Franziska Prütz
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | | | - Julia Fiebig
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Giselle Sarganas
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Stefanie Seeling
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Roma Thamm
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Jan Baumann
- Robert Koch Institute, Berlin Centre for International Health Protection
| | - Osamah Hamouda
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
| | - Ruth Offergeld
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
| | - Lars Schaade
- Robert Koch Institute, Berlin Centre for Biological Threats and Special Pathogens, Vice president
| | - Thomas Lampert
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Hannelore Neuhauser
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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10
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Santos-Hövener C, Neuhauser HK, Rosario AS, Busch M, Schlaud M, Hoffmann R, Gößwald A, Koschollek C, Hoebel J, Allen J, Haack-Erdmann A, Brockmann S, Ziese T, Nitsche A, Michel J, Haller S, Wilking H, Hamouda O, Corman VM, Drosten C, Schaade L, Wieler LH, Lampert T. Serology- and PCR-based cumulative incidence of SARS-CoV-2 infection in adults in a successfully contained early hotspot (CoMoLo study), Germany, May to June 2020. Euro Surveill 2020; 25:2001752. [PMID: 33243353 PMCID: PMC7693167 DOI: 10.2807/1560-7917.es.2020.25.47.2001752] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/25/2020] [Indexed: 11/20/2022] Open
Abstract
Three months after a coronavirus disease (COVID-19) outbreak in Kupferzell, Germany, a population-based study (n = 2,203) found no RT-PCR-positives. IgG-ELISA seropositivity with positive virus neutralisation tests was 7.7% (95% confidence interval (CI): 6.5-9.1) and 4.3% with negative neutralisation tests. We estimate 12.0% (95% CI: 10.4-14.0%) infected adults (24.5% asymptomatic), six times more than notified. Full hotspot containment confirms the effectiveness of prompt protection measures. However, 88% naïve adults are still at high COVID-19 risk.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Stefan Brockmann
- Department of Health Protection and Epidemiology, Baden-Wuerttemberg State Health Office, Stuttgart, Germany
| | | | | | | | | | | | | | - Victor M Corman
- National Consultant Laboratory for Coronaviruses, Berlin Institute of Virology, Charité - Universitätsmedizin, Berlin, Germany
- German Centre for Infection Research (DZIF), Berlin, Germany
| | - Christian Drosten
- National Consultant Laboratory for Coronaviruses, Berlin Institute of Virology, Charité - Universitätsmedizin, Berlin, Germany
- German Centre for Infection Research (DZIF), Berlin, Germany
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11
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Santos-Hövener C, Busch MA, Koschollek C, Schlaud M, Hoebel J, Hoffmann R, Wilking H, Haller S, Allen J, Wernitz J, Butschalowsky H, Kuttig T, Stahlberg S, Strandmark J, Rosario AS, Gößwald A, Nitsche A, Hamouda O, Drosten C, Corman V, Wieler LH, Schaade L, Lampert T. Seroepidemiological study on the spread of SARS-CoV-2 in populations in especially affected areas in Germany - Study protocol of the CORONA-MONITORING lokal study. J Health Monit 2020; 5:2-16. [PMID: 35146295 PMCID: PMC8734078 DOI: 10.25646/7053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/06/2020] [Indexed: 01/04/2023]
Abstract
At a regional and local level, the COVID-19 pandemic has not spread out uniformly and some German municipalities have been particularly affected. The seroepidemiological data from these areas helps estimate the proportion of the population that has been infected with SARS-CoV-2 (seroprevalence), as well as the number of undetected infections and asymptomatic cases. In four municipalities which were especially affected, 2,000 participants will be tested for an active SARS-CoV-2 infection (oropharyngeal swab) or a past infection (blood specimen IgG antibody test). Participants will also be asked to fill out a short written questionnaire at study centres and complete a follow-up questionnaire either online or by telephone, including information on issues such as possible exposure, susceptability, symptoms and medical history. The CORONA-MONITORING lokal study will allow to determine the proportion of the population with SARS-CoV-2 antibodies in four particularly affected locations. This study will increase the accuracy of estimates regarding the scope of the epidemic, help determine risk and protective factors for an infection and therefore also identify especially exposed groups and, as such, it will be crucial towards planning of prevention measures.
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Affiliation(s)
| | - Markus A. Busch
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Carmen Koschollek
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Martin Schlaud
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Jens Hoebel
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Robert Hoffmann
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Hendrik Wilking
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
| | - Sebastian Haller
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
| | - Jennifer Allen
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Jörg Wernitz
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Hans Butschalowsky
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Tim Kuttig
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Silke Stahlberg
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Julia Strandmark
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | | | - Antje Gößwald
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Andreas Nitsche
- Robert Koch Institute, Berlin Centre for Biological Threats and Special Pathogens
| | - Osamah Hamouda
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
| | - Christian Drosten
- Charité – UniversitätsmedizinBerlin Institute of Virology, National Consultant Laboratory for Coronaviruses
| | - Victor Corman
- Charité – UniversitätsmedizinBerlin Institute of Virology, National Consultant Laboratory for Coronaviruses
| | - Lothar H. Wieler
- Robert Koch Institute, Berlin Institute Leadership
- Robert Koch Institute, Berlin Methodology and Research Infrastructure
| | - Lars Schaade
- Robert Koch Institute, Berlin Centre for Biological Threats and Special Pathogens
- Robert Koch Institute, Berlin Institute Leadership
| | - Thomas Lampert
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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12
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Böhmer MM, Buchholz U, Corman VM, Hoch M, Katz K, Marosevic DV, Böhm S, Woudenberg T, Ackermann N, Konrad R, Eberle U, Treis B, Dangel A, Bengs K, Fingerle V, Berger A, Hörmansdorfer S, Ippisch S, Wicklein B, Grahl A, Pörtner K, Muller N, Zeitlmann N, Boender TS, Cai W, Reich A, an der Heiden M, Rexroth U, Hamouda O, Schneider J, Veith T, Mühlemann B, Wölfel R, Antwerpen M, Walter M, Protzer U, Liebl B, Haas W, Sing A, Drosten C, Zapf A. Investigation of a COVID-19 outbreak in Germany resulting from a single travel-associated primary case: a case series. Lancet Infect Dis 2020; 20:920-928. [PMID: 32422201 PMCID: PMC7228725 DOI: 10.1016/s1473-3099(20)30314-5] [Citation(s) in RCA: 281] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND In December, 2019, the newly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, causing COVID-19, a respiratory disease presenting with fever, cough, and often pneumonia. WHO has set the strategic objective to interrupt spread of SARS-CoV-2 worldwide. An outbreak in Bavaria, Germany, starting at the end of January, 2020, provided the opportunity to study transmission events, incubation period, and secondary attack rates. METHODS A case was defined as a person with SARS-CoV-2 infection confirmed by RT-PCR. Case interviews were done to describe timing of onset and nature of symptoms and to identify and classify contacts as high risk (had cumulative face-to-face contact with a confirmed case for ≥15 min, direct contact with secretions or body fluids of a patient with confirmed COVID-19, or, in the case of health-care workers, had worked within 2 m of a patient with confirmed COVID-19 without personal protective equipment) or low risk (all other contacts). High-risk contacts were ordered to stay at home in quarantine for 14 days and were actively followed up and monitored for symptoms, and low-risk contacts were tested upon self-reporting of symptoms. We defined fever and cough as specific symptoms, and defined a prodromal phase as the presence of non-specific symptoms for at least 1 day before the onset of specific symptoms. Whole genome sequencing was used to confirm epidemiological links and clarify transmission events where contact histories were ambiguous; integration with epidemiological data enabled precise reconstruction of exposure events and incubation periods. Secondary attack rates were calculated as the number of cases divided by the number of contacts, using Fisher's exact test for the 95% CIs. FINDINGS Patient 0 was a Chinese resident who visited Germany for professional reasons. 16 subsequent cases, often with mild and non-specific symptoms, emerged in four transmission generations. Signature mutations in the viral genome occurred upon foundation of generation 2, as well as in one case pertaining to generation 4. The median incubation period was 4·0 days (IQR 2·3-4·3) and the median serial interval was 4·0 days (3·0-5·0). Transmission events were likely to have occurred presymptomatically for one case (possibly five more), at the day of symptom onset for four cases (possibly five more), and the remainder after the day of symptom onset or unknown. One or two cases resulted from contact with a case during the prodromal phase. Secondary attack rates were 75·0% (95% CI 19·0-99·0; three of four people) among members of a household cluster in common isolation, 10·0% (1·2-32·0; two of 20) among household contacts only together until isolation of the patient, and 5·1% (2·6-8·9; 11 of 217) among non-household, high-risk contacts. INTERPRETATION Although patients in our study presented with predominately mild, non-specific symptoms, infectiousness before or on the day of symptom onset was substantial. Additionally, the incubation period was often very short and false-negative tests occurred. These results suggest that although the outbreak was controlled, successful long-term and global containment of COVID-19 could be difficult to achieve. FUNDING All authors are employed and all expenses covered by governmental, federal state, or other publicly funded institutions.
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Affiliation(s)
- Merle M Böhmer
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany; Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University, Magdeburg, Germany.
| | | | - Victor M Corman
- Institute of Virology, Charité University Medicine, Berlin, Germany,German Center for Infection Research, Partner Site Munich and Associated Partner Site Charité, Berlin, Germany
| | - Martin Hoch
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Katharina Katz
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | | | - Stefanie Böhm
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany,Postgraduate Training for Applied Epidemiology, Berlin, Germany,ECDC Fellowship Programme, Field Epidemiology Path, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Tom Woudenberg
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany,ECDC Fellowship Programme, Field Epidemiology Path, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Regina Konrad
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Ute Eberle
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Bianca Treis
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Alexandra Dangel
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Katja Bengs
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Volker Fingerle
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Anja Berger
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | | | - Siegfried Ippisch
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Bernd Wicklein
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Andreas Grahl
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Kirsten Pörtner
- Postgraduate Training for Applied Epidemiology, Berlin, Germany,ECDC Fellowship Programme, Field Epidemiology Path, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Nadine Muller
- Postgraduate Training for Applied Epidemiology, Berlin, Germany,ECDC Fellowship Programme, Field Epidemiology Path, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - T Sonia Boender
- Postgraduate Training for Applied Epidemiology, Berlin, Germany,ECDC Fellowship Programme, Field Epidemiology Path, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Wei Cai
- Robert Koch Institute, Berlin, Germany
| | | | | | | | | | - Julia Schneider
- Institute of Virology, Charité University Medicine, Berlin, Germany
| | - Talitha Veith
- Institute of Virology, Charité University Medicine, Berlin, Germany
| | - Barbara Mühlemann
- Institute of Virology, Charité University Medicine, Berlin, Germany,German Center for Infection Research, Partner Site Munich and Associated Partner Site Charité, Berlin, Germany
| | - Roman Wölfel
- German Center for Infection Research, Partner Site Munich and Associated Partner Site Charité, Berlin, Germany,Bundeswehr Institute of Microbiology, Munich, Germany
| | - Markus Antwerpen
- German Center for Infection Research, Partner Site Munich and Associated Partner Site Charité, Berlin, Germany,Bundeswehr Institute of Microbiology, Munich, Germany
| | - Mathias Walter
- German Center for Infection Research, Partner Site Munich and Associated Partner Site Charité, Berlin, Germany,Bundeswehr Institute of Microbiology, Munich, Germany
| | - Ulrike Protzer
- German Center for Infection Research, Partner Site Munich and Associated Partner Site Charité, Berlin, Germany,Institute of Virology, Technical University Munich, Munich, Germany
| | - Bernhard Liebl
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany,Ludwig-Maximilians University, Munich, Germany
| | | | - Andreas Sing
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany,Ludwig-Maximilians University, Munich, Germany
| | - Christian Drosten
- Institute of Virology, Charité University Medicine, Berlin, Germany; German Center for Infection Research, Partner Site Munich and Associated Partner Site Charité, Berlin, Germany.
| | - Andreas Zapf
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
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13
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Rexroth U, Hamouda O, Hanefeld J, Ruehe B, Wieler LH, Schaade L. Letter to the editor: Wide indication for SARS-CoV-2-testing allowed identification of international risk areas during the early phase of the COVID-19 pandemic in Germany. Euro Surveill 2020; 25. [PMID: 32553063 PMCID: PMC7403636 DOI: 10.2807/1560-7917.es.2020.25.23.2001119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Machnowska P, Meixenberger K, Schmidt D, Jessen H, Hillenbrand H, Gunsenheimer-Bartmeyer B, Hamouda O, Kücherer C, Bannert N. Prevalence and persistence of transmitted drug resistance mutations in the German HIV-1 Seroconverter Study Cohort. PLoS One 2019; 14:e0209605. [PMID: 30650082 PMCID: PMC6334938 DOI: 10.1371/journal.pone.0209605] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/07/2018] [Indexed: 02/03/2023] Open
Abstract
The prevalence of transmitted drug resistance (TDR) in antiretroviral therapy (ART)-naïve individuals remains stable in most developed countries despite a decrease in the prevalence of acquired drug resistance. This suggests that persistence and further transmission of HIV-1 that encodes transmitted drug resistance mutations (TDRMs) is occurring in ART-naïve individuals. In this study, we analysed the prevalence and persistence of TDRMs in the protease and reverse transcriptase-sequences of ART-naïve patients within the German HIV-1 Seroconverter Study Cohort who were infected between 1996 and 2017. The prevalence of TDRMs and baseline susceptibility to antiretroviral drugs were assessed using the Stanford HIVdb list and algorithm. Mean survival times of TDRMs were calculated by Kaplan-Meier analysis. The overall prevalence of TDR was 17.2% (95% CI 15.7–18.6, N = 466/2715). Transmitted NNRTI resistance was observed most frequently with 7.8% (95% CI 6.8–8.8), followed by NRTI resistance (5.0%, 95% CI 4.2–5.9) and PI resistance (2.8%, 95% CI 2.2–3.4). Total TDR (OR = 0.89, p = 0.034) and transmitted NRTI resistance (OR = 0.65, p = 0.000) decreased between 1996 and 2017 but has remained stable during the last decade. Viral susceptibility to NNRTIs (6.5%-6.9% for individual drugs) was mainly reduced, while <3% of the recommended NRTIs and PIs were affected. The longest mean survival times were calculated for the NNRTI mutations K103N (5.3 years, 95% CI 4.2–5.6) and E138A/G/K (8.0 years, 95% CI 5.8–10.2 / 7.9 years, 95% CI 5.4–10.3 / 6.7 years, 95% CI 6.7–6.7) and for the NRTI mutation M41L (6.4 years, 95% CI 6.0–6.7).The long persistence of single TDRMs indicates that onward transmission from ART-naïve individuals is the main cause for TDR in Germany. Transmitted NNRTI resistance was the most frequent TDR, showing simultaneously the highest impact on baseline ART susceptibility and on TDRMs with prolonged persistence. These results give cause for concern regarding the use of NNRTI in first-line regimens.
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Affiliation(s)
- Patrycja Machnowska
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
- * E-mail: (NB); (PM)
| | | | - Daniel Schmidt
- Division of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | | | | | | | - Osamah Hamouda
- Division of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Claudia Kücherer
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Norbert Bannert
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
- Institute of Virology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- * E-mail: (NB); (PM)
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15
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Hamouda O. [In Process Citation]. MMW Fortschr Med 2018; 157 Suppl 2:10-3. [PMID: 26048113 DOI: 10.1007/s15006-015-3160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Osamah Hamouda
- Abteilung für Infektionsepidemiologie, Robert-Koch-Institut, Postfach 65 02 61, D-13302, Berlin, Deutschland,
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16
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Meixenberger K, Yousef KP, Smith MR, Somogyi S, Fiedler S, Bartmeyer B, Hamouda O, Bannert N, von Kleist M, Kücherer C. Molecular evolution of HIV-1 integrase during the 20 years prior to the first approval of integrase inhibitors. Virol J 2017; 14:223. [PMID: 29137637 PMCID: PMC5686839 DOI: 10.1186/s12985-017-0887-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/31/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Detailed knowledge of the evolutionary potential of polymorphic sites in a viral protein is important for understanding the development of drug resistance in the presence of an inhibitor. We therefore set out to analyse the molecular evolution of the HIV-1 subtype B integrase at the inter-patient level in Germany during a 20-year period prior to the first introduction of integrase strand inhibitors (INSTIs). METHODS We determined 337 HIV-1 integrase subtype B sequences (amino acids 1-278) from stored plasma samples of antiretroviral treatment-naïve individuals newly diagnosed with HIV-1 between 1986 and 2006. Shannon entropy was calculated to determine the variability at each amino acid position. Time trends in the frequency of amino acid variants were identified by linear regression. Direct coupling analysis was applied to detect covarying sites. RESULTS Twenty-two time trends in the frequency of amino acid variants demonstrated either single amino acid exchanges or variation in the degree of polymorphy. Covariation was observed for 17 amino acid variants with a temporal trend. Some minor INSTI resistance mutations (T124A, V151I, K156 N, T206S, S230 N) and some INSTI-selected mutations (M50I, L101I, T122I, T124 N, T125A, M154I, G193E, V201I) were identified at overall frequencies >5%. Among these, the frequencies of L101I, T122I, and V201I increased over time, whereas the frequency of M154I decreased. Moreover, L101I, T122I, T124A, T125A, M154I, and V201I covaried with non-resistance-associated variants. CONCLUSIONS Time-trending, covarying polymorphisms indicate that long-term evolutionary changes of the HIV-1 integrase involve defined clusters of possibly structurally or functionally associated sites independent of selective pressure through INSTIs at the inter-patient level. Linkage between polymorphic resistance- and non-resistance-associated sites can impact the selection of INSTI resistance mutations in complex ways. Identification of these sites can help in improving genotypic resistance assays, resistance prediction algorithms, and the development of new integrase inhibitors.
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Affiliation(s)
| | - Kaveh Pouran Yousef
- Department of Mathematics and Computer Science, Freie Universität Berlin, Berlin, Germany
| | - Maureen Rebecca Smith
- Department of Mathematics and Computer Science, Freie Universität Berlin, Berlin, Germany
| | - Sybille Somogyi
- HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Stefan Fiedler
- HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Barbara Bartmeyer
- HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Osamah Hamouda
- HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Norbert Bannert
- HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Max von Kleist
- Department of Mathematics and Computer Science, Freie Universität Berlin, Berlin, Germany
| | - Claudia Kücherer
- HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
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17
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Ziese T, Hamouda O. Surveillance und Monitoring. Gesundheitswesen 2017; 79:932-935. [DOI: 10.1055/s-0043-121466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungEvidenzorientierte Gesundheitspolitik und evidenzbasierte Maßnahmen brauchen umfassende Informationen zur Gesundheit der Bevölkerung. Die bestehende Gesundheitssurveillance liefert zu vielen gesundheitspolitischen Fragen verlässliche Antworten. Dennoch bestehen in vielen Bereichen Informationslücken, die bisher nicht oder nur über kurzfristige Projektlösungen geschlossen werden. 1. Wir brauchen eine Stärkung und einen Ausbau der bestehenden Gesundheitssurveillance bzw. -monitoring, um kontinuierlich Informationen über den Gesundheitsstatus aller Bevölkerungsgruppen zu erheben, darunter auch Gruppen, die mit den bisherigen Erhebungen und Methoden schwer zu erreichen sind, wie z. B. Menschen mit Migrationshintergrund oder sozial Benachteiligte. Diese Informationen müssen auf der nationalen, regionalen und idealerweise auch auf der lokalen Ebene regelmäßig verfügbar sein. 2. Die Nutzung von vorhandenen Daten zur Gesundheit bspw. aus der amtlichen Statistik oder der Sozialversicherung muss deutlich ausgebaut und verstärkt werden. Die Infrastruktur für wissenschaftliche Analysen von Gesundheitsdaten sowie den Informationstransfer an die Politik und die Öffentlichkeit muss gestärkt werden. Durch einen Ausbau der Ressourcen für die wissenschaftliche Bearbeitung von gesundheitspolitisch relevanten Fragestellungen kann Public Health einen wichtigen Beitrag für eine effektive Gesundheitspolitik leisten.
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Affiliation(s)
- Thomas Ziese
- Robert Koch-Institut, Abteilung für Epidemiologie und Gesundheitsmonitoring, Fachgebiet Gesundheitsberichterstattung, Berlin
| | - Osamah Hamouda
- Robert Koch-Institut, Abteilung für Infektionsepidemiologie, Berlin
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Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, Schomaker M, Smit C, Sterne J, Thiebaut R, Thorne C, Torti C, van der Valk M, Wittkop L, Tanser F, Vinikoor M, Macete E, Wood R, Stinson K, Garone D, Fatti G, Giddy J, Malisita K, Eley B, Fritz C, Hobbins M, Kamenova K, Fox M, Prozesky H, Technau K, Sawry S, Benson CA, Bosch RJ, Kirk GD, Boswell S, Mayer KH, Grasso C, Hogg RS, Richard Harrigan P, Montaner JSG, Yip B, Zhu J, Salters K, Gabler K, Buchacz K, Brooks JT, Gebo KA, Moore RD, Moore RD, Rodriguez B, Horberg MA, Silverberg MJ, Thorne JE, Rabkin C, Margolick JB, Jacobson LP, D’Souza G, Klein MB, Rourke SB, Rachlis AR, Cupido P, Hunter-Mellado RF, Mayor AM, John Gill M, Deeks SG, Martin JN, Patel P, Brooks JT, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Rebeiro P, Turner M, Bebawy S, Rogers B, Justice AC, Dubrow R, Fiellin D, Gange SJ, Anastos K, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, Horberg MA, Klein MB, McKaig RG, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing J, Modur S, Wong C, Hogan B, Desir F, Liu B, You B, Cahn P, Cesar C, Fink V, Sued O, Dell’Isola E, Perez H, Valiente J, Yamamoto C, Grinsztejn B, Veloso V, Luz P, de Boni R, Cardoso Wagner S, Friedman R, Moreira R, Pinto J, Ferreira F, Maia M, Célia de Menezes Succi R, Maria Machado D, de Fátima Barbosa Gouvêa A, Wolff M, Cortes C, Fernanda Rodriguez M, Allendes G, William Pape J, Rouzier V, Marcelin A, Perodin C, Tulio Luque M, Padgett D, Sierra Madero J, Crabtree Ramirez B, Belaunzaran P, Caro Vega Y, Gotuzzo E, Mejia F, Carriquiry G, McGowan CC, Shepherd BE, Sterling T, Jayathilake K, Person AK, Rebeiro PF, Giganti M, Castilho J, Duda SN, Maruri F, Vansell H, Ly PS, Khol V, Zhang FJ, Zhao HX, Han N, Lee MP, Li PCK, Lam W, Chan YT, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Gaikwad S, Chitalikar A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Tanuma J, Oka S, Nishijima T, Na S, Choi JY, Kim JM, Sim BLH, Gani YM, David R, Kamarulzaman A, Syed Omar SF, Ponnampalavanar S, Azwa I, Ditangco R, Uy E, Bantique R, Wong WW, Ku WW, Wu PC, Ng OT, Lim PL, Lee LS, Ohnmar PS, Avihingsanon A, Gatechompol S, Phanuphak P, Phadungphon C, Kiertiburanakul S, Sungkanuparph S, Chumla L, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Praparattanapan J, Kantipong P, Kambua P, Ratanasuwan W, Sriondee R, Nguyen KV, Bui HV, Nguyen DTH, Nguyen DT, Cuong DD, An NV, Luan NT, Sohn AH, Ross JL, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Ellis D, Bloch M, Agrawal S, Vincent T, Allen D, Smith D, Rankin A, Baker D, Templeton DJ, O’Connor CC, Thackeray O, Jackson E, McCallum K, Ryder N, Sweeney G, Cooper D, Carr A, Macrae K, Hesse K, Finlayson R, Gupta S, Langton-Lockton J, Shakeshaft J, Brown K, Idle S, Arvela N, Varma R, Lu H, Couldwell D, Eswarappa S, Smith DE, Furner V, Smith D, Cabrera G, Fernando S, Cogle A, Lawrence C, Mulhall B, Boyd M, Law M, Petoumenos K, Puhr R, Huang R, Han A, Gunathilake M, Payne R, O’Sullivan M, Croydon A, Russell D, Cashman C, Roberts C, Sowden D, Taing K, Marshall P, Orth D, Youds D, Rowling D, Latch N, Warzywoda E, Dickson B, Donohue W, Moore R, Edwards S, Boyd S, Roth NJ, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Allen A, Guelfi G, Mills G, Wharry C, Raymond N, Bargh K, Templeton D, Giles M, Brown K, Hoy J. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clin Infect Dis 2017; 65:1316-1326. [PMID: 28531260 PMCID: PMC5850623 DOI: 10.1093/cid/cix480] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). RESULTS We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. CONCLUSIONS Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
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Karo B, Krause G, Castell S, Kollan C, Hamouda O, Haas W. Immunological recovery in tuberculosis/HIV co-infected patients on antiretroviral therapy: implication for tuberculosis preventive therapy. BMC Infect Dis 2017; 17:517. [PMID: 28743248 PMCID: PMC5526303 DOI: 10.1186/s12879-017-2627-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/21/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Understanding the immune response to combination antiretroviral therapy (cART) is essential for a clear approach to tuberculosis (TB) preventive therapy. We investigated the immunological recovery in cART-treated HIV-infected patients developing TB compared to those who remained free of TB. METHODS We extracted data of HIV-infected patients from a multicenter cohort for the HIV clinical surveillance in Germany. No patients included in our study had TB at the beginning of the observation. Using a longitudinal mixed model, we assessed the differences in the mean change of biomarkers (CD4+ cell count, CD8+ cell count, CD4:CD8 ratio and viral load) since cART initiation in patients who remained free of TB vs. those developing TB. To detect the best-fit trajectories of the immunological biomarkers, we applied a multivariable fractional polynomials model. RESULTS We analyzed a total of 10,671 HIV-infected patients including 139 patients who developed TB during follow-up. The highest TB incidences were observed during the first two years since cART initiation (0.32 and 0.50 per 100 person-years). In an adjusted multivariable mixed model, we found that the average change in CD4+ cell count recovery was significantly greater by 33 cells/μl in patients who remained free of TB compared with those developing TB. After the initial three months of cART, 65.6% of patients who remaining free of TB achieved CD4+ count of ≥400 cells/μl, while only 11.3% of patients developing TB reached this immunological status after the three months of cART. We found no differences in the average change of CD8+ cell count, CD4:CD8 ratio or viral load between the two-patient groups. CONCLUSION All HIV-infected patients responded to cART. However, patients developing TB showed reduced recovery in CD4+ cell count and this might partly explain the incident TB in HIV-infected patients receiving cART. These findings reinforce the importance of adjunctive TB preventive therapy for patients with reduced recovery in CD4+ cell count.
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Affiliation(s)
- Basel Karo
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Seestr. 10, 13353, Berlin, Germany. .,PhD Programme, "Epidemiology", Braunschweig-Hannover, Germany.
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany.,Hannover Medical School (MHH), Hannover, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Christian Kollan
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Seestr. 10, 13353, Berlin, Germany
| | - Osamah Hamouda
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Seestr. 10, 13353, Berlin, Germany
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Seestr. 10, 13353, Berlin, Germany
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Dudareva-Vizule S, Haar K, Sailer A, Jansen K, Hamouda O, Wisplinghoff H, Tiemann C, Pape E, Bremer V. Establishment of a voluntary electronic Chlamydia trachomatis laboratory surveillance system in Germany, 2008 to 2014. ACTA ACUST UNITED AC 2017; 22:30459. [PMID: 28205505 PMCID: PMC5316906 DOI: 10.2807/1560-7917.es.2017.22.6.30459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/08/2016] [Indexed: 11/20/2022]
Abstract
Chlamydia trachomatis (CT) infections are not reportable in Germany and limited data on prevalence are available. CT screening has been offered free of charge to pregnant women since 1995 and to all women under 25 years since 2008. For symptomatic women and men, diagnostic testing is covered by statutory health insurance. We describe the establishment of a nationwide, laboratory-based, voluntary sentinel that electronically collects information on all performed CT tests with test results, test reason and patient information. The sentinel represents one third of all performed CT tests in Germany. In the period from 2008 to 2014, 3,877,588 CT tests were reported, 93% in women. Women aged 20–24 years and men aged 25–29 years were the most frequently tested age groups. The overall proportion of positive tests (PPT) among women was 3.9% and among men 11.0%. The highest PPT among women was in the age groups 15–19 (6.8%) and 20–24 years (5.9%), and among men in the age groups 20–24 (19.2%), 15–19 (15.4%) and 25–29 years (14.8%). The PPT for CT was high among women and men younger than 25 years. Prevention is urgently needed. Monitoring of CT infection in Germany should be continued.
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Affiliation(s)
- Sandra Dudareva-Vizule
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Charité University Medicine, Berlin, Germany
| | - Karin Haar
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Andrea Sailer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Klaus Jansen
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Osamah Hamouda
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Hilmar Wisplinghoff
- Wisplinghoff Laboratories, Cologne, Germany.,Institute for Medical Microbiology, University of Cologne, Cologne, Germany.,Institute for Microbiology, University Witten/Herdecke, Witten, Germany
| | | | - Eberhard Pape
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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- The Chlamydia trachomatis laboratory sentinel team is listed at the end of the article
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21
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Chereau F, Madec Y, Sabin C, Obel N, Ruiz-Mateos E, Chrysos G, Fidler S, Lehmann C, Zangerle R, Wittkop L, Reiss P, Hamouda O, Estrada Perez V, Leal M, Mocroft A, Garcia De Olalla P, Ammassari A, D’Arminio Monforte A, Mussini C, Segura F, Castagna A, Cavassini M, Grabar S, Morlat P, De Wit S, Lambotte O, Meyer L. Impact of CD4 and CD8 dynamics and viral rebounds on loss of virological control in HIV controllers. PLoS One 2017; 12:e0173893. [PMID: 28380038 PMCID: PMC5381858 DOI: 10.1371/journal.pone.0173893] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/28/2017] [Indexed: 11/20/2022] Open
Abstract
Objective HIV controllers (HICs) spontaneously maintain HIV viral replication at low level without antiretroviral therapy (ART), a small number of whom will eventually lose this ability to control HIV viremia. The objective was to identify factors associated with loss of virological control. Methods HICs were identified in COHERE on the basis of ≥5 consecutive viral loads (VL) ≤500 copies/mL over ≥1 year whilst ART-naive, with the last VL ≤500 copies/mL measured ≥5 years after HIV diagnosis. Loss of virological control was defined as 2 consecutive VL >2000 copies/mL. Duration of HIV control was described using cumulative incidence method, considering loss of virological control, ART initiation and death during virological control as competing outcomes. Factors associated with loss of virological control were identified using Cox models. CD4 and CD8 dynamics were described using mixed-effect linear models. Results We identified 1067 HICs; 86 lost virological control, 293 initiated ART, and 13 died during virological control. Six years after confirmation of HIC status, the probability of losing virological control, initiating ART and dying were 13%, 37%, and 2%. Current lower CD4/CD8 ratio and a history of transient viral rebounds were associated with an increased risk of losing virological control. CD4 declined and CD8 increased before loss of virological control, and before viral rebounds. Discussion Expansion of CD8 and decline of CD4 during HIV control may result from repeated low-level viremia. Our findings suggest that in addition to superinfection, other mechanisms, such as low grade viral replication, can lead to loss of virological control in HICs.
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Affiliation(s)
- Fanny Chereau
- Université Paris-Saclay, and Université Paris-Sud and Université de Versailles Saint-Quentin-en-Yvelines, and CESP, INSERM U1018, Kremlin-Bicêtre, France
| | - Yoann Madec
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France
| | - Caroline Sabin
- Research Department of Infection and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London, United Kingdom
| | - Niels Obel
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Ezequiel Ruiz-Mateos
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medecine, Institute of Biomedecine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Georgios Chrysos
- Department of Medicine, Infectious Disease Unit, Tzaneio General Hospital of Piraeus, Piraeus, Greece
| | | | - Clara Lehmann
- Department of Internal Medicine I, University of Cologne and German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Robert Zangerle
- Department of Dermatology and Venereology, Medical University Innsbruck, Innsbruck, Austria
| | - Linda Wittkop
- University Bordeaux, ISPED, INSERM U1219-Bordeaux Population Health, INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, CHU de Bordeaux, Pole de santé publique, Service d’information médicale, Bordeaux, France
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, the Netherlands, and Department of Global Health, Academic Medical Center, Amsterdam, the Netherlands
| | - Osamah Hamouda
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | | | - Manuel Leal
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medecine, Institute of Biomedecine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Amanda Mocroft
- Research Department of Infection and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London, United Kingdom
| | - Patricia Garcia De Olalla
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona and CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Adriana Ammassari
- Istituto Nazionale Malattie Infettive L. Spallanzani, IRCCS, Roma, Italy
| | - Antonella D’Arminio Monforte
- Infectious Diseases Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, University Hospital, Milan, Italy
| | - Cristina Mussini
- Clinic of Infectious diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Ferran Segura
- Infectious Diseases Service, Parc Taulí Hospital Universitario and Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Sophie Grabar
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and UPMC Université Paris 06, and Université Paris Descartes, Hôpital Cochin Hôtel-Dieu Paris, Paris, France
| | - Philippe Morlat
- Service de médecine interne et maladies infectieuses, CHU de Bordeaux, Université de Bordeaux, Inserm U1219, Bordeaux, France
| | - Stéphane De Wit
- Department of Infectious Diseases, St Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Lambotte
- Université Paris Sud, UMR 1184, Le Kremlin-Bicêtre, and CEA, DSV/iMETI, IDMIT, Fontenay-aux-Roses, and INSERM, U1184, Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin-Bicêtre, France and Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne et Immunologie clinique, Le Kremlin-Bicêtre, France
| | - Laurence Meyer
- Université Paris-Saclay, and Université Paris-Sud and Université de Versailles Saint-Quentin-en-Yvelines, and CESP, INSERM U1018, Kremlin-Bicêtre, France
- * E-mail:
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Haller S, Höller C, Jacobshagen A, Hamouda O, Abu Sin M, Monnet DL, Plachouras D, Eckmanns T. Contamination during production of heater-cooler units by Mycobacterium chimaera potential cause for invasive cardiovascular infections: results of an outbreak investigation in Germany, April 2015 to February 2016. ACTA ACUST UNITED AC 2017; 21:30215. [PMID: 27168588 DOI: 10.2807/1560-7917.es.2016.21.17.30215] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 04/18/2016] [Indexed: 12/17/2022]
Abstract
Invasive infections with Mycobacterium chimaera were reported in patients with previous open chest surgery and exposure to contaminated heater-cooler units (HCUs). We present results of the surveillance of clinical cases and of contaminated HCUs as well as environmental investigations in Germany up until February 2016. Clinical infections occurred in five male German cases over 50 years of age (range 53-80). Cases had been exposed to HCUs from one single manufacturer during open chest surgery up to five years prior to onset of symptoms. During environmental investigations, M. chimaera was detected in samples from used HCUs from three different countries and samples from new HCUs as well as in the environment at the manufacturing site of one manufacturer in Germany. Our investigation suggests that at least some of the M. chimaera infections may have been caused by contamination of HCUs at manufacturing site. We recommend that until sustainable measures for safe use of HCUs in operation theatres are implemented, users continue to adhere to instructions for use of HCUs and Field Safety Notices issued by the manufacturer, implement local monitoring for bacterial contamination and continuously check the websites of national and European authorities for current recommendations for the safe operation of HCUs.
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Affiliation(s)
- Sebastian Haller
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
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Bremer V, Haar K, Gassowski M, Hamouda O, Nielsen S. STI tests and proportion of positive tests in female sex workers attending local public health departments in Germany in 2010/11. BMC Public Health 2016; 16:1175. [PMID: 27871264 PMCID: PMC5117614 DOI: 10.1186/s12889-016-3847-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 11/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Germany, local public health departments (LPHD) are required to offer low-threshold access to confidential counselling and testing for sexually transmitted infections (STI) for sex workers. We collected data from LPHD in Germany to estimate the number of performed STI tests and the proportion of positive STI tests among attending female sex workers (FSW) in order to formulate recommendations for improving STI testing and care for FSW in Germany. METHODS We recruited LPHD across Germany to collect aggregated data on attending FSW between January 2010 and March 2011. Baseline characteristics, the number of attending FSW, STI tests (HIV, Chlamydia trachomatis, Neisseria gonorrhoea, syphilis and Trichomonas vaginalis) and the number of positive results were provided by participating LPHD. We described the number of STI tests per FSW visit and the proportion of positive test results, including interquartile range (IQR). We tested whether baseline characteristics of LPHD were associated with the proportion of positive test results. RESULTS Overall, 28 LPHD from 14 of the 16 federal states reported 9284 FSW visits over the study period, with a median of 188 FSW visits (IQR 45-440) per LPHD. Overall, a median of 77.1% (IQR 60.7-88.0) of visiting FSW received a test for Neisseria gonorrhoea, followed by HIV (66.0%, IQR 47.9-86.8), Chlamydia trachomatis (65.4%, IQR 50.7-83.6) and syphilis (61.6, IQR 48.6-78.6). In total, 22,914 STI tests were performed. The proportion of positive tests was 3.1% (IQR 1.3-4.8), with the highest proportion of positive tests for Chlamydia trachomatis (6.8%, IQR 2.5-10.4), followed by Neisseria gonorrhoea (3.2%, IQR 0.0-5.3), Trichomonas vaginalis (3.0%, IQR 0.0-15.4), syphilis (1.1%, IQR 0.0-1.3) and HIV (0.2%, IQR 0.0-0.4). The proportion of positive tests varied between 0 and 13.9% between LPHD, with a higher variation of proportion of positive tests in LPHD with a smaller number of reported STI tests. CONCLUSIONS Participating LPHD varied in terms of performed STI tests and FSW visits. The proportion of positive STI tests was low, but varied between LPHD. This variation likely reflects different testing strategies. Existing testing guidelines should be used by all LPHD to ensure high quality care for FSW.
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Affiliation(s)
- Viviane Bremer
- Department for Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Bloodborne Infections, Robert Koch-Institute, Berlin, Germany.
| | - Karin Haar
- Department for Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Bloodborne Infections, Robert Koch-Institute, Berlin, Germany
| | - Martyna Gassowski
- Department for Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Bloodborne Infections, Robert Koch-Institute, Berlin, Germany
| | - Osamah Hamouda
- Department for Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Bloodborne Infections, Robert Koch-Institute, Berlin, Germany
| | - Stine Nielsen
- Department for Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Bloodborne Infections, Robert Koch-Institute, Berlin, Germany
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Wenz B, Nielsen S, Gassowski M, Santos-Hövener C, Cai W, Ross RS, Bock CT, Ratsch BA, Kücherer C, Bannert N, Bremer V, Hamouda O, Marcus U, Zimmermann R. High variability of HIV and HCV seroprevalence and risk behaviours among people who inject drugs: results from a cross-sectional study using respondent-driven sampling in eight German cities (2011-14). BMC Public Health 2016; 16:927. [PMID: 27595567 PMCID: PMC5011883 DOI: 10.1186/s12889-016-3545-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 08/18/2016] [Indexed: 12/15/2022] Open
Abstract
Background People who inject drugs (PWID) are at increased risk of acquiring and transmitting HIV and Hepatitis C (HCV) due to sharing injection paraphernalia and unprotected sex. To generate seroprevalence data on HIV and HCV among PWID and related data on risk behaviour, a multicentre sero- and behavioural survey using respondent driven sampling (RDS) was conducted in eight German cities between 2011 and 2014. We also evaluated the feasibility and effectiveness of RDS for recruiting PWID in the study cities. Methods Eligible for participation were people who had injected drugs within the last 12 months, were 16 years or older, and who consumed in one of the study cities. Participants were recruited, using low-threshold drop-in facilities as study sites. Initial seeds were selected to represent various sub-groups of people who inject drugs (PWID). Participants completed a face-to-face interview with a structured questionnaire about socio-demographics, sexual and injecting risk behaviours, as well as the utilisation of health services. Capillary blood samples were collected as dried blood spots and were anonymously tested for serological and molecular markers of HIV and HCV. The results are shown as range of proportions (min. and max. values (%)) in the respective study cities. For evaluation of the sampling method we applied criteria from the STROBE guidelines. Results Overall, 2,077 PWID were recruited. The range of age medians was 29–41 years, 18.5–35.3 % of participants were female, and 9.2–30.6 % were foreign born. Median time span since first injection were 10–18 years. Injecting during the last 30 days was reported by 76.0–88.4 % of participants. Sharing needle/syringes (last 30 days) ranged between 4.7 and 22.3 %, while sharing unsterile paraphernalia (spoon, filter, water, last 30 days) was reported by 33.0–43.8 %. A majority of participants (72.8–85.8 %) reported incarceration at least once, and 17.8–39.8 % had injected while incarcerated. Between 30.8 and 66.2 % were currently in opioid substitution therapy. Unweighted HIV seroprevalence ranged from 0–9.1 %, HCV from 42.3–75.0 %, and HCV-RNA from 23.1–54.0 %. The implementation of RDS as a recruiting method in cooperation with low-threshold drop in facilities was well accepted by both staff and PWID. We reached our targeted sample size in seven of eight cities. Conclusions In the recruited sample of mostly current injectors with a long duration of injecting drug use, seroprevalence for HIV and HCV varied greatly between the city samples. HCV was endemic among participants in all city samples. Our results demonstrate the necessity of intensified prevention strategies for blood-borne infections among PWID in Germany. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3545-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Wenz
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Stine Nielsen
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.,Charité University Medicine, Berlin, Germany
| | - Martyna Gassowski
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Claudia Santos-Hövener
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Wei Cai
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - R Stefan Ross
- Institute of Virology, National Reference Centre for Hepatitis C, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Claus-Thomas Bock
- Department of Infectious Diseases, Division for Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Robert Koch Institute, Berlin, Germany
| | - Boris-Alexander Ratsch
- Department of Infectious Diseases, Division for Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Robert Koch Institute, Berlin, Germany
| | - Claudia Kücherer
- Department of Infectious Diseases, Division for HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Norbert Bannert
- Department of Infectious Diseases, Division for HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Osamah Hamouda
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ulrich Marcus
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ruth Zimmermann
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.
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Marcus U, Zucs P, Bremer V, Hamouda O, Prager R, Tschaepe H, Futh U, Kramer M. Shigellosis — a re-emerging sexually transmitted infection: outbreak in men having sex with men in Berlin. Int J STD AIDS 2016; 15:533-7. [PMID: 15307964 DOI: 10.1258/0956462041558221] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In December 2001, the Robert Koch-Institut (RKI) was informed about a cluster of 10 Shigella sonnei infections in men who have sex with men (MSM), diagnosed in Berlin since September 2001. A retrospective investigation on sexual risk factors for infection in all shigella cases from Berlin from 2001 was initiated by sending a questionnaire to all patients without known travel history. Simultaneously laboratories were asked to send new shigella isolates from patients to the National Reference Centre at the RKI. Out of 29 responders, 24 self-identified as MSM. Seventeen of these reported sexual contacts as the most likely potential risk of infection. Almost all MSM reported direct or indirect oral–anal sexual contacts in the week before they fell ill. Fifteen of 27 shigella isolates collected during the prospective sampling period showed identical plasmid profiles, PFGE- and resistance patterns and can therefore be regarded as clonally identical. Asymptomatic and/or prolonged shedding in the reconvalescent phase may contribute to the transmission risk of shigella infection during oral–anal sexual practices. Awareness among practitioners and among MSM about the risk of sexual transmission of orally transmitted agents needs to be raised.
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Affiliation(s)
- U Marcus
- Center of Infectious Disease Epidemiology, Robert Koch-Institut, Seestrasse 10, 13353 Berlin, Germany.
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Magiorkinis G, Angelis K, Mamais I, Katzourakis A, Hatzakis A, Albert J, Lawyer G, Hamouda O, Struck D, Vercauteren J, Wensing A, Alexiev I, Åsjö B, Balotta C, Gomes P, Camacho RJ, Coughlan S, Griskevicius A, Grossman Z, Horban A, Kostrikis LG, Lepej SJ, Liitsola K, Linka M, Nielsen C, Otelea D, Paredes R, Poljak M, Puchhammer-Stöckl E, Schmit JC, Sönnerborg A, Staneková D, Stanojevic M, Stylianou DC, Boucher CAB, Nikolopoulos G, Vasylyeva T, Friedman SR, van de Vijver D, Angarano G, Chaix ML, de Luca A, Korn K, Loveday C, Soriano V, Yerly S, Zazzi M, Vandamme AM, Paraskevis D. The global spread of HIV-1 subtype B epidemic. Infect Genet Evol 2016; 46:169-179. [PMID: 27262355 PMCID: PMC5157885 DOI: 10.1016/j.meegid.2016.05.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 01/04/2023]
Abstract
Human immunodeficiency virus type 1 (HIV-1) was discovered in the early 1980s when the virus had already established a pandemic. For at least three decades the epidemic in the Western World has been dominated by subtype B infections, as part of a sub-epidemic that traveled from Africa through Haiti to United States. However, the pattern of the subsequent spread still remains poorly understood. Here we analyze a large dataset of globally representative HIV-1 subtype B strains to map their spread around the world over the last 50years and describe significant spread patterns. We show that subtype B travelled from North America to Western Europe in different occasions, while Central/Eastern Europe remained isolated for the most part of the early epidemic. Looking with more detail in European countries we see that the United Kingdom, France and Switzerland exchanged viral isolates with non-European countries than with European ones. The observed pattern is likely to mirror geopolitical landmarks in the post-World War II era, namely the rise and the fall of the Iron Curtain and the European colonialism. In conclusion, HIV-1 spread through specific migration routes which are consistent with geopolitical factors that affected human activities during the last 50years, such as migration, tourism and trade. Our findings support the argument that epidemic control policies should be global and incorporate political and socioeconomic factors.
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Affiliation(s)
| | - Konstantinos Angelis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Ioannis Mamais
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | | | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Glenn Lawyer
- Department of Computational Biology, Max Planck Institute for Informatics, Saarbrücken, Germany
| | | | - Daniel Struck
- Centre de Recherche Public de la Sante, Luxembourg, Luxembourg
| | - Jurgen Vercauteren
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Annemarie Wensing
- Department of Virology, University Medical Center, Utrecht, The Netherlands
| | - Ivailo Alexiev
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | | | - Perpétua Gomes
- Molecular Biology Lab, LMCBM, SPC, HEM, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ricardo J Camacho
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | | | | | | | | | | | - Snjezana J Lepej
- Department of Molecular Diagnostics and Flow Cytometry, University Hospital for Infectious Diseases "Dr. F. Mihaljevic", Zagreb, Croatia
| | - Kirsi Liitsola
- National Institute of Health and Welfare, Helsinki, Finland
| | - Marek Linka
- National Reference Laboratory of AIDS, National Institute of Health, Prague, Czech Republic
| | | | - Dan Otelea
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania
| | | | - Mario Poljak
- Slovenian HIV/AIDS Reference Centre, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | | | | | - Anders Sönnerborg
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Divisions of Infectious Diseases and Clinical Virology, Karolinska Institute, Stockholm, Sweden
| | | | - Maja Stanojevic
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | | | | | | | - Georgios Nikolopoulos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | | | - Samuel R Friedman
- Institute of Infectious Diseases Research, National Development and Research Institutes, Inc., New York, USA
| | - David van de Vijver
- Eijkman Winkler Institute, Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Andrea de Luca
- Institute of Clinical Infectious Diseases, Catholic university, Rome, Italy
| | - Klaus Korn
- University of Erlangen, Erlangen, Germany
| | - Clive Loveday
- International Clinical Virology Centre, Buckinghamshire, England, United Kingdom
| | | | | | | | - Anne-Mieke Vandamme
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece.
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Karo B, Krause G, Hollo V, van der Werf MJ, Castell S, Hamouda O, Haas W. Impact of HIV infection on treatment outcome of tuberculosis in Europe. AIDS 2016; 30:1089-98. [PMID: 26752278 DOI: 10.1097/qad.0000000000001016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The effect of HIV on tuberculosis (TB) treatment outcomes has not been well established. We aimed to assess the impact of HIV infection on TB treatment outcomes by using data from notifiable disease surveillance in Europe. METHODS We analyzed the treatment outcomes of TB cases reported from nine European countries during 2010-2012. We investigate the effect of HIV on TB treatment outcomes using a multilevel and a multinomial logistic model, and considering the interaction between HIV and multidrug-resistant (MDR) TB. RESULTS A total of 61,138 TB cases including 5.5% HIV-positive were eligible for our analysis. In the multilevel model adjusted for age and an interaction with MDR TB, HIV was significantly associated with lower treatment success in all MDR strata [non-MDR TB: odds ratio (OR) 0.24 CI (confidence interval) 0.20-0.29; unknown MDR TB status: OR 0.26 CI 0.23-0.30; MDR TB: OR 0.57 CI 0.35-0.91]. In the multinomial regression model, HIV-positive cases had significantly higher relative risk ratio (RRR) for death (non-MDR TB: RRR 4.30 CI 2.31-7.99; unknown MDR TB status: 5.55 CI 3.10-9.92; MDR TB: 3.59 CI 1.56-8.28) and being 'still on treatment' (non-MDR TB: RRR 7.27 CI 3.00-17.6; unknown MDR TB status: 5.36 CI 2.44-11.8; MDR TB: 3.76 CI 2.48-5.71). We did not find any significant association between HIV and TB treatment failure (non-MDR TB: RRR 0.50 CI 0.15-1.67; unknown MDR TB status: 1.51 CI 0.86-2.64; MDR TB: 0.51 CI 0.13-1.87). CONCLUSION This large study confirms that HIV is a strong risk factor for an adverse TB treatment outcome, which is mainly manifested by an increased risk of death and still being on TB treatment.
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Hofstra LM, Sauvageot N, Albert J, Alexiev I, Garcia F, Struck D, Van de Vijver DAMC, Åsjö B, Beshkov D, Coughlan S, Descamps D, Griskevicius A, Hamouda O, Horban A, Van Kasteren M, Kolupajeva T, Kostrikis LG, Liitsola K, Linka M, Mor O, Nielsen C, Otelea D, Paraskevis D, Paredes R, Poljak M, Puchhammer-Stöckl E, Sönnerborg A, Staneková D, Stanojevic M, Van Laethem K, Zazzi M, Zidovec Lepej S, Boucher CAB, Schmit JC, Wensing AMJ, Puchhammer-Stockl E, Sarcletti M, Schmied B, Geit M, Balluch G, Vandamme AM, Vercauteren J, Derdelinckx I, Sasse A, Bogaert M, Ceunen H, De Roo A, De Wit S, Echahidi F, Fransen K, Goffard JC, Goubau P, Goudeseune E, Yombi JC, Lacor P, Liesnard C, Moutschen M, Pierard D, Rens R, Schrooten Y, Vaira D, Vandekerckhove LPR, Van den Heuvel A, Van Der Gucht B, Van Ranst M, Van Wijngaerden E, Vandercam B, Vekemans M, Verhofstede C, Clumeck N, Van Laethem K, Beshkov D, Alexiev I, Lepej SZ, Begovac J, Kostrikis L, Demetriades I, Kousiappa I, Demetriou V, Hezka J, Linka M, Maly M, Machala L, Nielsen C, Jørgensen LB, Gerstoft J, Mathiesen L, Pedersen C, Nielsen H, Laursen A, Kvinesdal B, Liitsola K, Ristola M, Suni J, Sutinen J, Descamps D, Assoumou L, Castor G, Grude M, Flandre P, Storto A, Hamouda O, Kücherer C, Berg T, Braun P, Poggensee G, Däumer M, Eberle J, Heiken H, Kaiser R, Knechten H, Korn K, Müller H, Neifer S, Schmidt B, Walter H, Gunsenheimer-Bartmeyer B, Harrer T, Paraskevis D, Hatzakis A, Zavitsanou A, Vassilakis A, Lazanas M, Chini M, Lioni A, Sakka V, Kourkounti S, Paparizos V, Antoniadou A, Papadopoulos A, Poulakou G, Katsarolis I, Protopapas K, Chryssos G, Drimis S, Gargalianos P, Xylomenos G, Lourida G, Psichogiou M, Daikos GL, Sipsas NV, Kontos A, Gamaletsou MN, Koratzanis G, Sambatakou H, Mariolis H, Skoutelis A, Papastamopoulos V, Georgiou O, Panagopoulos P, Maltezos E, Coughlan S, De Gascun C, Byrne C, Duffy M, Bergin C, Reidy D, Farrell G, Lambert J, O'Connor E, Rochford A, Low J, Coakely P, O'Dea S, Hall W, Mor O, Levi I, Chemtob D, Grossman Z, Zazzi M, de Luca A, Balotta C, Riva C, Mussini C, Caramma I, Capetti A, Colombo MC, Rossi C, Prati F, Tramuto F, Vitale F, Ciccozzi M, Angarano G, Rezza G, Kolupajeva T, Vasins O, Griskevicius A, Lipnickiene V, Schmit JC, Struck D, Sauvageot N, Hemmer R, Arendt V, Michaux C, Staub T, Sequin-Devaux C, Wensing AMJ, Boucher CAB, van de Vijver DAMC, van Kessel A, van Bentum PHM, Brinkman K, Connell BJ, van der Ende ME, Hoepelman IM, van Kasteren M, Kuipers M, Langebeek N, Richter C, Santegoets RMWJ, Schrijnders-Gudde L, Schuurman R, van de Ven BJM, Åsjö B, Kran AMB, Ormaasen V, Aavitsland P, Horban A, Stanczak JJ, Stanczak GP, Firlag-Burkacka E, Wiercinska-Drapalo A, Jablonowska E, Maolepsza E, Leszczyszyn-Pynka M, Szata W, Camacho R, Palma C, Borges F, Paixão T, Duque V, Araújo F, Otelea D, Paraschiv S, Tudor AM, Cernat R, Chiriac C, Dumitrescu F, Prisecariu LJ, Stanojevic M, Jevtovic D, Salemovic D, Stanekova D, Habekova M, Chabadová Z, Drobkova T, Bukovinova P, Shunnar A, Truska P, Poljak M, Lunar M, Babic D, Tomazic J, Vidmar L, Vovko T, Karner P, Garcia F, Paredes R, Monge S, Moreno S, Del Amo J, Asensi V, Sirvent JL, de Mendoza C, Delgado R, Gutiérrez F, Berenguer J, Garcia-Bujalance S, Stella N, de Los Santos I, Blanco JR, Dalmau D, Rivero M, Segura F, Elías MJP, Alvarez M, Chueca N, Rodríguez-Martín C, Vidal C, Palomares JC, Viciana I, Viciana P, Cordoba J, Aguilera A, Domingo P, Galindo MJ, Miralles C, Del Pozo MA, Ribera E, Iribarren JA, Ruiz L, de la Torre J, Vidal F, Clotet B, Albert J, Heidarian A, Aperia-Peipke K, Axelsson M, Mild M, Karlsson A, Sönnerborg A, Thalme A, Navér L, Bratt G, Karlsson A, Blaxhult A, Gisslén M, Svennerholm B, Bergbrant I, Björkman P, Säll C, Mellgren Å, Lindholm A, Kuylenstierna N, Montelius R, Azimi F, Johansson B, Carlsson M, Johansson E, Ljungberg B, Ekvall H, Strand A, Mäkitalo S, Öberg S, Holmblad P, Höfer M, Holmberg H, Josefson P, Ryding U. Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe. Clin Infect Dis 2015; 62:655-663. [PMID: 26620652 PMCID: PMC4741360 DOI: 10.1093/cid/civ963] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/06/2015] [Indexed: 11/13/2022] Open
Abstract
Transmitted human immunodeficiency virus drug resistance in Europe is stable at around 8%. The impact of baseline mutation patterns on susceptibility to antiretroviral drugs should be addressed using clinical guidelines. The impact on baseline susceptibility is largest for nonnucleoside reverse transcriptase inhibitors. Background. Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001. Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)–infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0. Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%–9.5%) in 2008–2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones. Conclusions. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.
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Affiliation(s)
- L Marije Hofstra
- Luxembourg Institute of Health, Luxembourg.,Department of Virology, University Medical Center Utrecht, The Netherlands
| | | | - Jan Albert
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
| | - Ivailo Alexiev
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Federico Garcia
- Complejo Hospitalario Universitario de Granada, Instituto de Investigación IBS Granada; on behalf of Cohorte de Adultos de la Red de Investigación en SIDA, Spain
| | | | | | | | - Danail Beshkov
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Diane Descamps
- AP-HP Groupe hospitalier Bichat-Claude Bernard, IAME INSERM UMR 1137, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | | | | | | | | | | | | | - Kirsi Liitsola
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland
| | - Marek Linka
- National Reference Laboratory for HIV/AIDS, National Institute of Public Health, Prague, Czech Republic
| | - Orna Mor
- National HIV Reference Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Dan Otelea
- National Institute for Infectious Diseases "Prof. dr. Matei Bals", Bucharest, Romania
| | | | | | - Mario Poljak
- Faculty of Medicine, Slovenian HIV/AIDS Reference Centre, University of Ljubljana, Slovenia
| | | | - Anders Sönnerborg
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
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Vogel U, Beermann S, Gerlich W, Hamouda O, Kempf VAJ, Slack M. Twenty years of National Reference and Consultant laboratories for infectious diseases in Germany. Int J Med Microbiol 2015; 305:591-4. [PMID: 26363622 DOI: 10.1016/j.ijmm.2015.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ulrich Vogel
- University of Würzburg, Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, Josef-Schneider-Str. 2 (E1), 97080 Würzburg, Germany.
| | - Sandra Beermann
- Robert Koch Institute, Department of Infectious Diseases Epidemiology, Berlin, Germany
| | - Wolfram Gerlich
- Justus Liebig University Giessen, Institute for Medical Virology, National Reference Centre for Hepatitis B and D, Giessen, Germany
| | - Osamah Hamouda
- Robert Koch Institute, Department of Infectious Diseases Epidemiology, Berlin, Germany
| | - Volkhard A J Kempf
- University Hospital of Frankfurt am Main, Institute for Medical Microbiology and Infection Control, National Consultant Laboratory for Bartonella spp., Frankfurt am Main, Germany
| | - Mary Slack
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
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Dudareva-Vizule S, Jansen K, Haar K, Sailer A, Hofmann A, Hamouda O, Bremer V. P08.36 Chlamydia trachomatisinfection in women in germany, 2008–2014. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Beermann S, Allerberger F, Wirtz A, Burger R, Hamouda O. Public health microbiology in Germany: 20 years of national reference centers and consultant laboratories. Int J Med Microbiol 2015; 305:595-600. [PMID: 26321004 PMCID: PMC7106537 DOI: 10.1016/j.ijmm.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In 1995, in agreement with the German Federal Ministry of Health, the Robert Koch Institute established a public health microbiology system consisting of national reference centers (NRCs) and consultant laboratories (CLs). The goal was to improve the efficiency of infection protection by advising the authorities on possible measures and to supplement infectious disease surveillance by monitoring selected pathogens that have high public health relevance. Currently, there are 19 NRCs and 40 CLs, each appointed for three years. In 2009, an additional system of national networks of NRCs and CLs was set up in order to enhance effectiveness and cooperation within the national reference laboratory system. The aim of these networks was to advance exchange in diagnostic methods and prevention concepts among reference laboratories and to develop geographic coverage of services. In the last two decades, the German public health laboratory reference system coped with all major infectious disease challenges. The European Union and the European Centre for Disease Prevention and Control (ECDC) are considering implementing a European public health microbiology reference laboratory system. The German reference laboratory system should be well prepared to participate actively in this upcoming endeavor.
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Affiliation(s)
- Sandra Beermann
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| | - Franz Allerberger
- Austrian Agency for Health and Food Safety, Spargelfeldstr. 191, 1220 Vienna, Austria
| | - Angela Wirtz
- Department of Public Health, Ministry of Social Affairs, Hesse, Dostojewskistr. 4, 65187 Wiesbaden, Germany
| | | | - Osamah Hamouda
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany.
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Santos-Hövener C, Marcus U, Koschollek C, Oudini H, Wiebe M, Ouedraogo OI, Thorlie A, Bremer V, Hamouda O, Dierks ML, An der Heiden M, Krause G. Determinants of HIV, viral hepatitis and STI prevention needs among African migrants in Germany; a cross-sectional survey on knowledge, attitudes, behaviors and practices. BMC Public Health 2015; 15:753. [PMID: 26246382 PMCID: PMC4545823 DOI: 10.1186/s12889-015-2098-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrants from sub-Saharan Africa (MisSA) are a relevant sub-group for HIV-transmission in Germany. A total of 10-15 % of all newly diagnosed cases are MisSA, and approximately one third acquired HIV in Germany. There is limited information on knowledge, attitudes, behaviors and practices (KABP) regarding sexual health in African communities residing in Germany. METHODS From October-December 2013 we conducted a cross-sectional survey on KABP regarding HIV, viral hepatitis (HEP), and sexually transmitted infections (STI) among MisSA in Hamburg as a community-based participatory research project to identify knowledge gaps, sexual risk behavior regarding HIV/HEP/STI, HIV/STI-testing history and attitudes toward people living with HIV (PLWH). Trained peer researchers recruited participants through outreach. Questionnaires in German, English or French were either administered face-to-face or self-completed. Questions on knowledge about HIV/HEP/STI presented true statements; participants were asked if they knew the information before. To detect differences in sub-groups, unadjusted odds ratios (OR) were calculated, and a multivariate analysis for knowledge on HIV/HEP/STI was performed. RESULTS The final sample included 569 participants of whom 57 % were men. Most participants originated from Western and Central sub-Saharan Africa. Median time living in Germany was 6 years. Overall, 28 % had a university degree and 54 % reported a good level of German language. Over 80 % knew the risks for HIV transmission. A total of 44 % of respondents wrongly assumed that an HIV-diagnosis might lead to deportation and 64 % were not aware of the free and anonymous local HIV/STI-testing service. The proportion of participants with knowledge of presented facts on HEP varied from 40-58 %. The respective proportion on STI was 28-68 % and better among women compared to men (44 % vs. 54 %; OR = 1.45; 95 % CI 1.22-1.74). Men reported more often casual sex partners than women (43 % vs. 23 %; OR = 2.6; 95 % CI 1.7-4.0), and more frequently a previous STI (58 % vs. 39 %; OR = 2.1; 95 % CI 1.1-4.1). Overall, 16 % of women reported a history of sexual violence. The majority of respondents (75 %) reported that they would treat PLWH like any other person. CONCLUSION Study participants demonstrated good knowledge on HIV-transmission but knowledge gaps regarding HIV/STI-testing services, HEP and STI. This calls for targeted interventions providing more information about these topics in African communities in Hamburg and possibly also elsewhere.
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Affiliation(s)
- Claudia Santos-Hövener
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
| | - Ulrich Marcus
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
| | - Carmen Koschollek
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
| | - Hapsatou Oudini
- AIDS Foundation Hamburg, Lange Reihe 32, 20099, Hamburg, Germany.
| | - Mara Wiebe
- AIDS Foundation Hamburg, Lange Reihe 32, 20099, Hamburg, Germany.
| | | | - Adama Thorlie
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
| | - Viviane Bremer
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
| | - Osamah Hamouda
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
| | - Marie-Luise Dierks
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany.
| | - Matthias An der Heiden
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre of Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. .,Hannover Medical School, Hannover, Germany.
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Schmidt D, Kollan C, Stoll M, Stellbrink HJ, Plettenberg A, Fätkenheuer G, Bergmann F, Bogner JR, van Lunzen J, Rockstroh J, Esser S, Jensen BEO, Horst HA, Fritzsche C, Kühne A, an der Heiden M, Hamouda O, Bartmeyer B. From pills to patients: an evaluation of data sources to determine the number of people living with HIV who are receiving antiretroviral therapy in Germany. BMC Public Health 2015; 15:252. [PMID: 25848706 PMCID: PMC4369891 DOI: 10.1186/s12889-015-1598-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/27/2015] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to determine the number of people living with HIV receiving antiretroviral therapy (ART) between 2006 and 2013 in Germany by using the available numbers of antiretroviral drug prescriptions and treatment data from the ClinSurv HIV cohort (CSH). Methods The CSH is a multi-centre, open, long-term observational cohort study with an average number of 10.400 patients in the study period 2006–2013. ART has been documented on average for 86% of those CSH patients and medication history is well documented in the CSH. The antiretroviral prescription data (APD) are reported by billing centres for pharmacies covering >99% of nationwide pharmacy sales of all individuals with statutory health insurance (SHI) in Germany (~85%). Exactly one thiacytidine-containing medication (TCM) with either emtricitabine or lamivudine is present in all antiretroviral fixed-dose combinations (FDCs). Thus, each daily dose of TCM documented in the APD is presumed to be representative of one person per day receiving ART. The proportion of non-TCM regimen days in the CSH was used to determine the corresponding number of individuals in the APD. Results The proportion of CSH patients receiving TCMs increased continuously over time (from 85% to 93%; 2006–2013). In contrast, treatment interruptions declined remarkably (from 11% to 2%; 2006–2013). The total number of HIV-infected people with ART experience in Germany increased from 31,500 (95% CI 31,000-32,000) individuals to 54,000 (95% CI 53,000-55,500) over the observation period (including 16.3% without SHI and persons who had interrupted ART). An average increase of approximately 2,900 persons receiving ART was observed annually in Germany. Conclusions A substantial increase in the number of people receiving ART was observed from 2006 to 2013 in Germany. Currently, the majority (93%) of antiretroviral regimens in the CSH included TCMs with ongoing use of FDCs. Based on these results, the future number of people receiving ART could be estimated by exclusively using TCM prescriptions, assuming that treatment guidelines will not change with respect to TCM use in ART regimens.
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Angelis K, Albert J, Mamais I, Magiorkinis G, Hatzakis A, Hamouda O, Struck D, Vercauteren J, Wensing AMJ, Alexiev I, Åsjö B, Balotta C, Camacho RJ, Coughlan S, Griskevicius A, Grossman Z, Horban A, Kostrikis LG, Lepej S, Liitsola K, Linka M, Nielsen C, Otelea D, Paredes R, Poljak M, Puchhammer-Stöckl E, Schmit JC, Sönnerborg A, Staneková D, Stanojevic M, Boucher CAB, Kaplan L, Vandamme AM, Paraskevis D. Global Dispersal Pattern of HIV Type 1 Subtype CRF01_AE: A Genetic Trace of Human Mobility Related to Heterosexual Sexual Activities Centralized in Southeast Asia. J Infect Dis 2014; 211:1735-44. [PMID: 25512631 DOI: 10.1093/infdis/jiu666] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/24/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus type 1 (HIV-1) subtype CRF01_AE originated in Africa and then passed to Thailand, where it established a major epidemic. Despite the global presence of CRF01_AE, little is known about its subsequent dispersal pattern. METHODS We assembled a global data set of 2736 CRF01_AE sequences by pooling sequences from public databases and patient-cohort studies. We estimated viral dispersal patterns, using statistical phylogeographic analysis run over bootstrap trees estimated by the maximum likelihood method. RESULTS We show that Thailand has been the source of viral dispersal to most areas worldwide, including 17 of 20 sampled countries in Europe. Japan, Singapore, Vietnam, and other Asian countries have played a secondary role in the viral dissemination. In contrast, China and Taiwan have mainly imported strains from neighboring Asian countries, North America, and Africa without any significant viral exportation. DISCUSSION The central role of Thailand in the global spread of CRF01_AE can be probably explained by the popularity of Thailand as a vacation destination characterized by sex tourism and by Thai emigration to the Western world. Our study highlights the unique case of CRF01_AE, the only globally distributed non-B clade whose global dispersal did not originate in Africa.
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Affiliation(s)
- Konstantinos Angelis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, University of Athens, Greece
| | - Jan Albert
- Department of Microbiology, Tumor, and Cell Biology Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ioannis Mamais
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, University of Athens, Greece
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, University of Athens, Greece Department of Zoology, University of Oxford, United Kingdom
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, University of Athens, Greece
| | | | | | - Jurgen Vercauteren
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Belgium
| | | | - Ivailo Alexiev
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | | | - Ricardo J Camacho
- Centro de Malária e OutrasDoenças Tropicais and Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal
| | | | | | | | | | | | - Snjezana Lepej
- Department of Molecular Diagnostics and Flow Cytometry, University Hospital for Infectious Diseases Dr F. Mihaljevic, Zagreb, Croatia
| | - Kirsi Liitsola
- National Institute of Health and Welfare, Helsinki, Finland
| | - Marek Linka
- National Reference Laboratory of AIDS, National Institute of Health, Prague, Czech Republic
| | | | - Dan Otelea
- National Institute for Infectious Diseases Prof Dr Matei Bals, Bucharest, Romania
| | | | - Mario Poljak
- Faculty of Medicine, Slovenian HIV/AIDS Reference Center, University of Ljubljana, Slovenia
| | | | | | - Anders Sönnerborg
- Division of Infectious Diseases Division of Clinical Virology, Karolinska Institute Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Lauren Kaplan
- Alcohol Research Group, University California, Berkeley
| | - Anne-Mieke Vandamme
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Belgium Centro de Malária e OutrasDoenças Tropicais and Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, University of Athens, Greece
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an der Heiden M, Ritter S, Hamouda O, Offergeld R. Estimating the residual risk for HIV, HCV and HBV in different types of platelet concentrates in Germany. Vox Sang 2014; 108:123-30. [PMID: 25335096 DOI: 10.1111/vox.12204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES We estimated and compared the residual risks due to window-period donations for pooled and apheresis platelets in Germany using a modification of a previously described statistical model. This model directly utilizes the reported interdonation intervals before a positive donation and reflects in this aspect the look-back procedures used in haemovigilance. MATERIALS AND METHODS Data from the German National Blood Donor Surveillance System for the years 2006-2012, including reports about donations from repeat donors with confirmed positive test results for HIV, HCV and HBV, were used to estimate the risk of undetected infectious units for both pooled and apheresis platelets. RESULTS Demographics of whole-blood and apheresis donors differed in age, gender, catchment area and interdonation interval. These differences impact on the prevalence and incidence of transfusion relevant infections and consequently the residual risk. The estimates for the residual risks for pooled and apheresis platelets were comparable. For HIV, there was no significant difference, for HCV apheresis platelets had a lower residual risk, whereas pooled platelets had a lower risk for undetected HBV infections. CONCLUSION These findings do not support calls for a shift to an apheresis platelets-only policy in Germany.
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Affiliation(s)
- M an der Heiden
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Schmidt D, Kollan C, Fätkenheuer G, Schülter E, Stellbrink HJ, Noah C, Jensen BEO, Stoll M, Bogner JR, Eberle J, Meixenberger K, Kücherer C, Hamouda O, Bartmeyer B. Estimating trends in the proportion of transmitted and acquired HIV drug resistance in a long term observational cohort in Germany. PLoS One 2014; 9:e104474. [PMID: 25148412 PMCID: PMC4141736 DOI: 10.1371/journal.pone.0104474] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/14/2014] [Indexed: 11/19/2022] Open
Abstract
Objective We assessed trends in the proportion of transmitted (TDR) and acquired (ADR) HIV drug resistance and associated mutations between 2001 and 2011 in the German ClinSurv-HIV Drug Resistance Study. Method The German ClinSurv-HIV Drug Resistance Study is a subset of the German ClinSurv-HIV Cohort. For the ClinSurv-HIV Drug Resistance Study all available sequences isolated from patients in five study centres of the long term observational ClinSurv-HIV Cohort were included. TDR was estimated using the first viral sequence of antiretroviral treatment (ART) naïve patients. One HIV sequence/patient/year of ART experienced patients was considered to estimate the proportion of ADR. Trends in the proportion of HIV drug resistance were calculated by logistic regression. Results 9,528 patients were included into the analysis. HIV-sequences of antiretroviral naïve and treatment experienced patients were available from 34% (3,267/9,528) of patients. The proportion of TDR over time was stable at 10.4% (95% CI 9.1–11.8; p for trend = 0.6; 2001–2011). The proportion of ADR among all treated patients was 16%, whereas it was high among those with available HIV genotypic resistance test (64%; 1,310/2,049 sequences; 95% CI 62–66) but declined significantly over time (OR 0.8; 95% CI 0.77–0.83; p for trend<0.001; 2001–2011). Viral load monitoring subsequent to resistance testing was performed in the majority of treated patients (96%) and most of them (67%) were treated successfully. Conclusions The proportion of TDR was stable in this study population. ADR declined significantly over time. This decline might have been influenced by broader resistance testing, resistance test guided therapy and the availability of more therapeutic options and not by a decline in the proportion of TDR within the study population.
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Affiliation(s)
- Daniel Schmidt
- Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood Born Infections, Robert Koch-Institute, Berlin, Germany
| | - Christian Kollan
- Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood Born Infections, Robert Koch-Institute, Berlin, Germany
| | | | - Eugen Schülter
- Clinic of Internal Medicine, University Köln, Köln, Germany
| | | | | | - Björn-Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Matthias Stoll
- Clinic for Immunology and Rheumatology, Infectious Diseases Unit, Medical University Hannover, Hannover, Germany
| | - Johannes R. Bogner
- Department of Infectious Disease, Med IV, University Hospital of Munich, Munich Germany
| | - Josef Eberle
- Max von Pettenkofer Institute, Institute of Virology, Ludwig Maximilians University, Munich, Germany
| | - Karolin Meixenberger
- Department of Infectious Diseases, HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Claudia Kücherer
- Department of Infectious Diseases, HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Osamah Hamouda
- Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood Born Infections, Robert Koch-Institute, Berlin, Germany
| | - Barbara Bartmeyer
- Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood Born Infections, Robert Koch-Institute, Berlin, Germany
- * E-mail:
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Zimmermann R, Marcus U, Schäffer D, Leicht A, Wenz B, Nielsen S, Santos-Hövener C, Ross RS, Stambouli O, Ratsch BA, Bannert N, Bock CT, Kücherer C, Hamouda O. A multicentre sero-behavioural survey for hepatitis B and C, HIV and HTLV among people who inject drugs in Germany using respondent driven sampling. BMC Public Health 2014; 14:845. [PMID: 25124485 PMCID: PMC4247126 DOI: 10.1186/1471-2458-14-845] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/25/2014] [Indexed: 01/03/2023] Open
Abstract
Background People who inject drugs are at high risk for hepatitis B, hepatitis C and HIV. HTLV was reported by neighboring countries to be prevalent in this population, but the situation for Germany is unclear. To generate seroprevalence and related behavioural data and to enhance prevention efforts against these infections for drug users in Germany, a multicentre sero- and behavioural survey was initiated. People who inject drugs are not well reached by services for testing and counselling for blood-borne infections in Germany. An interventional part of the study is intended to prove feasibility and acceptance of testing and counselling in low-threshold drop-in settings. Methods/Design Between May 2011 and March 2015, eligible participants (persons having injected drugs within the last 12 months, aged 16 years+, and living in the study city) are recruited by respondent driven sampling, using low-threshold drop-in facilities as study-sites in eight German cities with large drug scenes. Calculated sample size is 2,033 participants. Capillary blood samples collected as dried blood spots are anonymously tested for serological and molecular markers of hepatitis B and C, HIV, and HTLV I and II. A detailed face-to-face-interview about hepatitis- and HIV-related knowledge, former testing, imprisonment, sexual and injecting risk behaviour is conducted with participants. Staff is trained to offer pre- and post-test-counselling of blood-borne infections and HIV rapid testing to participants. Discussion We chose respondent driven sampling for recruitment of participants to improve representativeness of results. Persons, who are not reached by the facility where the study is conducted, are aimed to be included by recruitment through their personal social network of injecting drug users. To reduce differential biases in the questions on knowledge of transmission and prevention of infections, we present true statements on hepatitis B, C and HIV, their possible routes of transmission and measures of prevention to participants. Participants are told that the statements are true and are asked to answer if they knew this fact already or if it is new to them. In case of knowledge gaps they are offered free targeted counselling as well as free HIV rapid testing and post-test counselling of HIV and hepatitis test results.
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Affiliation(s)
- Ruth Zimmermann
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.
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Hauser A, Santos-Hoevener C, Meixenberger K, Zimmermann R, Somogyi S, Fiedler S, Hofmann A, Bartmeyer B, Jansen K, Hamouda O, Bannert N, Kuecherer C. Improved testing of recent HIV-1 infections with the BioRad avidity assay compared to the limiting antigen avidity assay and BED Capture enzyme immunoassay: evaluation using reference sample panels from the German Seroconverter Cohort. PLoS One 2014; 9:e98038. [PMID: 24892795 PMCID: PMC4043688 DOI: 10.1371/journal.pone.0098038] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 04/28/2014] [Indexed: 11/30/2022] Open
Abstract
Background The variety and limitations of current laboratory methods for estimating HIV-incidence has driven attempts to improve and standardize the performance of serological ‘Tests for Recent HIV-Infections’ (TRI). Primary and follow-up HIV-1 positive plasma samples from individuals with well-defined dates of infection collected as part of the German Seroconverter Cohort provided specimens highly suitable for use in comparing the performance of three TRIs: the AWARE™ BED™ EIA HIV-1 Incidence test (BED-CEIA), Genetic systems HIV-1/HIV-2 Plus O EIA antibody avidity-based assay (BioRad Avidity) and Sedia™ HIV-1 LAg Avidity EIA (LAg Avidity). Methods The evaluation panel included 180 specimens: 44 from antiretroviral (ARV)-naïve individuals with recently acquired HIV-infection (≤130 days; 25 B and 19 non-B subtypes) and 136 from long-term (>12 months) infected individuals [101 ARV-naïve subtype B, 16 non-B subtypes, 14 ARV-treated individuals, 5 slow progressors (SLP)]. Results For long-term infected, ARV-naïve individuals the false recent rates (FRR) of both the BioRad and LAg Avidity assays were 2% (2/101 for subtype B) and 6% (1/16 for subtype ‘non-B’), while the FRR of the BED-CEIA was 7% (7/101 for subtype B) and 25% (4/16 for subtype ‘non-B’) (all p>0.05). Misclassification of ARV-treated individuals and SLP was rare by LAg (1/14, 0/5) and BioRad Avidity assays (2/14, 1/5) but more frequent by BED-CEIA (5/14, 3/5). Among recently-infected individuals (subtype B), 60% (15/25) were correctly classified by BED-CEIA, 88% (22/25) by BioRad Avidity and significantly fewer by LAg (48%, 12/25) compared to BioRad Avidity (p = 0.005) with a higher true-recency rate among non-B infections for all assays. Conclusions This study using well-characterized specimens demonstrated lower FRRs for both avidity methods than with the BED-CEIA. For recently infected individuals the BioRad Avidity assay was shown to give the most accurate results.
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Affiliation(s)
- Andrea Hauser
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
- * E-mail:
| | - Claudia Santos-Hoevener
- Division of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | | | - Ruth Zimmermann
- Division of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Sybille Somogyi
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Stefan Fiedler
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Alexandra Hofmann
- Division of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Barbara Bartmeyer
- Division of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Klaus Jansen
- Division of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Osamah Hamouda
- Division of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Norbert Bannert
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Claudia Kuecherer
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
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Santos-Hövener C, Zimmermann R, Kücherer C, Bätzing-Feigenbaum J, Wildner S, Hamouda O, Marcus U. Conversation about Serostatus decreases risk of acquiring HIV: results from a case control study comparing MSM with recent HIV infection and HIV negative controls. BMC Public Health 2014; 14:453. [PMID: 24885694 PMCID: PMC4046506 DOI: 10.1186/1471-2458-14-453] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 05/06/2014] [Indexed: 11/24/2022] Open
Abstract
Background Data on knowledge, attitudes, behaviour and practices (KABP) of persons with recent HIV infection compared to controls with negative HIV test result provide information on current risk patterns and can help to re-focus HIV prevention strategies. Methods From March 2008 through May 2010, persons newly diagnosed with HIV (cases) and HIV-negative controls were recruited by physicians in Germany. To distinguish recent (< 5 months) from longstanding (> 5 months) infection, dried blood spots from people newly diagnosed with HIV were tested with the BED IgG-capture ELISA. Cases and controls completed a KABP-questionnaire. We compared cases with recent infection and controls among men having sex with men (MSM) regarding reported risk behaviour in the previous 6 months. To detect differences, unadjusted Odds Ratios (OR) were calculated and multivariate analysis was performed. Results Cases and controls did not differ in terms of knowledge on transmission risks, HIV testing frequency, partnership status, or regarding the frequency of any unprotected sex with partners known to be HIV-positive or assumed to be HIV-negative. Cases more often reported a shorter duration of partnership (< 6 months) with a primary partner than controls (OR = 3.9; p = 0.003) and indicated lower rates of condom use outside of primary relationships, with acquaintances (OR = 2.5; p = 0.01), and with persons met online (OR = 4.5; p = 0.04). Unprotected sex with persons of unknown HIV-serostatus was more often indicated by cases than controls (OR = 3.0; p = 0.003). Having a conversation about HIV serostatus before having sex was associated with a lower risk of infection (OR = 0.2; p = 0.01). In multivariate analysis “being always safe” (always using a condom when having sex in different situations outside of a relationship) and talking about serostatus before sex (OR = 0.23; p = 0.004; OR = 0.14; p = 0.014) were negatively associated with HIV- infection. Conclusions There were no significant differences regarding knowledge about HIV-transmission risks among cases and controls. Differences in risk behaviour were observed regarding unprotected sex with partners of unknown HIV-serostatus and duration of primary partnership at the time of diagnosis, suggesting some HIV-transmissions occurring in newly formed partnerships. The practice of discussing serostatus with prospective sex partners before engaging in sex seems to be protective for HIV-transmission.
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Affiliation(s)
- Claudia Santos-Hövener
- Department for Infectious Disease Epidemiology, HIV/AIDS, STI and Blood-borne Infections Unit, Robert Koch Institute, Berlin, Germany.
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Frentz D, van de Vijver D, Abecasis A, Albert J, Hamouda O, Jørgensen L, Kücherer C, Struck D, Schmit JC, Vercauteren J, Åsjö B, Balotta C, Bergin C, Beshkov D, Camacho R, Clotet B, Griskevicius A, Grossman Z, Horban A, Kolupajeva T, Korn K, Kostrikis L, Linka KLM, Nielsen C, Otelea D, Paraskevis D, Paredes R, Poljak M, Puchhammer-Stöckl E, Sönnerborg A, Stanekova D, Stanojevic M, Vandamme AM, Boucher C, Programme AWOBOTSPREAD. Patterns of transmitted HIV drug resistance in Europe vary by risk group. PLoS One 2014; 9:e94495. [PMID: 24721998 PMCID: PMC3983178 DOI: 10.1371/journal.pone.0094495] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/17/2014] [Indexed: 12/19/2022] Open
Abstract
Background In Europe, a continuous programme (SPREAD) has been in place for ten years to study transmission of drug resistant HIV. We analysed time trends of transmitted drug resistance mutations (TDRM) in relation to the risk behaviour reported. Methods HIV-1 patients newly diagnosed in 27 countries from 2002 through 2007 were included. Inclusion was representative for risk group and geographical distribution in the participating countries in Europe. Trends over time were calculated by logistic regression. Results From the 4317 patients included, the majority was men-having-sex-with-men -MSM (2084, 48%), followed by heterosexuals (1501, 35%) and injection drug users (IDU) (355, 8%). MSM were more often from Western Europe origin, infected with subtype B virus, and recently infected (<1 year) (p<0.001). The prevalence of TDRM was highest in MSM (prevalence of 11.1%), followed by heterosexuals (6.6%) and IDU (5.1%, p<0.001). TDRM was predominantly ascribed to nucleoside reverse transcriptase inhibitors (NRTI) with a prevalence of 6.6% in MSM, 3.3% in heterosexuals and 2.0% in IDU (p = 0.001). A significant increase in resistance to non- nucleoside reverse transcriptase inhibitors (NNRTIs) and a decrease in resistance to protease inhibitors was observed in MSM (p = 0.008 and p = 0.006, respectively), but not in heterosexual patients (p = 0.68 and p = 0.14, respectively). Conclusions MSM showed to have significantly higher TDRM prevalence compared to heterosexuals and IDU. The increasing NNRTI resistance in MSM is likely to negatively influence the therapy response of first-line therapy, as most include NNRTI drugs.
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Affiliation(s)
- Dineke Frentz
- Department of virology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Ana Abecasis
- Centro de Malária e outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Daniel Struck
- Laboratory of Retrovirology, CRP-Santé, Luxembourg, Luxembourg
| | - Jean-Claude Schmit
- Laboratory of Retrovirology, CRP-Santé, Luxembourg, Luxembourg
- Centre Hospitalier de Luxembourg, Luxembourg
| | | | - Birgitta Åsjö
- Section for Microbiology and Immunology, The Gade Institute, University of Bergen, Bergen, Norway
| | | | - Colm Bergin
- Department of GU Medicine & Infectious Diseases, St James's Hospital, Dublin, Ireland
| | - Danail Beshkov
- Department of Virology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Ricardo Camacho
- Centro de Malária e outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Bonaventura Clotet
- irsiCaixa AIDS Research Institute & Lluita contra la SIDA Foundation, Hospital Universitari "Germans Trias i Pujol," Badalona, Spain
| | | | | | - Andrzej Horban
- Warsaw Medical University and Hospital of Infectious Diseases, Warsaw, Poland
| | | | - Klaus Korn
- University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Kirsi Liitsola Marek Linka
- National Institute for Health and Welfare, Helsinki, Finland
- National Institute of Public Health, Prague, Czech Republic
| | | | - Dan Otelea
- Molecular Diagnostics, "Prof Dr Matei Bals" Institute for Infectious Diseases, Bucharest, Romania
| | | | - Roger Paredes
- Department of Virology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | | | - Anders Sönnerborg
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
- Divisions of Infectious Diseases and Clinical Virology, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Charles Boucher
- Department of virology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Annemarie Wensing31* on behalf of the SPREAD Programme
- Department of virology, Erasmus Medical Center, Rotterdam, the Netherlands
- Centro de Malária e outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
- Robert Koch Institute, Berlin, Germany
- Statens Serum Institute, Copenhagen, Denmark
- Laboratory of Retrovirology, CRP-Santé, Luxembourg, Luxembourg
- Centre Hospitalier de Luxembourg, Luxembourg
- Rega Institute, Katholieke Universiteit Leuven, Leuven, Belgium
- Section for Microbiology and Immunology, The Gade Institute, University of Bergen, Bergen, Norway
- University of Milan, Milan, Italy
- Department of GU Medicine & Infectious Diseases, St James's Hospital, Dublin, Ireland
- Department of Virology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
- Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
- irsiCaixa AIDS Research Institute & Lluita contra la SIDA Foundation, Hospital Universitari "Germans Trias i Pujol," Badalona, Spain
- National Public Health Surveillance Laboratory, Vilnius, Lithuania
- Sheba Medical Center, Tel Hashomer, Israel
- Warsaw Medical University and Hospital of Infectious Diseases, Warsaw, Poland
- Infectology Center of Latvia, Riga, Latvia
- University of Erlangen-Nuremberg, Erlangen, Germany
- University of Cyprus, Nicosia, Cyprus
- National Institute for Health and Welfare, Helsinki, Finland
- National Institute of Public Health, Prague, Czech Republic
- Molecular Diagnostics, "Prof Dr Matei Bals" Institute for Infectious Diseases, Bucharest, Romania
- Medical School, University of Athens, Athens, Greece
- University of Ljubljana, Ljubljana, Slovenia
- Medical University Vienna, Vienna, Austria
- Divisions of Infectious Diseases and Clinical Virology, Karolinska Institute, Stockholm, Sweden
- Slovak Medical University, Bratislava, Slovakia
- University of Belgrade School of Medicine, Belgrade, Serbia
- Department of Medical Microbiology,University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
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Karo B, Haas W, Kollan C, Gunsenheimer-Bartmeyer B, Hamouda O, Fiebig L. Tuberculosis among people living with HIV/AIDS in the German ClinSurv HIV Cohort: long-term incidence and risk factors. BMC Infect Dis 2014; 14:148. [PMID: 24646042 PMCID: PMC3994660 DOI: 10.1186/1471-2334-14-148] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/07/2014] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis (TB) still presents a leading cause of morbidity and mortality among people living with HIV/AIDS (PLWHA), including those on antiretroviral therapy. In this study, we aimed to determine the long-term incidence density rate (IDR) of TB and risk factors among PLWHA in relation to combination antiretroviral therapy (cART)-status. Methods Data of PLWHA enrolled from 2001 through 2011 in the German ClinSurv HIV Cohort were investigated using survival analysis and Cox regression. Results TB was diagnosed in 233/11,693 PLWHA either at enrollment (N = 62) or during follow-up (N = 171). The TB IDR during follow-up was 0.37 cases per 100 person-years (PY) overall [95% CI, 0.32-0.43], and was higher among patients who never started cART and among patients originating from Sub-Saharan Africa (1.23 and 1.20 per 100PY, respectively). In two multivariable analyses, both patients (I) who never started cART and (II) those on cART shared the same risk factors for TB, namely: originating from Sub-Saharan Africa compared to Germany (I, hazard ratio (HR); [95% CI]) 4.05; [1.87-8.78] and II, HR 5.15 [2.76-9.60], CD4+ cell count <200 cells/μl (I, HR 8.22 [4.36-15.51] and II, HR 1.90 [1.14-3.15]) and viral load >5 log10 copies/ml (I, HR 2.51 [1.33-4.75] and II, HR 1.77 [1.11-2.82]). Gender, age or HIV-transmission risk group were not independently associated with TB. Conclusion In the German ClinSurv HIV cohort, patients originating from Sub-Saharan Africa, with low CD4+ cell count or high viral load at enrollment were at increased risk of TB even after cART initiation. As patients might be latently infected with Mycobacterium tuberculosis complex, early screening for latent TB infection and implementing isoniazid preventive therapy in line with available recommendations is crucial.
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Affiliation(s)
- Basel Karo
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestr, 10, 13353 Berlin, Germany.
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42
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Bernard H, Faber M, Wilking H, Haller S, Höhle M, Schielke A, Ducomble T, Siffczyk C, Merbecks SS, Fricke G, Hamouda O, Stark K, Werber D, on behalf of the Outbreak Investigation Team. Large multistate outbreak of norovirus gastroenteritis associated with frozen strawberries, Germany, 2012. Euro Surveill 2014; 19:20719. [DOI: 10.2807/1560-7917.es2014.19.8.20719] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- H Bernard
- Robert Koch Institute, Berlin, Germany
- These authors contributed equally
| | - M Faber
- These authors contributed equally
- Robert Koch Institute, Berlin, Germany
| | - H Wilking
- Robert Koch Institute, Berlin, Germany
| | - S Haller
- European Programme for Intervention Epidemiology, Stockholm, Sweden
- Postgraduate Training for Applied Epidemiology, Berlin, Germany
- Robert Koch Institute, Berlin, Germany
| | - M Höhle
- Robert Koch Institute, Berlin, Germany
| | | | - T Ducomble
- European Centre for Disease Prevention and Control, Stockholm, Sweden
- European Programme for Intervention Epidemiology, Stockholm, Sweden
- Robert Koch Institute, Berlin, Germany
| | - C Siffczyk
- State Health Authority Brandenburg, Zossen, Germany
| | - S S Merbecks
- State Health Authority Saxony, Chemnitz, Germany
| | - G Fricke
- Federal Office of Consumer Protection and Food Safety, Berlin, Germany
| | - O Hamouda
- Robert Koch Institute, Berlin, Germany
| | - K Stark
- Robert Koch Institute, Berlin, Germany
| | - D Werber
- Robert Koch Institute, Berlin, Germany
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43
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Poethko-Müller C, Zimmermann R, Hamouda O, Faber M, Stark K, Ross RS, Thamm M. [Epidemiology of hepatitis A, B, and C among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:707-15. [PMID: 23703489 DOI: 10.1007/s00103-013-1673-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Ten years after seroepidemiological data were obtained in the German National Health Interview and Examination Survey 1998 (GNHIES98), German Health Interview and Examination Survey (DEGS1) data contribute to a population-based, representative surveillance of hepatitis A and B immunity and of the serological markers for hepatitis C in Germany. The prevalence of antibodies against the hepatitis A virus is 48.6 %. In comparison to the situation 10 years ago, seroprevalence is significantly higher among 18- to 39-year-old adults and is significantly lower in those aged 50-79 years. The association between age and seroprevalence has changed, indicating a decrease in naturally acquired hepatitis A immunity. Individual and population immunity has to be achieved through vaccination. Prevalence of hepatitis B antibodies indicates that 5.1 % of adults have been exposed to the virus, significantly fewer than 10 years ago (7.9 %). Prevalence of hepatitis B surface antibodies indicates that 22.9 % of adults have been vaccinated against hepatitis B. Vaccination coverage has increased in all age groups and is highest in the younger age groups. These positive trends can be attributed to the general recommendation since 1995 to vaccinate against hepatitis B. For hepatitis C, the prevalence of antibodies in the general population is 0.3 %. Germany thus remains a low-HCV-endemic country. An English full-text version of this article is available at SpringerLink as supplemental.
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Affiliation(s)
- C Poethko-Müller
- Robert Koch-Institut, General-Pape-Str. 62-66, 12101 Berlin, Deutschland.
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44
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Schmidt D, Päschke H, Bremer V, Hamouda O, Reischl U, Sailer A, Haar K. An assessment of the current Chlamydia trachomatis laboratory practices in Germany. Gesundheitswesen 2013; 76:e44-50. [PMID: 24203685 DOI: 10.1055/s-0033-1355406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Currently, no information is available about the number of Chlamydia trachomatis (CT) tests performed, testing facilities available or diagnostic methods used in Germany. This study aimed to map CT diagnostic facilities so that representative laboratories can be recruited for CT sentinel surveillance. METHODS Using a questionnaire, we collected information about population coverage, the number of tests performed, accreditation and current testing methods and systems for German facilities that potentially offer CT diagnostics. RESULTS Overall, 725/1,504 (48%) facilities responded; of the respondents, 143 reported that they perform CT diagnostics. Of the laboratories performing diagnostics, 45% were privately owned, and 42% were located in a hospital. Of the laboratories that provided information about their catchment area, 61% received samples from at least one federal state and therefore covered more than their surrounding area. The median length of time that CT diagnostics had been performed was 11.5 years. Over half (54%) of the laboratories that provided information on their accreditation status were accredited, for a median duration of 6 years. In accordance with national guidelines, 77% used nucleic acid amplification tests (NAAT) for acute CT infections. CONCLUSIONS The long duration since Ct diagnostics have been performed and laboratories have been accredited can be seen as an indication of the high diagnostic quality of German laboratories. Additionally, laboratories mostly serviced doctors and patients from a large region and are not representative for people living in the area where the lab is located. This has to be considered when sampling representative labs for CT sentinel surveillance and further epidemiological studies.
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Affiliation(s)
- D Schmidt
- Department for Infectious Diseases Epidemiology, HIV/AIDS, STI and Blood-borne Infections, Robert Koch-Institute, Berlin, Germany
| | | | - V Bremer
- Department for Infectious Diseases Epidemiology, HIV/AIDS, STI and Blood-borne Infections, Robert Koch-Institute, Berlin, Germany
| | - O Hamouda
- Department for Infectious Diseases Epidemiology, HIV/AIDS, STI and Blood-borne Infections, Robert Koch-Institute, Berlin, Germany
| | - U Reischl
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - A Sailer
- Department for Infectious Diseases Epidemiology, HIV/AIDS, STI and Blood-borne Infections, Robert Koch-Institute, Berlin, Germany
| | - K Haar
- Department for Infectious Diseases Epidemiology, HIV/AIDS, STI and Blood-borne Infections, Robert Koch-Institute, Berlin, Germany
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Haar K, Bremer V, Houareau C, Meyer T, Desai S, Thamm M, Hamouda O. Risk factors for Chlamydia trachomatis infection in adolescents: results from a representative population-based survey in Germany, 2003-2006. ACTA ACUST UNITED AC 2013; 18. [PMID: 23987832 DOI: 10.2807/1560-7917.es2013.18.34.20562] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Infections with Chlamydia trachomatis (CT) can lead to severe sequelae; however, they are not notifiable in Germany. We tested urine samples from participants of KiGGS (German Health Interview and Examination Survey for Children and Adolescents) for CT infections and linked the results to demographic and behavioural data from 1,925 participants (girls aged 15-17 years and boys aged 16-17 years) to determine a representative prevalence of CT infection in adolescents in Germany and to assess associated risk factors. Prevalence of CT infection was 2.2% (95% CI: 1.4-3.5) in girls and 0.2% (95% CI: 0.1-0.7) in boys. CT infection in girls was associated with higher use of alcohol, marijuana and cigarettes, lower social status, oral contraceptive use, pregnancy, repeated lower abdominal pain and higher rates of doctors' consultations within the preceding three months and consultation of gynaecologists within the last 12 months. In multiple logistic regression, we identified two predictors for CT infection: marijuana consumption often or several times within the last 12 months (F(1,164)=7.56; p<0.05) and general health status less than 'very good' (F(1,164)=3.83; p=0.052). Given our findings, we recommend enhancing sex education before sexual debut and promoting safe sex practices regardless of the contraceptive method used. Well-informed consumption of alcohol should be promoted, the risky behaviour of people intoxicated through consumption of marijuana highlighted and doctors' awareness of CT screening enhanced.
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Affiliation(s)
- K Haar
- Department for Infectious Disease Epidemiology, HIV/AIDS, STI and Bloodborne Infections Unit, Robert Koch Institute, Berlin, Germany.
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Hatzakis A, Van Damme P, Alcorn K, Gore C, Benazzouz M, Berkane S, Buti M, Carballo M, Cortes Martins H, Deuffic-Burban S, Dominguez A, Donoghoe M, Elzouki AN, Ben-Alaya Bouafif N, Esmat G, Esteban R, Fabri M, Fenton K, Goldberg D, Goulis I, Hadjichristodoulou C, Hatzigeorgiou T, Hamouda O, Hasurdjiev S, Hughes S, Kautz A, Malik M, Manolakopoulos S, Matičič M, Papatheodoridis G, Peck R, Peterle A, Potamitis G, Prati D, Roudot-Thoraval F, Reic T, Sharara A, Shennak M, Shiha G, Shouval D, Sočan M, Thomas H, Thursz M, Tosti M, Trépo C, Vince A, Vounou E, Wiessing L, Manns M, Manns M. The state of hepatitis B and C in the Mediterranean and Balkan countries: report from a summit conference. J Viral Hepat 2013; 20 Suppl 2:1-20. [PMID: 23827008 DOI: 10.1111/jvh.12120] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The burden of disease due to chronic viral hepatitis constitutes a global threat. In many Balkan and Mediterranean countries, the disease burden due to viral hepatitis remains largely unrecognized, including in high-risk groups and migrants, because of a lack of reliable epidemiological data, suggesting the need for better and targeted surveillance for public health gains. In many countries, the burden of chronic liver disease due to hepatitis B and C is increasing due to ageing of unvaccinated populations and migration, and a probable increase in drug injecting. Targeted vaccination strategies for hepatitis B virus (HBV) among risk groups and harm reduction interventions at adequate scale and coverage for injecting drug users are needed. Transmission of HBV and hepatitis C virus (HCV) in healthcare settings and a higher prevalence of HBV and HCV among recipients of blood and blood products in the Balkan and North African countries highlight the need to implement and monitor universal precautions in these settings and use voluntary, nonremunerated, repeat donors. Progress in drug discovery has improved outcomes of treatment for both HBV and HCV, although access is limited by the high costs of these drugs and resources available for health care. Egypt, with the highest burden of hepatitis C in the world, provides treatment through its National Control Strategy. Addressing the burden of viral hepatitis in the Balkan and Mediterranean regions will require national commitments in the form of strategic plans, financial and human resources, normative guidance and technical support from regional agencies and research.
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Affiliation(s)
- A Hatzakis
- National Retrovirus Reference Center, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
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Dudareva-Vizule S, Sailer A, Hamouda O, Bremer V. P3.028 Positivity Rate of Chlamydia Trachomatis and Status Quo of Opportunistic Screening in Germany. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jansen K, Scheufele R, Bock C, Gunsenheimer-Bartmeyer B, Hamouda O, Houareau C, Kücherer C, Thamm M, Meixenberger K. P3.196 High Prevalence of Hepatitis B (HBV) Coinfections, and Low Rate of Effective HBV-Vaccination in MSM with Known Date of HIV-1 Seroconversion in Germany: Abstract P3.196 Table 1. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bremer V, Marcus U, Hamouda O. P3.085 Syphilis on the Rise in Germany - is It Temporary or a New Trend? Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Santos-Hövener C, Hamouda O, Koschollek C, Charles T, Gangarova T, Marcus U. P3.165 Establishing Second Generation HIV/STI-surveillance For Migrants from Sub-Saharan Africa in Germany - A Participatory Process. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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