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Lehmann HC, Oberle D, Keller-Stanislawski B, Rieck T, Streit R. Rare cases of Guillain-Barré syndrome after COVID-19 vaccination, Germany, December 2020 to August 2021. Euro Surveill 2023; 28:2200744. [PMID: 37318764 PMCID: PMC10318936 DOI: 10.2807/1560-7917.es.2023.28.24.2200744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/10/2023] [Indexed: 06/16/2023] Open
Abstract
BackgroundGuillain-Barré syndrome (GBS) has been associated with vaccination against COVID-19.AimWe aimed to compare clinical characteristics and analyse excess GBS cases following administration of different COVID-19 and influenza vaccines in Germany versus the expected numbers estimated from pre-pandemic background incidence rates.MethodsWe analysed safety surveillance data reported to the German national competent authority between 27 December 2020 and 31 August 2021. GBS cases were validated according to Brighton Collaboration (BC) criteria. We conducted observed vs expected (OvE) analyses on cases fulfilling BC criteria levels 1 to 4 for all four European Medicines Agency-approved COVID-19 vaccines and for influenza vaccines.ResultsA total of 214 GBS cases after COVID-19 vaccination had been reported, of whom 156 were eligible for further analysis. Standardised morbidity ratio estimates 3-42 days after vaccination were 0.34 (95% confidence interval (CI): 0.25-0.44) for Comirnaty, 0.38 (95% CI: 0.15-0.79) for Spikevax, 3.10 (95% CI: 2.44-3.88) for Vaxzevria, 4.16 (95% CI: 2.64-6.24) for COVID-19 Vaccine Janssen and 0.60 (95% CI: 0.35-0.94) for influenza vaccines. Bilateral facial paresis was reported in 19.7% and 26.1% of the 156 GBS cases following vaccination with Vaxzevria and COVID-19 Vaccine Janssen, respectively, and only in 6% of cases exposed to Comirnaty.ConclusionThree and four times more GBS cases than expected were reported after vaccination with Vaxzevria and COVID-19 Vaccine Janssen, respectively, therefore GBS might be an adverse event of vector-based vaccines. Bifacial paresis was more common in cases with GBS following vaccination with vector-based than mRNA COVID-19 vaccines.
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Affiliation(s)
- Helmar C Lehmann
- Department of Neurology, Klinikum Leverkusen, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Doris Oberle
- Division of Safety of Biomedicines and Diagnostics, Paul-Ehrlich Institute, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Brigitte Keller-Stanislawski
- Division of Safety of Biomedicines and Diagnostics, Paul-Ehrlich Institute, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Thorsten Rieck
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Renz Streit
- Division of Safety of Biomedicines and Diagnostics, Paul-Ehrlich Institute, Federal Institute for Vaccines and Biomedicines, Langen, Germany
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Steffen A, Rieck T, Siedler A. Monitoring of Influenza Vaccination Coverage among Pregnant Women in Germany Based on Nationwide Outpatient Claims Data: Findings for Seasons 2014/15 to 2019/20. Vaccines (Basel) 2021; 9:vaccines9050485. [PMID: 34064546 PMCID: PMC8150878 DOI: 10.3390/vaccines9050485] [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: 04/13/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Pregnant women and their infants are at increased risk for severe influenza-related complications. A decade has passed since influenza vaccination was first recommended for pregnant women in Germany in 2010; however, monitoring of vaccination coverage (VC) has not yet been implemented for this target group. Using nationwide outpatient claims data, we here provide results on influenza VC among pregnant women in Germany for seasons 2014/15 to 2019/20. For any given season, pregnant women were defined as women who had undergone prenatal health care in at least two consecutive quarters within a season. VC increased from 9.0% in season 2014/15 to 16.6% in 2019/20 (+84%), while most of the increase occurred from season 2016/17 (VC: 9.9%) onwards (+68%). Consistently across seasons, women in east Germany were 40 to 60% more likely to be vaccinated compared to women residing in west Germany. According to age, the highest VC was observed among women aged 35 to <40 years (2019/20: 18.2%). Despite noticeable increases in influenza VC during recent years, overall coverage remains low among pregnant women. Starting with this analysis, VC among pregnant women in Germany will be monitored on a yearly basis in order to detect trends and identify immunization gaps.
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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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Zimmermann R, Faber M, Dudareva S, Ingiliz P, Jessen H, Koch J, Marcus U, Michaelis K, Rieck T, Ruscher C, Schilling B, Schumacher J, Sissolak D, Thoulass J, Wenzel JJ, Werber D, Sagebiel D. Hepatitis A outbreak among MSM in Berlin due to low vaccination coverage: Epidemiology, management, and successful interventions. Int J Infect Dis 2020; 103:146-153. [PMID: 33207272 DOI: 10.1016/j.ijid.2020.11.133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To describe the characteristics of a large hepatitis A virus (HAV) outbreak among men who have sex with men (MSM) in Berlin and to assess the impact of measures implemented. METHODS Cases of laboratory-confirmed, symptomatic HAV infection notified in Berlin, Germany between August 2016 and February 2018 were analysed using routine and enhanced surveillance data including genotyping results. Several studies involving different groups of participants were conducted to further investigate the outbreak, including surveys on knowledge and practices of HAV vaccination among physicians and vaccination coverage and determinants of vaccination status among MSM. The measures implemented were categorized by target group in a Gantt chart. To assess their impact, health insurance data on HAV vaccination uptake were analysed, comparing Berlin and other federal states. RESULTS During the outbreak period, a total of 222 cases were reported (of which 91 were sequence-confirmed), with a peak in case numbers in January 2017. Physicians were aware of the existing vaccination recommendations, but vaccination coverage among 756 MSM was low, with 32.7% being completely vaccinated and 17.3% being incompletely vaccinated before 2017. HAV vaccination before 2017 was associated with being born in Germany (odds ratio 2.36) and HIV-positive (odds ratio 1.80). HAV monovalent vaccination uptake increased by 164% from 2016 to 2017 among males in Berlin, compared to 7% in other federal states. CONCLUSIONS Multiple measures targeting the MSM community, physicians, and public health to increase HAV vaccination uptake were successfully implemented. To prevent future HAV outbreaks, we recommend monitoring vaccination coverage among MSM, promoting awareness of existing recommendations among physicians, and ensuring access for foreign-born and young MSM.
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Affiliation(s)
- Ruth Zimmermann
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Mirko Faber
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany.
| | - Sandra Dudareva
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | | | | | - Judith Koch
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Ulrich Marcus
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Kai Michaelis
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Thorsten Rieck
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Claudia Ruscher
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany; Postgraduate Training in Applied Epidemiology (PAE), Affiliated with the European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; State Office for Health and Social Affairs (LaGeSo), Berlin, Germany
| | - Birte Schilling
- Local Public Health Authority, Berlin Tempelhof-Schöneberg, Germany
| | | | | | - Janine Thoulass
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany; Postgraduate Training in Applied Epidemiology (PAE), Affiliated with the European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Jürgen J Wenzel
- National Consultant Laboratory for Hepatitis A and Hepatitis E, Institute of Clinical Microbiology and Hygiene, University Medical Centre Regensburg, Regensburg, Germany
| | - Dirk Werber
- State Office for Health and Social Affairs (LaGeSo), Berlin, Germany
| | - Daniel Sagebiel
- State Office for Health and Social Affairs (LaGeSo), Berlin, Germany
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Rieck T, Matysiak-Klose D, Hellenbrand W, Koch J, Feig M, Siedler A, Wichmann O. [Compliance with adult measles and pertussis vaccination recommendations : Analysis of data from the national monitoring system KV-Impfsurveillance]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:422-432. [PMID: 30805673 DOI: 10.1007/s00103-019-02902-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The Standing Committee on Vaccination recommends adult measles and pertussis vaccination. The measles vaccine has been recommended since 2010 to adults born after 1970 with less than two doses in childhood, and an acellular pertussis vaccine (ap) since 2009 to be administered to all adults, with the next recommended decennial tetanus (T) and diphtheria (d) booster as a Tdap combination vaccine.We aim to determine the annual uptake of the measles vaccine (vaccination incidence) and its proportion in pediatric and gynecological practices as interdisciplinary services (2009-2016). We further aim to calculate the 10-year ap vaccination coverage and missed vaccination opportunities as the proportion vaccinated with Td only among all Td and Tdap vaccinees (2007-2016).Within the national vaccination monitoring system KV-Impfsurveillance of the Robert Koch Institute and all Associations of Statutory Health Insurance Physicians, all persons receiving the relevant vaccinations were identified in nationwide statutory health insurance claims and related to the numbers of insured persons.The measles vaccination incidence in 2009 was 0.4%, increasing to ≥1.0% annually since 2013. It was higher in western than eastern federal states and higher among women than men. Of all measles vaccinations, 6.8% were given by pediatricians. Men received 2.6% of their vaccinations by gynecologists. The ap vaccination coverage was 32.4%. The proportion of exclusively Td vaccinated adults fell from 84% (2007) to 24% (from 2013 onwards).Since their recommendation, the KV-Impfsurveillance system shows increased uptake of measles and pertussis vaccines with regional and sex differences and is thus instrumental in their evaluation. Analyses of interdisciplinary vaccinations and missed vaccination opportunities provide insight into the potential for increasing uptake.
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Affiliation(s)
- Thorsten Rieck
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland. .,Charité Universitätsmedizin Berlin, Berlin, Deutschland.
| | | | - Wiebke Hellenbrand
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Judith Koch
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Marcel Feig
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Anette Siedler
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Ole Wichmann
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
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Abstract
Zusammenfassung
Das Impfsystem in Deutschland hat sich in den letzten 25 Jahren wesentlich weiterentwickelt. Essentiell war die Schaffung gesetzlicher Rahmenbedingungen sowohl für die Entwicklung einheitlicher Impfempfehlungen, deren Finanzierung und Umsetzung als auch für deren Evaluation. Mit der Zulassung neuer Impfstoffe und Einführung neuer Konzepte haben die Empfehlungen der Ständigen Impfkommission (STIKO) ein deutlich größeres Spektrum und tragen zu einem effektiven Schutz vor übertragbaren Erkrankungen in der Allgemeinbevölkerung und auch in speziellen Risikogruppen bei. Im Vergleich zu 1993 stehen heute Daten zur Verfügung, die es besser ermöglichen, die Inanspruchnahme von Impfungen auf regionaler Ebene und in einzelnen Altersgruppen zu analysieren oder die Effekte der Impfungen zu belegen.
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Affiliation(s)
- Ole Wichmann
- Robert Koch-Institut, Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention , Seestraße 10 , Berlin 13353
| | - Judith Koch
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention
| | - Thorsten Rieck
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention
| | - Anette Siedler
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention
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Rieck T, Feig M, An der Heiden M, Siedler A, Wichmann O. Assessing varicella vaccine effectiveness and its influencing factors using health insurance claims data, Germany, 2006 to 2015. ACTA ACUST UNITED AC 2017; 22:30521. [PMID: 28488996 PMCID: PMC5434885 DOI: 10.2807/1560-7917.es.2017.22.17.30521] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 11/15/2016] [Accepted: 04/06/2017] [Indexed: 11/26/2022]
Abstract
In Germany, routine childhood varicella vaccination was implemented in 2004 with two doses recommended since 2009. We used an immunisation information system based on countrywide health insurance claims data to analyse vaccine effectiveness (VE) and factors influencing VE. We applied proportional hazard models to estimate VE under various conditions and compared the risk of acquiring varicella among unvaccinated children in regions with high vs low vaccination coverage (VC). Among 1.4 million children we identified 29,404 varicella cases over a maximum follow-up of 8 years post-vaccination. One-dose VE was 81.9% (95% confidence interval (CI): 81.4–82.5), two-dose VE 94.4% (95% CI: 94.2–94.6). With dose one given 1–27 days after measles-containing vaccine (MCV), one-dose VE was 32.2% (95% CI: 10.4–48.6), two-dose VE 92.8% (95% CI: 84.8–96.6). VE was not associated with age at vaccination (11–14 vs ≥ 15 months), time since vaccination, or vaccine type. Unvaccinated children had a twofold higher risk of acquiring varicella in low VC regions. Our system generated valuable data, showing that two-dose varicella vaccination provides good protection for at least 8 years. Unvaccinated children benefit from herd effects. When the first varicella vaccine dose is given shortly after MCV, a second dose is essential.
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Affiliation(s)
- Thorsten Rieck
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany.,Charité - University Medicine Berlin, Berlin, Germany
| | - Marcel Feig
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | | | - Anette Siedler
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - Ole Wichmann
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
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Siedler A, Rieck T, Tolksdorf K. Strong Additional Effect of a Second Varicella Vaccine Dose in Children in Germany, 2009-2014. J Pediatr 2016; 173:202-206.e2. [PMID: 26995703 DOI: 10.1016/j.jpeds.2016.02.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/02/2016] [Accepted: 02/17/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Vaccine effectiveness (VE) of 1 and 2 varicella vaccine doses in children aged 1-4 years in Germany was evaluated to determine the additional effect of a second dose recommended at least 4 weeks after the first dose and before the second birthday. STUDY DESIGN To estimate the VE, the proportion of cases vaccinated was compared with the proportion of the population vaccinated using nationwide sentinel surveillance data from 2009-2014 and health insurance claims data covering the period January 2009-March 2014, respectively. A general linear model was used to estimate the OR of vaccination in the cases and the population and the corresponding CIs to observe the stability of the VE estimates over time, and to assess the incremental effectiveness of a second dose. RESULTS The overall VE after 1 dose was 86.6% (95% CI: 85.2-87.9), ranging between 94.6% (95% CI: 87.9-97.6) in the first quarter of 2011 and 50.3% (95% CI: 7.3-73.4) in the third quarter of 2013. The overall VE after 2 doses was 97.3% (95% CI: 97.0-97.6), ranging between 99.5% (95% CI: 97.8-99.9) in the second quarter of 2009 and 91.3% (95% CI: 85.7-94.8) in the third quarter of 2013. The incremental VE of 2 doses was 84.6% (95% CI: 81.7-86.9). CONCLUSIONS The substantially higher VE of 2 varicella vaccine doses compared with 1 dose in young children and the strong additional effect of the second dose support the public health relevance of a 2-dose schedule and the success of the early second vaccine dose.
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Affiliation(s)
| | - Thorsten Rieck
- Robert Koch Institute, Berlin, Germany; Charité-University Medicine Berlin, Berlin, Germany
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Remschmidt C, Rieck T, Bödeker B, Wichmann O. Application of the screening method to monitor influenza vaccine effectiveness among the elderly in Germany. BMC Infect Dis 2015; 15:137. [PMID: 25887460 PMCID: PMC4371628 DOI: 10.1186/s12879-015-0882-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 07/17/2014] [Accepted: 03/12/2015] [Indexed: 11/11/2022] Open
Abstract
Background Elderly people are at increased risk for severe influenza illness and constitute therefore a major target-group for seasonal influenza vaccination in most industrialized countries. The aim of this study was to estimate influenza vaccine effectiveness (VE) among individuals aged 60+ years over three seasons and to assess if the screening method is a suitable tool to monitor influenza VE in this particular target-group in Germany. Methods We identified laboratory-confirmed influenza cases aged 60+ years through the national communicable disease reporting system for seasons 2010/11, 2011/12 and 2012/13. Vaccination coverage (VC) data were retrieved from a database of health insurance claims representing ~85% of the total German population. We applied the screening method to calculate influenza subtype-specific VE and compared our results with VE estimates from other observational studies in Europe. Results In total, 7,156 laboratory-confirmed influenza cases were included. VE against all influenza types ranged between 49% (95% confidence interval [CI]: 39–56) in 2011/12 and 80% (95% CI: 76-83%) in 2010/11. In 2010/11 subtype-specific VE against influenza A(H1N1)pdm and B was 76% and 84%, respectively. In the following seasons, VE against influenza A(H1N1)pdm, A(H3N2) and B was 87%, -9% , 74% (2011/12), and 74%, 39%, 73% (2012/13). VE was higher among hospitalized compared to non-hospitalized influenza A cases. Seventeen observational studies from Europe reporting subtype-specific VE among the elderly were identified for the respective seasons (all applying the test-negative design) and showed comparable subtype-specific VE estimates. Conclusions According to our study, influenza vaccination provided moderate protection against laboratory-confirmed influenza A(H1N1)pdm and B in individuals aged 60+ but no or only little protection against A(H3N2). Higher VE among hospitalized cases might indicate higher protection against severe influenza disease. Based on the available data, the screening method allowed us to assess subtype-specific VE in hospitalized and non-hospitalized elderly persons. Since controlling for several important confounders was not possible, the applied method only provided crude VE estimates. However, given the precise VC-data and the large number of cases, the screening method provided results being in line with VE estimates from other observational studies in Europe that applied a different study design. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0882-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Thorsten Rieck
- Immunization Unit, Robert Koch Institute, Berlin, Germany. .,Charité - University Medicine Berlin, Berlin, Germany.
| | - Birte Bödeker
- Immunization Unit, Robert Koch Institute, Berlin, Germany.
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany.
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10
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Rieck T, Feig M, Deleré Y, Wichmann O. Utilization of administrative data to assess the association of an adolescent health check-up with human papillomavirus vaccine uptake in Germany. Vaccine 2014; 32:5564-9. [DOI: 10.1016/j.vaccine.2014.07.105] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/15/2014] [Accepted: 07/30/2014] [Indexed: 10/24/2022]
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Takla A, Wichmann O, Rieck T, Matysiak-Klose D. Measles incidence and reporting trends in Germany, 2007-2011. Bull World Health Organ 2014; 92:742-9. [PMID: 25378728 PMCID: PMC4208482 DOI: 10.2471/blt.13.135145] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 01/02/2014] [Revised: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 12/01/2022] Open
Abstract
Objective We aimed to quantify progress towards measles elimination in Germany from 2007 to 2011 and to estimate any potential underreporting over this period. Methods We determined the annual incidence of notified cases of measles – for each year – in northern, western, eastern and southern Germany and across the whole country. We then used measles-related health insurance claims to estimate the corresponding incidence. Findings In each year between 2007 and 2011, there were 6.9–19.6 (mean: 10.8) notified cases of measles per million population. Incidence decreased with age and showed geographical variation, with highest mean incidence – 20.3 cases per million – in southern Germany. Over the study period, incidence decreased by 10% (incidence rate ratio, IRR: 0.90; 95% confidence interval, CI: 0.85–0.95) per year in western Germany but increased by 77% (IRR: 1.77; 95% CI: 1.62–1.93) per year in eastern Germany. Although the estimated incidence of measles based on insurance claims showed similar trends, these estimates were 2.0- to 4.8-fold higher than the incidence of notified cases. Comparisons between the data sets indicated that the underreporting increased with age and was generally less in years when measles incidence was high than in low-incidence years. Conclusion Germany is still far from achieving measles elimination. There is substantial regional variation in measles epidemiology and, therefore, a need for region-specific interventions. Our analysis indicates underreporting in the routine surveillance system between 2007 and 2011, especially among adults.
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Affiliation(s)
- Anja Takla
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany
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Siedler A, Hecht J, Rieck T, Tolksdorf K, Hengel H. [Varicella vaccination in Germany. A provisional appraisal in the context of MMR vaccination]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 56:1313-20. [PMID: 23990095 DOI: 10.1007/s00103-013-1789-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 2004, a general varicella immunization was introduced in Germany for infants from the age of 11 months, followed by the subsequent recommendation in 2009 of a second vaccine dose. The vaccination is carried out at the same time as the immunization against measles, mumps, and rubella (MMR). Results of the nationwide sentinel surveillance of varicella and herpes zoster implemented by the Varicella Working Group (Arbeitsgemeinschaft Varizellen, AGV) show that the defined goals for varicella immunization (reduction of varicella-related morbidity, complications and hospitalizations) have been reached within a few years owing to the advances in vaccine coverage. Although coverage rates for varicella have not yet reached the same levels as for MMR, varicella immunization seems to have benefited from the established MMR immunization schedule. Moreover, there is no evidence for an adverse effect on the use and acceptance of the MMR vaccine. Lessons learnt in measles epidemiology (such as trends in the incidence of the disease in adolescents and infants), as well as in the history of MMR recommendations, may be useful for the evaluation of future epidemiological changes with respect to varicella and herpes zoster. In view of a rapidly waning immunity against the varicella zoster virus after vaccination with one dose and the lifelong persistence of the virus, achieving a robust and sustainable immunity in the general population seems to be an ambitious goal. However, this accomplishment will be indispensable in preventing breakthrough infections and a shift of varicella to older ages and in avoiding an increase in herpes zoster incidence.
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Affiliation(s)
- A Siedler
- Abt. für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, DGZ-Ring 1, 13086, Berlin, Deutschland.
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Rieck T, Feig M, Eckmanns T, Benzler J, Siedler A, Wichmann O. Vaccination coverage among children in Germany estimated by analysis of health insurance claims data. Hum Vaccin Immunother 2013; 10:476-84. [PMID: 24192604 PMCID: PMC4185903 DOI: 10.4161/hv.26986] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [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] [Indexed: 11/19/2022] Open
Abstract
In Germany, the national routine childhood immunization schedule comprises 12 vaccinations. Primary immunizations should be completed by 24 mo of age. However, nationwide monitoring of vaccination coverage (VC) is performed only at school entry. We utilized health insurance claims data covering ~85% of the total population with the objectives to (1) assess VC of all recommended childhood vaccinations in birth-cohorts 2004-2009, (2) analyze cross-sectional (at 24 and 36 mo) and longitudinal trends, and (3) validate the method internally and externally. Counting vaccine doses in a retrospective cohort fashion, we assembled individual vaccination histories and summarized VC to nationwide figures. For most long-established vaccinations, VC at 24 mo was at moderate levels (~73-80%) and increased slightly across birth-cohorts. One dose measles VC was high (94%), but low (69%) for the second dose. VC with a full course of recently introduced varicella, pneumococcal, and meningococcal C vaccines increased across birth-cohorts from below 10% above 60%, 70%, and 80%, respectively. At 36 mo, VC had increased further by up to 15 percentage points depending on vaccination. Longitudinal analysis suggested a continued VC increase until school entry. Validation of VC figures with primary data showed an overall good agreement. In conclusion, analysis of health insurance claims data allows for the estimation of VC among children in Germany considering completeness and timeliness of vaccination series. This approach provides valid nationwide VC figures for all currently recommended pediatric vaccinations and fills the information gap between early infancy and late assessment at school entry.
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Affiliation(s)
- Thorsten Rieck
- Immunization Unit; Robert Koch Institute; Berlin, Germany; Charité-University Medicine Berlin; Berlin, Germany
| | - Marcel Feig
- Surveillance Unit; Robert Koch Institute; Berlin, Germany
| | - Tim Eckmanns
- Surveillance Unit; Robert Koch Institute; Berlin, Germany
| | - Justus Benzler
- Surveillance Unit; Robert Koch Institute; Berlin, Germany
| | - Anette Siedler
- Immunization Unit; Robert Koch Institute; Berlin, Germany
| | - Ole Wichmann
- Immunization Unit; Robert Koch Institute; Berlin, Germany
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Abstract
In Germany, mumps has been notifiable until 2013 only in the five Eastern federal states (EFS) of former East Germany. Due to different immunisation policies until 1990 and varying vaccination coverages thereafter, mumps incidences cannot be extrapolated to the 11 Western federal states (WFS). We studied mumps-related International Classification of Diseases (ICD-10) code diagnoses claimed through statutory health insurances between 2007 and 2011 to estimate countrywide mumps incidences in the outpatient sector, and compared them with case numbers from ambulatory notification data. Overall, 32,330 outpatient mumps cases were claimed. Annual incidence ranged between 9.3/100,000 and 11.8/100,000 and showed a significant decreasing trend. Compared with EFS, mumps incidence in WFS was higher and indicated a shift towards older age groups. Notified outpatient case numbers in EFS were 13-fold lower and from voluntary surveillance during an outbreak in the WFS Bavaria 8-fold lower than from insurance data (n=316 versus n=4,217 and n=238 versus 1,995, respectively). Of all notified cases with available information, 75.4% (EFS) and 57.6% (Bavaria) were unvaccinated; 6.8% (EFS) and 19.3% (Bavaria) required hospitalisation. In Germany, mumps is still endemic despite decades of vaccination, with considerable underreporting in the established notification systems.
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Affiliation(s)
- A Takla
- European Programme for Intervention Epidemiology Training (EPIET), Stockholm, Sweden
- Postgraduate Training for Applied Epidemiology (PAE), Berlin, Germany
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - O Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - C Klinc
- Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - W Hautmann
- Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - T Rieck
- Charité – University Medical Center, Berlin, Germany
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - J Koch
- Immunization Unit, Robert Koch Institute, Berlin, Germany
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Greutélaers B, Wadl M, Nachtnebel M, Rieck T, Hogan B, Adlhoch C, Eckmanns T, Benzler J. [Hospital surveillance during major outbreaks of community-acquired diseases. Pandemic Influenza Hospital Surveillance (PIKS) 2009/2010 and Surveillance of Bloody Diarrhea (SBD) 2011]. Dtsch Med Wochenschr 2013; 138:632-7. [PMID: 23512362 DOI: 10.1055/s-0032-1332962] [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: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE During the influenza pandemic 2009/2010 and the outbreak of entero-haemorrhagic Escherichia coli (EHEC)/hemolytic-uremic syndrome (HUS) 2011, the statutory reporting system in Germany was complemented by additional event-related surveillance systems in hospitals. The Pandemic Influenza Hospital Surveillance (PIKS) and the Surveillance of Bloody Diarrhea (SBD) were evaluated, to make experiences available for similar future situations. METHODS The description and evaluation of our surveillance systems is based on the "Updated Guidelines for Evaluating Public Health Surveillance Systems" published by the U.S. Centers for Disease Control and Prevention in 2001. RESULTS PIKS and SBD could be implemented quickly and were able to capture resilient data in a timely manner both on the severity and course of the influenza pandemic 2009/2010 and the outbreak of EHEC and HUS 2011. Although lacking in representativeness, sensitive and useful data were generated. CONCLUSION In large outbreaks of severe diseases, the establishment of specific hospital surveillance should be considered as early as possible. In Germany, the participating hospitals were able to rapidly implement the required measures.
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Affiliation(s)
- B Greutélaers
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Germany.
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Siedler A, Rieck T, Reuss A, Walter D, Poggensee G, Poethko-Muller C, Reiter S. Estimating vaccination coverage in the absence of immunisation registers--the German experience. ACTA ACUST UNITED AC 2012; 17. [PMID: 22551497 DOI: 10.2807/ese.17.17.20152-en] [Citation(s) in RCA: 21] [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
Immunisation registers are regarded as an appropriate solution to measure vaccination coverage on a population level. In Germany, a decentralised healthcare system and data protection regulations constrain such an approach. Moreover, shared responsibilities in the process of immunisation and multiple providers form the framework for public health interventions on vaccination issues. On the national level, those interventions consist mainly of conceptualising immunisation strategies, establishing vaccination programmes, and issuing recommendations. This paper provides an overview on sources and methods for collecting appropriate coverage data at national level and their public health relevance in Germany. Methods of data collection and available information on immunisations are described for three approaches: school entrance health examination, population surveys and insurance refund claim data. School entrance health examinations allow regional comparisons and estimation of trends for a specific cohort of children and for all recommended childhood vaccinations. Surveys deliver population based data on completeness and timeliness of selected vaccinations in populations defined by age or socio-demographic parameters and on knowledge and attitudes towards vaccination. Insurance refund claim data inform continuously on immunisation status (e.g. of children aged two years) or on vaccination incidence promptly after new or modified recommendations. In a complex healthcare system, the German National Public Health Institute (Robert Koch Institute, RKI) successfully compiles coverage data from different sources, which complement and validate one another. With the German approach of combining different data sources in the absence of immunisation registers, it is possible to gain solid and reliable data on the acceptance of vaccination programmes and target groups for immunisation. This approach might be of value for other countries with decentralised healthcare systems.
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Affiliation(s)
- A Siedler
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany.
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Ultsch B, Siedler A, Rieck T, Reinhold T, Krause G, Wichmann O. Herpes zoster in Germany: quantifying the burden of disease. BMC Infect Dis 2011; 11:173. [PMID: 21679419 PMCID: PMC3141411 DOI: 10.1186/1471-2334-11-173] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [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: 04/13/2011] [Accepted: 06/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes zoster (HZ) is caused by a reactivation of the varicella-zoster-virus (VZV) and mainly affects individuals aged≥50 years. Vaccines have been licensed or are under development that can protect against HZ and its main complication postherpetic neuralgia (PHN). In Germany, the burden of disease caused by HZ is not well known. To support the decision making process related to a potential vaccination recommendation, we estimated annual HZ disease burden in people aged≥50 years in Germany by utilizing various data sources. METHODS We assessed for 2007 and 2008 HZ-outpatient incidence (number of cases per 1,000 person-years, PY) by utilizing the Association of Statutory Health Insurance Physicians (ASHIP) database, which contains nationwide routine outpatient data. For the same time period annual number of HZ-inpatients and HZ-associated deaths were identified by using the Federal Health Monitoring System (FHM). PHN-incidence and loss of quality-adjusted life years (QALYs) caused by HZ were calculated by multiplying number of identified HZ-patients with upper and lower limit estimates for proportion of HZ-cases developing PHN and HZ-related QALY, respectively. RESULTS For the study period we identified an annual average of 306,511 HZ-outpatients aged 50+, resulting in a HZ-incidence of 9.6/1,000 PY. A total 14,249 HZ-associated inpatients and 66 deaths were reported in both years on average. HZ-incidence increased by age from 6.21 in people 50-54 years to 13.19 per 1,000 PY in people aged≥90 years. Females were significantly more frequently affected than males in terms of outpatient HZ-incidence (11.12 vs. 7.8 per 1,000 PY), inpatient HZ-incidence (0.51 vs. 0.38 per 1,000 PY) and mortality (0.29 vs. 0.10 per 100,000 PY). PHN-incidence was estimated to range between 0.43 and 1.33 per 1,000 PY. Based on these figures, there were between 3,065 to 24,094 QALYs lost due to HZ in persons aged≥50 years in Germany per annum. CONCLUSION Our study provides important baseline estimates for HZ-related disease burden in Germany. HZ poses a considerable burden on the health care system in Germany both in terms of outpatient and inpatient services. Follow-up assessments of HZ disease burden are needed to monitor the impact of VZV-vaccinations in Germany.
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Affiliation(s)
- Bernhard Ultsch
- Immunization Unit, Robert Koch Institute, 13086 Berlin, Germany.
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Wadl M, Rieck T, Nachtnebel M, Greutélaers B, an der Heiden M, Altmann D, Hellenbrand W, Faber M, Frank C, Schweickert B, Krause G, Benzler J, Eckmanns T. Enhanced surveillance during a large outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/verotoxin-producing Escherichia coli in Germany, May to June 2011. ACTA ACUST UNITED AC 2011; 16. [PMID: 21699769 DOI: 10.2807/ese.16.24.19893-en] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [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]
Abstract
Germany has a well established broad statutory surveillance system for infectious diseases. In the context of the current outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/ verotoxin-producing Escherichia coli in Germany it became clear that the provisions of the routine surveillance system were not sufficient for an adequate response. This article describes the timeline and concepts of the enhanced surveillance implemented during this public health emergency.
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Affiliation(s)
- M Wadl
- Robert Koch Institute, Berlin, Germany.
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Rieck T, Feig M, Reuß A, Eckmanns T, Poggensee G. Zunahme gemäß STIKO durchgeführter Masernimpfungen bei nur leichtem Anstieg der Masernimpfquote für die Geburtsjahrgänge 2004 bis 2006 im Gebiet der KV Nordrhein. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266504] [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: 10/19/2022]
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