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Cai W, Köndgen S, Tolksdorf K, Dürrwald R, Schuler E, Biere B, Schweiger B, Goerlitz L, Haas W, Wolff T, Buda S, Reiche J. Atypical age distribution and high disease severity in children with RSV infections during two irregular epidemic seasons throughout the COVID-19 pandemic, Germany, 2021 to 2023. Euro Surveill 2024; 29:2300465. [PMID: 38551098 PMCID: PMC10979527 DOI: 10.2807/1560-7917.es.2024.29.13.2300465] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/01/2024] [Indexed: 04/01/2024] Open
Abstract
BackgroundNon-pharmaceutical interventions (NPIs) during the COVID-19 pandemic affected respiratory syncytial virus (RSV) circulation worldwide.AimTo describe, for children aged < 5 years, the 2021 and 2022/23 RSV seasons in Germany.MethodsThrough data and 16,754 specimens from outpatient sentinel surveillance, we investigated RSV seasonality, circulating lineages, and affected children's age distributions in 2021 and 2022/23. Available information about disease severity from hospital surveillance was analysed for patients with RSV-specific diagnosis codes (n = 13,104). Differences between RSV seasons were assessed by chi-squared test and age distributions trends by Mann-Kendall test.ResultsRSV seasonality was irregular in 2021 (weeks 35-50) and 2022/23 (weeks 41-3) compared to pre-COVID-19 2011/12-2019/20 seasons (median weeks 51-12). RSV positivity rates (RSV-PR) were higher in 2021 (40% (522/1,291); p < 0.001) and 2022/23 (30% (299/990); p = 0.005) than in prior seasons (26% (1,430/5,511)). Known globally circulating RSV-A (lineages GA2.3.5 and GA2.3.6b) and RSV-B (lineage GB5.0.5a) strains, respectively, dominated in 2021 and 2022/23. In 2021, RSV-PRs were similar in 1 - < 2, 2 - < 3, 3 - < 4, and 4 - < 5-year-olds. RSV hospitalisation incidence in 2021 (1,114/100,000, p < 0.001) and in 2022/23 (1,034/100,000, p < 0.001) was approximately double that of previous seasons' average (2014/15-2019/20: 584/100,000). In 2022/23, proportions of RSV patients admitted to intensive care units rose (8.5% (206/2,413)) relative to pre-COVID-19 seasons (6.8% (551/8,114); p = 0.004), as did those needing ventilator support (6.1% (146/2,413) vs 3.8% (310/8,114); p < 0.001).ConclusionsHigh RSV-infection risk in 2-4-year-olds in 2021 and increased disease severity in 2022/23 possibly result from lower baseline population immunity, after NPIs diminished exposure to RSV.
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Affiliation(s)
- Wei Cai
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Sophie Köndgen
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch Institute, Berlin, Germany
| | - Kristin Tolksdorf
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Ralf Dürrwald
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch Institute, Berlin, Germany
| | | | - Barbara Biere
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
| | - Brunhilde Schweiger
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
| | - Luise Goerlitz
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Thorsten Wolff
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch Institute, Berlin, Germany
| | - Silke Buda
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Janine Reiche
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch Institute, Berlin, Germany
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Otto-Knapp R, Bauer T, Brinkmann F, Feiterna-Sperling C, Friesen I, Geerdes-Fenge H, Hartmann P, Häcker B, Hauer B, Haas W, Heyckendorf J, Kuhns M, Lange C, Maurer FP, Nienhaus A, Priwitzer M, Richter E, Salzer HJF, Schoch O, Schönfeld N, Schaberg T. [Treatment of MDR, pre-XDR, XDR and rifampicin resistant tuberculosis or in case of intolerance to at least rifampicin in Austria, Germany and Switzerland - Amendment dated 19.09.2023 to the Sk2-Guideline: Tuberculosis in adulthood of the German Central Committee against Tuberculosis (DZK) on behalf of the German Respiratory Society (DGP)]. Pneumologie 2024; 78:35-46. [PMID: 37931778 DOI: 10.1055/a-2182-1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/08/2023]
Abstract
In December 2022, based on the assessment of new evidence, the World Health Organization (WHO) updated its guidelines for the treatment of drug-resistant tuberculosis (TB). The evaluation of both, these recommendations, and the latest study data, makes it necessary to update the existing guidelines on the treatment of at least rifampicin-resistant tuberculosis for the German-speaking region, hereby replacing the respective chapters. A shortened MDR-TB treatment of at least 6 month using the fixed and non-modifiable drug combination of bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) is now also recommended for Germany, Austria, and Switzerland under certain conditions. This recommendation applies to TB cases with proven rifampicin resistance, including rifampicin monoresistance. For treatment of pre-extensively drug resistant TB (pre-XDR-TB), an individualized treatment for 18 months adjusted to resistance data continues to be the primary recommendation. The non-modifiable drug combination of bedaquiline, pretomanid, and linezolid (BPaL) may be used alternatively in pre-XDR TB if all prerequisites are met. The necessary prerequisites for the use of BPaLM and BPaL are presented in this amendment to the S2k guideline for 'Tuberculosis in adulthood'.
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Affiliation(s)
- Ralf Otto-Knapp
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin, Deutschland
| | - Torsten Bauer
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin, Deutschland
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Deutschland
| | - Folke Brinkmann
- Sektion pädiatrische Pneumologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Cornelia Feiterna-Sperling
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Inna Friesen
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Leibniz Lungenzentrum, Borstel, Deutschland
| | | | - Pia Hartmann
- Department für Klinische Infektiologie, St. Vinzenz-Hospital, Köln, Deutschland
| | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin, Deutschland
| | | | | | - Jan Heyckendorf
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Martin Kuhns
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Leibniz Lungenzentrum, Borstel, Deutschland
| | - Christoph Lange
- Klinische Infektiologie, Forschungszentrum Borstel, Borstel, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Hamburg-Lübeck-Borstel-Riems, Deutschland
- Respiratory Medicine and International Health, Universität zu Lübeck, Lübeck, Deutschland
- Baylor College of Medicine and Texas Children's Hospital, Global TB Program, Houston, TX, USA
| | - Florian P Maurer
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Albert Nienhaus
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | | | - Elvira Richter
- MVZ Labor Dr. Limbach & Kollegen GbR, Heidelberg, Deutschland
| | - Helmut J F Salzer
- Klinische Abteilung für Infektiologie und Tropenmedizin, Universitätsklinik für Innere Medizin 4 - Pneumologie, Kepler Universitätsklinikum, Linz, Österreich
- Medizinische Fakultät, Johannes Kepler Universität, Linz, Österreich
- Ignaz-Semmelweis-Institut, Wien, Österreich
| | - Otto Schoch
- Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - Nicolas Schönfeld
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Deutschland
| | - Tom Schaberg
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin, Deutschland
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Domaszewska T, Korzeniewska-Kosela M, Hauer B, Perumal N, Wesolowski S, Haas W, Kroeger S. Inventory study on completeness of tuberculosis case notifications in Poland in 2018. Euro Surveill 2024; 29:2300081. [PMID: 38179620 PMCID: PMC10905660 DOI: 10.2807/1560-7917.es.2024.29.1.2300081] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/18/2023] [Indexed: 01/06/2024] Open
Abstract
BackgroundEvaluating tuberculosis (TB) notification completeness is important for monitoring TB surveillance systems, while estimating the TB disease burden is crucial for control strategies.AimWe conducted an inventory study to assess TB reporting completeness in Poland in 2018.MethodsUsing a double-pronged inventory approach, we compared notifications of culture-positive TB cases in the National TB Register to records of diagnostic laboratories. We calculated under-reporting both with observed and capture-recapture (CRC)-estimated case numbers. We further compared the notifications by region (i.e. voivodship), sex, and age to aggregated data from hospitalised TB patients, which provided an independent estimate of reporting completeness.ResultsIn 2018, 4,075 culture-positive TB cases were notified in Poland, with 3,789 linked to laboratory records. Laboratories reported further 534 TB patients, of whom 456 were linked to notifications from 2017 or 2019. Thus, 78 (534 - 456) cases were missing in the National TB Register, yielding an observed TB under-reporting of 1.9% (78/(4,075 + 78) × 100). CRC-modelled total number of cases in 2018 was 4,176, corresponding to 2.4% ((4,176 - 4,075)/4,176 × 100) under-reporting. Based on aggregated hospitalisation data from 13 of 16 total voivodeships, under-reporting was 5.1% (3,482/(3,670 - 3,482) × 100), similar in both sexes but varying between voivodeships and age groups.ConclusionsOur results suggest that the surveillance system captures ≥ 90% of estimated TB cases in Poland; thus, the notification rate is a good proxy for the diagnosed TB incidence in Poland. Reporting delays causing discrepancies between data sources could be improved by the planned change from a paper-based to a digital reporting system.
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Affiliation(s)
| | | | | | | | - Stefan Wesolowski
- National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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Lehfeld AS, Buda S, Haas W, Hauer B, Schulze-Wundling K, Buchholz U. The Changing Symptom Profile of COVID-19 During the Pandemic-Results From the German Mandatory Notification System. Dtsch Arztebl Int 2023; 120:420-421. [PMID: 37563873 PMCID: PMC10437038 DOI: 10.3238/arztebl.m2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 10/26/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Ann-Sophie Lehfeld
- Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Berlin
| | - Silke Buda
- Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Berlin
| | - Walter Haas
- Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Berlin
| | - Barbara Hauer
- Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Berlin
| | | | - Udo Buchholz
- Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Berlin
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Hauer B, Kröger S, Haas W, Brodhun B. Tuberculosis in times of war and crisis: Epidemiological trends and characteristics of patients born in Ukraine, Germany, 2022. Euro Surveill 2023; 28:2300284. [PMID: 37318760 PMCID: PMC10318937 DOI: 10.2807/1560-7917.es.2023.28.24.2300284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/16/2023] Open
Abstract
The Russian invasion of Ukraine in 2022 caused a large migration to other European countries, including Germany. This movement impacted the TB epidemiology, as Ukraine has a higher prevalence of TB and multidrug-resistant TB rates compared to Germany. Our descriptive analysis of TB surveillance data reveals important information to improve TB care in people displaced from Ukraine. We observed an expected increase in the number of TB patients born in Ukraine, which is, however, so far below WHO/Europe estimates.
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Affiliation(s)
- Barbara Hauer
- Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Stefan Kröger
- Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Bonita Brodhun
- Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Lehfeld AS, Petzold M, Brodhun B, Haas W, Buchholz U. How valid is the 2- to 10-day incubation period for cases of Legionnaires' disease? - A reappraisal in the context of the German LeTriWa study; Berlin, 2016-2020. Epidemiol Infect 2023:1-14. [PMID: 37246510 DOI: 10.1017/s0950268823000833] [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: 05/30/2023] Open
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7
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Houard A, Walch P, Produit T, Moreno V, Mahieu B, Sunjerga A, Herkommer C, Mostajabi A, Andral U, André YB, Lozano M, Bizet L, Schroeder MC, Schimmel G, Moret M, Stanley M, Rison WA, Maurice O, Esmiller B, Michel K, Haas W, Metzger T, Rubinstein M, Rachidi F, Cooray V, Mysyrowicz A, Kasparian J, Wolf JP. Laser-guided lightning. Nat Photonics 2023; 17:231-235. [PMID: 36909208 PMCID: PMC9988683 DOI: 10.1038/s41566-022-01139-z] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/29/2022] [Indexed: 06/18/2023]
Abstract
Lightning discharges between charged clouds and the Earth's surface are responsible for considerable damages and casualties. It is therefore important to develop better protection methods in addition to the traditional Franklin rod. Here we present the first demonstration that laser-induced filaments-formed in the sky by short and intense laser pulses-can guide lightning discharges over considerable distances. We believe that this experimental breakthrough will lead to progress in lightning protection and lightning physics. An experimental campaign was conducted on the Säntis mountain in north-eastern Switzerland during the summer of 2021 with a high-repetition-rate terawatt laser. The guiding of an upward negative lightning leader over a distance of 50 m was recorded by two separate high-speed cameras. The guiding of negative lightning leaders by laser filaments was corroborated in three other instances by very-high-frequency interferometric measurements, and the number of X-ray bursts detected during guided lightning events greatly increased. Although this research field has been very active for more than 20 years, this is the first field-result that experimentally demonstrates lightning guided by lasers. This work paves the way for new atmospheric applications of ultrashort lasers and represents an important step forward in the development of a laser based lightning protection for airports, launchpads or large infrastructures.
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Affiliation(s)
- Aurélien Houard
- Laboratoire d’Optique Appliquée – ENSTA Paris, Ecole Polytechnique, CNRS, IP Paris, Palaiseau, France
| | - Pierre Walch
- Laboratoire d’Optique Appliquée – ENSTA Paris, Ecole Polytechnique, CNRS, IP Paris, Palaiseau, France
| | - Thomas Produit
- Groupe de Physique Appliquée, Université de Genève, Geneva, Switzerland
- Present Address: Institute of Materials Research and Engineering, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Victor Moreno
- Groupe de Physique Appliquée, Université de Genève, Geneva, Switzerland
| | - Benoit Mahieu
- Laboratoire d’Optique Appliquée – ENSTA Paris, Ecole Polytechnique, CNRS, IP Paris, Palaiseau, France
| | - Antonio Sunjerga
- EMC Laboratory, Electrical Engineering Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | | - Amirhossein Mostajabi
- EMC Laboratory, Electrical Engineering Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Ugo Andral
- Groupe de Physique Appliquée, Université de Genève, Geneva, Switzerland
| | - Yves-Bernard André
- Laboratoire d’Optique Appliquée – ENSTA Paris, Ecole Polytechnique, CNRS, IP Paris, Palaiseau, France
| | - Magali Lozano
- Laboratoire d’Optique Appliquée – ENSTA Paris, Ecole Polytechnique, CNRS, IP Paris, Palaiseau, France
| | - Laurent Bizet
- Laboratoire d’Optique Appliquée – ENSTA Paris, Ecole Polytechnique, CNRS, IP Paris, Palaiseau, France
| | | | | | - Michel Moret
- Groupe de Physique Appliquée, Université de Genève, Geneva, Switzerland
| | - Mark Stanley
- Langmuir Laboratory for Atmospheric Research, New Mexico Institute of Mining and Technology, Socorro, NM USA
| | - W. A. Rison
- Langmuir Laboratory for Atmospheric Research, New Mexico Institute of Mining and Technology, Socorro, NM USA
| | | | | | - Knut Michel
- TRUMPF Scientific Lasers GmbH + Co. KG, Unterfohring, Germany
| | | | - Thomas Metzger
- TRUMPF Scientific Lasers GmbH + Co. KG, Unterfohring, Germany
| | - Marcos Rubinstein
- School of Management and Engineering Vaud, University of Applied Sciences and Arts Western Switzerland, Yverdon-les-Bains, Switzerland
| | - Farhad Rachidi
- EMC Laboratory, Electrical Engineering Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Vernon Cooray
- Department of Electrical Engineering, Uppsala University, Uppsala, Sweden
| | - André Mysyrowicz
- Laboratoire d’Optique Appliquée – ENSTA Paris, Ecole Polytechnique, CNRS, IP Paris, Palaiseau, France
- André Mysyrowicz Consultants, Versailles, France
| | - Jérôme Kasparian
- Groupe de Physique Appliquée, Université de Genève, Geneva, Switzerland
- Institute for Environmental Sciences, Université de Genève, Geneva, Switzerland
| | - Jean-Pierre Wolf
- Groupe de Physique Appliquée, Université de Genève, Geneva, Switzerland
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Oh DY, Hölzer M, Paraskevopoulou S, Trofimova M, Hartkopf F, Budt M, Wedde M, Richard H, Haldemann B, Domaszewska T, Reiche J, Keeren K, Radonić A, Calderón JPR, Smith MR, Brinkmann A, Trappe K, Drechsel O, Klaper K, Hein S, Hildt E, Haas W, Calvignac-Spencer S, Semmler T, Dürrwald R, Thürmer A, Drosten C, Fuchs S, von Kleist M, Kröger S, Wolff T. 1358. Establishing Genomic SARS-CoV-2 Surveillance at the National Level: Germany, 2021. Open Forum Infect Dis 2022. [PMCID: PMC9752442 DOI: 10.1093/ofid/ofac492.1187] [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: 12/23/2022] Open
Abstract
Background The COVID-19 pandemic has demonstrated the importance of pathogen genomic surveillance. At RKI, the German National Institute of Public Health, we established the Integrated Molecular Surveillance for SARS-CoV-2 (IMS-SC2) network to perform SARS-CoV-2 genomic surveillance. Methods SARS-CoV-2 positive samples from laboratories distributed across Germany regularly undergo whole-genome sequencing at RKI. This surveillance instrument enables (i) almost-real-time monitoring of SARS-CoV-2 genomic diversity and evolution, (ii) in vitro assessment of vaccine coverage against emerging variants and (iii) genome-based estimates of SARS-CoV-2-incidences. Results We report the results of our analyses of 3623 SARS-CoV-2 genomes collected between 12/1/2020 and 12/31/2021. All variants of concern were identified, at ratios equivalent to those in the 100-fold larger German GISAID sequence dataset from the same time period. Lineage distributions fluctuated over time, covering the rise of the Alpha and Delta, as well as the emergence of Omicron. Phylogenetic analysis confirmed variant assignments. Multiple mutations of concern emerged during the observation period. To model vaccine effectiveness in vitro, we employed authentic-virus neutralization assays, confirming that both the Beta and Zeta variants are capable of immune evasion. The IMS-SC2 sequence dataset facilitated an estimate of the SARS-CoV-2 incidence based on genetic evolution rates. Together with modelled vaccine efficacies, Delta-specific incidence estimation indicated that the German vaccination campaign contributed substantially to a deceleration of the nascent German Delta wave. Conclusion This example illustrates that pathogen genomics enables a proactive approach to controlling a pandemic as the virus evolves. Molecular and genomic SARS-CoV-2 surveillance will be crucial during the post-pandemic future, informing public health policies including vaccination strategies. Of note, the IMS-SC2 infrastructure can be adapted to many other pathogens, serving as a blueprint for future efforts to increase genomic pathogen surveillance. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Djin-Ye Oh
- Robert Koch Institute (RKI), Berlin, Berlin, Germany
| | - Martin Hölzer
- Robert Koch Institute (RKI), Berlin, Berlin, Germany
| | | | | | | | - Matthias Budt
- Robert Koch Institute (RKI), Berlin, Berlin, Germany
| | | | | | | | | | - Janine Reiche
- Robert Koch Institute (RKI), Berlin, Berlin, Germany
| | | | | | | | | | | | | | | | | | - Sascha Hein
- Paul Ehrlich Institute, Berlin, Berlin, Germany
| | | | - Walter Haas
- Robert Koch Institute (RKI), Berlin, Berlin, Germany
| | | | | | - Ralf Dürrwald
- Robert Koch Institute (RKI), Berlin, Berlin, Germany
| | | | - Christian Drosten
- Institute of Virology, Charité-University Medicine Berlin, Berlin, Berlin, Germany
| | - Stephan Fuchs
- Robert Koch Institute (RKI), Berlin, Berlin, Germany
| | | | - Stefan Kröger
- Robert Koch Institute (RKI), Berlin, Berlin, Germany
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Neuberger F, Grgic M, Buchholz U, Maly-Motta HL, Fackler S, Lehfeld AS, Haas W, Kalicki B, Kuger S. Delta and Omicron: protective measures and SARS-CoV-2 infections in day care centres in Germany in the 4th and 5th wave of the pandemic 2021/2022. BMC Public Health 2022; 22:2106. [DOI: 10.1186/s12889-022-14521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
During the five waves of the SARS-CoV-2 pandemic so far, German early childhood education and care (ECEC) centres implemented various protective measures, such as wearing a face mask, fixed children-staff groups or regular ventilation. In addition, parents and ECEC staff were increasingly vaccinated throughout 2021. During the 4th wave, variant of concern (VOC) Delta-driven transmission indicators reached record values at the end of 2021. Those values were even exceeded in the 5th wave at the beginning of 2022 when Omicron dominated. We examine which factors facilitated or prevented infection with SARS-CoV-2 in ECEC centres, and if these differed between different phases within wave 4 (Delta) and 5 (Omicron).
Methods
Since August 2020, a weekly online survey among approximately 8000 ECEC managers has been conducted, monitoring both incident SARS-CoV-2 infections and protective measures taken. We included data from calendar week 26/2021 to 05/2022. We estimate the probability of any infections and the number of SARS-CoV-2 infections in children, parents and staff using random-effect-within-between (REWB) panel models for binomial and count data.
Results
While children, parents and staff of ECEC centres with a high proportion of children from families with low socioeconomic status (SES) have a higher risk of infections in the beginning of wave 4 (OR up to 1.99 [1.56; 2.56]), this effect diminishes for children and parents with rising incidences. Protective measures, such as wearing face masks, tend to have more extensive effects with rising incidences in wave 5 (IRR up to 0.87 [0.8; 0.93]). Further, the protective effect of vaccination against infection among staff is decreasing from wave 4 to wave 5 (OR 0.3 [0.16; 0.55] to OR 0.95, [0.84; 1.07, n.s.]). The degree of transmission from staff to child and from staff to parent is decreasing from wave 4 to wave 5, while transmission from child to staff seems to increase.
Conclusion
While Omicron seems to affect children and parents from ECEC centres with families with all SES levels more equally than Delta, the protective effect of vaccination against infection is decreasing and the effect of protective measures like face masks becomes increasingly important. In order to prevent massive closures of ECEC centres due to infection of staff, protective measures should be strictly adhered to, especially to protect staff in centres with a high proportion of children from families with low socioeconomic status.
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Wurm J, Lehfeld AS, Varnaccia G, Iwanowski H, Finkel B, Schienkiewitz A, Perlitz H, Loer AKM, Wess B, Franke A, Hüther A, Kuttig T, Sandoni A, Kubisch U, Jordan S, Haas W, Buchholz U, Loss J. Symptomatik einer akuten SARS-CoV-2-Infektion bei Kindern im Kita-Alter. Monatsschr Kinderheilkd 2022; 170:1113-1121. [PMCID: PMC9645339 DOI: 10.1007/s00112-022-01640-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/11/2022]
Abstract
Hintergrund Die Symptomatik einer pädiatrischen SARS-CoV-2-Infektion ist sehr variabel. Es gibt nur wenige Studien zu nichthospitalisierten Kindern bzw. Kindern im Kita-Alter. Ziel der Arbeit Die Arbeit soll die Häufigkeit verschiedener COVID-19-Symptome bei ein- bis 6‑jährigen Kindern beschreiben. Sie führt dazu Daten aus 2 Modulen der Corona-KiTa-Studie zusammen: 1) das Modul „COALA“ – Corona: Anlassbezogene Untersuchungen in Kitas und 2) das Modul „CATS“ – Corona KiTa Surveillance (Meldedaten). Material und Methoden In COALA wurden die Infektionsgeschehen in 30 Kitas, in denen ein SARS-CoV-2-Fall gemeldet wurde, untersucht (Oktober 2020 bis Juni 2021). Kita-Kinder wurden prospektiv über 12 Tage beobachtet (SARS-CoV-2-Tests, Symptomtagebuch). Die Ergebnisse wurden mit den Symptomangaben der deutschlandweit gemeldeten SARS-CoV-2-Fälle (Meldedaten) verglichen. Ergebnisse Aus den teilnehmenden Kitas liegen für 289 Kinder Angaben vor. Von 39 Kindern mit SARS-CoV‑2 (Wildtyp, α‑Variante) hatten 64 % mindestens ein Symptom, von den nicht mit SARS-CoV‑2 infizierten Kindern 40 %. In beiden Gruppen war Schnupfen das häufigste Symptom (36 % vs. 25 %, n. s.). Aus den Meldedaten liegen für 84.371 Kinder klinische Informationen vor, Fieber war am häufigsten (27 %), neben Schnupfen (26 %). Schwere Beschwerden wie z. B. Atemnot wurden in den Ausbruchsuntersuchungen und in den Meldedaten nur selten angegeben (3 % bzw. 1 %). Schlussfolgerung Kinder im Kita-Alter haben meist milde bzw. asymptomatische Verläufe einer SARS-CoV-2-Infektion. Ihre Symptome ähneln denjenigen von nicht mit SARS-CoV‑2 infizierten Kindern aus denselben Kitas. Es erscheint sinnvoll, Erkenntnisse aus den Meldedaten durch Ausbruchsuntersuchungen zu ergänzen, um methodische Limitationen der einzelnen Vorgehensweisen auszugleichen. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00112-022-01640-3) enthält eine weitere Tabelle, die Symptome bei symptomatischen SARS-CoV-2-Fällen von Kindern im Alter von einem bis 6 Jahren in der COALA-Stichprobe und in den Meldedaten gegenüberstellt.
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Affiliation(s)
- Juliane Wurm
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Ann-Sophie Lehfeld
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Gianni Varnaccia
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Helena Iwanowski
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Bianca Finkel
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Anja Schienkiewitz
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Hanna Perlitz
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Anne-Kathrin Mareike Loer
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Barbara Wess
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Andrea Franke
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Antje Hüther
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Tim Kuttig
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Anna Sandoni
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Ulrike Kubisch
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Susanne Jordan
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
| | - Walter Haas
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Udo Buchholz
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Julika Loss
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62–66, 12101 Berlin, Deutschland
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11
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Schaberg T, Brinkmann F, Feiterna-Sperling C, Geerdes-Fenge H, Hartmann P, Häcker B, Hauer B, Haas W, Heyckendorf J, Lange C, Maurer FP, Nienhaus A, Otto-Knapp R, Priwitzer M, Richter E, Salzer HJ, Schoch O, Schönfeld N, Stahlmann R, Bauer T. Tuberkulose im Erwachsenenalter. Pneumologie 2022; 76:727-819. [DOI: 10.1055/a-1934-8303] [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: 11/18/2022]
Abstract
ZusammenfassungDie Tuberkulose ist in Deutschland eine seltene, überwiegend gut behandelbare Erkrankung. Weltweit ist sie eine der häufigsten Infektionserkrankungen mit ca. 10 Millionen Neuerkrankungen/Jahr. Auch bei einer niedrigen Inzidenz in Deutschland bleibt Tuberkulose insbesondere aufgrund der internationalen Entwicklungen und Migrationsbewegungen eine wichtige Differenzialdiagnose. In Deutschland besteht, aufgrund der niedrigen Prävalenz der Erkrankung und der damit verbundenen abnehmenden klinischen Erfahrung, ein Informationsbedarf zu allen Aspekten der Tuberkulose und ihrer Kontrolle. Diese Leitlinie umfasst die mikrobiologische Diagnostik, die Grundprinzipien der Standardtherapie, die Behandlung verschiedener Organmanifestationen, den Umgang mit typischen unerwünschten Arzneimittelwirkungen, die Besonderheiten in der Diagnostik und Therapie resistenter Tuberkulose sowie die Behandlung bei TB-HIV-Koinfektion. Sie geht darüber hinaus auf Versorgungsaspekte und gesetzliche Regelungen wie auch auf die Diagnosestellung und präventive Therapie einer latenten tuberkulösen Infektion ein. Es wird ausgeführt, wann es der Behandlung durch spezialisierte Zentren bedarf.Die Aktualisierung der S2k-Leitlinie „Tuberkulose im Erwachsenenalter“ soll allen in der Tuberkuloseversorgung Tätigen als Richtschnur für die Prävention, die Diagnose und die Therapie der Tuberkulose dienen und helfen, den heutigen Herausforderungen im Umgang mit Tuberkulose in Deutschland gewachsen zu sein.
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Affiliation(s)
- Tom Schaberg
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | - Folke Brinkmann
- Abteilung für pädiatrische Pneumologie/CF-Zentrum, Universitätskinderklinik der Ruhr-Universität Bochum, Bochum
| | - Cornelia Feiterna-Sperling
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin
| | | | - Pia Hartmann
- Labor Dr. Wisplinghoff Köln, Klinische Infektiologie, Köln
- Department für Klinische Infektiologie, St. Vinzenz-Hospital, Köln
| | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | - Jan Heyckendorf
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Christoph Lange
- Klinische Infektiologie, Forschungszentrum Borstel
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Hamburg-Lübeck-Borstel-Riems
- Respiratory Medicine and International Health, Universität zu Lübeck, Lübeck
- Baylor College of Medicine and Texas Childrenʼs Hospital, Global TB Program, Houston, TX, USA
| | - Florian P. Maurer
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Borstel
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Albert Nienhaus
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg
| | - Ralf Otto-Knapp
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | | | | | | | - Ralf Stahlmann
- Institut für klinische Pharmakologie und Toxikologie, Charité Universitätsmedizin, Berlin
| | - Torsten Bauer
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
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12
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Oh DY, Hölzer M, Paraskevopoulou S, Trofimova M, Hartkopf F, Budt M, Wedde M, Richard H, Haldemann B, Domaszewska T, Reiche J, Keeren K, Radonić A, Ramos Calderón JP, Smith MR, Brinkmann A, Trappe K, Drechsel O, Klaper K, Hein S, Hildt E, Haas W, Calvignac-Spencer S, Semmler T, Dürrwald R, Thürmer A, Drosten C, Fuchs S, Kröger S, von Kleist M, Wolff T. Advancing Precision Vaccinology by Molecular and Genomic Surveillance of Severe Acute Respiratory Syndrome Coronavirus 2 in Germany, 2021. Clin Infect Dis 2022; 75:S110-S120. [PMID: 35749674 PMCID: PMC9278222 DOI: 10.1093/cid/ciac399] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Comprehensive pathogen genomic surveillance represents a powerful tool to complement and advance precision vaccinology. The emergence of the Alpha variant in December 2020 and the resulting efforts to track the spread of this and other severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern led to an expansion of genomic sequencing activities in Germany. METHODS At Robert Koch Institute (RKI), the German National Institute of Public Health, we established the Integrated Molecular Surveillance for SARS-CoV-2 (IMS-SC2) network to perform SARS-CoV-2 genomic surveillance at the national scale, SARS-CoV-2-positive samples from laboratories distributed across Germany regularly undergo whole-genome sequencing at RKI. RESULTS We report analyses of 3623 SARS-CoV-2 genomes collected between December 2020 and December 2021, of which 3282 were randomly sampled. All variants of concern were identified in the sequenced sample set, at ratios equivalent to those in the 100-fold larger German GISAID sequence dataset from the same time period. Phylogenetic analysis confirmed variant assignments. Multiple mutations of concern emerged during the observation period. To model vaccine effectiveness in vitro, we employed authentic-virus neutralization assays, confirming that both the Beta and Zeta variants are capable of immune evasion. The IMS-SC2 sequence dataset facilitated an estimate of the SARS-CoV-2 incidence based on genetic evolution rates. Together with modeled vaccine efficacies, Delta-specific incidence estimation indicated that the German vaccination campaign contributed substantially to a deceleration of the nascent German Delta wave. CONCLUSIONS SARS-CoV-2 molecular and genomic surveillance may inform public health policies including vaccination strategies and enable a proactive approach to controlling coronavirus disease 2019 spread as the virus evolves.
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Affiliation(s)
- Djin Ye Oh
- Correspondence: D.-Y. Oh Robert Koch Institute, Dept. of Infectious Diseases, Seestr. 10, 13353 Berlin, Germany ()
| | | | - Sofia Paraskevopoulou
- Methodology and Research Infrastructure, Bioinformatics and Systems Biology (MF1), Robert Koch Institute, Berlin, Germany
| | - Maria Trofimova
- Systems Medicine of Infectious Disease (P5), Robert Koch Institute, Berlin, Germany
| | - Felix Hartkopf
- Methodology and Research Infrastructure, Genome Sequencing and Genomic Epidemiology (MF2), Robert Koch Institute, Berlin, Germany
| | - Matthias Budt
- Influenza and Other Respiratory Viruses (FG17), Robert Koch Institute, Berlin, Germany
| | - Marianne Wedde
- Influenza and Other Respiratory Viruses (FG17), Robert Koch Institute, Berlin, Germany
| | - Hugues Richard
- Methodology and Research Infrastructure, Bioinformatics and Systems Biology (MF1), Robert Koch Institute, Berlin, Germany
| | - Berit Haldemann
- Methodology and Research Infrastructure, Bioinformatics and Systems Biology (MF1), Robert Koch Institute, Berlin, Germany
| | | | - Janine Reiche
- Influenza and Other Respiratory Viruses (FG17), Robert Koch Institute, Berlin, Germany
| | - Kathrin Keeren
- Gastroenteritis and Hepatitis Pathogens and Enteroviruses (FG15), Robert Koch Institute, Berlin, Germany
| | - Aleksandar Radonić
- Methodology and Research Infrastructure, Genome Sequencing and Genomic Epidemiology (MF2), Robert Koch Institute, Berlin, Germany
| | | | | | - Annika Brinkmann
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS1), Robert Koch Institute, Berlin, Germany
| | - Kathrin Trappe
- Methodology and Research Infrastructure, Bioinformatics and Systems Biology (MF1), Robert Koch Institute, Berlin, Germany
| | - Oliver Drechsel
- Methodology and Research Infrastructure, Bioinformatics and Systems Biology (MF1), Robert Koch Institute, Berlin, Germany
| | - Kathleen Klaper
- Methodology and Research Infrastructure, Genome Sequencing and Genomic Epidemiology (MF2), Robert Koch Institute, Berlin, Germany,Sexually Transmitted Bacterial Pathogens and HIV (FG18), Robert Koch Institute, Berlin, Germany
| | - Sascha Hein
- Division of Virology, Paul Ehrlich Institute, Langen, Germany
| | - Eberhardt Hildt
- Division of Virology, Paul Ehrlich Institute, Langen, Germany
| | - Walter Haas
- Gastroenteritis and Hepatitis Pathogens and Enteroviruses (FG15), Robert Koch Institute, Berlin, Germany
| | - Sébastien Calvignac-Spencer
- Epidemiology of Highly Pathogenic Microorganisms (P3), Viral Evolution, Robert Koch Institute, Berlin, Germany
| | - Torsten Semmler
- Methodology and Research Infrastructure, Genome Sequencing and Genomic Epidemiology (MF2), Robert Koch Institute, Berlin, Germany
| | - Ralf Dürrwald
- Influenza and Other Respiratory Viruses (FG17), Robert Koch Institute, Berlin, Germany
| | - Andrea Thürmer
- Methodology and Research Infrastructure, Genome Sequencing and Genomic Epidemiology (MF2), Robert Koch Institute, Berlin, Germany
| | - Christian Drosten
- Institute of Virology, Charité-University Medicine Berlin, Berlin, Germany
| | - Stephan Fuchs
- Methodology and Research Infrastructure, Bioinformatics and Systems Biology (MF1), Robert Koch Institute, Berlin, Germany
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13
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Sievers C, Zacher B, Ullrich A, Huska M, Fuchs S, Buda S, Haas W, Diercke M, An der Heiden M, Kröger S. SARS-CoV-2 Omicron variants BA.1 and BA.2 both show similarly reduced disease severity of COVID-19 compared to Delta, Germany, 2021 to 2022. Euro Surveill 2022; 27:2200396. [PMID: 35656831 PMCID: PMC9164675 DOI: 10.2807/1560-7917.es.2022.27.22.2200396] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [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] [Indexed: 04/10/2023] Open
Abstract
German national surveillance data analysis shows that hospitalisation odds associated with Omicron lineage BA.1 or BA.2 infections are up to 80% lower than with Delta infection, primarily in ≥ 35-year-olds. Hospitalised vaccinated Omicron cases' proportions (2.3% for both lineages) seemed lower than those of the unvaccinated (4.4% for both lineages). Independent of vaccination status, the hospitalisation frequency among cases with Delta seemed nearly threefold higher (8.3%) than with Omicron (3.0% for both lineages), suggesting that Omicron inherently causes less severe disease.
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Affiliation(s)
- Claudia Sievers
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- These authors contributed equally to this work and share first authorship
| | - Benedikt Zacher
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- These authors contributed equally to this work and share first authorship
| | - Alexander Ullrich
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Matthew Huska
- Department of Genome Sequencing and Genomic Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Stephan Fuchs
- Department of Genome Sequencing and Genomic Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Silke Buda
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Michaela Diercke
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Stefan Kröger
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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14
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Cai W, Dürrwald R, Biere B, Schweiger B, Haas W, Wolff T, Buda S, Reiche J. Determination of respiratory syncytial virus epidemic seasons by using 95% confidence interval of positivity rates, 2011-2021, Germany. Influenza Other Respir Viruses 2022; 16:854-857. [PMID: 35485999 PMCID: PMC9343324 DOI: 10.1111/irv.12996] [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: 03/16/2022] [Revised: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 11/30/2022] Open
Abstract
Based on our national outpatient sentinel surveillance, we have developed a novel approach to determine respiratory syncytial virus (RSV) epidemic seasons in Germany by using RSV positivity rate and its lower limit of 95% confidence interval. This method was evaluated retrospectively on nine RSV seasons, and it is also well‐suited to describe off‐season circulation of RSV in near real time as observed for seasons 2020/21 and 2021/22 during the COVID‐19 pandemic. Prospective application is of crucial importance to enable timely actions for health service delivery and prevention.
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Affiliation(s)
- Wei Cai
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Ralf Dürrwald
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany.,Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch Institute, Berlin, Germany
| | - Barbara Biere
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
| | - Brunhilde Schweiger
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Thorsten Wolff
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
| | - Silke Buda
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Janine Reiche
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany.,Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch Institute, Berlin, Germany
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15
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Wroblewski D, Saylors A, Haas W, Cummings K, Cukrovany A, Connors J, Thompson L, Dickinson M, Baker D, Morse M, Smith G, Dziewulski D, Zartarian M, Savage B, Gowie D, Musser K, Mingle L. The Use of Culture, Molecular Methods and Whole Genome Sequencing to Detect the Source of an Outbreak of Legionnaire's Disease in New York State. Int J Infect Dis 2022. [DOI: 10.1016/j.ijid.2021.12.227] [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: 11/29/2022] Open
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16
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Neuberger F, Grgic M, Diefenbacher S, Spensberger F, Lehfeld AS, Buchholz U, Haas W, Kalicki B, Kuger S. COVID-19 infections in day care centres in Germany: social and organisational determinants of infections in children and staff in the second and third wave of the pandemic. BMC Public Health 2022; 22:98. [PMID: 35031025 PMCID: PMC8758891 DOI: 10.1186/s12889-021-12470-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND During the SARS-CoV-2 pandemic, German early childhood education and care (ECEC) centres organised children's attendance in different ways, they reduced opening hours, provided emergency support for a few children, or closed completely. Further, protection and hygiene measures like fixed children-staff groups, ventilation and surface disinfection were introduced in ECEC centres. To inform or modify public health measures in ECEC, we investigate the occurrence of SARS-CoV-2 infections among children and staff in ECEC centres in light of social determinants (i.e. the socioeconomic status of the children) and recommended structural and hygiene measures. We focus on the question if the relevant factors differ between the 2nd (when no variant of concern (VOC) circulated) and the 3rd wave (when VOC B.1.1.7 (Alpha) predominated). METHODS Based on panel data from a weekly online survey of ECEC centre managers (calendar week 36/2020 to 22/2021, ongoing) including approx. 8500 centres, we estimate the number of SARS-CoV-2 infections in children and staff using random-effect-within-between (REWB) panel models for count data in the 2nd and 3rd wave. RESULTS ECEC centres with a high proportion of children with low socioeconomic status (SES) have a higher risk of infections in staff and children. Strict contact restrictions between groups like fixed group assignments for children and fixed staff assignments to groups prevent infections. Both effects tend to be stronger in the 3rd wave. CONCLUSION ECEC centres with a large proportion of children with a low SES background and lack of using fixed child/staff cohorts experience higher COVID-19 rates. Over the long run, centres should be supported in maintaining recommended measures. Preventive measures such as the vaccination of staff should be prioritised in centres with large proportions of low SES children.
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Affiliation(s)
- Franz Neuberger
- German Youth Institute (DJI), Nockherstr. 2, Munich, 81541, Germany.
| | - Mariana Grgic
- German Youth Institute (DJI), Nockherstr. 2, Munich, 81541, Germany
| | | | - Florian Spensberger
- Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, Eichstätt, 85072, Germany
| | | | - Udo Buchholz
- Robert Koch-Institute (RKI), Nordufer 20, Berlin, 13353, Germany
| | - Walter Haas
- Robert Koch-Institute (RKI), Nordufer 20, Berlin, 13353, Germany
| | - Bernhard Kalicki
- German Youth Institute (DJI), Nockherstr. 2, Munich, 81541, Germany
| | - Susanne Kuger
- German Youth Institute (DJI), Nockherstr. 2, Munich, 81541, Germany
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17
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Feiterna-Sperling C, Thoulass J, Krüger R, Haas W, Hauer B. Correction to: Pilot study to identify missed opportunities for prevention of childhood tuberculosis. Eur J Pediatr 2022; 181:3563-3564. [PMID: 35900450 PMCID: PMC9395305 DOI: 10.1007/s00431-022-04571-z] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Cornelia Feiterna-Sperling
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Janine Thoulass
- grid.508718.3Health Protection Scotland, Glasgow, Scotland ,grid.418914.10000 0004 1791 8889Postgraduate Training for Applied Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany affiliated to the European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Renate Krüger
- grid.6363.00000 0001 2218 4662Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Walter Haas
- grid.13652.330000 0001 0940 3744Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- grid.13652.330000 0001 0940 3744Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Sandoni A, Schaffrath Rosario A, Michel J, Kuttig T, Wurm J, Damerow S, Iwanowski H, Finkel B, Schrick L, Buchholz U, Haas W, Varnaccia G, Kubisch U, Jordan S, Schienkiewitz A, Nitsche A, Loss J. SARS-CoV-2 viral clearance and viral load kinetics in young children (1-6 years) compared to adults: Results of a longitudinal study in Germany. Front Pediatr 2022; 10:989456. [PMID: 36452353 PMCID: PMC9702089 DOI: 10.3389/fped.2022.989456] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/10/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate SARS-COV-2 viral clearance and viral load kinetics in the course of infection in children aged 1-6 years in comparison with adults. METHODS Prospective cohort study of infected daycare children and staff and their close contacts in households from 11/2020 to 06/2021. Adult participants took upper respiratory tract specimen from themselves and/or their children, for PCR tests on SARS-CoV-2. Data on symptoms and exposure were used to determine the date of probable infection for each participant. We determined (a) viral clearance, and (b) viral load dynamics over time. Samples were taken from day 4-6 to day 16-18 after diagnosis of the index case in the respective daycare group (5 samples per participant). RESULTS We included 40 children (1-6 years) and 67 adults (18-77 years) with SARS-CoV-2 infection. Samples were available at a mean of 4.3 points of time per participant. Among the participants, the 12-day study period fell in different periods within the individual course of infection, ranging from day 5-17 to day 15-26 after assumed infection.Children reached viral clearance at a median of 20 days after assumed infection (95% CI 17-21 days, Kaplan-Meier Analysis), adults at 23 days (95% CI 20-25 days, difference not significant). In both children and adults, viral load decreased over time with trajectories of the mean viral load not being statistically different between groups. Kaplan-Meier calculations show that from day 15 (95% CI 13-15), 50% of all participants had a viral load <1 million copies/ml, i.e. were no longer infectious or negative. CONCLUSION Children aged 1-6 and adults infected with SARS-CoV-2 (wild type and Alpha variant) did not differ significantly in terms of viral load kinetics and time needed to clear the virus. Therefore, containment measures are important also in the daycare settings as long as the pandemic continues.
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Affiliation(s)
- Anna Sandoni
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Janine Michel
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Tim Kuttig
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Juliane Wurm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Stefan Damerow
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Helena Iwanowski
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Bianca Finkel
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Livia Schrick
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Udo Buchholz
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Gianni Varnaccia
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ulrike Kubisch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Susanne Jordan
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Julika Loss
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Schienkiewitz A, Jordan S, Hornbacher A, Perlitz H, Zeisler ML, Sandoni A, Kubisch U, Wess B, Kuttig T, Schaffrath-Rosario A, Damerow S, Rattay P, Varnaccia G, Loer AKM, Wormsbächer J, Cohrdes C, Wetzstein M, Albrecht S, Hey I, Michel J, Schrick L, Gößwald A, Allen J, Schlaud M, Busch MA, Butschalowsky H, Wernitz J, Otte im Kampe E, Buchholz U, Haas W, Schaade L, Wieler LH, Ziese T, Lampert T, Loss J. SARS-CoV-2 Transmissibility Within Day Care Centers-Study Protocol of a Prospective Analysis of Outbreaks in Germany. Front Public Health 2021; 9:773850. [PMID: 34976930 PMCID: PMC8717701 DOI: 10.3389/fpubh.2021.773850] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/05/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction: Until today, the role of children in the transmission dynamics of SARS-CoV-2 and the development of the COVID-19 pandemic seems to be dynamic and is not finally resolved. The primary aim of this study is to investigate the transmission dynamics of SARS-CoV-2 in child day care centers and connected households as well as transmission-related indicators and clinical symptoms among children and adults. Methods and Analysis: COALA ("Corona outbreak-related examinations in day care centers") is a day care center- and household-based study with a case-ascertained study design. Based on day care centers with at least one reported case of SARS-CoV-2, we include one- to six-year-old children and staff of the affected group in the day care center as well as their respective households. We visit each child's and adult's household. During the home visit we take from each household member a combined mouth and nose swab as well as a saliva sample for analysis of SARS-CoV-2-RNA by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) and a capillary blood sample for a retrospective assessment of an earlier SARS-CoV-2 infection. Furthermore, information on health status, socio-demographics and COVID-19 protective measures are collected via a short telephone interview in the subsequent days. In the following 12 days, household members (or parents for their children) self-collect the same respiratory samples as described above every 3 days and a stool sample for children once. COVID-19 symptoms are documented daily in a symptom diary. Approximately 35 days after testing the index case, every participant who tested positive for SARS-CoV-2 during the study is re-visited at home for another capillary blood sample and a standardized interview. The analysis includes secondary attack rates, by age of primary case, both in the day care center and in households, as well as viral shedding dynamics, including the beginning of shedding relative to symptom onset and viral clearance. Discussion: The results contribute to a better understanding of the epidemiological and virological transmission-related indicators of SARS-CoV-2 among young children, as compared to adults and the interplay between day care and households.
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Affiliation(s)
- Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Susanne Jordan
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anselm Hornbacher
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hanna Perlitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Marie-Luise Zeisler
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anna Sandoni
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ulrike Kubisch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Barbara Wess
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Tim Kuttig
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Stefan Damerow
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Petra Rattay
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Gianni Varnaccia
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anne-Kathrin M. Loer
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jan Wormsbächer
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Carolin Cohrdes
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Matthias Wetzstein
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Stefan Albrecht
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Isabell Hey
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Janine Michel
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Livia Schrick
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Antje Gößwald
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jennifer Allen
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Martin Schlaud
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Markus A. Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hans Butschalowsky
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jörg Wernitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Eveline Otte im Kampe
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Udo Buchholz
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Lars Schaade
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Lothar H. Wieler
- Leadership Robert Koch Institute, Robert Koch Institute, Berlin, Germany
- Department of Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
| | - Thomas Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Lampert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Julika Loss
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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20
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Marx FM, Hauer B, Menzies NA, Haas W, Perumal N. Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries - a model-based cost-effectiveness analysis. BMC Public Health 2021; 21:2172. [PMID: 34836526 PMCID: PMC8622109 DOI: 10.1186/s12889-021-12142-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/02/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background Enhancing tuberculosis (TB) prevention and care in a post-COVID-19-pandemic phase will be essential to ensure progress towards global TB elimination. In low-burden countries, asylum seekers constitute an important high-risk group. TB frequently arises post-immigration due to the reactivation of latent TB infection (LTBI). Upon-entry screening for LTBI and TB preventive treatment (TPT) are considered worthwhile if targeted to asylum seekers from high-incidence countries who usually present with higher rates of LTBI. However, there is insufficient knowledge about optimal incidence thresholds above which introduction could be cost-effective. We aimed to estimate, among asylum seekers in Germany, the health impact and costs of upon-entry LTBI screening/TPT introduced at different thresholds of country-of-origin TB incidence. Methods We sampled hypothetical cohorts of 30–45 thousand asylum seekers aged 15 to 34 years expected to arrive in Germany in 2022 from cohorts of first-time applicants observed in 2017–2019. We modelled LTBI prevalence as a function of country-of-origin TB incidence fitted to data from observational studies. We then used a probabilistic decision-analytic model to estimate health-system costs and quality-adjusted life years (QALYs) under interferon gamma release assay (IGRA)-based screening for LTBI and rifampicin-based TPT (daily, 4 months). Incremental cost-effectiveness ratios (ICERs) were calculated for scenarios of introducing LTBI screening/TPT at different incidence thresholds. Results We estimated that among 15- to 34-year-old asylum seekers arriving in Germany in 2022, 17.5% (95% uncertainty interval: 14.2–21.6%) will be latently infected. Introducing LTBI screening/TPT above 250 per 100,000 country-of-origin TB incidence would gain 7.3 (2.7–14.8) QALYs at a cost of €51,000 (€18,000–€114,100) per QALY. Lowering the threshold to ≥200 would cost an incremental €53,300 (€19,100–€122,500) per additional QALY gained relative to the ≥250 threshold scenario; ICERs for the ≥150 and ≥ 100 thresholds were €55,900 (€20,200–€128,200) and €62,000 (€23,200–€142,000), respectively, using the next higher threshold as a reference, and considerably higher at thresholds below 100. Conclusions LTBI screening and TPT among 15- to 34-year-old asylum seekers arriving in Germany could produce health benefits at reasonable additional cost (with respect to international benchmarks) if introduced at incidence thresholds ≥100. Empirical trials are needed to investigate the feasibility and effectiveness of this approach.
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Affiliation(s)
- Florian M Marx
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany. .,Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. .,DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
| | - Barbara Hauer
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Nita Perumal
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany.,Immunization Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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21
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Loss J, Kuger S, Buchholz U, Lehfeld AS, Varnaccia G, Haas W, Jordan S, Kalicki B, Schienkiewitz A, Rauschenbach T. [SARS-CoV-2 incidence, transmission, and containment measures in daycare centers during the COVID-19 pandemic-findings from the Corona Daycare Study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1581-1591. [PMID: 34731294 PMCID: PMC8564588 DOI: 10.1007/s00103-021-03449-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/28/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022]
Abstract
Hintergrund Kindertageseinrichtungen (Kitas) spielen eine wichtige gesellschaftspolitische Rolle; gleichzeitig begünstigt der enge Kontakt der Kinder in Kitagruppen untereinander und mit Beschäftigten die Übertragung von Infektionen. In der COVID-19-Pandemie ergaben sich die Fragen, wie Infektionsgeschehen in Kitas verlaufen, welche Rolle Kitakinder in der Pandemie spielen und welche Schutz- und Hygienemaßnahmen in Kitas umgesetzt werden. Von 06/2020 bis 12/2021 wird die „Corona-KiTa-Studie“ durchgeführt, in der pädagogische und infektionsepidemiologische Themen gemeinsam bearbeitet werden. Methoden In der Studie werden Daten aus unterschiedlichen Quellen erhoben. Es werden amtliche Meldedaten sowie wöchentliche Angaben von Kitas im sog. KiTa-Register kontinuierlich ausgewertet. Zudem werden SARS-CoV-2-Ausbrüche in Kitas vor Ort durch wiederholte Probengewinnung und Befragungen untersucht. Ergebnisse Das SARS-CoV-2-Infektionsgeschehen in Kitas bzw. bei Kindern im Kitaalter war von 03/2020 bis 05/2021 sehr dynamisch. In der 2. und 3. Pandemiewelle stiegen SARS-CoV-2-Ausbrüche in Kitas deutlich an, begleitet von einer erheblichen Zunahme an Kita- und Gruppenschließungen. Zuletzt erhöhte sich der Anteil der betroffenen Kinder bei den Ausbrüchen kontinuierlich. Allerdings ergab die erste Untersuchung von SARS-CoV-2-Ausbrüchen (n = 28), dass bei kindlichen Indexfällen im Schnitt nur ein Bruchteil der Kitakontakte (6,8 %) angesteckt wurde. Die Übertragungshäufigkeiten unterschieden sich zwischen einzelnen Kitas deutlich. Diskussion Die Zusammenführung von regelmäßig erhobenen Melde- und Befragungsdaten sowie Ausbruchsuntersuchungen ermöglicht ein vielschichtiges Monitoring des Infektionsgeschehens in Kitas, dessen Ergebnisse in Empfehlungen für Public-Health-Maßnahmen einfließen können.
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Affiliation(s)
- Julika Loss
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland.
| | - Susanne Kuger
- Zentrum für Dauerbeobachtung und Methoden, Deutsches Jugendinstitut, München, Deutschland
| | - Udo Buchholz
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Ann-Sophie Lehfeld
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Gianni Varnaccia
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Walter Haas
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Susanne Jordan
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Bernhard Kalicki
- Abteilung Kinder und Kinderbetreuung, Deutsches Jugendinstitut, München, Deutschland
| | - Anja Schienkiewitz
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
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22
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Buchholz U, Lehfeld AS, Lindahl M, Otte im Kampe E, Lewandowsky M, Haas W. Value of integrated mandatory national surveillance data and literature reviews to inform public health policy in the child care sector. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.326] [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: 11/13/2022] Open
Abstract
Abstract
Background
Epidemiological properties of children have been a matter of debate during the entire duration of the SARS-CoV-2-pandemic. To inform public health policy two instruments were used that stemmed from mandatory national surveillance data as well as continuous, up-to-date literature screening. We report how these two instruments complemented each other in the first/second (before the advent of the VOC Alpha (B.1.1.7)) and the 3rd wave (dominated by VOC Alpha (B.1.1.7)) in Germany.
Methods
We monitored and analysed continuously data reported from local health departments via state health departments to the Robert Koch Institute. In addition, we reviewed peer-reviewed, pre-prints and grey literature on key epidemiological parameters in children, such as susceptibility, infectiousness and viral load.
Results
After the 1st wave in March-May 2020 the 2nd wave started in early autumn and lasted until the first weeks in 2021. The proportion of cases among 0-5 year old children stayed mostly below the corresponding population proportion, and was always lower than that of older age groups. Reported outbreaks in child care centres were small (median 4 cases). Primary cases were mainly adults. Among the cases reported from child care centre outbreaks the proportion of 0-5 year old children was only 35%. Information from the literature indicated lower susceptibility of children, lower viral load, but provided equivocal information about infectiousness. In the 3rd, B.1.1.7-dominated wave the number of outbreaks increased rapidly and exceeded the highest number in the 2nd wave. In addition, the proportion of 0-5 year old children involved in the outbreaks increased to 45%.
Conclusions
During the 1st and 2nd wave susceptibility and likely also infectiousness of 0-5 year old children was limited allowing broad opening of child care centres. In contrast, in the 3rd wave affectedness of children increased leading to recommendations to scale-up prevention efforts in child care centres.
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Affiliation(s)
- U Buchholz
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - A-S Lehfeld
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - M Lindahl
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - E Otte im Kampe
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - M Lewandowsky
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - W Haas
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Schilling J, Tolksdorf K, Marquis A, Faber M, Pfoch T, Buda S, Haas W, Schuler E, Altmann D, Grote U, Diercke M. [The different periods of COVID-19 in Germany: a descriptive analysis from January 2020 to February 2021]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1093-1106. [PMID: 34374798 PMCID: PMC8353925 DOI: 10.1007/s00103-021-03394-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
The first case of coronavirus SARS-CoV‑2 infection in Germany was diagnosed on 27 January 2020. To describe the pandemic course in 2020, we regarded four epidemiologically different periods and used data on COVID-19 cases from the mandatory reporting system as well as hospitalized COVID-19 cases with severe acute respiratory infection from the syndromic hospital surveillance.Period 0 covers weeks 5 to 9 of 2020, where mainly sporadic cases of younger age were observed and few regional outbreaks emerged. In total, 167 cases with mostly mild outcomes were reported. Subsequently, the first COVID-19 wave occurred in period 1 (weeks 10 to 20 of 2020) with a total of 175,013 cases throughout Germany. Increasingly, outbreaks in hospitals and nursing homes were registered. Moreover, elderly cases and severe outcomes were observed more frequently. Period 2 (weeks 21 to 39 of 2020) was an interim period with more mild cases, where many cases were younger and often travel-associated. Additionally, larger trans-regional outbreaks in business settings were reported. Among the 111,790 cases, severe outcomes were less frequent than in period 1. In period 3 (week 40 of 2020 to week 8 of 2021), the second COVID-19 wave started and peaked at the end of 2020. With 2,158,013 reported cases and considerably more severe outcomes in all age groups, the second wave was substantially stronger than the first wave.Irrespective of the different periods, more elderly persons and more men were affected by severe outcomes.
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Affiliation(s)
- Julia Schilling
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland.
| | - Kristin Tolksdorf
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Adine Marquis
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Mirko Faber
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Thomas Pfoch
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Silke Buda
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Walter Haas
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | | | - Doris Altmann
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Ulrike Grote
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Michaela Diercke
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
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24
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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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Loenenbach A, Markus I, Lehfeld AS, An der Heiden M, Haas W, Kiegele M, Ponzi A, Unger-Goldinger B, Weidenauer C, Schlosser H, Beile A, Buchholz U. SARS-CoV-2 variant B.1.1.7 susceptibility and infectiousness of children and adults deduced from investigations of childcare centre outbreaks, Germany, 2021. ACTA ACUST UNITED AC 2021; 26. [PMID: 34047274 PMCID: PMC8161729 DOI: 10.2807/1560-7917.es.2021.26.21.2100433] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 12/21/2022]
Abstract
We investigated three SARS-CoV-2 variant B.1.1.7 childcare centre and related household outbreaks. Despite group cohorting, cases occurred in almost all groups, i.e. also among persons without close contact. Children’s secondary attack rates (SAR) were similar to adults (childcare centres: 23% vs 30%; p = 0.15; households: 32% vs 39%; p = 0.27); child- and adult-induced household outbreaks also led to similar SAR. With the advent of B.1.1.7, susceptibility and infectiousness of children and adults seem to converge. Public health measures should be revisited accordingly.
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Affiliation(s)
- Anna Loenenbach
- These authors contributed equally to this article and share first authorship.,Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Inessa Markus
- These authors contributed equally to this article and share first authorship.,Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Ann-Sophie Lehfeld
- Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | | | - Walter Haas
- Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Maya Kiegele
- Local Health Authority Bergstraße/Hesse, Heppenheim, Germany.,Federal Office of Administration, Cologne, Germany
| | - André Ponzi
- Local Health Authority Bergstraße/Hesse, Heppenheim, Germany.,Federal Office of Administration, Cologne, Germany
| | | | | | - Helen Schlosser
- Local Health Authority Bergstraße/Hesse, Heppenheim, Germany
| | - Alexander Beile
- Local Health Authority Bergstraße/Hesse, Heppenheim, Germany
| | - Udo Buchholz
- Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
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26
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Sanchini A, Jandrasits C, Tembrockhaus J, Kohl TA, Utpatel C, Maurer FP, Niemann S, Haas W, Renard BY, Kröger S. Improving tuberculosis surveillance by detecting international transmission using publicly available whole genome sequencing data. ACTA ACUST UNITED AC 2021; 26. [PMID: 33446303 PMCID: PMC7809720 DOI: 10.2807/1560-7917.es.2021.26.2.1900677] [Citation(s) in RCA: 5] [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] [Indexed: 12/30/2022]
Abstract
IntroductionImproving the surveillance of tuberculosis (TB) is especially important for multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB. The large amount of publicly available whole genome sequencing (WGS) data for TB gives us the chance to re-use data and to perform additional analyses at a large scale.AimWe assessed the usefulness of raw WGS data of global MDR/XDR Mycobacterium tuberculosis isolates available from public repositories to improve TB surveillance.MethodsWe extracted raw WGS data and the related metadata of M. tuberculosis isolates available from the Sequence Read Archive. We compared this public dataset with WGS data and metadata of 131 MDR- and XDR M. tuberculosis isolates from Germany in 2012 and 2013.ResultsWe aggregated a dataset that included 1,081 MDR and 250 XDR isolates among which we identified 133 molecular clusters. In 16 clusters, the isolates were from at least two different countries. For example, Cluster 2 included 56 MDR/XDR isolates from Moldova, Georgia and Germany. When comparing the WGS data from Germany with the public dataset, we found that 11 clusters contained at least one isolate from Germany and at least one isolate from another country. We could, therefore, connect TB cases despite missing epidemiological information.ConclusionWe demonstrated the added value of using WGS raw data from public repositories to contribute to TB surveillance. Comparing the German with the public dataset, we identified potential international transmission events. Thus, using this approach might support the interpretation of national surveillance results in an international context.
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Affiliation(s)
- Andrea Sanchini
- These authors contributed equally to this manuscript.,Respiratory Infections Unit (FG36), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Christine Jandrasits
- Bioinformatics Unit (MF1), Department of Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany.,These authors contributed equally to this manuscript
| | - Julius Tembrockhaus
- Bioinformatics Unit (MF1), Department of Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
| | - Thomas Andreas Kohl
- German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Germany.,Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
| | - Christian Utpatel
- German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Germany.,Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
| | - Florian P Maurer
- National and WHO Supranational Reference Laboratory for Mycobacteria, Research Center Borstel, Borstel, Germany
| | - Stefan Niemann
- German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Germany.,Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
| | - Walter Haas
- Respiratory Infections Unit (FG36), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Bernhard Y Renard
- Hasso Plattner Institute, Faculty for Digital Engineering, University of Potsdam, Potsdam, Germany.,Bioinformatics Unit (MF1), Department of Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
| | - Stefan Kröger
- German Center for Infection Research (DZIF), partner site Hannover - Brunswick, Germany.,Respiratory Infections Unit (FG36), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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27
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Charles T, Eckardt M, Karo B, Haas W, Kröger S. Seasonality in extra-pulmonary tuberculosis notifications in Germany 2004-2014- a time series analysis. BMC Public Health 2021; 21:661. [PMID: 33823839 PMCID: PMC8025493 DOI: 10.1186/s12889-021-10655-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/18/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Seasonality in tuberculosis (TB) has been found in different parts of the world, showing a peak in spring/summer and a trough in autumn/winter. The evidence is less clear which factors drive seasonality. It was our aim to identify and evaluate seasonality in the notifications of TB in Germany, additionally investigating the possible variance of seasonality by disease site, sex and age group. METHODS We conducted an integer-valued time series analysis using national surveillance data. We analysed the reported monthly numbers of started treatments between 2004 and 2014 for all notified TB cases and stratified by disease site, sex and age group. RESULTS We detected seasonality in the extra-pulmonary TB cases (N = 11,219), with peaks in late spring/summer and troughs in fall/winter. For all TB notifications together (N = 51,090) and for pulmonary TB only (N = 39,714) we did not find a distinct seasonality. Additional stratified analyses did not reveal any clear differences between age groups, the sexes, or between active and passive case finding. CONCLUSION We found seasonality in extra-pulmonary TB only, indicating that seasonality of disease onset might be specific to the disease site. This could point towards differences in disease progression between the different clinical disease manifestations. Sex appears not to be an important driver of seasonality, whereas the role of age remains unclear as this could not be sufficiently investigated.
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Affiliation(s)
- Tanja Charles
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
- Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany.
- European Programme for Intervention Epidemiology Training, ECDC, Solna, Sweden.
| | - Matthias Eckardt
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Basel Karo
- Centre for International Health Protection (ZIG), Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Stefan Kröger
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- German Center for Infection Research (DZIF), partner site Hanover - Brunswick, Germany
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28
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Grote U, Arvand M, Brinkwirth S, Brunke M, Buchholz U, Eckmanns T, von Kleist M, Niebank M, Ruehe B, Schulze K, Stoliaroff-Pépin A, Thanheiser M, Schaade L, Said D, Haas W. [Measures to cope with the COVID-19 pandemic in Germany: nonpharmaceutical and pharmaceutical interventions]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:435-445. [PMID: 33787944 PMCID: PMC8010780 DOI: 10.1007/s00103-021-03306-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
When the emerging novel SARS-CoV‑2 virus first appeared in December 2019, neither specific therapeutic options nor vaccinations were available. The role of nonpharmaceutical interventions (NPIs) became of central importance. At the Robert Koch Institute, a multilayer strategy consisting of population-based and individual preventive measures to control the pandemic was developed, which built upon existing influenza pandemic plans as well as generic plans. This paper explains the recommended NPIs and illustrates the pharmaceutical approaches developed in parallel.Among others, general contact bans, providing material for infection prevention and control, ban of events, closing educational institutions, and restricting travel are counted among population-based measures. Additional individual preventive measures are necessary, e.g., keeping a minimum distance, reducing contacts, and wearing a mouth-nose covering as well as quarantine and isolation. Measures within the health system are based on recommendations of the Commission on Hospital Hygiene and Infection Protection (Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO)) and specified and implemented by professional societies. Since November 2020, an antiviral therapy with remdesivir and treatment with the glucocorticoid dexamethasone have been available as pharmaceutical interventions. Monoclonal antibodies are at this time not approved. Therapeutic anticoagulation is recommended.Recommendations are constantly adapted to the increasing knowledge on the pathogen and its means of transmission. A challenge is to strengthen the trust of the population. Many measures have to be applied on an individual basis in order to work together.
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Affiliation(s)
- Ulrike Grote
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland.
- ÖGD Kontaktstelle: Infektionsepidemiologisches Krisenmanagement, Ausbruchsuntersuchungen und Trainingsprogramme (Fachgebiet 38), Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.
| | - Mardjan Arvand
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Simon Brinkwirth
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Melanie Brunke
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Udo Buchholz
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Tim Eckmanns
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Max von Kleist
- MF Methodenentwicklung und Forschungsinfrastruktur, Robert Koch-Institut, Berlin, Deutschland
| | - Michaela Niebank
- Zentrum für Biologische Gefahren und Spezielle Pathogene (ZBS), Robert Koch-Institut, Berlin, Deutschland
| | - Bettina Ruehe
- Zentrum für Biologische Gefahren und Spezielle Pathogene (ZBS), Robert Koch-Institut, Berlin, Deutschland
| | - Kai Schulze
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | | | - Marc Thanheiser
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Lars Schaade
- Zentrum für Biologische Gefahren und Spezielle Pathogene (ZBS), Robert Koch-Institut, Berlin, Deutschland
| | - Dunja Said
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Walter Haas
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
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29
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Goerlitz L, Tolksdorf K, Buchholz U, Prahm K, Preuß U, An der Heiden M, Wolff T, Dürrwald R, Nitsche A, Michel J, Haas W, Buda S. [Monitoring of COVID-19 by extending existing surveillance for acute respiratory infections]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:395-402. [PMID: 33760935 PMCID: PMC7988640 DOI: 10.1007/s00103-021-03303-2] [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] [Received: 11/30/2020] [Accepted: 02/26/2021] [Indexed: 11/27/2022]
Abstract
Im Rahmen der nationalen Influenzapandemieplanung wurden in Deutschland neben dem Meldewesen gemäß Infektionsschutzgesetz (IfSG) weitere Überwachungssysteme etabliert. Ziel dieser Systeme sind die Beschreibung, Analyse und Bewertung der Situation bei akuten respiratorischen Erkrankungen (ARE), die Identifikation der hauptsächlich zirkulierenden Atemwegserreger und die Beschreibung des zeitlichen Verlaufs. Seit Beginn der COVID-19-Pandemie wurden die Systeme erweitert, um auch Infektionen mit SARS-CoV‑2 erfassen zu können. In diesem Beitrag werden drei verschiedene Surveillance-Systeme für ARE vorgestellt: GrippeWeb, die Arbeitsgemeinschaft Influenza mit dem SEEDARE-Modul (Sentinel zur elektronischen Erfassung von Diagnosecodes) und das Krankenhaus-Sentinel ICOSARI (ICD-10-code-basierte Krankenhaus-Surveillance schwerer akuter respiratorischer Infektionen). Mit diesen Systemen können ARE auf Bevölkerungsebene, im ambulanten und im stationären Bereich überwacht werden. Zusammen mit dem Monitoring der Mortalität liefern sie wichtige Hinweise zur Häufigkeit verschieden schwerer Krankheitsverläufe in der Bevölkerung. Um die Systeme für SARS-CoV‑2 zu erweitern, waren nur wenige Anpassungen notwendig. Da die Falldefinitionen für ARE nicht geändert wurden, können in den beschriebenen Systemen historische Zeitreihen zum Vergleich herangezogen werden. Alle Systeme sind so aufgebaut, dass stabile und etablierte Bezugsgrößen für die Berechnung von wöchentlichen Anteilen und Raten zur Verfügung stehen. Dies ist eine wichtige Ergänzung zum Meldewesen gemäß IfSG, welches stark von Testkapazitäten und -strategien sowie veränderten Falldefinitionen abhängt. Die Surveillance-Systeme haben sich in der COVID-19-Pandemie auch im internationalen Vergleich als praktikabel und effizient erwiesen.
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Affiliation(s)
- Luise Goerlitz
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Kristin Tolksdorf
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Udo Buchholz
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Kerstin Prahm
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Ute Preuß
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | | | - Thorsten Wolff
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Ralf Dürrwald
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Andreas Nitsche
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Berlin, Deutschland
| | - Janine Michel
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Berlin, Deutschland
| | - Walter Haas
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Silke Buda
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland.
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30
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Schilling J, Lehfeld AS, Schumacher D, Ullrich A, Diercke M, Buda S, Haas W. Disease severity of the first COVID-19 wave in Germany using reporting data from the national notification system. J Health Monit 2021; 5:2-19. [PMID: 35146281 PMCID: PMC8734123 DOI: 10.25646/7170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/29/2020] [Indexed: 04/16/2023]
Abstract
As of December 31, 2019, initial reports circulated internationally of an unusual cluster of pneumonia of unknown cause in China. By the end of January 2020, the virus affected Germany with the first case confirmed on January 27, 2020. Intensive contact tracing and infection control measures contained the first two clusters in the country. However, the dynamic of the first wave gained momentum as of March, and by mid-June 2020 over 190,000 laboratory-confirmed cases had been reported to the Robert Koch Institute. This article examines these cases as part of a retrospective descriptive analysis focused on disease severity. Most cases (80%) were mild and two thirds of the cases were younger than 60 years (median age: 50 years). Severe cases were primarily reported among men aged 60 or over who had at least one risk factor (particularly cardiovascular disease, diabetes, neurological disorders and/or lung diseases). Cases between the ages of 40 and 59 years had the longest interval between symptom onset and hospitalisation (median: six days) and - if admitted to an intensive care unit (ICU) - also the longest ICU stay (median: eleven days). This analysis provides valuable information about disease severity of COVID-19 and particularly affected groups.
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Affiliation(s)
- Julia Schilling
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
- Corresponding author Julia Schilling, Robert Koch Institute, Department of Infectious Disease Epidemiology, Seestr. 10, 13353 Berlin, Germany, E-mail:
| | - Ann-Sophie Lehfeld
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
| | - Dirk Schumacher
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
- Federal Institute for Quality Assurance and Transparency in Healthcare (IQTIG), Berlin Unit for Medical Biometry and Statistics
| | - Alexander Ullrich
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
| | - Michaela Diercke
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
| | - Silke Buda
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
| | - Walter Haas
- Robert Koch Institute, Berlin Department of Infectious Disease Epidemiology
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31
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Dürrwald R, Wedde M, Biere B, Oh DY, Heßler-Klee M, Geidel C, Volmer R, Hauri AM, Gerst K, Thürmer A, Appelt S, Reiche J, Duwe S, Buda S, Wolff T, Haas W. Zoonotic infection with swine A/H1 avN1 influenza virus in a child, Germany, June 2020. ACTA ACUST UNITED AC 2021; 25. [PMID: 33094718 PMCID: PMC7651875 DOI: 10.2807/1560-7917.es.2020.25.42.2001638] [Citation(s) in RCA: 9] [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] [Indexed: 12/24/2022]
Abstract
A zoonotic A/sw/H1avN1 1C.2.2 influenza virus infection was detected in a German child that presented with influenza-like illness, including high fever. There was a history of close contact with pigs 3 days before symptom onset. The child recovered within 3 days. No other transmissions were observed. Serological investigations of the virus isolate revealed cross-reactions with ferret antisera against influenza A(H1N1)pdm09 virus, indicating a closer antigenic relationship with A(H1N1)pdm09 than with the former seasonal H1N1 viruses.
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Affiliation(s)
| | | | | | | | | | | | - Renate Volmer
- Landesbetrieb Hessisches Landeslabor (LHL), Fachgebiet II.4 Tiergesundheitsdienste, Gießen, Germany
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32
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Buchholz U, Jahn HJ, Brodhun B, Lehfeld AS, Lewandowsky MM, Reber F, Adler K, Bochmann J, Förster C, Koch M, Schreiner Y, Stemmler F, Gagell C, Harbich E, Bärwolff S, Beyer A, Geuß-Fosu U, Hänel M, Larscheid P, Murajda L, Morawski K, Peters U, Pitzing R, von Welczeck A, Widders G, Wischnewski N, Abdelgawad I, Hinzmann A, Hedeler D, Schilling B, Schmidt S, Schumacher J, Zuschneid I, Atmowihardjo I, Arastéh K, Behrens S, Creutz P, Elias J, Gregor M, Kahl S, Kahnert H, Kimmel V, Lehmke J, Migaud P, Mikolajewska A, Moos V, Naumann MB, Pankow W, Scherübl H, Schmidt B, Schneider T, Stocker H, Suttorp N, Thiemig D, Gollnisch C, Mannschatz U, Haas W, Schaefer B, Lück C. Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019. PLoS One 2020; 15:e0241724. [PMID: 33237924 PMCID: PMC7688155 DOI: 10.1371/journal.pone.0241724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/25/2020] [Accepted: 10/20/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown. OBJECTIVE Identification of sources of infection of CALD. SETTING Berlin; December 2016-May 2019. PARTICIPANTS Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls. MAIN OUTCOME MEASURE Percentage of cases of CALD with attributed source of infection. METHODS Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)). RESULTS Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed. CONCLUSION Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation.
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Affiliation(s)
- Udo Buchholz
- Department of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany
| | - Heiko Juergen Jahn
- Department of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany
| | - Bonita Brodhun
- Department of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany
| | - Ann-Sophie Lehfeld
- Department of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany
| | - Marina M. Lewandowsky
- Department of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany
| | - Franziska Reber
- Department of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany
| | - Kristin Adler
- Section II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany
| | - Jacqueline Bochmann
- Section II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany
| | - Christina Förster
- Section II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany
| | - Madlen Koch
- Section II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany
| | - Yvonne Schreiner
- Section II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany
| | - Fabian Stemmler
- Section II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany
| | - Corinna Gagell
- Faculty of Medicine Carl Gustav Carus, Institute of Medical Microbiology and Hygiene/Institute of Virology, National Consulting Laboratory for Legionella, TU Dresden, Dresden, Germany
| | - Edith Harbich
- Faculty of Medicine Carl Gustav Carus, Institute of Medical Microbiology and Hygiene/Institute of Virology, National Consulting Laboratory for Legionella, TU Dresden, Dresden, Germany
| | - Sina Bärwolff
- Health Department, DHA Tempelhof-Schöneberg, Berlin, Germany
| | - Andreas Beyer
- Health Department, DHA Steglitz-Zehlendorf, Berlin, Germany
| | | | - Martina Hänel
- Health Department, DHA Marzahn-Hellersdorf, Berlin, Germany
| | | | | | | | - Uwe Peters
- Health Department, DHA Pankow, Berlin, Germany
| | - Raimund Pitzing
- Health Department, DHA Friedrichshain-Kreuzberg, Berlin, Germany
| | | | | | | | | | | | - Denis Hedeler
- Health Department, DHA Treptow-Köpenick, Berlin, Germany
| | - Birte Schilling
- Health Department, DHA Tempelhof-Schöneberg, Berlin, Germany
| | - Silvia Schmidt
- Health Department, DHA Steglitz-Zehlendorf, Berlin, Germany
| | | | - Irina Zuschneid
- Health Department, DHA Charlottenburg-Wilmersdorf, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Uwe Mannschatz
- Hygiene Inspection for Drinking Water Systems, Berlin, Germany
| | - Walter Haas
- Department of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany
| | - Benedikt Schaefer
- Section II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany
| | - Christian Lück
- Faculty of Medicine Carl Gustav Carus, Institute of Medical Microbiology and Hygiene/Institute of Virology, National Consulting Laboratory for Legionella, TU Dresden, Dresden, Germany
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Domaszewska T, Karo B, Preuss U, Kollan C, Reuss A, Blank HP, Brodhun B, Hauer B, Altmann D, Fiebig L, Haas W, Perumal N. Completeness of tuberculosis case notifications in Germany in 2013-2017: first results of an inventory study. BMC Infect Dis 2020; 20:766. [PMID: 33069210 PMCID: PMC7568379 DOI: 10.1186/s12879-020-05467-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Evaluating the completeness of tuberculosis (TB) notification data is important for monitoring of TB surveillance systems. We conducted an inventory study to calculate TB underreporting in Germany in 2013-2017. METHODS Acquisition of two pseudonymized case-based data sources (national TB notification data and antibiotic resistance surveillance data) was followed by two-source Capture-recapture (CRC) analysis, as case-based data from a third source was unavailable. Aggregated data on consumption of a key anti-TB drug (pyrazinamide [PZA]) was compared to an estimated need for PZA based on TB notification data to obtain an independent underreporting estimation. Additionally, notified TB incidence was compared to TB rate in an aggregated health insurance fund dataset. RESULTS CRC and PZA-based approaches indicated that between 93 and 97% (CRC) and between 91 and 95% (PZA) of estimated cases were captured in the national TB notification data in the years 2013-2017. Insurance fund dataset did not indicate TB underreporting on the national level in 2017. CONCLUSIONS Our results suggest that more than 90% of estimated TB cases are captured within the German TB surveillance system, and accordingly the TB notification rate is likely a good proxy of the diagnosed TB incidence rate. An increase in underreporting and discrepancies however should be further investigated.
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Affiliation(s)
- Teresa Domaszewska
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | - Basel Karo
- Robert Koch Institute, Centre for International Health Protection (ZIG), Berlin, Germany
| | - Ute Preuss
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Christian Kollan
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Annicka Reuss
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Hans-Peter Blank
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Bonita Brodhun
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Doris Altmann
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Lena Fiebig
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- Current affiliation: APOPO, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Nita Perumal
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Abstract
Mitigation of the coronavirus disease (COVID-19) pandemic in Germany included school closures in early March 2020. After reopening in April, preventive measures were taken in schools. We analysed national surveillance system data on COVID-19 school outbreaks during different time periods. After reopening, smaller outbreaks (average: 2.2/week) occurred despite low incidence in the general population. School closures might have a detrimental effect on children and should be applied only cautiously and in combination with other measures.
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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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Garcia EG, Veloso A, Oliveira ML, Allen JR, Loontiens S, Brunson D, Do D, Yan C, Morris R, Iyer S, Garcia SP, Iftimia N, Van Loocke W, Matthijssens F, McCarthy K, Barata JT, Speleman F, Taghon T, Gutierrez A, Van Vlierberghe P, Haas W, Blackburn JS, Langenau DM. PRL3 enhances T-cell acute lymphoblastic leukemia growth through suppressing T-cell signaling pathways and apoptosis. Leukemia 2020; 35:679-690. [PMID: 32606318 PMCID: PMC8009053 DOI: 10.1038/s41375-020-0937-3] [Citation(s) in RCA: 6] [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: 09/04/2019] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 01/06/2023]
Abstract
T cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy of thymocytes and is largely driven by the NOTCH/MYC pathway. Yet, additional oncogenic drivers are required for transformation. Here, we identify protein tyrosine phosphatase type 4 A3 (PRL3) as a collaborating oncogenic driver in T-ALL. PRL3 is expressed in a large fraction of primary human T-ALLs and is commonly co-amplified with MYC. PRL3 also synergized with MYC to initiate early-onset ALL in transgenic zebrafish and was required for human T-ALL growth and maintenance. Mass spectrometry phosphoproteomic analysis and mechanistic studies uncovered that PRL3 suppresses downstream T cell phosphorylation signaling pathways, including those modulated by VAV1, and subsequently suppresses apoptosis in leukemia cells. Taken together, our studies have identified new roles for PRL3 as a collaborating oncogenic driver in human T-ALL and suggest that therapeutic targeting of the PRL3 phosphatase will likely be a useful treatment strategy for T-ALL.
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Affiliation(s)
- E G Garcia
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - A Veloso
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - M L Oliveira
- Instituto de Medicina Molecular João Lobo Antunes Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - J R Allen
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - S Loontiens
- Cancer Research Institute Ghent, Ghent, Belgium
| | - D Brunson
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - D Do
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - C Yan
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - R Morris
- Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - S Iyer
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - S P Garcia
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - N Iftimia
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - W Van Loocke
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - F Matthijssens
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - K McCarthy
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - J T Barata
- Instituto de Medicina Molecular João Lobo Antunes Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - F Speleman
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - T Taghon
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - A Gutierrez
- Division of Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, USA
| | - P Van Vlierberghe
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - W Haas
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - J S Blackburn
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY, 40536, USA
| | - D M Langenau
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA. .,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA. .,Harvard Stem Cell Institute, Boston, MA, 02114, USA. .,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
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Unizony S, Morris R, Kreuzer J, Haas W, Stone JH. OP0338 MASS SPECTROMETRY IDENTIFIES NOVEL BIOMARKERS IN GIANT CELL ARTERITIS, USEFUL IN PATIENTS ON INTERLEUKIN-6 RECEPTOR BLOCKADE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Acute phase reactants (erythrosedimentation rate [ESR], C-reactive protein [CRP]) have limited utility in GCA, even in patients treated with prednisone alone. Furthermore, the lack of reliable biomarkers in patients receiving interleukin (IL)-6 blockade therapy is a major unmet need.Objectives:To identify biomarkers of disease activity in GCA patients treated with prednisone monotherapy and with prednisone in combination with tocilizumab (TCZ).Methods:We mapped the serum proteome of GCA patients with active and inactive disease in an unbiased manner using high-throughput multiplexed mass spectrometry. Proteomic analyses were performed in 5 µl serum samples with 11-plexed tandem mass tag (TMT) technology using an Orbitrap Lumos mass spectrometer. A SEQUEST-based database search engine was employed for peptide identification. Quantification was based on TMT reporter ion intensities. All patients were sampled during their participation in the GiACTA trial,1in which they received TCZ plus 26 weeks of prednisone (TCZ group) or placebo plus 26 or 52 weeks of prednisone (PRED group). Active disease was defined as the presence of cranial or PMR symptoms requiring treatment intensification regardless of ESR and CRP levels. Samples were selected if patients were in clear states of active or inactive disease at GiACTA systematic sample collection timepoints (baseline and weeks 4, 12, 24, 48). An exhaustive leave-2-out strategy was used to identify classification markers. All possible pairs of samples were isolated as test samples and the remaining training samples were used to identify the protein markers. Proteins with an absolute log2 fold concentration difference ≥0.5 between active and inactive samples and a P-value <0.1 were retained and sorted based on the metric -log10(P-value)*absolute(log2 fold change). Top markers within each training set were selected to generate normalized ranks {0,1} across all samples. A mean rank was calculated for every sample. The set of normalized ranks for the test samples across all sets of top markers were bootstrapped for each test sample 100 times with replacement. The bootstrapped rankings were evaluated by determining areas under the curves (AUC) of receiver operator characteristic (ROC) curves.Results:The PRED group included 21 patients (active, n = 16; inactive, n = 5) and the TCZ group included 21 patients (active, n = 14; inactive, n = 7). Using high-throughput sample preparation methods without applying any depletion of known highly abundant serum proteins, we quantified 760 proteins across all samples and 344 proteins in at least half the samples. Compared to inactive PRED-treated patients, active PRED-treated patients showed significant overexpression of several acute phase reactants including serum amyloid A1 and 2 (SAA1, SAA2) and complement factor H (CFH) (Fig. 1a). The magnitude of concentration change and the level of statistical significance observed for SSA1, SSA2 and CFH in PRED-treated patients were higher than those of CRP (Fig. 1a). Compared to inactive TCZ-treated patients, active TCZ-treated patients demonstrated significant overexpression of multiple biomarkers including haptoglobin, haptoglobin precursor, SSA2 and complement factor 4A, and underexpression of peptidase inhibitor 16 (Fig. 1b), a protein involved in vascular and regulatory T cell biology. Sets of 10 biomarkers resulted in a classification of active versus inactive disease with ROC AUCs of 0.89 (95% CI 0.79-0.96) in the PRED group (Fig. 2a) and 0.97 (95% CI 0.95-0.97) in the TCZ group (Fig. 2b).Conclusion:We identified several differentially expressed serum proteins in GCA patients with active and inactive disease receiving prednisone monotherapy or TCZ-based treatment regimens. In both treatment groups, a signature of biomarkers classified disease activity status with high accuracy. Haptoglobin, a readily available laboratory test, may be useful in monitoring disease activity in GCA patients receiving IL-6 blockade therapy.References:[1]Stoneet al.NEJM2017Disclosure of Interests:Sebastian Unizony Grant/research support from: Genentech, Inc., Robert Morris: None declared, Johannes Kreuzer: None declared, Wilhelm Haas: None declared, John H. Stone Grant/research support from: Roche, Consultant of: Roche
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Glasauer S, Kröger S, Haas W, Perumal N. International tuberculosis contact-tracing notifications in Germany: analysis of national data from 2010 to 2018 and implications for efficiency. BMC Infect Dis 2020; 20:267. [PMID: 32252650 PMCID: PMC7137477 DOI: 10.1186/s12879-020-04982-z] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/19/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND International contact-tracing (CT) following exposure during long-distance air travel is resource-intensive, whereas evidence for risk of tuberculosis (TB) transmission during international travel is weak. In this study, we systematically analyzed the information from international requests for CT received at the national level in Germany in order to evaluate the continued utility of the current approach and to identify areas for improvement. METHODS An anonymized archive of international CT notifications received by the Robert Koch Institute between 2010 and 2018 was searched for key parameters for data collection. A total of 31 parameters, such as characteristics of TB patients and their identified contacts, were extracted from each CT notification and collated into a dataset. Descriptive data analysis and trend analyses were performed to identify key characteristics of CT notifications, patients, and contacts over the years. RESULTS 192 CT notifications, each corresponding to a single TB index case, were included in the study, increasing from 12 in 2010 to 41 in 2018. The majority of notifications (N = 130, 67.7%) concerned international air travel, followed by private contact (N = 39, 20.3%) and work exposure (N = 16, 8.3%). 159 (82.8%) patients had sputum smear results available, of which 147 (92.5%) were positive. Of 119 (62.0%) patients with drug susceptibility testing results, most (N = 92, 77.3%) had pan-sensitive TB, followed by 15 (12.6%) with multi-drug resistant TB. 115 (59.9%) patients had information on infectiousness, of whom 99 (86.1%) were considered infectious during the exposure period. 7 (5.3%) patients travelled on long-distance flights despite a prior diagnosis of active TB. Of the 771 contact persons, 34 (4.4%) could not be reached for CT measures due to lack of contact information. CONCLUSION The high variability in completeness of information contained within the international CT requests emphasizes the need for international standards for reporting of CT information. With the large proportion of TB patients reported to have travelled while being infectious in our study, we feel that raising awareness among patients and health professionals to detect TB early and prevent international long-distance travel during the infectious disease phase should be a cornerstone strategy to safeguard against possible transmission during international travel.
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Affiliation(s)
- Saskia Glasauer
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Stefan Kröger
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Nita Perumal
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
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Tolksdorf K, Buda S, Schuler E, Wieler LH, Haas W. Influenza-associated pneumonia as reference to assess seriousness of coronavirus disease (COVID-19). Euro Surveill 2020; 25:2000258. [PMID: 32186278 PMCID: PMC7096775 DOI: 10.2807/1560-7917.es.2020.25.11.2000258] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 03/06/2020] [Accepted: 03/16/2020] [Indexed: 01/11/2023] Open
Abstract
Information on severity of coronavirus disease (COVID-19) (transmissibility, disease seriousness, impact) is crucial for preparation of healthcare sectors. We present a simple approach to assess disease seriousness, creating a reference cohort of pneumonia patients from sentinel hospitals. First comparisons exposed a higher rate of COVID-19 patients requiring ventilation. There were more case fatalities among COVID-19 patients without comorbidities than in the reference cohort. Hospitals should prepare for high utilisation of ventilation and intensive care resources.
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Cai W, Buda S, Schuler E, Hirve S, Zhang W, Haas W. Risk factors for hospitalized respiratory syncytial virus disease and its severe outcomes. Influenza Other Respir Viruses 2020; 14:658-670. [PMID: 32064773 PMCID: PMC7578333 DOI: 10.1111/irv.12729] [Citation(s) in RCA: 21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/10/2020] [Accepted: 01/24/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Respiratory syncytial virus (RSV) is a major cause of hospital admission for acute lower respiratory tract infection in young children. Objectives We aimed to identify risk factors for hospitalized RSV disease and its severe outcomes. Methods We conducted a retrospective cohort study analyzing data of a ICD‐10‐code‐based hospital surveillance for severe acute respiratory infections (SARI). Using univariable and multivariable logistic regression analysis, we assessed age‐group, gender, season, and underlying medical conditions as possible risk factors for RSV and its severe outcomes including ICU admission, application of ventilator support, and death, respectively. Results Of the 413 552 patients hospitalized with SARI in the database, 8761 were diagnosed with RSV from week 01/2009 to 20/2018 with 97% (8521) aged <5 years. Among children aged <5 years, age‐groups 0‐5 months (OR: 20.29, 95% CI: 18.37‐22.41) and 6 months‐1 year (OR: 4.59, 95% CI: 4.16‐5.06), and underlying respiratory and cardiovascular disorders specific to the perinatal period (OR: 1.32, 95% CI: 1.11‐1.57) were risk factors for being diagnosed with RSV. Age‐group 0‐5 months (OR: 2.39, 95% CI: 1.45‐3.94), low birth weight (OR: 6.77, 95% CI: 1.28‐35.71), preterm newborn (OR: 6.71, 95% CI: 2.19‐20.61), underlying respiratory and cardiovascular disorders specific to the perinatal period (OR: 4.97, 95% CI: 3.36‐7.34), congenital malformation of the heart (OR: 3.65, 95% CI: 1.90‐7.02), congenital malformation of the great vessels (OR: 3.50, 95% CI: 1.10‐11.18), congenital defect originating in perinatal period (OR: 4.07, 95% CI: 1.71‐9.70), cardiovascular disease (OR: 5.19, 95% CI: 2.77‐9.72), neurological disorders (OR: 6.48, 95% CI: 3.76‐11.18), blood disease (OR: 3.67, 95% CI: 1.98‐6.79), and liver disease (OR: 14.99, 95% CI: 1.49‐150.82) contributed to ICU admission in RSV cases. Conclusions Using ICD‐10‐based surveillance data allows to identify risk factors for hospitalized RSV disease and its severe outcomes, and quantify the risk in different age‐groups.
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Affiliation(s)
- Wei Cai
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Medizinische Fakultät Charité - Universitätsmedizin, Berlin, Germany
| | - Silke Buda
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | | | - Wenqing Zhang
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
| | - Walter Haas
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Medizinische Fakultät Charité - Universitätsmedizin, Berlin, Germany
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Jandrasits C, Kröger S, Haas W, Renard BY. Computational pan-genome mapping and pairwise SNP-distance improve detection of Mycobacterium tuberculosis transmission clusters. PLoS Comput Biol 2019; 15:e1007527. [PMID: 31815935 PMCID: PMC6922483 DOI: 10.1371/journal.pcbi.1007527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/01/2019] [Revised: 12/19/2019] [Accepted: 11/03/2019] [Indexed: 12/30/2022] Open
Abstract
Next-generation sequencing based base-by-base distance measures have become an integral complement to epidemiological investigation of infectious disease outbreaks. This study introduces PANPASCO, a computational pan-genome mapping based, pairwise distance method that is highly sensitive to differences between cases, even when located in regions of lineage specific reference genomes. We show that our approach is superior to previously published methods in several datasets and across different Mycobacterium tuberculosis lineages, as its characteristics allow the comparison of a high number of diverse samples in one analysis—a scenario that becomes more and more likely with the increased usage of whole-genome sequencing in transmission surveillance. Tuberculosis still is a threat to global health. It is essential to detect and interrupt transmissions to stop the spread of this infectious disease. With the rising use of next-generation sequencing methods, its application in the surveillance of Mycobacterium tuberculosis has become increasingly important in the last years. The main goal of molecular surveillance is the identification of patient-patient transmission and cluster detection. The mutation rate of M. tuberculosis is very low and stable. Therefore, many existing methods for comparative analysis of isolates provide inadequate results since their resolution is too limited. There is a need for a method that takes every detectable difference into account. We developed PANPASCO, a novel approach for comparing pairs of isolates using all genomic information available for each pair. We combine improved SNP-distance calculation with the use of a pan-genome incorporating more than 100 M. tuberculosis reference genomes representing lineages 1-4 for read mapping prior to variant detection. We thereby enable the collective analysis and comparison of similar and diverse isolates associated with different M. tuberculosis strains.
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Affiliation(s)
| | - Stefan Kröger
- Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
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Cai W, Tolksdorf K, Hirve S, Schuler E, Zhang W, Haas W, Buda S. Evaluation of using ICD-10 code data for respiratory syncytial virus surveillance. Influenza Other Respir Viruses 2019; 14:630-637. [PMID: 31206246 PMCID: PMC7578302 DOI: 10.1111/irv.12665] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 01/10/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 01/16/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory tract infection (ALRI) in young children. ICD‐10‐based syndromic surveillance can transmit data rapidly in a standardized way. Objectives We investigated the use of RSV‐specific ICD‐10 codes for RSV surveillance. Methods We performed a retrospective descriptive data analysis based on existing ICD‐10‐based surveillance systems for ALRI in primary and secondary care and a linked virological surveillance in Germany. We described RSV epidemiology and compared the epidemiological findings based on ICD‐10 and virological data. We calculated sensitivity and specificity of RSV‐specific ICD‐10 codes and in combination with ICD‐10 codes for acute respiratory infections (ARI) for the identification of laboratory‐confirmed RSV infections. Results Based on the ICD‐10 and virological data, epidemiology of RSV was described, and common findings were found. The RSV‐specific ICD‐10 codes had poor sensitivity 6% (95%‐CI: 3%‐12%) and high specificity 99.8% (95%‐CI: 99.6%‐99.9%). In children <5 years and in RSV seasons, the sensitivities of RSV‐specific ICD‐10 codes combined with general ALRI ICD‐10 codes J18.‐, J20.‐ and with J12.‐, J18.‐, J20.‐, J21.‐, J22 were moderate (44%, 95%‐CI: 30%‐59%). The specificities of both combinations remained high (91%, 95%‐CI: 86%‐94%; 90%, 95%‐CI: 85%‐94%). Conclusions The use of RSV‐specific ICD‐10 codes may be a useful indicator to describe RSV epidemiology. However, RSV‐specific ICD‐10 codes underestimate the number of actual RSV infections. This can be overcome by combining RSV‐specific and general ALRI ICD‐10 codes. Further investigations are required to validate this approach in other settings.
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Affiliation(s)
- Wei Cai
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Kristin Tolksdorf
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | | | - Wenqing Zhang
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
| | - Walter Haas
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Silke Buda
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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44
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Glasauer S, Altmann D, Hauer B, Brodhun B, Haas W, Perumal N. First-line tuberculosis drug resistance patterns and associated risk factors in Germany, 2008-2017. PLoS One 2019; 14:e0217597. [PMID: 31188848 PMCID: PMC6561568 DOI: 10.1371/journal.pone.0217597] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/04/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022] Open
Abstract
Background Drug-resistant tuberculosis (TB), especially multidrug-resistant TB (MDR-TB), poses a threat to public health. While standard surveillance focuses on Rifampicin and/or Isoniazid resistance, little is known about other resistance patterns. This study aims to identify predominant drug resistance (DR) patterns in Germany and risk factors associated with them in order to inform diagnostic and treatment strategies. Methods Case-based TB surveillance data notified in Germany from 2008–2017 were utilized to investigate DR and MDR-TB patterns for Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E), and Streptomycin (S). Predominant patterns were further analyzed stratified by sex, age, country of birth, prior TB, and disease site. Multivariable logistic regression was conducted to determine risk factors associated with any resistance, MDR-TB, and complete HRZES resistance. Results 26,228 cases with complete DST results were included in the study, among which 3,324 cases had any DR (12.7%). Four patterns were predominant, representing about ¾ of all cases with any resistance (S: 814 [3.1%]; H: 768 [2.9%]; HS: 552 [2.1%]; Z: 412 [1.6%]). High proportions of S and H resistances were found among both German and foreign-born populations, especially those born in Eastern Europe, and were unexpectedly high among children (H: 4.3%; S: 4.6%). Foreign-born cases had significantly higher proportion of any resistance (16.0%) and MDR-TB (3.3%) compared to German-born cases (8.3% and 0.6%). Of 556 MDR-TB cases, 39.2% showed complete HRZES resistance. Logistic regression revealed having prior TB and being foreign-born as consistently strong risk factors for any DR, MDR-TB, and complete HRZES resistance. Conclusions DR patterns observed in Germany, particularly for MDR-TB were more complex than expected, highlighting the fact that detailed drug-testing results are crucial before incorporating HRZES drugs in MDR-TB treatment. Furthermore, the relatively high rate of H-resistance in Germany provides strong rationale against the use of only H-based preventive therapy for LTBI.
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Affiliation(s)
- Saskia Glasauer
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, LMU Munich, Munich, Germany
- * E-mail:
| | - Doris Altmann
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Bonita Brodhun
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Nita Perumal
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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45
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Haussig JM, Targosz A, Engelhart S, Herzhoff M, Prahm K, Buda S, Nitsche A, Haas W, Buchholz U. Feasibility study for the use of self-collected nasal swabs to identify pathogens among participants of a population-based surveillance system for acute respiratory infections (GrippeWeb-Plus)-Germany, 2016. Influenza Other Respir Viruses 2019; 13:319-330. [PMID: 30925029 PMCID: PMC6586186 DOI: 10.1111/irv.12644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/06/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/01/2022] Open
Abstract
Background Internet‐based participatory surveillance systems, such as the German GrippeWeb, monitor the frequency of acute respiratory illnesses on population level. In order to interpret syndromic information better, we devised a microbiological feasibility study (GrippeWeb‐Plus) to test whether self‐collection of anterior nasal swabs is operationally possible, acceptable for participants and can yield valid data. Methods We recruited 103 GrippeWeb participants (73 adults and 30 children) and provided them with a kit, instructions and a questionnaire for each sample. In the first half of 2016, participants took an anterior nasal swab and sent it to the Robert Koch Institute whenever an acute respiratory illness occurred. Reporting of illnesses through the GrippeWeb platform continued as usual. We analysed swabs for the presence of human c‐myc‐DNA and 22 viral and bacterial pathogens. After the study, we sent participants an evaluation questionnaire. We analysed timeliness, completeness, acceptability and validity. Results One hundred and two participants submitted 225 analysable swabs. Ninety per cent of swabs were taken within 3 days of symptom onset. Eighty‐nine per cent of swabs had a corresponding reported illness in the GrippeWeb system. Ninety‐nine per cent of adults and 96% of children would be willing to participate in a self‐swabbing scheme for a longer period. All swabs contained c‐myc‐DNA. In 119 swabs, we identified any of 14 viruses but no bacteria. The positivity rate of influenza was similar to that in the German physician sentinel. Conclusion Self‐collection of anterior nasal swabs proofed to be feasible, was well accepted by participants, gave valid results and was an informative adjunct to syndromic data.
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Affiliation(s)
- Joana M Haussig
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.,European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Angelina Targosz
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Susanne Engelhart
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Michael Herzhoff
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Kerstin Prahm
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Silke Buda
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Udo Buchholz
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Sanchini A, Andrés M, Fiebig L, Albrecht S, Hauer B, Haas W. Assessment of the use and need for an integrated molecular surveillance of tuberculosis: an online survey in Germany. BMC Public Health 2019; 19:321. [PMID: 30885160 PMCID: PMC6423790 DOI: 10.1186/s12889-019-6631-6] [Citation(s) in RCA: 7] [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: 08/24/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background The implementation of an integrated molecular surveillance (IMS) of tuberculosis (TB) is of high priority for TB control. IMS is defined as the systematic inclusion of molecular typing results in the national TB surveillance system. Although not standardized, an IMS of TB is already implemented in several low TB incidence countries. Germany is in the process of implementing a nationwide IMS of TB. This requires close collaboration between national and local health authorities. We conducted an online survey to understand the current use of molecular typing results for TB surveillance among the local public health offices (PHO)s in Germany, and to collect their perception and expectations towards the implementation of a nationwide IMS of TB. Methods The online survey was developed using the software Voxco and included 31 questions. The survey was sent to all the 377 local PHOs in Germany in April 2017. Responses were collected until June 2017. Results A total of 174/377 (46.2%) local PHOs participated in our survey, and 88/377 (23.3%) used molecular typing results in their routine TB surveillance work. The PHOs used molecular typing results especially as support for epidemiological contact tracing (62/88, 70.4%). We found statistically significant differences between answers of PHOs that did not use molecular typing results (n = 86) vs. PHOs that did use molecular typing results (n = 88): the latter perceived the use of molecular typing results as more beneficial for their work compared to the former (65.9% vs. 34.9%, p < 0.05). Moreover, the PHOs using molecular typing results expect for the future more support and coordination from regional and national public health institutes, especially regarding the identification and analysis of molecular clusters. Conclusions Our study is a step forward in the broader goal of implementing an IMS of TB in Germany. The local PHOs currently using the molecular typing results highlighted their positive attitude towards the implementation of an IMS, but also their needs of more support. Similar assessments might serve as an example for other countries which are on the way to implement a nationwide IMS of TB. Electronic supplementary material The online version of this article (10.1186/s12889-019-6631-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Sanchini
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany.
| | - Marta Andrés
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany.,Current address: Ear Institute, University College London, London, UK
| | - Lena Fiebig
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany.,Current address: Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling - APOPO, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Stefan Albrecht
- Department for Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany
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Andrés M, van der Werf MJ, Ködmön C, Albrecht S, Haas W, Fiebig L. Molecular and genomic typing for tuberculosis surveillance: A survey study in 26 European countries. PLoS One 2019; 14:e0210080. [PMID: 30865640 PMCID: PMC6415850 DOI: 10.1371/journal.pone.0210080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/03/2018] [Accepted: 12/17/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Molecular typing and whole genome sequencing (WGS) information is used for (inter-) national outbreak investigations. To assist the implementation of these techniques for tuberculosis (TB) surveillance and outbreak investigations at European level there is a need for inter-country collaboration and standardization. This demands more information on molecular typing practices and capabilities of individual countries. We aimed to review the use of molecular/genomic typing for TB surveillance in European Union and European Economic Area countries in 2016; assess its public health value; and collect experiences on typing data use for cross-border cluster investigations. METHOD A web-based questionnaire was provided to all TB National Focal Points. The questionnaire consisted of three parts: i) Use and integration of molecular and genomic typing data into TB surveillance; ii) Cross-border cluster investigation and international collaboration, and iii) Perception and evaluation of public health benefits of molecular and genomic typing for TB surveillance. RESULTS Of 26 responding countries, 20 used molecular typing for TB surveillance, including nine applying WGS. The level of integration into the national surveillance was heterogeneous. Among six countries not using typing for TB surveillance, more than half planned its implementation soon. Overall, most countries perceived an added public health value of molecular typing for TB control. Concerning international cluster investigations, countries had little experience and did not have standard protocols to exchange typing data. CONCLUSION Our study shows a wide use of molecular and genomic typing data for TB surveillance in EU/EEA countries and reveals that transition to WGS-based typing is ongoing or is considered in most countries. However, our results also show a high heterogeneity in the use and integration of typing data for TB surveillance. Standardization of typing data use for TB surveillance is needed and formal procedures should be developed to facilitate international collaboration.
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Affiliation(s)
- Marta Andrés
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Csaba Ködmön
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Stefan Albrecht
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Lena Fiebig
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- * E-mail: ,
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48
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Helbling P, Kröger S, Haas W, Brusin S, Cirillo D, Groenheit R, Guthmann JP, Soini H, Pfaff G, Hendrickx D, van der Werf M. The role of entry-screening procedures in the identification of multidrug-resistant Mycobacterium tuberculosis cluster cases amongst patients arriving in Europe from the horn of Africa, 2016-17. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.068] [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: 11/24/2022] Open
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49
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Rosales-Klintz S, Bruchfeld J, Haas W, Heldal E, Houben RM, van Kessel F, Mandelbaum M, Matteelli A, Migliori GB, Oordt-Speets A, Solovic I, Vašáková M, Verver S, de Vlas SJ, Vonk Noordegraaf-Schouten MJ, de Vries G, Zenner D, van der Werf MJ. Guidance for programmatic management of latent tuberculosis infection in the European Union/European Economic Area. Eur Respir J 2019; 53:53/1/1802077. [DOI: 10.1183/13993003.02077-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/09/2018] [Indexed: 11/05/2022]
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50
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Buchholz U, Reber F, Lehfeld AS, Brodhun B, Haas W, Schaefer B, Stemmler F, Otto C, Gagell C, Lück C, Gamradt R, Heinig M, Meisel C, Kölsch U, Eisenblätter M, Jahn HJ. Probable reinfection with Legionella pneumophila - A case report. Int J Hyg Environ Health 2018; 222:315-318. [PMID: 30501994 DOI: 10.1016/j.ijheh.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/30/2018] [Revised: 09/25/2018] [Accepted: 11/07/2018] [Indexed: 11/16/2022]
Abstract
In Germany community-acquired Legionnaires' disease is usually caused by the species Legionella pneumophila. Recurrent cases of Legionnaires' disease are rarely reported and are due either to a second infection (reinfection) or a relapse of a previous case. We report a case of recurrent Legionnaires' disease in an 86-year-old female patient infected with Legionella pneumophila serogroup 1, monoclonal antibody-subtype Knoxville, sequence type unknown. Between the two disease incidents the patient had completely recovered. Legionella pneumophila was detected with the monoclonal antibody-subtype Knoxville, sequence type 182, in the drinking water of the patient's apartment. Exposure to contaminated drinking water was interrupted after the first incident exposure through the application of point-of-use water filters. The filters were later removed due to low water pressure, and the second illness occurred thereafter. It is unclear if immunological predisposition has contributed to this case of probable reinfection of Legionnaires' disease. Clinical, microbiological and epidemiological information combined suggest this is a case of reinfection of Legionnaires' disease. In cases of recurrent Legionnaires' disease complete collection of patient and water samples is necessary to differentiate relapse from reinfection cases, to implicate the source of infection and to gain more evidence for the role of immunological predisposition.
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Affiliation(s)
- Udo Buchholz
- Robert Koch Institute, Seestr. 10, Berlin, Germany.
| | | | | | | | - Walter Haas
- Robert Koch Institute, Seestr. 10, Berlin, Germany.
| | | | | | | | - Corinna Gagell
- Institute for Medical Microbiology and Hygiene, Medical Faculty "Carl Gustav Carus", Technical University Dresden, Germany.
| | - Christian Lück
- Institute for Medical Microbiology and Hygiene, Medical Faculty "Carl Gustav Carus", Technical University Dresden, Germany.
| | | | - Maxi Heinig
- Health Department of Neukölln, Berlin, Germany.
| | | | | | | | - Heiko J Jahn
- Robert Koch Institute, Seestr. 10, Berlin, Germany.
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