Electronic Outbreak Surveillance in Germany: A First Evaluation for Nosocomial Norovirus Outbreaks

BACKGROUND: In Germany, surveillance for infectious disease outbreaks is integrated into an electronic surveillance system. For 2007, the national surveillance database contains case-based information on 201,224 norovirus cases, three-quarters of which are linked to outbreaks. We evaluated the data quality of the national database in reflecting nosocomial norovirus outbreak (NNO) data available in 19 Hessian local public health authorities (LPHAs) and the influence of differences between LPHA's follow-up procedures for laboratory notifications of Norovirus positive stool samples on outbreak underascertainment. METHODS: Data on NNO beginning in 2007 and notified to the 19 LPHAs were extracted from the national database, investigated regarding internal validity and compared to data collected from LPHAs for a study on NNO control. LPHAs were questioned whether they routinely contacted all persons for whom a laboratory diagnosis of norovirus infection was notified. The number of outbreaks per 1,000 hospital beds and the number of cases within NNOs for acute care and rehabilitation hospitals were compared between counties with and without complete follow-up. RESULTS: The national database contained information on 155 NNOs, including 3,115 cases. Cases were missed in the national database in 58 (37%) of the outbreaks. Information on hospitalisation was incorrect for an estimated 47% of NNO cases. Information on county of infection was incorrect for 24% (199/820) of cases being forwarded between LPHAs for data entry. Reported NNO incidence and number of NNO cases in acute care hospitals was higher in counties with complete follow-up (incidence-rate ratio (IRR) 2.7, 95% CI 1.4-5.7, p-value 0.002 and IRR 2.1, 95% CI 1.9-2.4, p-value 0.001, respectively). CONCLUSIONS: Many NNOs are not notified by hospitals and differences in LPHA procedures have an impact on the number of outbreaks captured in the surveillance system. Forwarding of case-by-case data on Norovirus outbreak cases from the local to the state and national level should not be required

Complete Nucleotide Sequence of a Citrobacter freundii Plasmid Carrying KPC-2 in a Unique Genetic Environment

The complete and annotated nucleotide sequence of a 54,036-bp plasmid harboring a blaKPC-2 gene that is clonally present in Citrobacter isolates from different species is presented. The plasmid belongs to incompatibility group N (IncN) and harbors the class A carbapenemase KPC-2 in a unique genetic environment

Major Outbreak of Hepatitis A Associated with Orange Juice among Tourists, Egypt, 2004

In 2004, a major outbreak of hepatitis A among tourists returning from Egypt involved 351 case-patients from 9 European countries who were infected with a single strain (genotype 1b). The case-control study identified orange juice as the most likely infection vehicle. Vaccination against hepatitis A virus is strongly recommended before travel to disease-endemic areas

Investigating an Airborne Tularemia Outbreak, Germany

Infectious aerosols can contribute to the transmission of tularemia during processing of dead hares

What will the next influenza season bring about: seasonal influenza or the new A(H1N1)V? An analysis of German influenza surveillance data

For the next influenza season (winter 2009-10) the relative contributions to virus circulation and influenza-associated morbidity of the seasonal influenza viruses A(H3N2), A(H1N1) and B, and the new influenza A(H1N1)v are still unknown. We estimated the chances of seasonal influenza to circulate during the upcoming season using data of the German influenza sentinel scheme from 1992 to 2009. We calculated type and subtype-specific indices for past exposure and the corresponding morbidity indices for each season. For the upcoming season 2009-10 our model suggests that it is unlikely that influenza A(H3N2) will circulate with more than a low intensity, seasonal A(H1N1) with more than a low to moderate intensity, and influenza B with more than a low to median intensity. The probability of a competitive circulation of seasonal influenza A with the new A(H1N1)v is low, increasing the chance for the latter to dominate the next influenza season in Germany

Clostridium difficile ribotypes 001, 017, and 027 are associated with lethal C. difficile infection in Hesse, Germany

From January 2008 to April 2009, 72 cases of severe Clostridium difficile infection were reported from 18 different districts in the state of Hesse, Germany. A total of 41 C. difficile isolates from 41 patients were subjected to PCR ribotyping. PCR ribotype (RT) 027 was the most prevalent strain accounting for 24 of 41 (59%) of typed isolates, followed by RT 001 (eight isolates, 20%), RT 017 and 042 (two isolates each), and RT 003, 066, 078, 081, and RKI-034 (one isolate each). Eighteen patients had died within 30 days after admission. C. difficile was reported as underlying cause of or contributing to death in 14 patients, indicating a case fatality rate of 19%. The patients with lethal outcome attributable to C. difficile were 59-89 years-old (median 78 years). Ribotyping results were available for seven isolates associated with lethal outcome, which were identified as RT 027 in three and as RT 001 and 017 in two cases each. Our data suggest that C. difficile RT 027 is prevalent in some hospitals in Hesse and that, in addition to the possibly more virulent RT 027, other toxigenic C. difficile strains like RT 001 and 017 are associated with lethal C. difficile infections in this region

Aktuelles zu Hantaviren

„Gefährliches Hantavirus – Die Seuche kommt mit dem Wind“ titelte der Spiegel in seiner Ausgabe vom 25. August 2008 und skizzierte diverse Szenarien dieser Erkrankung, die im Jahr 2007 in Deutschland sprunghaft angestiegen war: von der Einschleppung und Ausbreitung hochpathogener Hantavirusstämme, der Verbreitung der Viren durch den Wind bis hin zum potentiellen Einsatz als bioterroristische Waffe. Im folgenden Beitrag werden wir keine Risikobewertung der oben angeführten hypothetischen Szenarien diskutieren, vielmehr möchten wir die aktuelle Situation dieser Erkrankung in Hessen im Vergleich zum Bundesgebiet beleuchten. Hierzu wurden die nach Infektionsschutzgesetz (IfSG) gemeldeten Fälle von 2001 bis 2008 betrachtet (RKI, 2009), bei denen ein labordiagnostischer Nachweis mit klinisch manifester Erkrankung bzw. ein klinisch-epidemiologischer Zusammenhang vorlag

Zeitnahe Erfassung und Übermittlung von Todesfällen in Hessen

Die Erfassung von Todesfällen ist ein wichtiges epidemiologisches Instrument, um den Verlauf, das Ausmaß, betroffene Altersgruppen und die Schwere von Gesundheitsgefahren einschätzen zu können. Dennoch sind in Deutschland weder auf Landes- noch auf Bundesebene geeignete Daten oder Auswertungen zeitnah zugänglich. Im vorliegenden Beitrag werden Aufbau und Struktur eines Surveillance-Systems zur zeitnahen Erfassung von Todesfällen in Hessen (ZETH) und erste Erfahrungen während der Influenza-A/H1N1v-Pandemie 2009/2010 dargestellt. Während des Aufbaus des ZETH wurde 2008 auf eine wöchentliche Übermittlung der bei den Standesämtern elektronisch erfassten Todesfälle (das heißt etwa 95% aller Todesfälle) an das Statistische Landesamt umgestellt. Das Landesamt stellt nun – ebenfalls wöchentlich – diese Daten dem Hessischen Landesprüfungs- und Untersuchungsamt im Gesundheitswesen (HLPUG) in todesfallbasierter datenschutzkonformer Form zur Verfügung. Während der Influenza-Pandemie gestattete das ZETH die zeitnahen Einschätzungen der Übersterblichkeit nach Altersgruppen mit einer zweiwöchigen Verzögerung. Es zeigte sich eine geringe Zunahme der Todesfälle über das Erwartungsniveau in den Altersgruppen von 15 bis 34, 35 bis 49 und 50 bis 59 Jahren. Der Zusammenhang zum zeitlichen Verlauf und zur Intensität der Erkrankungswelle war jedoch nicht stark ausgeprägt, sodass eine Übersterblichkeit, die offensichtlich über die im Meldewesen erfassten Influenza-Todesfälle (21 für Hessen) hinausgeht, nicht deutlich wurde