Tick-Borne Encephalitis Risk Increases with Dog Ownership, Frequent Walks, and Gardening: A Case-Control Study in Germany 2018–2020

In Germany, tick-borne encephalitis (TBE) infections mainly occur in southern regions. Despite recent increases in incidence, TBE vaccination coverage remains low, necessitating additional preventive strategies against TBE. Our case-control study in Southern Germany from 2018 to 2020 mapped knowledge/application of tick-protective strategies and identified TBE risk factors. We calculated odds ratios (OR), with 95% confidence intervals (CI). We interviewed 581 cases and 975 matched controls. Most participants recalled lifetime tick bites, mainly while walking, gardening, or hiking. However, only 45% of cases noticed ticks during exposure time; another 12% reported unpasteurized milk intake. While tick-protection knowledge was satisfactory, application lagged behind. Risk factors included dog ownership (OR = 2.45, 95% CI: 1.85–3.24), walks ≥ 4×/week (OR = 2.11, 95% CI: 1.42–3.12), gardening ≥ 4×/week (OR = 1.83, 95% CI: 1.11–3.02), and garden proximity < 250 m of forests (OR = 2.54, 95% CI: 1.82–3.56). Applying ≥2 tick-protective strategies (OR = 0.52, 95% CI: 0.40–0.68) and keeping lawns mowed (OR = 0.63, 95% CI: 0.43–0.91) were inversely associated with TBE. In 2020 (likely pandemic-related), cases reported significantly more walks than previously, potentially explaining the record high case numbers. Our findings provide guidance on targets for TBE prevention. Persons with gardens near forests, frequent outdoor activities, or dogs could particularly benefit from targeted information, including on vaccination and preventing tick bites.Peer Reviewe

Vaccination coverage, behaviour and acceptance among adults in Germany

Um den Grad der Umsetzung von Impfempfehlungen bzw. den Erfolg eines Impfprogramms messen und Kommunikationsaktivitäten ggf. intensivieren zu können, sind detaillierte Daten zu Impfquoten notwendig, die zudem zeitnah vorliegen sollten. Da eine systematische, bundesweite Erhebung von Impfquoten in Deutschland nur im Rahmen der Schuleingangsuntersuchungen stattfindet, fehlten bislang gerade für die erwachsene Bevölkerung in Deutschland entsprechende Daten. Ziel dieses Promotionsprojektes war es, Impfquoten für drei öffentlich empfohlene Impfungen im Erwachsenenalter (Impfung gegen saisonale Influenza, Tetanus und Pertussis) sowie für die Impfung gegen pandemische Influenza („Schweinegrippe“, Saison 2009/10) zu ermitteln sowie Faktoren zu identifizieren, die mit niedrigen Impfquoten assoziiert sind. Zu diesem Zweck wurden Daten aus dem bundesweiten Survey „Gesundheit in Deutschland aktuell“ (GEDA) herangezogen. GEDA ist ein Survey zu gesundheitsrelevanten Themen, der seit 2009 in der Regel jährlich vom Robert Koch-Institut unter ~22.000 Erwachsenen in Deutschland durchgeführt wird. Die Daten wurden mittels computergestützter Telefoninterviews erhoben und sind bundesweit repräsentativ für die deutschsprachige erwachsene Wohnbevölkerung. Im Rahmen des Promotionsprojekts wurden Daten des GEDA09 und GEDA10 sowie einer Nachbefragung zum Thema Schutzimpfungen von ~2.500 GEDA10-Teilnehmern analysiert. In einem Vergleich der drei Hauptzielgruppen für die saisonale Influenzaimpfung wies das medizinische Personal eine deutlich niedrigere Impfquote (Saisons 2007/08-2010/11: durchschnittlich 26%) auf als Personen ≥60 Jahre (52%) oder chronisch Kranke (42%). Das Ziel der Europäischen Union, das eine Impfquote von ≥75% für die beiden letztgenannten Gruppen vorsieht, wird in Deutschland bisher bei Weitem nicht erreicht. Die Akzeptanz der pandemischen Influenzaimpfung („Schweinegrippe“-Impfung) in der Saison 2009/10 war mit einer Impfquote von rund 9% in der erwachsenen Bevölkerung in Deutschland gering. Gegen Tetanus hatten insgesamt 73% der Erwachsenen einen adäquaten Impfstatus (d.h. Impfung innerhalb der letzten zehn Jahre). Die seit mehreren Jahren bestehende Pertussis-Impfempfehlung für Risikogruppen (z.B. medizinisches Personal, Personen mit Kontakt zu Säuglingen) wurde bislang völlig unzureichend umgesetzt (Pertussis-Impfquote: 11%). Sowohl für Tetanus als auch für Pertussis waren u.a. ein Wohnort in den Neuen Bundesländern sowie jüngeres Alter signifikant mit höheren Impfquoten assoziiert. Mit dem vorliegenden Promotionsprojekt konnte ein Beitrag zur Schließung der Datenlücke zu Impfquoten Erwachsener in Deutschland geleistet werden. Es konnten Bevölkerungsgruppen mit besonders niedriger Durchimpfung (z.B. medizinisches Personal für die saisonale Influenzaimpfung, Ältere für die Tetanusimpfung) identifiziert werden. Die so gewonnenen Erkenntnisse können zukünftig genutzt werden, um zielgerichtete Maßnahmen zur Schließung von Impflücken bei Erwachsenen zu entwickeln.Detailed and up-to-date information on vaccination coverage is essential to monitor the degree of realization of a vaccination recommendation or the success of immunization programmes and – if necessary – to enhance communication activities. Since data on vaccination coverage is systematically collected only at school entry in Germany, respective data for the adult population was lacking so far. The main objectives of this dissertation were i) to assess coverage for standard vaccinations for adults (seasonal influenza, tetanus, pertussis) and for the vaccination against pandemic influenza (season 2009/10) and ii) to identify factors associated with low vaccination coverage. For this purpose we used data from the ‘German Health Update’ Survey (GEDA). GEDA is a large (~22,000 participants), computer assisted telephone interviewing (CATI) survey on health-relevant topics. The study population of GEDA is representative for the German-speaking adult population in Germany. GEDA was implemented in 2009 and is conducted annually by the Robert Koch Institute as part of Germany’s national health monitoring. For this dissertation data from GEDA09, GEDA10 and a follow-up interviewing of ~2,500 GEDA10 participants were analysed. In a comparison of the three main target groups for seasonal influenza vaccination, health care workers (HCW) had a significantly lower vaccination coverage (seasons 2007/08-2010/11: average coverage 26%) than persons ≥60 years (52%) and persons with underlying chronic diseases (42%). The EU-goal of reaching coverage of ≥75% in elderly and chronically ill persons has not been achieved in Germany yet. Acceptance of pandemic influenza vaccination in season 2009/10 was very low in the German adult population (coverage: 9%). In total, 73% of adults had an adequate tetanus vaccination status (vaccination in the past ten years). Only 11% of persons belonging to a risk group for pertussis (e.g. HCW, persons with close contact to infants) had an adequate pertussis vaccination status. Among other things living in the Eastern federal states and being of younger age were independently associated with both higher tetanus and pertussis vaccination coverage. This dissertation contributed to closing the data gap regarding vaccination coverage of adults living in Germany. Moreover, population subgroups with particular low coverage were identified (e.g. HCW for seasonal influenza vaccination, elderly persons for tetanus vaccination). Our results can be used to develop tailored strategies to close vaccination gaps among adults in Germany

Epidemiological Surveillance of Lyme Borreliosis in Bavaria, Germany, 2013–2020

Lyme borreliosis (LB) is the most common tick-borne disease in Germany. Mandatory notification of acute LB manifestations (erythema migrans (EM), neuroborreliosis (NB), and Lyme arthritis (LA)) was implemented in Bavaria on 1 March 2013. We aimed to describe the epidemiological situation and to identify LB risk areas and populations. Therefore, we analyzed LB cases notified from March 2013 to December 2020 and calculated incidence (cases/100,000 inhabitants) by time, place, and person. Overall, 35,458 cases were reported during the study period (EM: 96.7%; NB: 1.7%; LA: 1.8%). The average incidence was 34.3/100,000, but annual incidence varied substantially (2015: 23.2; 2020: 47.4). Marked regional differences at the district level were observed (annual average incidence range: 4–154/100,000). The Bavarian Forest and parts of Franconia were identified as high-risk regions. Additionally, high risk for LB was found in 5–9-year-old males and in 60–69-year-old females. The first group also had the highest risk of a severe disease course. We were able to identify areas and populations in Bavaria with an increased LB risk, thereby providing a basis for targeted measures to prevent LB. Since LB vaccination is currently not available, such measures should comprise (i) avoiding tick bites, (ii) removing ticks rapidly after a bite, and (iii) treating LB early/adequately

Oral H1 antihistamines as 'add-on' therapy to topical treatment for eczema

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of oral H1 antihistamines as 'add‐on' therapy to topical treatment in adults and children with eczema