Nationally representative results on SARS-CoV-2 seroprevalence and testing in Germany at the end of 2020

Pre-vaccine SARS-CoV-2 seroprevalence data from Germany are scarce outside hotspots, and socioeconomic disparities remained largely unexplored. The nationwide representative RKI-SOEP study (15,122 participants, 18–99 years, 54% women) investigated seroprevalence and testing in a supplementary wave of the Socio-Economic-Panel conducted predominantly in October–November 2020. Self-collected oral-nasal swabs were PCR-positive in 0.4% and Euroimmun anti-SARS-CoV-2-S1-IgG ELISA from dry-capillary-blood antibody-positive in 1.3% (95% CI 0.9–1.7%, population-weighted, corrected for sensitivity = 0.811, specificity = 0.997). Seroprevalence was 1.7% (95% CI 1.2–2.3%) when additionally correcting for antibody decay. Overall infection prevalence including self-reports was 2.1%. We estimate 45% (95% CI 21–60%) undetected cases and lower detection in socioeconomically deprived districts. Prior SARS-CoV-2 testing was reported by 18% from the lower educational group vs. 25% and 26% from the medium and high educational group (p < 0.001, global test over three categories). Symptom-triggered test frequency was similar across educational groups. Routine testing was more common in low-educated adults, whereas travel-related testing and testing after contact with infected persons was more common in highly educated groups. This countrywide very low pre-vaccine seroprevalence in Germany at the end of 2020 can serve to evaluate the containment strategy. Our findings on social disparities indicate improvement potential in pandemic planning for people in socially disadvantaged circumstances

Hepatitis-B-Virus-Infektionen und impfinduzierte Immunität: die Rolle von soziodemografischen Determinanten

Hintergrund und Ziel: Trotz niedriger Prävalenz der Hepatitis-B-Virus-(HBV-)Infektion in Deutschland ist es wichtig, vulnerable Gruppen und Ansatzpunkte für die Prävention zu identifizieren. In ersten Analysen der „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1, 2008–2011) waren HBV-Infektion und -Impfung mit sozidemografischen Determinanten assoziiert. In dieser Arbeit werden die Ergebnisse im Detail untersucht. Material und Methoden: In DEGS1 lag für 7046 Teilnehmende (Alter: 18–79 Jahre) eine HBV-Serologie vor. Die stattgehabte HBV-Infektion war durch Antikörper gegen das Hepatitis-B-Core-Antigen (Anti-HBc) definiert, die impfinduzierte Immunität durch alleinigen Nachweis von Antikörpern gegen das Hepatitis-B-Surface-Antigen (Anti-HBs). Seroprävalenzen von HBV-Infektions- und -Impfstatus wurden geschlechtsstratifiziert geschätzt und Assoziationen mit Alter, Gemeindegröße, Einkommen, formaler Bildung, Krankenversicherung und Migrationsgeneration in logistischen Regressionen analysiert. Ergebnisse: Die HBV-Infektion war bei Männern und Frauen unabhängig mit den Altersgruppen 34–64 und ≥ 65 Jahre, erster Migrationsgeneration und Leben in größeren Gemeinden assoziiert, zudem bei Männern mit niedrigem Einkommen und bei Frauen mit niedriger Bildung. Die impfinduzierte Immunität war bei Männern und Frauen unabhängig mit den Altersgruppen 18–33 und 34–64 Jahre, mittlerer und hoher Bildung und hohem Einkommen assoziiert, darüber hinaus bei Männern mit mittlerem Einkommen und privater Krankenversicherung und bei Frauen mit fehlendem Migrationshintergrund. Diskussion: Die Berücksichtigung von Migrationsstatus, Einkommen und Bildung könnte zur zielgenauen Ausrichtung der HBV-Prävention beitragen.Background and objective: Even though the prevalence of hepatitis B virus (HBV) infection in Germany is low, it is important to identify vulnerable groups and targeted approaches for infection prevention. Previous analyses from the “German Health Interview and Examination Survey for Adults” (DEGS1, 2008–2011) have shown that HBV infections and vaccination are associated with sociodemographic determinants. This paper examines the results in detail. Materials and methods: In the DEGS1, HBV serology was available for 7046 participants aged 18–79 years. HBV infection was defined by antibodies to hepatitis B core antigen (anti-HBc), vaccine-induced immunity by antibodies to hepatitis B surface antigen (anti-HBs) in the absence of other markers. Seroprevalences of HBV infection and vaccine-induced immunity were estimated stratified by sex, and associations with age, municipality size, income, formal education, health insurance and migration generation were analysed by logistic regression. Results: In both sexes, HBV infection was independently associated with age groups 34–64 and ≥ 65 years, first migrant generation and living in larger municipalities as well as low income in men and low education in women. Vaccine-induced immunity was independently associated with age groups 18–33 and 34–64 years, middle and high education and high income in both sexes, middle income and private health insurance in men and having no migration background in women. Conclusions: HBV prevention measures should take into account migration status, income and education in order to focus prevention measures.Peer Reviewe

What is the health status of girls and boys in the COVID-19 pandemic? Selected results of the KIDA study

Background: It is well known that there are gender differences in the health behaviour and physical and mental health of children. The COVID-19 pandemic influenced the health and lifestyles of children and adolescents by changing their living conditions. The present work investigates whether gender differences in selected health indicators are evident more than two years after the onset of the pandemic. Methods: In the study Kindergesundheit in Deutschland aktuell (KIDA) (German Children’s Health Update), cross-sectional telephone surveys were conducted with parents of 3- to 15-year-olds (n=3,478). Parental information on the general and mental health of the child, on increased need for health care and mental health services, as well as on physical activity and utilisation of sports activities were queried in standardised manner. Gender differences were assessed using Chi2 tests. Results: A total of 91% of the girls and 92% of the boys had their general health assessed as being (very) good by their parents (difference not significant, n.s.). An increased need for care and support was indicated for 10.6% of the 3- to 15-year-olds (girls: 9%, boys: 12%, n.s.). Boys met the physical activity recommendations of the WHO significantly more often (60%) than girls (54%). Good to excellent mental health was reported for 93% of both boys and girls. When changes during the pandemic were reported, no differences were found in the responses for girls compared to boys. Conclusions: Gender differences were found for individual parameters and age groups. These differences must be assessed in the context of other social determinants of health, and need to be considered when planning preventive measures

Day care study showed no differences in long-term symptoms in children who were and were not infected during COVID-19 outbreaks

Peer Reviewe

Wie steht es um die Gesundheit von Mädchen und Jungen in der COVID-19-Pandemie? Ausgewählte Ergebnisse der KIDA-Studie

Hintergrund: Es ist bekannt, dass es bei Kindern geschlechterbezogene Unterschiede im Gesundheitsverhalten sowie in der körperlichen und psychischen Gesundheit gibt. Die COVID-19-Pandemie beeinflusste durch veränderte Lebensbedingungen die Gesundheit und die Lebensweisen von Kindern und Jugendlichen. Die vorliegende Arbeit untersucht, ob sich mehr als zwei Jahre nach Pandemiebeginn Geschlechterunterschiede bei ausgewählten Gesundheitsindikatoren zeigen. Methode: In der Studie Kindergesundheit in Deutschland aktuell (KIDA) wurden telefonische Querschnittsbefragungen mit Eltern von 3- bis 15-Jährigen (n = 3.478) durchgeführt. Elternangaben zur allgemeinen und psychischen Gesundheit des Kindes, zu erhöhten Versorgungs- oder Unterstützungsbedarfen sowie zur körperlichen Aktivität und Nutzung von Sportangeboten wurden standardisiert erfragt. Geschlechterunterschiede wurden mit Chi2-Tests bewertet. Ergebnisse: Für 91 % der Mädchen und 92 % der Jungen wurde die allgemeine Gesundheit durch ihre Eltern als (sehr) gut eingeschätzt (Unterschied nicht signifikant). Erhöhte Versorgungs- und Unterstützungsbedarfe wurden für 10,6 % der 3- bis 15-Jährigen angegeben (Mädchen: 9 %, Jungen 12 %, n. s.). Jungen erreichten mit 60 % signifikant häufiger die WHO-Bewegungsempfehlungen als Mädchen (54 %). Für je 93 % der Jungen und Mädchen wurde eine gute bis ausgezeichnete psychische Gesundheit angegeben. Bei Veränderungen der psychischen Gesundheit im Vergleich zum vorpandemischen Zeitraum fanden sich keine Unterschiede in den Antworten zu Mädchen im Vergleich zu Jungen. Schlussfolgerungen: Für einzelne Parameter und Altersgruppen fanden sich Geschlechterunterschiede, die zusammen mit anderen sozialen Determinanten der Gesundheit bewertet und bei präventiven Maßnahmen berücksichtigt werden müssen

Long COVID – eine Herausforderung an Public Health und Gesundheitsforschung

Im Zusammenhang mit einer vorangegangenen SARS-CoV-2-Infektion sind zahlreiche gesundheitliche Langzeitfolgen beobachtet worden, welche auch als „Long COVID“ bezeichnet werden. Nach aktuellen Leitlinien umfasst dieser Begriff alle gesundheitlichen Beschwerden, welche direkt im Anschluss an eine akute COVID-19-Erkrankung und mindestens vier Wochen nach Symptombeginn noch vorliegen. Sollten die Beschwerden mit längerem Abstand im Anschluss an eine SARS-CoV-2-Infektion über längere Zeit bestehen oder neu auftreten und anderweitig nicht erklärbar sein, wird dies gemäß einer vorläufigen WHO-Falldefinition auch als „Post-COVID-19-Syndrom“ bezeichnet. Es handelt sich hierbei um eine Arbeitsdefinition, die den aktuellen Wissensstand reflektiert und zukünftig entsprechend an neu verfügbare Evidenz angepasst wird. Im vorliegenden Beitrag werden das Krankheitsbild Long COVID sowie mögliche Ursachen und Risiken vorgestellt und die aktuelle Studienlage diskutiert.Peer Reviewe

Seroepidemiologische Studien zu SARS-CoV-2 in Stichproben der Allgemeinbevölkerung und bei Blutspenderinnen und Blutspendern in Deutschland – Ergebnisse bis August 2021

Seroepidemiologische Studien geben Aufschluss über den Bevölkerungsanteil, der bereits eine SARS-CoV-2-Infektion durchgemacht hat und schließen dabei auch nicht erkannte Infektionen (Untererfassung) ein¬. Die hier zusammengestellten Ergebnisse zur Sero¬prävalenz von SARS-CoV-2 basieren auf Zufalls¬stichproben der erwachsenen Allgemeinbevölke¬rung in Deutschland und liegen für verschiedene Zeiträume der Pandemie aus 20 Studien vor. Die geringe und im Pandemieverlauf deutlich ge¬sunkene Untererfassung in Deutschland zeigt, dass SARS-CoV-2-Infektionen gut im Meldesystem abgebildet werden.Peer Reviewe

Socioeconomic Differences in SARS-CoV-2 Infection and Vaccination in Germany: A Seroepidemiological Study After One Year of COVID-19 Vaccination Campaign

Objective: To evaluate the socioeconomic patterns of SARS-CoV-2 antigen contacts through infection, vaccination or both (“hybrid immunity”) after 1 year of vaccination campaign.Methods: Data were derived from the German seroepidemiological Corona Monitoring Nationwide study (RKI-SOEP-2; n = 10,448; November 2021–February 2022). Combining serological and self-report data, we estimated adjusted prevalence ratios (PR) of SARS-CoV-2 infection, COVID-19 vaccination, basic immunization (at least two SARS-CoV-2 antigen contacts through vaccination and/or infection), and three antigen contacts by education and income.Results: Low-education groups had 1.35-times (95% CI 1.01–1.82) the risk of SARS-CoV-2 infection compared to high-education groups. COVID-19 vaccination (at least one dose) and basic immunization decreased with lower education and income. Low-education and low-income groups were less likely to have had at least three antigen contacts (PR low vs. high education: 0.74, 95% CI 0.65–0.84; PR low vs. high income: 0.66, 95% CI 0.57–0.77).Conclusion: The results suggest a lower level of protection against severe COVID-19 for individuals from low and medium socioeconomic groups. Pandemic response and vaccination campaigns should address the specific needs and barriers of these groups

Varicella-zoster virus seroprevalence in children and adolescents in the pre-varicella vaccine era, Germany

Background: In 2004, universal childhood varicella vaccination was introduced in Germany. We aimed to determine the age-specific prevalence of anti-varicella zoster virus (VZV) IgG-antibodies among children in the pre-varicella vaccine era in Germany, to identify factors associated with VZV seropositivity, and to assess the suitability of a commercially available ELISA for VZV seroepidemiological studies by comparing it with an in-house fluorescent antibody to membrane antigen test (FAMA) as the gold standard. Methods: Serum samples of 13,433 children and adolescents aged 1–17 years included in the population-based German Health Interview and Examination Survey for Children and Adolescents (KiGGS; conducted 2003–2006) were tested for anti-VZV IgG by ELISA. All samples with equivocal ELISA results and a random selection of ELISA-negative and -positive samples were tested by FAMA. Statistical analyses were conducted using a weighting factor adjusting the study population to the total population in Germany. Seroprevalences were calculated as percentages (%) with a 95% confidence interval (CI). Odds ratios (OR) were computed by multivariate logistic regression to determine the association between socio-demographic factors and VZV seropositivity. Results: The VZV seropositivity rate was 80.3% (95% CI: 79.3–81.3) in varicella-unvaccinated children and adolescents. VZV seropositivity rates differed significantly between age groups up to age 6 years, but not by gender. Of 118 retested serum samples with an equivocal ELISA result, 45.8% were FAMA-positive. The proportion of samples tested as false-negative in by ELISA varied by age group: 2.6% in children aged 1–6 and 9% in children aged 7–17 years. Multivariate analyses showed that age, having older siblings, and early daycare start were associated with seropositivity in preschoolers; migration background reduced the chance of VZV seropositivity in schoolchildren (OR: 0.65; 0.43–0.99) and adolescents (OR: 0.62; 0.4–0.97). Conclusion: In the pre-varicella vaccine era, most children in Germany contracted varicella by age six. Schoolchildren with a migration background and children without siblings have an increased risk of being VZV seronegative and should be targeted for catch-up vaccination, if they have no history of chickenpox. ELISAs are suitable for use in population-level serosurveys on VZV, but samples with equivocal ELISA results should be retested by FAMA

The uptake of influenza vaccination for the 2013/2014 season in Germany

Seasonal influenza (flu) is an acute viral disease that occurs every winter in Germany and is referred to as the ‘flu wave’. The Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends annual vaccination for people who are at greater risk of disease-related complications, this includes men and women aged 60 or above. In this target group, 48.1% of women and 48.7% of men who participated in the GEDA 2014/2015-EHIS study reported that they had been vaccinated against influenza during the 2013/2014 winter season. However, there were marked differences according to region. Vaccination rates decreased over time. Moreover, although the European Commission has been calling for a vaccination rate of at least 75% among the elderly from the 2014/2015 influenza season onwards, it is unclear to what extent this rate can actually be achieved. However, rates can be improved by doctors providing advice and recommending vaccination to their patients