Reducing the barriers against analytical epidemiological studies in investigations of local foodborne disease outbreaks in Germany – a starter kit for local health authorities

Thousands of infectious food-borne disease outbreaks (FBDO) are reported annually to the European Food Safety Authority within the framework of the zoonoses Directive (2003/99/EC). Most recognised FBDO occur locally following point source exposure, but only few are investigated using analytical epidemiological studies. In Germany, and probably also in other countries of the European Union, this seems to be particularly true for those investigated by local health authorities. Analytical studies, usually cohort studies or case–control studies, are a powerful tool to identify suspect food vehicles. Therefore, from a public health and food safety perspective, their more frequent usage is highly desirable. We have developed a small toolbox consisting of a strategic concept and a simple software tool for data entry and analysis, with the objective to increase the use of analytical studies in the investigation of local point source FBDO in Germany

Shiga Toxin–producing Escherichia coli Serogroups in Food and Patients, Germany

We compared 61 Shiga toxin–producing Escherichia coli (STEC) serogroups from 448 food isolates with 71 STEC serogroups from 1,447 isolates from patients in Germany. Two thirds (41/61), representing 72% of food isolates, were also found in patients. Serogroups typically isolated from patients with hemolytic uremic syndrome were rarely found in food

Ongoing outbreaks of hepatitis A among men who have sex with men (MSM), Berlin, November 2016 to January 2017 – linked to other German cities and European countries

Since 14 November 2016, 38 cases of hepatitis A have been notified in Berlin; of these, 37 were male and 30 reported to have sex with men (MSM). Median age of MSM cases is 31 years (range: 24–52 years). Phylogenetic analysis revealed three distinct sequences, linking cases in Berlin to those in other German cities and to clusters recognised in other European countries in 2016

Enteropathisches hämolytisch-urämisches Syndrom: Sporadischer Einzelfall oder Teil eines Krankheitsausbruchs?

Das hämolytisch-urämische Syndrom (HUS) ist ein lebensbedrohlicher Zustand, charakterisiert durch akutes Nierenversagen, hämolytische Anämie und Thrombozytopenie. In >80% der Fälle liegen gastrointestinale Infektionen mit enterohämorrhagischen Escherichia coli (EHEC) zugrunde. Diese enterisch-infektiöse (enteropathische) Form des HUS tritt meist bei Kindern unter 6 Jahren auf. Da u. U. rasch eine Blutreinigung eingeleitet werden muss, sollten die Betroffenen in spezialisierten Kinderdialysezentren behandelt werden. Aufgrund der überwiegend enterisch-infektiösen Ätiologie können vereinzelt auftretende Fälle wichtige Hinweise auf Erkrankungshäufungen liefern. In Deutschland treten Infektionen mit einer seltenen Sorbitol fermentierenden Variante von EHEC O157 auf, die schon mehrfach in HUS-Krankheitsausbrüchen mit Todesfällen resultierten. Bereits der Verdacht sowie die Erkrankung oder der Tod an enteropathischem HUS sind durch den feststellenden Arzt unverzüglich an das zuständige Gesundheitsamt zu melden. Dadurch können zeitnah Maßnahmen zur Verhinderung der Ausbreitung der Infektion getroffen werden. Die epidemischen Aspekte des EHEC-assoziierten HUS werden dargestellt, und Kinderärzten Hilfestellungen im Hinblick auf eine frühzeitige Diagnose und Meldung gegeben.Hemolytic uremic syndrome (HUS) is a life-threatening condition characterized by acute renal failure, hemolytic anemia and thrombocytopenia. More than 80% of pediatric HUS is caused by infection with enterohemorrhagic Escherichia coli (EHEC). EHEC-associated HUS mainly affects children under six years of age. HUS patients should be treated in specialized clinics, which are able to provide dialysis. Importantly, sporadic cases of HUS can signalize outbreaks of EHEC infections. In Germany, a rare sorbitol-fermenting variant of EHEC O157 caused several large HUS outbreaks with fatal cases. Physicians are required to notify every suspected, confirmed or fatal case of HUS to their local health department, thereby enabling public health authorities to intervene promptly. This article describes the epidemic aspects of EHEC-associated HUS and assists physicians and pediatricians in terms of timely diagnosis and notification

Aetiology of community-acquired, acute gastroenteritis in hospitalised adults: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>The aetiology of severe gastroenteritis leading to hospitalisation in adults frequently remains unclear. Our objective was to study the causes and characteristics of community-acquired, acute gastroenteritis in adult hospitalized patients to support the clinical management of these patients.</p> <p>Methods</p> <p>From August 2005 to August 2007, we conducted a prospective cohort study among patients ≥18 y hospitalized with community-acquired gastroenteritis in a university hospital in Berlin, Germany. Stool specimens were examined for 26 gastrointestinal pathogens, supplemented by serologic tests for antibodies to <it>Campylobacter spp.</it>, <it>Yersinia spp.</it>, and <it>Entamoeba histolytica</it>. Patient data on demographics and clinical presentation were recorded and analyzed. Coexisting medical conditions were assessed using the Charlson Comorbidity Index score.</p> <p>Results</p> <p>Of 132 patients presenting with acute community-acquired gastroenteritis, 104 were included in the study. A non-infectious aetiology was diagnosed in 8 patients (8%). In 79 (82%) of the remaining 96 patients at least one microorganism was identified. <it>Campylobacter spp. </it>(35%) was detected most frequently, followed by norovirus (23%), <it>Salmonella spp. </it>(20%), and rotavirus (15%). In 46% of the patients with <it>Campylobacter spp. </it>infection, the diagnosis was made solely by serology. More than one pathogen was found in seventeen (22%) patients. Simultaneous infection was significantly more likely in patients with rotavirus and salmonella infections (RR 3.6; 95% CI: 1.8–7.4; RR 2.5; 95%CI: 1.2–5.5). Length of hospital stay (median: 5.5 days) was independent of the pathogen, but was associated with coexisting medical conditions (OR 4,8; 95%CI:2,0–11,6).</p> <p>Conclusion</p> <p>Known enteric pathogens were detected in 82% of adult patients who were hospitalized with acute gastroenteritis. We found that currently used culture-based methods may miss a substantial proportion of <it>Campylobacter </it>infections, and additional serological testing for <it>Campylobacter </it>should be considered. Viral infections emerged as an important cause of severe gastroenteritis in adults, and viral-bacterial co-infections in adults are probably underrecognized so far. The presence of coexisting medical conditions – but not the etiological agent – was a predictor for the duration of the hospital stay.</p

Outbreaks of virulent diarrheagenic Escherichia coli - are we in control?

Shiga toxin-producing Escherichia coli (STEC) are the most virulent diarrheagenic E. coli known to date. They can be spread with alarming ease via food as exemplified by a large sprout-borne outbreak of STEC O104:H4 in 2011 that was centered in northern Germany and affected several countries. Effective control of such outbreaks is an important public health task and necessitates early outbreak detection, fast identification of the outbreak vehicle and immediate removal of the suspected food from the market, flanked by consumer advice and measures to prevent secondary spread

Prävention des Eintrags von SARS-CoV-2 in Kitas: Erfahrungen aus dem Berliner Bezirk Treptow-Köpenick, Januar bis März 2021

Das Robert Koch-Institut, das Landesamt für Gesundheit und Soziales Berlin und das Gesundheitsamt des Bezirks Treptow-Köpenick untersuchten im Rahmen eines Amtshilfeersuchens Faktoren, die möglicherweise zum Eintrag und zur Übertragung von SARS-CoV-2 in Kitas des Berliner Bezirks im Zeitraum Januar bis März 2021 beigetragen haben. Im Beitrag werden Präventionsmaßnahmen und potenzielle Risikofaktoren für SARS-CoV-2-Infektionen in Kitas analysiert sowie Einzelfälle und Ausbrüche auf Grundlage der Daten des Gesundheitsamtes epidemiologisch ausgewertet. Aus den Erkenntnissen lassen sich anschließend drei Handlungsempfehlungen ableiten.Peer Reviewe

Identifying outbreaks of sexually transmitted infection: who cares?

BACKGROUND: Current routine surveillance schemes for sexually transmitted infections (STIs) in the United Kingdom (UK) are not designed for outbreak identification. Recognising STI outbreaks, therefore, depends almost entirely on the alertness of health professionals. The objective of this study was to explore health professionals' knowledge of, and attitudes towards, identification and investigation of STI outbreaks in Wales. METHODS: We conducted a cross-sectional survey in Wales in June 2005, and sent a questionnaire to consultants of genitourinary medicine (GUM, n = 11), a consultant microbiologist from each laboratory (n = 14), all consultants in communicable disease control (n = 5), and to epidemiologists of the National Public Health Service (n = 4). RESULTS: 26 (76%) of 34 survey recipients responded. Of these, 17 (65%) ranked the investigation of STI outbreaks as important or very important, and 19 (73%) perceived participation in the investigation of an STI outbreak as part of their responsibility. Only six (25%) respondents had actively searched their computer system or patient records for a possible STI outbreak in the previous twelve months, and 15 (63%) had never looked for an outbreak. Of seven GUM physicians who said they had identified at least one STI outbreak, three had never informed public health authorities. CONCLUSION: Prompt identification and coordinated investigation of outbreaks, usually through a multidisciplinary outbreak control team, is central to the control of many infectious diseases. This does not appear to be the case for STIs, which we believe represents a lost opportunity to reduce transmission. Besides improved surveillance methods, a change in culture towards STI outbreaks is needed among health professionals in Wales

Resurgence of an international hepatitis A outbreak linked to imported frozen strawberries, Germany, 2018 to 2020

Following outbreaks linked to frozen strawberries in Sweden and Austria in 2018, 65 cases linked to the same hepatitis A virus strain were detected in Germany between October 2018 and January 2020, presenting in two waves. Two case-control studies and a comparison of cases' consumption frequencies with purchase data from a large consumer panel provided strong evidence for frozen strawberry cake as the main vehicle of transmission. Of 46 cases interviewed, 27 reported consuming frozen strawberry cake and 25 of these identified cake(s) from brand A spontaneously or in product picture-assisted recall. Trace back investigations revealed that the Polish producer involved in the previous outbreaks in Sweden and Austria had received frozen strawberries from Egypt via a wholesaler that also delivered frozen strawberries to manufacturer of brand A. Phylogenetic analyses linked the outbreak strain to similar strains formerly isolated from sewage, stool and strawberries in Egypt. Complete trace back and timely recall of products with strong evidence of contamination is important to control an outbreak and prevent later resurgence, particularly for food items with a long shelf life. Continued molecular surveillance of hepatitis A is needed to identify outbreaks and monitor the success of food safety interventions

Phylogeny and disease association of Shiga toxin-producing Escherichia coli O91

The diversity and relatedness of 100 Shiga toxin–producing Escherichia coli O91 isolates from different patients were examined by multilocus sequence typing. We identified 10 specific sequence types (ST) and 4 distinct clonal groups. ST442 was significantly associated with hemolytic uremic syndrome