A web-based app to provide personalized recommendations for COVID-19

Peer Reviewe

Outbreak of cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013

Background: During weeks 32–33, 2013, 24 cases of cryptosporidiosis were notified in the city of Halle (annual mean 2008–2012: 9 cases). We investigated the outbreak to identify the source and recommend control measures, considering that between weeks 23–25 the river Saale which flows through the city centre overflowed the floodplain, parts of the city centre and damaged sewage systems. Methods: We defined a case as a resident of Halle with gastroenteritis, Cryptosporidium-positive stool and disease onset weeks 27 through 47. In a case–control study among kindergarten children, we compared cases and controls regarding environmental exposure, use of swimming pools, zoo visits and tap water consumption 14 days pre-onset or a corresponding 14-days-period (controls) and adjusted for residence. Stool specimens were tested by microscopy and PCR, and Cryptosporidium DNA was sequenced. Samples from public water system, swimming pools and river Saale were examined for Cryptosporidium oocysts (microscopy and PCR). Results: Overall, 167 cases were detected, 40/167 (24%) were classified as secondary cases. First disease onsets occurred during week 29, numbers peaked in week 34 and started to decrease in week 36. Median age was 8 years (range: 0–77). Compared to controls (n = 61), cases (n = 20) were more likely to report visits to previously flooded areas (OR: 4.9; 95%-CI: 1.4-18) and the zoo (OR: 2.6; 95%-CI: 0.9-7.6). In multivariable analysis visits to the floodplain remained the sole risk factor (OR: 5.5; 95%-CI: 1.4-22). Only C.hominis of a single genotype (IbA9G2) was detected in stools. Oocysts were detected in samples from the river, two local lakes and three public swimming pools by microscopy, but not in the public water supply. Conclusions: Evidence suggests that activities in the dried out floodplain led to infection among children. Secondary transmissions may be involved. Consequently, authorities recommended to avoid playing, swimming and having picnics in the flood-affected area. Health authorities should consider the potential health risks of long-term surviving parasites persisting on flooded grounds and in open waters even several weeks after the flooding and of bathing places close to sewage spill-overs. Preventive measures comprise water sampling (involving parasites), information of the public and prolonged closures of potentially contaminated sites

Diagnostic accuracy and feasibility of patient self-testing with a SARS-CoV-2 antigen-detecting rapid test.

BACKGROUND: Considering the possibility of nasal self-sampling and the ease of use in performing SARS-CoV-2 antigen-detecting rapid diagnostic tests (Ag-RDTs), self-testing is a feasible option. OBJECTIVE: The goal of this study was a head-to-head comparison of diagnostic accuracy of patient self-testing with professional testing using a SARS-CoV-2 Ag-RDT. STUDY DESIGN: We performed a manufacturer-independent, prospective diagnostic accuracy study of nasal mid-turbinate self-sampling and self-testing with symptomatic adults using a WHO-listed SARS-CoV-2 Ag-RDT. Procedures were observed without intervention. For comparison, Ag-RDTs with nasopharyngeal sampling were professionally performed. Estimates of agreement, sensitivity, and specificity relative to RT-PCR on a combined oro-/nasopharyngeal sample were calculated. Feasibility was evaluated by observer and participant questionnaires. RESULTS: Among 146 symptomatic adults, 40 (27.4%) were RT-PCR-positive for SARS-CoV-2. Sensitivity with self-testing was 82.5% (33/40; 95% CI 68.1-91.3), and 85.0% (34/40; 95% CI 70.9-92.9) with professional testing. At high viral load (≥7.0 log10 SARS-CoV-2 RNA copies/ml), sensitivity was 96.6% (28/29; 95% CI 82.8-99.8) for both self- and professional testing. Deviations in sampling and testing were observed in 25 out of the 40 PCR-positives. Most participants (80.9%) considered the Ag-RDT as easy to perform. CONCLUSION: Laypersons suspected for SARS-CoV-2 infection were able to reliably perform the Ag-RDT and test themselves. Procedural errors might be reduced by refinement of the instructions for use or the product design/procedures. Self-testing allows more wide-spread and frequent testing. Paired with the appropriate information of the public about the benefits and risks, self-testing may have significant impact on the pandemic

Assessment of recall error in self-reported food consumption histories among adults—Particularly delay of interviews decrease completeness of food histories—Germany, 2013

Introduction: Poor recall during investigations of foodborne outbreaks may lead to misclassifications in exposure ascertainment. We conducted a simulation study to assess the frequency and determinants of recall errors. Methods Lunch visitors in a cafeteria using exclusively cashless payment reported their consumption of 13 food servings available daily in the three preceding weeks using a self-administered paper-questionnaire. We validated this information using electronic payment information. We calculated associated factors on misclassification of recall according to time, age, sex, education level, dietary habits and type of servings. Results: We included 145/226 (64%) respondents who reported 27,095 consumed food items. Sensitivity of recall was 73%, specificity 96%. In multivariable analysis, for each additional day of recall period, the adjusted chance for false-negative recall increased by 8% (OR: 1.1;95%-CI: 1.06, 1.1), for false-positive recall by 3% (OR: 1.03;95%-CI: 1.02, 1.05), for indecisive recall by 12% (OR: 1.1;95%-CI: 1.08, 1.15). Sex and education-level had minor effects. Discussion: Forgetting to report consumed foods is more frequent than reporting food-items actually not consumed. Bad recall is strongly enhanced by delay of interviews and may make hypothesis generation and testing very challenging. Side dishes are more easily missed than main courses. If available, electronic payment data can improve food-history information

Internationale Ebola-Hilfe: Stigmatisierte Helfer

„Bist Du eigentlich in Quarantäne und ansteckend?“ – „Nein, bin ich nicht!“ Rückkehrer aus dem Ebola-Einsatz kämpfen mit oft irrationalen Ängsten ihrer Umgebung

Results of multivariable logistic regression of associated variables on different categories of misclassification of reported food selections, Berlin, Germany, 2013.

<p>Results of multivariable logistic regression of associated variables on different categories of misclassification of reported food selections, Berlin, Germany, 2013.</p

Distribution of the proportion of misclassifications of food recalls by recall period, Berlin, Germany, 2013.

<p>Distribution of the proportion of misclassifications of food recalls by recall period, Berlin, Germany, 2013.</p

Ebolafieberepidemie in Westafrika – schnelle und praxisnahe Ausbildung: Das Vorbereitungstraining für Einsatzkräfte des Deutschen Roten Kreuzes, anderer Hilfsorganisationen und der Bundeswehr, Würzburg, 2014 und 2015

Hintergrund Im September 2014 beauftragte die Bundesregierung das Deutsche Rote Kreuz (DRK) und die Bundeswehr, die Eindämmung der Ebolafieberepidemie in Westafrika zu unterstützen. Das DRK fragte Ausbildung für Einsatzkräfte beim Missionsärztlichen Institut Würzburg (MI) an. Zielsetzung Darstellung sowie Diskussion der Entwicklung, Umsetzung, Ergebnisse und Evaluation des Vorbereitungstrainings für Ebolafiebereinsatzkräfte sowie Empfehlungen für ähnliche Krisen. Methoden Am 26.09.2014 wurde vereinbart, Einsatzkräfte in zweitägigen Trainings in einem Simulationszentrum auf Einsätze in Ebolafieberbehandlungsstationen (ETC) im Epidemiegebiet vorzubereiten. Trainingsevaluation mittels Gruppengesprächen und standardisierter Fragebogen. Ergebnisse Das Training startete am 06.10.2014. Bis zum 24.02.2015 wurden 214 Teilnehmer (TN) in 14 Kursen ausgebildet. 94 % (90/96) der nach Westafrika entsandten DRK-Helfer nahmen teil. Trainingsinhalte: unter anderem Eindämmungsmaßnahmen bei durch humanpathogene Filoviren hervorgerufenen Ausbrüchen, Arbeitstechniken und Infektionsschutz im ETC mit praktischen Übungen in Persönlicher Schutzausrüstung (PSA). Durchschnittlich leitete ein Ausbilder drei TN in Standardprozeduren in Original-PSA an. 93 % der Teilnehmer bewerten das Training als sehr gut oder gut. Diskussion Rasche Trainingsumsetzung wurde möglich durch Lehre eines einheitlichen und praxisbewährten Infektionsschutz- und Behandlungskonzeptes. Wissenslücken und Verunsicherung der TN wurden durch realistische Simulationen in Kleingruppen und Einsatzerfahrung der Ausbilder adressiert. Weitere Empfehlungen: zunächst weitere Verstetigung des Trainingsprogramms an einer geeigneten Institution sowie im Krisenfall Verzahnung des Trainings mit der Einsatzplanung, sodass die Ausbildung rasch eskaliert und adaptiert werden könnte. Darüber hinaus sollten die Einsatz- und Trainingskonzepte harmonisiert und für zusätzliche Herausforderungen, wie z. B. über Tröpfcheninfektionen übertragbare Erkrankungen und den Einsatz intensivmedizinischer Maßnahmen, weiterentwickelt werden.Background In September 2014, the German government mandated the German Red Cross (GRC) and the German Armed Forces to support the international efforts to stop the epidemic of Ebola virus disease (EVD) in West-Africa. The GRC requested specific training from the Medical Mission Institute Wuerzburg (MI). Objectives We describe and discuss the development, strategy, results, and evaluation of the program to formulate conclusions and recommendations for similar emergencies. Methods On 26 September 2014, it was agreed to establish a two-day training program to prepare Ebola aid workers for the treatment of EVD patients and infection protection in Ebola treatment centers (ETC) in the epidemic area. Course evaluation was based on protocoled discussions with participants and standardized questionnaires. Results The training started on 6 October 2014. By 24 February 2015, 214 trainees participated in 14 courses. Of 96 GRC staff deployed to West Africa, 90 (94%) participated in the training. Course content included containment strategy in filovirus outbreaks and practical exercises for standardized procedures in personal protective equipment (PPE). The average trainer-trainee ratio in PPE exercises was 1:3. “Excellent” or “good” ratings were received on 93% of the evaluations. Conclusion Rapid implementation was possible by teaching a harmonized, and field-approved concept for infection protection and treatment. Realistic simulated scenarios and field-experienced trainers allowed transfer of knowledge as well as reassurance. Additional recommendations are further conversion of the training into a permanent program and, in the case of a crisis, interlocking of training with operational planning to allow rapid escalation and adaptation. Also, the concepts for training and interventions should be harmonized and developed further for additional challenges like airborne transmission and application of intensive-care medicine.Peer Reviewe

Self-collected oral, nasal and saliva samples yield sensitivity comparable to professionally collected oro-nasopharyngeal swabs in SARS-CoV-2 diagnosis among symptomatic outpatients

Introduction Containing COVID-19 requires broad-scale testing. However, sample collection requires qualified personnel and protective equipment and may cause transmission. We assessed the sensitivity of SARS-CoV-2-rtPCR applying three self-sampling techniques as compared to professionally collected oro-nasopharyngeal samples (cOP/NP). Methods From 62 COVID-19 outpatients, we obtained: (i) multi-swab, MS; (ii) saliva sponge combined with nasal vestibula, SN; (iii) gargled water, GW; (iv) professionally collected cOP/NP (standard). We compared ct-values for E-gene and ORF1ab and analysed variables reducing sensitivity of self-collecting procedures. Results The median ct-values for E-gene and ORF1ab obtained in cOP/NP samples were 20.7 and 20.2, in MS samples 22.6 and 21.8, in SN samples 23.3 and 22.3, and in GW samples 30.3 and 29.8, respectively. MS and SN samples showed sensitivities of 95.2% (95%CI, 86.5-99.0) and GW samples of 88.7% (78.1-95.3). Sensitivity was inversely correlated with ct-values, and became <90% for samples obtained more than 8 days after symptom onset. For MS and SN samples, false negativity was associated with language problems, sampling errors, and symptom duration. Conclusion Conclusions from this study are limited to the sensitivity of self-sampling in mildly to moderately symptomatic patients. Still, self-collected oral/nasal/saliva samples can facilitate up-scaling of testing in early symptomatic COVID-19 patients if operational errors are minimized.Peer Reviewe

Increase in hepatitis A in tourists from Denmark, England, Germany, the Netherlands, Norway and Sweden returning from Egypt, November 2012 to March 2013

Since November 2012, there has been an increase in reported cases of hepatitis A in tourists returning from Egypt in several European countries. As of 24 April, 80 HAV cases in travellers with symptom onset after 1 November 2012 visiting different areas in Egypt have been reported. Four cases from Norway, six cases from the Netherlands and five cases from England share an identical hepatitis A viral RNA sequence. This increase in cases suggests that vaccination recommendations for travellers to hepatitis A endemic countries should be reinforced