Die Rolle des Bundes bei der Verhütung und Bekämpfung von Infektionskrankheiten

Die Gesundheitspolitik steht heute und auch in Zukunft vor der Herausforderung, das Gesundheitswesen qualitativ auf einem hohen Stand und gleichzeitig finanzierbar zu halten. Dazu bedarf es eines umfassenden Systems gesundheitlicher Sicherung, das allen Bürgern wirksam und ohne Hindernisse zur Verfügung steht. Wenngleich die Bürger in hohem Maß für die Förderung und den Erhalt ihrer Gesundheit selbst verantwortlich sind, ist es die Aufgabe des Staates, gegen Gefahren Vorsorge zu treffen, die von gefährlichen Krankheitserregern, Produkten oder auch von Umwelteinflüssen ausgehen können. Es gilt, den Schutz gegen bisher bekannte Gefahren auszubauen, neuen Bedrohungen entgegenzutreten und neue wissenschaftliche Erkenntnisse zu berücksichtigen. Prävention, Gesundheitsförderung und Gesundheitsschutz sind wichtige Schlüssel zur Verbesserung des Gesundheitszustands der Bevölkerung sowie zur Senkung der Kosten des Gesundheitssektors und stellen daher eine wichtige Säule im Gesundheitswesen dar. Die Prävention von Infektionskrankheiten und der Infektionsschutz bilden dabei prioritäre Aufgaben in der Fortentwicklung eines leistungsfähigen Gesundheitswesens in Deutschland. Die Bewältigung der genannten Aufgaben bei der Bekämpfung von Infektionskrankheiten erfordert das enge Zusammenwirken einer Reihe von Bundesoberbehörden und Bundesinstituten im Zuständigkeitsbereich des Ministeriums für Gesundheit und Soziale Sicherung sowie des Bundesministerium für Verbraucherschutz, Ernährung und Landwirtschaft.Health policy is faced today with the challenge of keeping the health care system up to a high standard and affordable at the same time. A comprehensive health protection system that is efficient and readily accessible to all is required. Although it is to a great extent the responsibility of every citizen to promote and sustain their own health, it is the duty of the Federal Government to provide for risks that can emanate from pathogens, products or environmental factors. Protection against all known risks should be improved, new health threats have to be countered and new scientific findings must be considered. Prevention, health promotion and health protection are important key factors to improve health in the general population and to reduce health care costs. The prevention of and protection from infectious diseases are high priority tasks in the further development of an effective health care system in Germany. In order to accomplish these tasks in the control of infectious diseases close collaboration between a number of federal agencies and federal institutes under the responsibility of the Ministry of Health and Social Security as well as the Ministry of Consumer Protection, Food and Agriculture has to be ensured

The denominator problem: Estimating MSM-specific incidence of sexually transmitted infections and prevalence of HIV using population sizes of MSM derived from Internet surveys

<p>Abstract</p> <p>Background</p> <p>Measuring prevalence and incidence of sexually transmitted infections in hard to reach populations like men who have sex with men (MSM) is hampered by unknown size and regional distribution of this population. Community sample – and study-based measurements are often fraught with participation biases and do not allow generalization of the results for other regions or the whole population group of MSM.</p> <p>Methods</p> <p>We used the proportional regional distribution of participants of large internet-based surveys among MSM from Germany together with a general population survey-derived estimate of the MSM population to estimate regional population sizes. Based on transmission group category from surveillance data and regional MSM population size we calculated regional population-specific incidence rates of newly diagnosed HIV infection and syphilis. For HIV prevalence we compared estimates of prevalent HIV infections in MSM from a surveillance data-based model with a mixed model in which we used the proportional regional distribution of HIV positive participants from surveys and the estimated total number of prevalent HIV infections from the surveillance based model.</p> <p>Results</p> <p>Assuming a similar regional distribution of survey participants and the MSM population as a whole, the regional proportion of MSM in the general population can be estimated. Regional incidence calculated with the estimated MSM population as denominator and national surveillance data as numerator results in regional peak incidence rates of 7–8 per 1,000 MSM for newly diagnosed HIV infection and syphilis. The gradient between metropolitan and rural areas narrows considerably compared with calculations which use the total (male) population as denominator. Regional HIV prevalence estimates are comparable in the two models.</p> <p>Conclusion</p> <p>Considering the difficulties to obtain regionally representative data by other sampling methods for MSM, in Western post-industrialized countries internet-based surveys may provide an easy and low cost tool to estimate regional population distributions. With national surveillance data, which categorize transmission groups, regional population-specific incidence rates for reportable sexually transmitted infections can be estimated. HIV prevalence estimates for regional MSM populations show differences related to the level of urbanization, MSM concentration, and starting points of the HIV epidemic in western and eastern Germany.</p

Viral hepatitis in Germany: poor vaccination coverage and little knowledge about transmission in target groups

<p>Abstract</p> <p>Background</p> <p>In Germany, vaccination against hepatitis B is recommended for infants, children and adolescents since 1995 and for specific target groups since 1982. Little is known about knowledge about viral hepatitis and attitudes toward hepatitis B vaccination-factors likely to influence vaccine uptake.</p> <p>Methods</p> <p>In order to estimate vaccination coverage in adult target groups and in the overall adult population and to assess knowledge and attitudes, we conducted a nationwide cross-sectional telephone survey among 412 persons in November 2004. We defined participants as being vaccinated if they reported at least one previous vaccination against hepatitis B.</p> <p>Results</p> <p>Vaccination coverage (vc) standardised for age, sex and residence was 29.6% in the general population and 58.2% in target groups for hepatitis B vaccination. Particular gaps in vaccine coverage were detected among health care workers (vc: 69.5%) and chronically ill persons (vc: 22.0%). Knowledge on risk factors and transmission was far below expectations, whereas the acceptance of vaccination in the majority of the population (79.0%) was good.</p> <p>Conclusion</p> <p>We conclude that educational measures could lead to a higher vaccination uptake in adult target groups.</p

Impact of the COVID-19 pandemic and associated non-pharmaceutical interventions on other notifiable infectious diseases in Germany: An analysis of national surveillance data during week 1–2016 – week 32–2020

Background The COVID-19 pandemic and associated non-pharmaceutical interventions (NPIs) affect healthcare seeking behaviour, access to healthcare, test strategies, disease notification and workload at public health authorities, but may also lead to a true change in transmission dynamics. We aimed to assess the impact of the pandemic and NPIs on other notifiable infectious diseases under surveillance in Germany. Methods We included 32 nationally notifiable disease categories with case numbers >100/year in 2016–2019. We used quasi-Poisson regression analysis on a weekly aggregated time-series incorporating trend and seasonality, to compute the relative change in case numbers during week 2020–10 to 2020–32 (pandemic/NPIs), in comparison to week 2016–01 to 2020–09. Findings During week 2020–10 to 2020–32, 216,825 COVID-19 cases, and 162,942 (-35%) cases of other diseases, were notified. Case numbers decreased across all ages and notification categories (all p<0•05), except for tick-borne encephalitis, which increased (+58%). The number of cases decreased most for respiratory diseases (from -86% for measles, to -12% for tuberculosis), gastro-intestinal diseases (from -83% for rotavirus gastroenteritis, to -7% for yersiniosis) and imported vector-borne diseases (-75% dengue fever, -73% malaria). The less affected infections were healthcare associated pathogens (from -43% infection/colonisation with carbapenem-non-susceptible Acinetobacter, to -28% for Methicillin-resistant Staphylococcus aureus invasive infection) and sexually transmitted and blood-borne diseases (from -28% for hepatitis B, to -12% for syphilis). Interpretation During the COVID-19 pandemic a drastic decrease of notifications for most infectious diseases and pathogens was observed. Our findings suggest effects of NPIs on overall disease transmission that require further investigation.Peer Reviewe

Country-wide HIV incidence study complementing HIV surveillance in Germany

Serological methods exist that allow differentiating between recent and long-standing infections in persons infected with HIV. During a pilot study in Berlin between 2005 and 2007 methodologies have been evaluated. In a cross-sectional study blood samples, demographic, laboratory, clinical and behavioural data based on a KABP survey were collected from patients with newly diagnosed HIV infections. The BED-CEIA was used to determine recency of infection. Recent HIV infections contributed 54% (CI [95%]: 45; 64) in MSM and 16% (CI [95%]: 0; 39) in patients with other transmission risks (p=0.041). Proportions of recent infections were significantly higher in MSM ≤30 years (p=0.019). The mean age was 33.9 (median 34 years) in recent compared with 38.6 years (median: 38 years) in long-standing infections (p=0.011). High-risk behaviour indicated through very low condom use in recently HIV infected MSM could be identified. The results of the pilot study support expectations that the modified application of the method may contribute to improving HIV prevention efforts in Germany. On this basis the Robert Koch Institute implemented a countrywide HIV incidence study to complement HIV surveillance in early 2008. The study is funded by the German Ministry of Health. Data on recent HIV infections and current HIV transmission risks are collected. Design, methods and impact are described in detail

Einsatz von Antigentests in Einrichtungen in Deutschland - Ergebnisse einer RKI-Umfrage

Peer Reviewe

Welche Impfquote ist notwendig, um COVID-19 zu kontrollieren?

Die COVID-19-Pandemie stellt die Welt vor große medizinische, aber auch gesellschaftliche und wirtschaftliche Herausforderungen. Die langfristigen direkten und indirekten Folgen der Pandemie bzw. der notwendigen Kontrollmaßnahmen lassen sich derzeit noch nicht exakt definieren. Seit Ende 2020 bzw. Anfang 2021 stehen in Deutschland zwei mRNA-Impfstoffe sowie zwei Vektor-basierte Impfstoffe zur Verfügung. Mittlerweile liegen mehr als 15 Studien vor, die nach vollständiger Impfserie eine sehr gute Effektivität der COVID-19-Impfung bzgl. Schutz vor jeglicher Infektion wie auch vor asymptomatischen Infektionen zeigen. Basierend auf Ergebnissen mathematischer Modellszenarien und Bevölkerungssurveys zur Impfakzeptanz wird die Frage adressiert, welche Impfquote in Deutschland notwendig und auch realistisch ist, um COVID-19 in den kommenden Monaten zu kontrollieren.Peer Reviewe

Erfassung der SARS-CoV-2-Testzahlen in Deutschland (Stand 26.8.2020)

Das Robert Koch-Institut erfasst wöchentlich die Anzahl der in Deutschland durchgeführten SARS-CoV-2-Tests, sowie einige Begleitinformationen. Hierfür werden deutschlandweit Daten von Universitätskliniken, Forschungseinrichtungen sowie klinischen und in der ambulanten Versorgung tätigen Laboren zusammengeführt. Der Artikel im Epidemiologischen Bulletin 35/2020 geht u. a. auf die Sensitivität und Spezifität der diagnostischen Tests und die Rolle falsch-positiver Testergebnisse für die Bewertung der Lage in Deutschland sowie auf die Testkapazitäten ei

Retrospektive Phaseneinteilung der COVID-19-Pandemie in Deutschland bis Februar 2021

Seit Anfang März 2020 wurde in Deutschland eine deutliche Zunahme der COVID-19-Fälle beobachtet, mit einem Höhepunkt von etwa 35.000 Fällen in der Meldewoche 14/2020. Im folgenden Sommer wurden zunächst deutlich rückläufige Fallzahlen beobachtet. Diese waren insbesondere auf Ausbrüche in Gemeinschaftsunterkünften, fleischverarbeitenden Betrieben und auf Einreisende zurückzuführen. Im Spätsommer stieg die Anzahl übermittelter Fälle erneut an und mündete in einem starten exponentiellen Anstieg zum Herbst 2020. Um Änderungen im Gesamtgeschehen erkennen und interpretieren zu können, ist es erforderlich den Verlauf basierend auf den verfügbaren Daten in klar definierte Phasen einzuteilen. Dazu sind objektive Kriterien notwendig, die unterschiedliche Zeiträume möglichst klar voneinander trennen. Die Phaseneinteilung anhand epidemiologischer Parameter soll eine Grundlage für zukünftige Auswertungen und Darstellungen schaffen und Vergleiche (z. B. zur Transmission, individuellen klinischen Schwere und zur Belastung des Gesundheitswesen) innerhalb der verschiedenen Phasen ermöglichen

Estimating the regional distribution of men who have sex with men (MSM) based on Internet surveys

<p>Abstract</p> <p>Background</p> <p>Measurement of prevalence and incidence of infections in a hard to reach population like men who have sex with men (MSM) is hampered by its unknown size and regional distribution. Population-based surveys have recently been used to estimate the total number of MSM, but these surveys are usually not large enough to measure regional differences in the proportion of MSM in the population. We explored the use of the proportional regional distribution of participants of large internet-based surveys among MSM from Germany to estimate the regional distribution of MSM in Germany.</p> <p>Methods</p> <p>We compared participants from two separate MSM behavioural surveys with each other and with the distribution of user profiles of the largest contact and dating website for gay and other MSM in Germany in terms of the representativeness of the regional distribution. In addition, we compared the regional distribution of reportedly HIV positive survey participants with the regional distribution of HIV notifications within the national surveillance system that can be attributed to transmission through homosexual contacts.</p> <p>Results</p> <p>Regional distribution of survey participants was almost identical in both surveys, despite little overlap between survey participants. Slight discrepancies between surveys and user profiles could be observed. Proportional regional distribution of survey participants with HIV diagnosis resembled national surveillance data.</p> <p>Conclusion</p> <p>Considering the difficulties to obtain representative data by other sampling methods for "hidden" populations like MSM, internet-based surveys may provide an easy and low cost tool to estimate the regional population distribution – at least in Western post-industrialized countries. Some uncertainties remain about the exact place of residence of MSM in larger cities or catchment areas of these cities. Slightly different results from different datasets may be due to unequal popularity of MSM websites in different regions. The total population size of the MSM population can be estimated based on e.g. data from representative national population surveys. Both estimates can then be combined to calculate the absolute size of regional MSM populations.</p