Cluster of human Puumala orthohantavirus infections due to indoor exposure?—An interdisciplinary outbreak investigation

Puumala orthohantavirus (PUUV) is the most important hantavirus species in Europe, causing the majority of human hantavirus disease cases. In central and western Europe, the occurrence of human infections is mainly driven by bank vole population dynamics influenced by beech mast. In Germany, hantavirus epidemic years are observed in 2- to 5-year intervals. Many of the human infections are recorded in summer and early autumn, coinciding with peaks in bank vole populations. Here, we describe a molecular epidemiological investigation in a small company with eight employees of whom five contracted hantavirus infections in late 2017. Standardized interviews with employees were conducted to assess the circumstances under which the disease cluster occurred, how the employees were exposed and which counteractive measures were taken. Initially, two employees were admitted to hospital and serologically diagnosed with hantavirus infection. Subsequently, further investigations were conducted. By means of a self-administered questionnaire, three additional symptomatic cases could be identified. The hospital patients' sera were investigated and revealed in one patient a partial PUUV L segment sequence, which was identical to PUUV sequences from several bank voles collected in close proximity to company buildings. This investigation highlights the importance of a One Health approach that combines efforts from human and veterinary medicine, ecology and public health to reveal the origin of hantavirus disease clusters.Peer Reviewe

Bakterielle Zoonosen mit Bedeutung für den öffentlichen Gesundheitsschutz in Deutschland – Vorkommen, Verbreitung und Übertragungswege

Bakterielle zoonotische Erreger sind häufig Auslöser von Erkrankungen mit teilweise schweren Verläufen. Sie sind wechselseitig zwischen Tieren (sowohl Wild- als auch Haustieren) und Menschen übertragbar. Die Transmissionswege sind sehr variabel, so kann die Übertragung u. a. durch orale Aufnahme über Lebensmittel, respiratorische Aufnahme über Tröpfchen und Aerosole sowie über Vektoren wie Zeckenstiche oder Nagerkontakte stattfinden. In diesem Zusammenhang sind auch das Auftreten und die Verbreitung von antibiotikaresistenten bakteriellen Erregern von zunehmender Bedeutung für den öffentlichen Gesundheitsschutz. Die Ausbreitung zoonotischer Erreger wird aktuell durch zahlreiche Faktoren verstärkt. Dazu gehören die Zunahme des internationalen Warenverkehrs, die Einengung der Lebensräume von Tieren und der dadurch zunehmend engere Kontakt zwischen Menschen und Wildtieren. Aber auch eine veränderte Tierhaltung in der Landwirtschaft und Klimaveränderungen können zur Ausbreitung beitragen. Der öffentliche Gesundheitsschutz und die Erforschung von Zoonosen sind deshalb von besonderer krankheitspräventiver, aber auch gesellschaftlicher, politischer und wirtschaftlicher Bedeutung. Ziel dieses Übersichtsartikels ist es, anhand von Beispielen die Spannbreite von Infektionskrankheiten darzustellen, die durch bakterielle zoonotische Erreger ausgelöst werden. Die unterschiedlichen Transmissionswege, epidemischen Potenziale und epidemiologischen Maßzahlen der beispielhaft gewählten Krankheiten sind Herausforderungen für den öffentlichen Gesundheitsdienst, den Tiergesundheitsdienst und die Lebensmittelüberwachung, deren Aufgabe es ist, die Bevölkerung vor diesen Infektionskrankheiten zu schützen.Bacterial zoonotic pathogens are often the cause of diseases, sometimes with severe outcomes. They are mutually transferable between animals (both wild and domestic) and humans. The transmission paths are very variable and include oral intake via food, respiratory infection via droplets and aerosols, or infections via vectors such as tick bites or rodent contact. Furthermore, the emergence and spread of antibiotic-resistant bacterial pathogens is of paramount public health concern. The likelihood of further spread is influenced by various factors. These include the increase in international trade, the endangerment of animal habitats, and the increasingly closer contact between humans and wild animals. Additionally, changes in livestock and climate change may also contribute. Therefore, research into zoonoses serves to protect human and animal health and is of particular social, political, and economic importance. The aim of this review article is to present the range of infectious diseases caused by bacterial zoonotic pathogens in order to provide a better understanding of the important work in public health services, animal health services, and food safety control. The different transmission routes, epidemic potentials, and epidemiological measures of the exemplary selected diseases show the challenges for the public health system to monitor and control the spread of these bacterial pathogens in order to protect the population from disease.Peer Reviewe

Surveillance übertragbarer Krankheiten auf der Grundlage des Infektionsschutzgesetzes in Deutschland durch den öffentlichen Gesundheitsdienst

Durch das Infektionsschutzgesetz (IfSG) hat die Surveillance übertragbarer Krankheiten in Deutschland ein neues Instrumentarium erhalten. Wesentliche Neuerungen waren eine Verlagerung von Meldeverantwortlichkeiten von Ärzten zu Laboren, die Validierung der Fälle in den Gesundheitsämtern anhand von Falldefinitionen und die elektronische Übermittlung von Einzelfalldaten über Landesbehörden an das Robert Koch-Institut. Vier Jahre nach Einführung des IfSG kann die Umsetzung aus Sicht der Landes- und Bundesbehörden als erfolgreich bewertet werden. Dies belegen auch Erfolge bei der Identifizierung und Aufklärung überregionaler Erkrankungsausbrüche. Folgende Aspekte werden noch als verbesserungswürdig angesehen und sollten bei einer Gesetzesnovellierung berücksichtigt werden: Verkürzung der Übermittlungsfristen, klare Regelung der Zuständigkeiten und des Datenaustausches bei überregionalen Ausbrüchen sowie bei der grenzüberschreitenden Weitergabe von Fallinformationen, Verankerung einer ergänzenden Auskunftspflicht der behandelnden Ärzte gegenüber dem Gesundheitsamt bei Labormeldungen. Der öffentliche Gesundheitsdienst (ÖGD) kann zu einer weiteren Stärkung des Systems beitragen, indem er sich um eine noch bessere Information und damit Motivation der Meldenden bemüht und die wissenschaftliche Evaluation des Systems—insbesondere hinsichtlich möglicher Untererfassungen—vorantreibt.By the Protection against Infection Act new instruments were established for infectious disease surveillance in Germany. The main innovations were a shift of responsibility for notifications from clinicians to laboratories, the validation of cases by means of case definitions in local public health departments, and the electronic transmission of single case data via state health departments to the Robert Koch Institute. Four years after the Protection against Infection Act was enacted, its implementation was successful from the perspective of state and national health authorities. This was proven by the detection and successful investigation of several diffuse outbreaks. However, further improvements seem necessary and the following points should be considered in a revision of the act: reduction of time limits for data transmission, unambiguous regulation of responsibilities and for data exchange in non-localized outbreaks as well as for international exchange of case data, and introduction of an obligation for clinicians to supply local public health departments with complementary information regarding laboratory reports on demand. The public health sector can contribute to a further improvement of the surveillance system by working to better inform clinicians and laboratories and therewith motivate them to comply with their obligations for notifying diseases and by promoting the scientific evaluation of the system, in particular concerning potential underreporting

Practical usage of computer-supported outbreak detection in five European countries

This paper discusses computer-supported outbreak detection using routine surveillance data, as implemented at six institutes for infectious disease control in five European countries. We give an overview of the systems used at the Statens Serum Institut (Denmark), Health Protection Agency (England, Wales and Northern Ireland), Robert Koch Institute (Germany), Governmental Institute of Public Health of Lower Saxony (Germany), National Institute for Public Health and the Environment (the Netherlands) and Swedish Institute for Infectious Disease Control (Sweden). Despite the usefulness of the algorithms or the outbreak detection procedure itself, all institutes have experienced certain limitations of the systems. The paper therefore concludes with a list of recommendations for institutes planning to introduce computer-supported outbreak detection, based on experiences on the practical usage of the systems. This list – which concerns usability, standard operating procedures and evaluation – might also inspire improvements of systems in use today

Kommunen, Länder, Bund und Europäische Gemeinschaft. Zuständigkeiten und Aufgaben bei Seuchennotfällen im Kontext der neuen Internationalen Gesundheitsvorschriften

Die weltweite Ausbreitung und Zunahme von Infektionskrankheiten sind wesentliche Herausforderungen für den öffentlichen Gesundheitsdienst. Dies gilt nicht nur für eine möglicherweise drohende Influenzapandemie, sondern auch für andere, bislang kaum oder gar nicht bekannte Infektionskrankheiten, z. B. für das Severe Acute Respiratory Syndrome (SARS), wie die erste Pandemie dieses Jahrtausends eindrücklich zeigte. Zunehmend wird auch die Gefahr bioterroristischer Anschläge mit in die Planungen des Managements von Seuchennotfällen einbezogen. In Deutschland sind die diesbezüglichen politischen und fachlichen Zuständigkeiten komplex, da die Gesetzgebungskompetenz für Gesundheitsfragen bei den Bundesländern liegt. Die Ausführungsorgane für die Maßnahmen bei Seuchennotfällen sind die regional zuständigen Gesundheitsämter. Ihnen übergeordnet sind Fachbehörden der Länder und des Bundes. Da Infektionskrankheiten häufig grenzüberschreitend auftreten, ist mit dem European Centre for Disease Prevention and Control (ECDC) eine europäische Behörde zur Identifizierung und Bewertung von Infektionskrankheiten, einschließlich Seuchennotfällen eingerichtet worden.Pandemic preparedness has become a catch phrase for politicians, government agencies and communities, both nationally and internationally. This is due to the increasing number of infectious diseases emergencies that are important challenges for health protection authorities, which was shown impressively when SARS emerged as the first pandemic in this millennium. In Germany, effective and efficient infection control is complex, with local health protection authorities having their own responsibilities. In the case of an emergency epidemic, regional health departments are responsible. Having authority over these are authorities on the federal state level as well as on the federal level. For the European Community, the European Centre for Disease Prevention and Control (ECDC) was established. The mission of this agency is to identify, assess and communicate current and emerging threats to human health posed by infectious diseases

Seroprevalence of Antibodies against Measles, Rubella and Varicella among Asylum Seekers Arriving in Lower Saxony, Germany, November 2014–October 2015

The number of asylum seekers arriving in Germany has increased rapidly since 2014 and cases of vaccine-preventable diseases at reception centres were reported. Asylum seekers 12 years and older arriving in Lower Saxony were serologically screened for antibodies against measles, rubella and varicella between November 2014 and October 2015. We calculated the seroprevalence from the screening data by disease, country of origin and age group and compared them to literature-based herd immunity thresholds in order to identify immunisation gaps. In total, 23,647 specimens were included in our study. Although the vast majority of asylum seekers tested positive for antibodies against measles, rubella and varicella, the seroprevalences were not sufficient to ensure herd immunity. The seroprevalences varied substantially between countries of origin and increased with age. Immunisation of asylum seekers against measles, rubella and varicella is needed and the detailed information on seroprevalences among subgroups of asylum seekers can be used for targeted immunisations at reception centres

Foodborne hepatitis A outbreak associated with bakery products in northern Germany, 2012

In October 2012, a hepatitis A (HA) outbreak with 83 laboratory-confirmed cases occurred in Lower Saxony. We defined primary outbreak cases as people with laboratory-confirmed HA and symptom onset between 8 October and 12 November 2012, residing in or visiting the affected districts. Secondary outbreak cases were persons with symptom onset after 12 November 2012 and close contact with primary cases. We identified 77 primary and six secondary cases. We enrolled 50 primary cases and 52 controls matched for age and sex, and found that 82% of cases and 60% of controls had consumed products from a particular bakery (OR=3.09; 95% CI: 1.15–8.68). Cases were more likely to have eaten sweet pastries (OR=5.74; 95% CI: 1.46–22.42). Viral isolates from five selected cases and three positively tested surfaces in the bakery had identical nucleotide sequences. One additional identical isolate derived from a salesperson of the bakery suffering from a chronic disease that required immunosuppressive treatment. Epidemiological and laboratory findings suggested that the salesperson contaminated products while packing and selling. Future risk assessment should determine whether food handlers with chronic diseases under immunosuppressive treatment could be more at risk of contaminating food and might benefit from HAV immunisation

Feasibility of a birth cohort study dedicated to assessing acute infections using symptom diaries and parental collection of biomaterials.

A birth cohort dedicated to studying infections in early childhood may be assisted by parental recording of symptoms on a daily basis and a collection of biomaterials. We aimed at testing the feasibility of this approach for use in a long-term study focusing on infections in children in Germany