Seroprevalence of mucosal and cutaneous human papillomavirus (HPV) types among children and adolescents in the general population in Germany

Background In Germany, HPV vaccination of adolescent girls was introduced in 2007. Nationally representative data on the distribution of vaccine-relevant HPV types in the pre-vaccination era are, however, only available for the adult population. To obtain data in children and adolescents, we assessed the prevalence and determinants of serological response to 16 different HPV types in a representative sample of 12,257 boys and girls aged 1–17 years living in Germany in 2003–2005. Methods Serum samples were tested for antibodies to nine mucosal and seven cutaneous HPV types. The samples had been collected during the nationally representative German Health Interview and Examination Survey for Children and Adolescents in 2003–2006. We calculated age- and gender-specific HPV seroprevalence. We used multivariable regression models to identify associations between demographic and behavioral characteristics and HPV seropositivity. Results We found low but non-zero seroprevalence for the majority of tested HPV types among children and adolescents in Germany. The overall seroprevalence of HPV-16 was 2.6%, with slightly higher values in adolescents. Seroprevalence of all mucosal types but HPV-6 ranged from 0.6% for HPV-33, to 6.4% for HPV-31 and did not differ by gender. We found high overall seroprevalence for HPV-6 with 24.8%. Cutaneous HPV type seroprevalence ranged from 4.0% for HPV-38 to 31.7% for HPV-1. In the majority of cutaneous types, seroprevalence did not differ between boys and girls, but increased sharply with age, (e.g., HPV-1 from 1.5% in 1–3-years-old to 45.1% in 10–11-years-old). Associations between behavioral factors and type-specific HPV prevalence were determined to be heterogeneous. Conclusions We report the first nationally representative data of naturally acquired HPV antibody reactivity in the pre-HPV-vaccination era among children and adolescents living in Germany. These data can be used as baseline estimates for evaluating the impact of the current HPV vaccination strategy targeting 9–14-years-old boys and girls.Peer Reviewe

Background paper to the recommendation for routine rotavirus vaccination of infants in Germany

Two rotavirus (RV) vaccines were introduced to the European market in 2006. To support the decision-making process of the German Standing Committee on Vaccination ("Ständige Impfkommission", STIKO) regarding adoption of routine RV vaccination into the national vaccination schedule in Germany relevant scientific background was reviewed. According to STIKO’s Standard Operating Procedures for the development of evidence-based vaccination recommendations, a set of key questions was addressed and systematic reviews were performed with a focus on the efficacy, effectiveness, impact and safety of RV vaccines. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the quality of available evidence. Data from 5 randomized controlled trials demonstrated a high efficacy of RV vaccines in preventing severe RV-associated gastroenteritis (91%) and hospitalization (92%) in settings comparable to Germany. Post-marketing observational studies confirmed these findings. In several countries, impact studies suggest that age groups not eligible for vaccination might also benefit from herd effects and demonstrated a decrease in the number of nosocomial RV infections after RV vaccine introduction. The vaccines were considered safe, except for a slightly increased risk of intussusception shortly after the first dose, corresponding to 1-2 additional cases per 100,000 infants vaccinated (relative risk =1.21, 95% confidence interval [CI] 0.68-2.14). RV case-fatality is extremely low in Germany. However, RV incidence among children age

Risk factors for nosocomial SARS-CoV-2 infections in patients: results from a retrospective matched case–control study in a tertiary care university center

Background: Factors contributing to the spread of SARS-CoV-2 outside the acute care hospital setting have been described in detail. However, data concerning risk factors for nosocomial SARS-CoV-2 infections in hospitalized patients remain scarce. To close this research gap and inform targeted measures for the prevention of nosocomial SARS-CoV-2 infections, we analyzed nosocomial SARS-CoV-2 cases in our hospital during a defined time period. Methods: Data on nosocomial SARS-CoV-2 infections in hospitalized patients that occurred between May 2020 and January 2021 at Charite university hospital in Berlin, Germany, were retrospectively gathered. A SARS-CoV-2 infection was considered nosocomial if the patient was admitted with a negative SARS-CoV-2 reverse transcription polymerase chain reaction test and subsequently tested positive on day five or later. As the incubation period of SARS-CoV-2 can be longer than five days, we defined a subgroup of "definite" nosocomial SARS-CoV-2 cases, with a negative test on admission and a positive test after day 10, for which we conducted a matched case-control study with a one to one ratio of cases and controls. We employed a multivariable logistic regression model to identify factors significantly increasing the likelihood of nosocomial SARS-CoV-2 infections. Results: A total of 170 patients with a nosocomial SARS-CoV-2 infection were identified. The majority of nosocomial SARS-CoV-2 patients (n = 157, 92%) had been treated at wards that reported an outbreak of nosocomial SARS-CoV-2 cases during their stay or up to 14 days later. For 76 patients with definite nosocomial SARS-CoV-2 infections, controls for the case-control study were matched. For this subgroup, the multivariable logistic regression analysis revealed documented contact to SARS-CoV-2 cases (odds ratio: 23.4 (95% confidence interval: 4.6-117.7)) and presence at a ward that experienced a SARS-CoV-2 outbreak (odds ratio: 15.9 (95% confidence interval: 2.5-100.8)) to be the principal risk factors for nosocomial SARS-CoV-2 infection. Conclusions: With known contact to SARS-CoV-2 cases and outbreak association revealed as the primary risk factors, our findings confirm known causes of SARS-CoV-2 infections and demonstrate that these also apply to the acute care hospital setting. This underscores the importance of rapidly identifying exposed patients and taking adequate preventive measures

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

Changes to the varicella and pertussis immunisation schedule in Germany 2009: Background, rationale and implementation

In July 2009, the German Standing Committee on Vaccination (STIKO) modified its recommendations for varicella and pertussis vaccination, based on newly available data on disease epidemiology, vaccine effectiveness (VE) and safety, and an evaluation of the feasibility of the recommended immunisation strategy. The recommendation for varicella vaccine now includes a routine two-dose schedule with the administration of the first dose at the age of 11 to 14 months and the second dose at the age of 15 to 23 months, with a minimum interval of four weeks between these doses. Furthermore, STIKO recommended adding a one-time pertussis booster to the adult vaccination schedule to expand the cocoon strategy in place since 2004. The recommendation of a booster vaccination with an acellular pertussis vaccine every 10 years for persons employed in the care of pre-school children and for healthcare personnel in paediatric, gynaecologic and obstetric health facilities was extended to persons employed in schools and in other institutions caring for older children, and to all healthcare personnel. These recommendations were based on available epidemiological data showing an increase in incidence from 7-10 cases per 100,000 inhabitants in 2002-2004 to over 30 by 2007. Moreover, the high burden of pertussis in infants at 94 hospitalised cases per 100,000 infants in 2007 suggested that the previous cocoon strategy was insufficient

Elements and basics of infection prevention

Infektionsprävention ist ein wichtiger Aspekt der Gesunderhaltung der Menschen und der sie umgebenden Lebensräume. Für die Infektionsprävention werden in der vorliegenden Schrift verschiedene Bausteine von Maßnahmen sowie notwendige Grundlagen für die Entwicklung von geeigneten Präventionsbündeln beschrieben werden. Infektionspräventionsmaßnahmen finden Anwendung in verschiedenen Settings, wie im Krankenhaus oder in der Allgemeinbevölkerung. Zudem richten sich die Maßnahmen nach den vorliegenden Optionen, d.h. liegen für die jeweilige Infektionskrankheit Impfstoffe vor, ist eine Dekolonisation möglich oder kann durch eine rationale Antibiotikaanwendung die Entwicklung von antimikrobieller Resistenz (AMR) eingedämmt werden. Zudem ist stets die Umgebung in den Gesundheitsschutz einzubeziehen. Für die Entwicklung von Maßnahmen zur Verhinderung bzw. Reduktion von Transmissionen und Infektionen sowie zur Kontrolle von Infektionskrankheiten, AMR und multiresistenten Erregern sind ausreichend valide Daten aus der infektionsepidemiologischen Forschung notwendig. Diese geben ein Verständnis für die Häufigkeit und Schwere einer Infektionskrankheit (Krankheitslast), für die Infektionsdynamik, mögliche Transmissionswege, Risikofaktoren in der Bevölkerung sowie Behandlungs- und Präventionsmöglichkeiten. Daraus lassen sich geeignete Maßnahmen für die Infektionsprävention ableiten, die die Besonderheit von Infektionskrankheiten berücksichtigt, nämlich, dass sie über Erreger von einem Menschen zum anderen übertragen werden können. Je nach Erregerspezifikationen, der aktuellen epidemiologischen Situation, Risikogruppen und Therapieoptionen können aus nicht-pharmakologischen und pharmakologischen Maßnahmen Präventionsbündel komponiert werden. Die in dieser Schrift vorgestellten wissenschaftlichen Ergebnisse finden Anwendung in der Praxis und gingen in Empfehlungen oder als Daten für den Entscheidungsfindungsprozess bzw. die Entwicklung von Präventionsstrategien ein.Infection prevention is an important aspect of keeping people and their environment healthy. For infection prevention, this paper describes different elements of measures as well as the necessary basis for developing appropriate prevention bundles. Infection prevention measures are applied in different settings, e.g. in hospitals or in the general population. Furthermore, the measures depend on the available options, i.e. are vaccines available for the respective infectious disease, is decolonisation possible or can the development of antimicrobial resistance (AMR) be contained by appropriate antibiotic use. In addition, the environment must always be included in health protection. For the development of measures to prevent or reduce transmissions and infections and to control infectious diseases, AMR and multiresistant pathogens, sufficiently valid data from infectious disease epidemiological research are necessary. These provide information on the frequency and severity of an infectious disease (disease burden), the infection dynamics, possible transmission routes and risk factors in the population as well as on treatment and prevention options. From this, suitable infection prevention measures can be derived that take into account the special feature of infectious diseases that they can be transmitted from person to person via pathogens. Depending on the pathogen specification, current epidemiological situation, risk groups and therapy options, prevention bundles can be put together from non-pharmacological and pharmacological measures. The scientific results presented in this paper are applied in practice and have been incorporated into recommendations or as data for the decision-making process or the development of prevention strategies

Impfempfehlungen für Deutschland

Hintergrund: Impfungen stellen eine effektive Maßnahme zum Schutz vor Infektionskrankheiten dar. In Deutschland werden Empfehlungen für Impfungen, die populationsbezogen das Auftreten und die Ausbreitung von Infektionen verhindern können, durch die Ständige Impfkommission (STIKO) am Robert Koch-Institut (RKI) auf Grundlage von infektionsepidemiologischen Erkenntnissen vorbereitet. Methoden: Selektive Literaturrecherche unter Berücksichtigung der aktuellen STIKO-Impfempfehlungen. Ergebnisse: Die Impfempfehlungen sind im jährlich aktualisierten Impfkalender dargestellt und umfassen ab der achten vollendeten Lebenswoche Impfungen gegen Diphtherie, Tetanus, Pertussis, Haemophilus influenzae Typ b, Hepatitis B, Poliomyelitis und Pneumokokken. Ab dem zweiten Lebensjahr folgen Impfungen gegen Masern, Mumps, Röteln, Varizellen und Meningokokken der Serogruppe C. Im Kindes- und Jugendalter werden Auffrischimpfungen und das Schließen von Impflücken empfohlen. Mädchen werden, nach der Empfehlung der STIKO, im Alter von 12 bis 17 Jahre gegen Humane Papillomviren geimpft. Bei Erwachsenen sollen regelmäßig die Impfungen gegen Tetanus, Diphtherie sowie einmalig gegen Pertussis aufgefrischt werden, und ab dem 60. Lebensjahr sollten Erwachsene gegen Pneumokokken und Influenza geimpft werden. Schlussfolgerungen: Mit den von der STIKO empfohlenen für alle Bürger kostenfreien Impfungen kann ein effektiver Infektionsschutz aufgebaut werden.Background: Vaccination is an effective means of preventing infectious diseases. In Germany, the Standing Vaccination Committee at the Robert Koch Institute (Ständige Impfkommission, STIKO) issues recommendations on vaccination to prevent the occurrence and spread of infectious diseases in the nation’s population. Methods: Selective literature review, including consideration of the current STIKO recommendations. Results: The annually updated vaccination calendar currently includes recommendations for vaccination against diphtheria, tetanus, pertussis, type b Haemophilus influenzae, hepatitis B, poliomyelitis, and pneumococci, beginning at the age of eight weeks. From the age of twelve months onward, children should be vaccinated against measles, mumps, rubella, varicella, and serogroup C meningococci. In later childhood and adolescence, booster vaccinations are recommended, in addition to the provision of any vaccinations that may have been missed. Girls aged 12 to 17 years should be vaccinated against human papilloma virus. Adults should have their tetanus and diphtheria vaccinations refreshed regularly, and their pertussis vaccination refreshed once; from age 60 onward, they should be vaccinated against pneumococci and influenza. Conclusions: The vaccinations recommended by the STIKO are available to all German citizens free of charge and provide effective protection against infectious disease

Needs and obstacles of uniform immunisation schedules in the European Union

Impfempfehlungen werden von nationalen Impfkommissionen erarbeitet und können sich zwischen den Mitgliedsstaaten (MS) der Europäischen Union (EU) erheblich unterscheiden. Die Europäische Kommission startete eine Initiative für eine Empfehlung des Rates mit dem Ziel, einen europäischen, wissenschaftlich fundierten Referenz-Impfkalender für Kinder zu entwickeln. Unserer Meinung nach impliziert diese Initiative die Etablierung eines einzigen europäischen Impfkalenders, der als der einzig wissenschaftlich zu rechtfertigende bewertet werden könnte. Die Erwartungen, dass ein einheitlicher Impfkalender die Freizügigkeit von EU-Bewohnern erleichtern, die Datenerfassung verbessern und die Impfquote erhöhen könnte, erscheint quantitativ und qualitativ nicht relevant oder sogar ethisch bedenklich. Impfstoffpreise und der Bedarf für klinische Studien könnten durch einheitliche Impfkalender gesenkt werden, aber dies könnte durch alternative Maßnahmen sogar effektiver gelingen. Auf der anderen Seite unterscheiden sich folgende Faktoren zwischen den MS erheblich und begründen unterschiedliche Impfkalender, wie a) Werte und Zielsetzungen, b) epidemiologische Lage, c) Gesundheitsversorgungssysteme, d) Impflogistik und e) wirtschaftliche Situation. Die Vereinheitlichung von Impfkalendern sollte nicht als primäres Ziel gesehen werden, sondern allenfalls als Nebeneffekt infolge zunehmender Einigung über Ziele und Werte sowie einer verbesserten Evidenzgrundlage, die von nationalen Impfkommissionen verwendet werden könnte.Immunisation schedules are developed by national committees on immunisation and may differ considerably between the European Union (EU) member states (MS). The European Commission has launched an initiative for a council recommendation with the aim to establish a scientifically substantiated reference childhood immunisation schedule for the EU. In our view this initiative implies the establishment of one European childhood immunisation schedule, which could lead to the perception that this schedule is the only one scientifically justified. The expectations that one uniform immunisation schedule will facilitate mobility of EU residents, improve data collection and increase vaccination coverage are either quantitatively or qualitatively not relevant or even ethically problematic. Arguments that uniform schedules would lead to lower vaccine prices and reduce the need for clinical trials appear to be more relevant but could be addressed more effectively by other measures. On the other hand the following factors may differ substantially between MS and thus support different immunisation schedules, such as (a) values and goals, (b) epidemiological situation, (c) health care delivery system, (d) logistics of vaccine delivery and (e) economic situation. We argue that uniform schedules should not be perceived as a goal in itself but rather as a possibly desired by-product following increasing agreement on goals and values between MS and improved evidence base to be used by national committees on immunisation

Expert recommendations for prevention and management of Candida auris transmission

Candida auris was first described as a yeast pathogen in 2009. Since then, the species has emerged worldwide. In contrast to most other Candida spp., C. auris frequently exhibits multi-drug resistance and is readily transmitted in hospital settings. While most detections so far are from colonised patients, C. auris does cause superficial and life-threatening invasive infections. During management of the first documented C. auris transmission in a German hospital, experts from the National Reference Centers for Invasive Fungal Infections (NRZMyk) and the National Reference Center for Surveillance of Nosocomial Infections screened available literature and integrated available knowledge on infection prevention and C. auris epidemiology and biology to enable optimal containment. Relevant recommendations developed during this process are summarised in this guidance document, intended to assist in management of C. auris transmission and potential outbreak situations. Rapid and effective measures to contain C. auris spread require a multi-disciplinary approach that includes clinical specialists of the affected unit, nursing staff, hospital hygiene, diagnostic microbiology, cleaning staff, hospital management and experts in diagnostic mycology / fungal infections. Action should be initiated in a step-wise process and relevant interventions differ between management of singular C. auris colonised / infected patients and detection of potential C. auris transmission or nosocomial outbreaks

Successful termination of a furunculosis outbreak due to lukS-lukF-positive, methicillin-susceptible Staphylococcus aureus in a German village by stringent decolonization, 2002-2005

Background: Skin infections due to Staphylococcus aureus have recently become a public concern, mainly because of emerging resistance against widely used antibiotics and specific virulence determinants. Strains harboring the lukS-lukF gene (which codes for Panton-Valentine leukocidin) are frequently associated with severe furunculosis. Generally applicable strategies for the control of community outbreaks of furunculosis have not been defined. Methods: We report the investigation and successful termination of an outbreak of furunculosis due to lukS-lukF-positive S. aureus in a German village (n=144). Nasal swab specimens were obtained from village residents. A retrospective cohort study was conducted. Nasally colonized persons, persons who had current furuncles or who had experienced relapsing furuncles since 2002, and their family members underwent stringent decolonization measures using mupirocin nasal ointment and disinfecting wash solution. Multiple nasal swab specimens were obtained to monitor the long-term outcome of decolonization measures. Results: From January 1998 through December 2004, 42 cases and 59 relapses of furunculosis were identified by active case finding. Of 140 participants tested, 51 (36%) were found to be nasally colonized with S. aureus. In 9 participants, the strain was positive for lukS-lukF. No methicillin resistance was detected. Risk of furunculosis was associated with contact with case patients (relative risk, 6.8; 95% confidence interval, 3.2-14.3) and nasal colonization with a lukS-lukF-positive strain of S. aureus (relative risk, 3.6; 95% confidence interval, 2.3-5.9). Passive surveillance implemented in January 2005 did not detect any case of lukS-lukF-positive, S. aureus-associated furuncles in this village. Conclusion: This report describes a successful strategy for terminating the transmission of epidemic strains of S. aureus among a nonhospitalized population