Reliability of case definitions for public health surveillance assessed by Round-Robin test methodology

BACKGROUND: Case definitions have been recognized to be important elements of public health surveillance systems. They are to assure comparability and consistency of surveillance data and have crucial impact on the sensitivity and the positive predictive value of a surveillance system. The reliability of case definitions has rarely been investigated systematically. METHODS: We conducted a Round-Robin test by asking all 425 local health departments (LHD) and the 16 state health departments (SHD) in Germany to classify a selection of 68 case examples using case definitions. By multivariate analysis we investigated factors linked to classification agreement with a gold standard, which was defined by an expert panel. RESULTS: A total of 7870 classifications were done by 396 LHD (93%) and all SHD. Reporting sensitivity was 90.0%, positive predictive value 76.6%. Polio case examples had the lowest reporting precision, salmonellosis case examples the highest (OR = 0.008; CI: 0.005–0.013). Case definitions with a check-list format of clinical criteria resulted in higher reporting precision than case definitions with a narrative description (OR = 3.08; CI: 2.47–3.83). Reporting precision was higher among SHD compared to LHD (OR = 1.52; CI: 1.14–2.02). CONCLUSION: Our findings led to a systematic revision of the German case definitions and build the basis for general recommendations for the creation of case definitions. These include, among others, that testable yes/no criteria in a check-list format is likely to improve reliability, and that software used for data transmission should be designed in strict accordance with the case definitions. The findings of this study are largely applicable to case definitions in many other countries or international networks as they share the same structural and editorial characteristics of the case definitions evaluated in this study before their revision

Perspectives Pathways to clean hands: highlights of successful hand hygiene implementation

infections and estimates of vaccine effectiveness i

A super-spreading ewe infects hundreds with Q fever at a farmers' market in Germany

BACKGROUND: In May 2003 the Soest County Health Department was informed of an unusually large number of patients hospitalized with atypical pneumonia. METHODS: In exploratory interviews patients mentioned having visited a farmers' market where a sheep had lambed. Serologic testing confirmed the diagnosis of Q fever. We asked local health departments in Germany to identiy notified Q fever patients who had visited the farmers market. To investigate risk factors for infection we conducted a case control study (cases were Q fever patients, controls were randomly selected Soest citizens) and a cohort study among vendors at the market. The sheep exhibited at the market, the herd from which it originated as well as sheep from herds held in the vicinity of Soest were tested for Coxiella burnetii (C. burnetii). RESULTS: A total of 299 reported Q fever cases was linked to this outbreak. The mean incubation period was 21 days, with an interquartile range of 16–24 days. The case control study identified close proximity to and stopping for at least a few seconds at the sheep's pen as significant risk factors. Vendors within approximately 6 meters of the sheep's pen were at increased risk for disease compared to those located farther away. Wind played no significant role. The clinical attack rate of adults and children was estimated as 20% and 3%, respectively, 25% of cases were hospitalized. The ewe that had lambed as well as 25% of its herd tested positive for C. burnetii antibodies. CONCLUSION: Due to its size and point source nature this outbreak permitted assessment of fundamental, but seldom studied epidemiological parameters. As a consequence of this outbreak, it was recommended that pregnant sheep not be displayed in public during the 3(rd )trimester and to test animals in petting zoos regularly for C. burnetii

Launch meeting of the new World Health Organization Collaborating Centre for Antimicrobial Resistance, Consumption and Health Care-Associated Infections at the Robert Koch institute, Berlin, Germany, October 2022

Peer Reviewe

Wochenbericht zur hitzebedingten Mortalität KW 34

Hitzeperioden führen in Deutschland regelmäßig zu einem Anstieg der Mortalität. Um über die aktuelle Lage in Deutschland zu informieren, wird dieser Bericht während des Sommers 2025 (Juni-September) wöchentlich aktualisiert. Der aktuelle Bericht umfasst Schätzungen der hitzebedingten Sterbefälle im Zeitraum der Kalenderwochen (KW) 15 bis 34/2025

Wochenbericht zur hitzebedingten Mortalität KW 31

Hitzeperioden führen in Deutschland regelmäßig zu einem Anstieg der Mortalität. Um über die aktuelle Lage in Deutschland zu informieren, wird dieser Bericht während des Sommers 2024 (Juni-September) wöchentlich aktualisiert. Der aktuelle Bericht umfasst Schätzungen der hitzebedingten Sterbefälle im Zeitraum der Kalenderwochen (KW) 15 bis 31/2024

Wochenbericht zur hitzebedingten Mortalität KW 36

Hitzeperioden führen in Deutschland regelmäßig zu einem Anstieg der Mortalität. Um über die aktuelle Lage in Deutschland zu informieren, wird dieser Bericht während des Sommers 2025 (Juni-September) wöchentlich aktualisiert. Der aktuelle Bericht umfasst Schätzungen der hitzebedingten Sterbefälle im Zeitraum der Kalenderwochen (KW) 15 bis 36/2025

Wochenbericht zur hitzebedingten Mortalität KW 34

Hitzeperioden führen in Deutschland regelmäßig zu einem Anstieg der Mortalität. Um über die aktuelle Lage in Deutschland zu informieren, wird dieser Bericht während des Sommers 2024 (Juni-September) wöchentlich aktualisiert. Der aktuelle Bericht umfasst Schätzungen der hitzebedingten Sterbefälle im Zeitraum der Kalenderwochen (KW) 15 bis 34/2024

Wochenbericht zur hitzebedingten Mortalität KW 28

Hitzeperioden führen in Deutschland regelmäßig zu einem Anstieg der Mortalität. Um über die aktuelle Lage in Deutschland zu informieren, wird dieser Bericht während des Sommers 2025 (Juni-September) wöchentlich aktualisiert. Der aktuelle Bericht umfasst Schätzungen der hitzebedingten Sterbefälle im Zeitraum der Kalenderwochen (KW) 15 bis 28/2025