Hepatitis B vaccination coverage in Germany: systematic review

Background Despite being considered as a low prevalence country for hepatitis B (HBV), some populations in Germany are at higher risk of infection. In the context of the World Health Organization’s (WHO) viral hepatitis elimination goals, a valid epidemiological data base is needed to plan and monitor the national response. Prevention strategies include general and targeted HBV vaccination programmes. Objective The aim of this work was to estimate the HBV vaccination coverage (VC) in the general population (GP) and different population groups in Germany from available evidence and to identify current evidence gaps for future research. Methods We conducted a systematic review on HBV VC in the general population and populations at high risk of HBV exposure or severe infection in Germany. We included eligible publications (01/01/2017 to 06/06/2020) from databases Embase, Pubmed and Livivo, from a previous scoping review (including data published 01/01/2005–17/03/2017), from the national surveillance system and screened the reference lists of all publications at full text level. Risk of bias was assessed using the Hoy et al. tool. Results We included 68 publications of 67 studies and assigned them to one or more suitable population groups. Twenty-one studies contained data among children/adolescents and three among adults from the GP (VC 65.8–90.5% and 22.9–52.1%, respectively), one among travelers (VC 89.0%), 13 among immunocompromised populations (VC 7.8–89.0%), 16 among populations with occupational risk and 16 with non-occupational risk of HBV exposure (VC 63.6–96.5% and 4.4–84.5%, respectively). Conclusion Comprehensive evidence at low risk of bias was identified for children/adolescents. However, 25 years after including HBV in the national immunisation schedule, VC in Germany is still below the 95%-goal defined by WHO. For people at occupational risk of HBV exposure, VC was mostly reported to be over the WHO goal of 80%, but quality of evidence was heterogenous and should be improved. For people at non-occupational risk of HBV exposure, evidence was sparse and of low quality. The low VC highlights the need for future research to plan vaccination programmes targeting these populations.Peer Reviewe

Epidemiologie der Virushepatitiden A bis E in Deutschland

Mit Virushepatitis A bis E werden verschiedene infektiöse Entzündungen des Leberparenchyms bezeichnet, die durch die Hepatitisviren A bis E (HAV, HBV, HCV, HDV und HEV) ausgelöst werden. Zwar ähneln sich die Krankheitsbilder, die Erreger gehören jedoch zu verschiedenen Virusfamilien und unterscheiden sich bezüglich der Pathogenese, der Übertragungswege, des klinischen Verlaufs und der Präventions- und Therapiemöglichkeiten. In Deutschland besteht eine namentliche Meldepflicht nach Infektionsschutzgesetz (IfSG) für den direkten oder indirekten Nachweis und für Verdacht, Erkrankung und Tod. Die Daten werden an das Robert Koch-Institut übermittelt. In diesem Beitrag wird die Epidemiologie der Hepatitiden A bis E anhand publizierter Studien und Meldedaten beschrieben und es werden aktuelle Herausforderungen und Präventionsansätze aufgezeigt. Letztere bestehen insbesondere in der verbesserten Umsetzung bereits bestehender Impfempfehlungen (Hepatitis A und B), dem verbesserten Zugang zu Prävention, Testung und Versorgung, einschließlich Therapie mit antiviralen Medikamenten (Hepatitis B, C und D), und der Erkennung und Verhinderung lebensmittelbedingter Infektionen und Ausbrüche und Verbesserungen auf dem Gebiet der Lebensmittelsicherheit (Hepatitis A und E).Viral hepatitis A to E describes various infectious inflammations of the liver parenchyma that are caused by the hepatitis viruses A to E (HAV, HBV, HCV, HDV, and HEV). Although the clinical pictures are similar, the pathogens belong to different virus families and differ in terms of pathogenesis, transmission routes, clinical course, prevention, and therapy options. In Germany, there is mandatory reporting according to the Infection Protection Act (IfSG) for direct or indirect laboratory evidence and for suspicion, illness, and death of viral hepatitis. The data are transmitted to the Robert Koch Institute. In this article, on the basis of published studies and notification data, we describe the epidemiology of hepatitis A to E as well as current challenges and prevention approaches. In particular, the latter contains the improvement of existing vaccination recommendations (hepatitis A and B); improvement of access to prevention, testing, and care including therapy with antiviral drugs (hepatitis B, C, and D) and the detection and prevention of foodborne infections and outbreaks; and improvements in the field of food safety (hepatitis A and E).Peer Reviewe

Markedly decreasing azithromycin susceptibility of Neisseria gonorrhoeae, Germany, 2014 to 2021

We monitored antimicrobial susceptibility developments of Neisseria gonorrhoeae in Germany from January 2014 to May 2021. The proportion of isolates with azithromycin minimum inhibitory concentrations above the epidemiological cut-off increased substantially, from 1.3% in 2014 to 12.2% in 2020. Preliminary data from 2021 showed a further rise (January to May: 20.7%). Therefore, azithromycin as part of the recommended dual therapy in Germany for non-adherent patients is challenged. Antimicrobial susceptibility testing in clinical practice is crucial and continuous susceptibility surveillance indispensable.Peer Reviewe

Gelingt das Screening von Schwangeren auf HIV, Syphilis und Hepatitis B in Deutschland? Eine Analyse auf Basis von Routinedaten

Hintergrund: Infektionen in der Schwangerschaft sind weltweit eine der führenden Ursachen für erhöhte Morbidität und Mortalität bei Müttern und ihren Neugeborenen. In Deutschland gibt es seit mehr als 50 Jahren eine standardisierte Gesundheitsvorsorge in der Schwangerschaft. Die Mutterschafts-Richtlinien des Gemeinsamen Bundesausschusses bilden hierzu den gesetzlichen Rahmen und umfassen unter anderem das Screening von Schwangeren auf HIV, Syphilis und Hepatitis B. Ziel der Arbeit: Im Rahmen dieser Arbeit soll eruiert werden, wie hoch die Abdeckung des Screenings in der deutschen Bevölkerung ist. Material und Methoden: Mithilfe von anonymisierten Routinedaten von gesetzlich Versicherten, die dem Institut für angewandte Gesundheitsforschung Berlin GmbH (InGef) aus den Jahren 2011 bis 2015 vorliegen, wurde mithilfe von verschiedenen Internationale statistische Klassifikationsziffern der Krankheiten und verwandter Gesundheitsprobleme(ICD-10)- und Einheitlicher Bewertungsmaßstab(EBM)-Ziffern eine Definition für Schwangerschaft entwickelt und eine erste Auswertung zur Inanspruchnahme von Testungen auf Infektionserreger in der Schwangerschaft vorgenommen. Ergebnisse: Der hohe Anteil von Frauen, die im Rahmen der Schwangerschaft auf Syphilis (95,3 %) und Hepatitis B (91,6 %) getestet werden, spricht für eine sehr gute Erreichbarkeit und Inanspruchnahme von vorgeburtlichen Screeningangeboten. Bei HIV ist der Anteil an getesteten Frauen deutlich niedriger (84,9 %). Diskussion: Ob Schwangere einen HIV-Test ablehnen, der Test anderweitig durchgeführt oder nicht durch das ärztliche Personal empfohlen wurde, lässt sich anhand der vorliegenden Datenlage nicht klären. Angesichts der hochwirksamen medizinischen Interventionsmöglichkeiten für Syphilis, HIV und Hepatitis B ist eine möglichst vollständige Testung von Schwangeren in Deutschland anzustreben. Die Gründe für fehlende Screeninguntersuchungen müssen weiter eruiert und Ansatzpunkte für eine Steigerung der Inanspruchnahme identifiziert werden.Peer Reviewe

Epidemiologie von Hepatitis-B- und Hepatitis-C-Virusinfektionen in Deutschland im Jahr 2023

Hepatitis-B- und Hepatitis-C-Viren (HBV, HCV) verursachen Leberentzündungen, die aufgrund der häufigen Chronifizierung der Infektionen oft schwerwiegende gesundheitliche Folgen haben. Es stehen evidenzbasierte Präventions- und Behandlungsoptionen für HBV- und HCV-Infektionen zur Verfügung. Für Hepatitis B gibt es eine Impfung und effektive Therapie, Hepatitis C kann seit einigen Jahren mit hochwirksamen antiviralen Medikamenten in den meisten Fällen geheilt werden. Dennoch bleibt die Krankheitslast beider Infektionen weltweit hoch. Die epidemiologische Situation von Hepatitis B und C in Deutschland im Jahr 2023 wird auf Grundlage der Meldedaten gemäß IfSG im Vergleich zu den Vorjahren dargestellt

Not again! Effect of previous test results, age group and reason for testing on (re-)infection with Chlamydia trachomatis in Germany

Background: Infection with Chlamydia trachomatis (Ct) is the most commonly reported sexually transmitted infection in Europe. In Germany, Ct screening is offered free of charge to pregnant women since 1995 and to women < 25 years of age since 2008. For symptomatic individuals, testing is covered by statutory health insurance. Study results have shown that repeat Ct infection occurs in 10–20% of previously infected women and men. Our aim was to describe persons tested for Ct and to investigate the determinants of (repeat) Ct infection in women and men in Germany. Methods: We analysed Ct test results from men and women tested between 2008 and 2014 in laboratories participating in the German Chlamydia trachomatis Laboratory Sentinel surveillance. Reinfection was defined as at least 2 positive laboratory tests within more than 30 days. We performed logistic regression stratified by sex and, for women, reason for testing to determine the effect of previous test results and age group on subsequent test results. Results: In total, 2,574,635 Ct tests could be attributed to 1,815,494 women and 123,033 men. 5% of women and 14% of men tested positive at least once. 15–19- and 20–24-year-old women tested positive at least once respectively in 6.8 and 6.0%, while men respectively in 16.6 and 21.2%. Altogether, 23.1% of tested women and 11.9% of tested men were tested repeatedly between 2008 and 2014. Among those who previously tested positive, reinfection occurred in 2.0% of women and 6.6% of men. Likelihood to be tested Ct positive was higher in women and men with a positive Ct test in the past compared to previously tested Ct negative, odds ratios 4.7 and 2.6 (p < 0.01) respectively. Odds ratios ranged by age group and test reason. Conclusion: A history of Ct infection increased the likelihood of infection with Ct in women and men taking into account the result of the previous test. Health education, safer sex and treatment of partners are necessary for women and men who have tested positive to prevent reinfection and complications and to interrupt the chain of transmission. To identify potential reinfection repeat testing after treatment should be performed.Peer Reviewe

Virushepatitis B und D im Jahr 2020

Infektionen mit Hepatitis-B-Viren (HBV) gehören zu den häufigsten Infektionskrankheiten weltweit. Hepatitis D ist ebenfalls weltweit verbreitet, auch wenn Deutschland zu den Niedrigprävalenzländern gehört. Sowohl die WHO als auch das Bundesministerium für Gesundheit haben Strategien zur Eindämmung von Hepatitis B veröffentlicht - die COVID-19-Pandemie stellt jedoch eine große Heraus¬forderung beim Erreichen der Eliminierungsziele bis 2030 dar. In Deutschland wurden im Jahr 2020 24% weniger HBV-Infektionen übermittelt als im Vorjahr. Wie das Epidemiologische Bulletin 29/2021 anlässlich des Welt-Hepatitis-Tages ausführt, sind die Gründe für die Re¬duktion übermittelter Fallzahlen vielfältig. Die COVID-19-Pandemie hat die Gesundheitsversor¬gung, den öffentlichen Gesundheitsdienst aber auch das Kontaktverhalten der Bevölkerung dras¬tisch verändert. Die Reduktion der Fallzahlen könnte aber auch durch die Änderungen im IfSG im Jahr 2017 begründet sein.Peer Reviewe

Increasing Number of Individuals Receiving Hepatitis B nucleos(t)ide Analogs Therapy in Germany, 2008–2019

Background: Germany is a low prevalence country for hepatitis B virus (HBV) infection with higher prevalence in vulnerable groups. The number of treated chronic hepatitis B (CHB) patients is unknown. We aimed to determine the number of CHB patients treated with nucleos(t)ide analogs (NUCs), the treatment costs within the statutory health insurance (SHI) in Germany and per patient per month. Methods: Data on pharmacy bills of NUCs to patients with SHI between 2008 and 2019 were purchased from Insight Health™ and described. Negative binomial regression was used for trend analysis. Results: Number of patients increased between 2008 and 2019 (4.9% per year) with little changes in treatment options. Overall prescription costs were increasing (6.7% per year on average) until the introduction of tenofovir and entecavir generics in 2017 after which costs decreased by 31% in 2019. Average therapy costs peaked at 498 Euro per patient per month in 2016 and decreased to 214 Euro in 2019. Prescriptions changed from 30 to 90 pills per pack over time. HBV therapy was prescribed to 97% by three medical specialist groups, mainly specialists in internal medicine (63%), followed by hospital-based outpatient clinics (20%) and general practitioners (15%). Contrary to guideline recommendation, adefovir was still prescribed after 2011 for 1–5% of patients albeit with decreasing tendency. Prescriptions per 100,000 inhabitants were highest in Berlin and Hamburg. Conclusion: Our data shows, that the number of treated CHB patients increased steadily, while NUC therapy costs decreased. We recommend continued testing and treatment for those eligible to prevent advanced liver disease and possibly decrease further transmission of HBV.Peer Reviewe

Prevalence of Chlamydia trachomatis in the general population in Germany – a triangulation of data from two population-based health surveys and a laboratory sentinel system

Background Chlamydia trachomatis (chlamydia) is a common, frequently asymptomatic, sexually transmitted infection. It can result in severe sequelae, such as ectopic pregnancy and infertility. In Germany, chlamydia is not notifiable. An opportunistic screening program for women < 25 years was introduced in 2008. The aim of this research was to triangulate different data sources to describe the epidemiological situation of chlamydia in Germany and to investigate whether the current target group of the chlamydia screening program aligns with these findings. Methods Urine specimens from participants from population-based health examination surveys of children (2014–17) and adults (2008–11) were tested for chlamydia, using nucleic acid amplification testing. These data were used to generate weighted chlamydia prevalence estimates by age group and sex. Data from a nationwide chlamydia laboratory sentinel system (2014–16) were used to calculate the positive proportion among individuals tested for chlamydia by age, sex and test reason. Results Using data from the population-based surveys, we found a chlamydia prevalence estimate of 2.8% (95% confidence interval (CI) 1.0–7.5%) among all 15- to 17-year-old girls and of 9.6% (95% CI 0.0–23) among those reporting to be sexually active. In adult women, we found the highest prevalence among 18- to 24-year-olds (all: 2.3%; 95% CI 1.0–5.3%; sexually active: 3.1%; 95% CI 1.3–7.0%). In adult men, we found the highest prevalence among 25- to 29-year-olds (all: 3.5%; 95% CI 1.6–7.7%; sexually active: 3.3%; 95% CI 1.3–7.8%). Data from the chlamydia laboratory sentinel showed the highest positive proportion among those opportunistically screened in 19-year-old women (6.1%; 95%- CI 5.9–6.4%), among those screened due to pregnancy in 15-year-old girls (10%; 95% CI 8.5–12%), and among those tested due to symptoms or a positive partner in 19-year-old women (10%; 95% CI 9.8–11%) and 19-year-old men (24%; 95% CI 22–26%). Conclusions Chlamydia seems to mainly affect adolescents and young adults in Germany, with similar overall prevalence in men and women, but with slightly different age distributions. Women at highest risk of chlamydia are covered by the current screening program but given the on-going discussions in high-income countries on cost-effectiveness and benefit-to-harm ratio of these programs, the program-aim needs reconsideration.Peer Reviewe