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

“What do you need? What are you experiencing?” Relationship building and power dynamics in participatory research projects : critical self-reflections of researchers

Participatory approaches create opportunities for cooperation, building relationships, gaining knowledge, rethinking, and eventually changing power structures. From an international perspective, the article looks at the historical development of different participatory approaches in which building relationships and managing the balance of power between persons engaged in participatory research are central. The authors present and critically reflect on four research projects to show how they understood and implemented participatory research in different ways and what they have learned from their respective experiences. The “PaSuMi” project worked in the context of addiction prevention with migrants and provides a glimpse into different contexts of participatory research. The initiator of the study “Back into life—with a power wheelchair” works with post-stroke individuals who use the assistive device in community mobility and reflects on the shifting and intertwining roles of participants. In the research project “Workshops for the implementation of expanded community nursing”, new professional roles for nurses in community nursing were developed; here limitations to participation and ways to deal with them are illustrated. Finally, the “DIPEx” project deals with challenges of enabling participation of persons with multiple sclerosis via narrative interviews on the experience of health and illness. All examples underline the necessity of a permanent reflection on relationships and power dynamics in participatory research processes

Recommendations for collecting and analysing migration-related determinants in public health research

Background: According to the definition of the German Federal Statistical Office, about every fourth person living in Germany has a so-called migration background (MB), i.e., the person or at least one of their parents was born without German citizenship. However, MB has been defined differently in many studies. Also, the MB summarises people in different living situations, making differentiated analysis in health science more difficult. This article formulates recommendations for the collection and analysis of migration-related, as well as social and structural, determinants of health. Indicators for capturing relevant determinants of health: As part of the Improving Health Monitoring in Migrant Populations project (IMIRA), the previous approaches to operationalise and measure migration-related determinants were revised based on literature research and exchange formats, such as workshops, meetings, congress contributions, etc. Instead of MB, the country of birth of the respondents and their parents, duration of residence, citizenship(s), residence status, and German language proficiency should be recorded as minimum indicators and analysed as individual variables. Further social and structural determinants, such as socioeconomic position, working and housing conditions, or self-reported discrimination, should be included. Conclusions: In order to describe health inequalities and to specifically identify the needs of people with a history of migration, a mutual and differentiated consideration of migration-related and social determinants of health is essential

Prävalenz von sexuell und durch Blut übertragenen Infektionen und Tuberkulose bei Menschen in Wohnungs­losigkeit in Berlin – Erste Ergebnisse der Pilotstudie POINT

Das RKI hat in Kooperation mit Fixpunkt e. V. und BeSog Berliner Sozialprojekte gGmbH die Querschnittsstudie POINT initiiert, um valide Aussagen zur Prävalenz von sexuell und durch Blut übertragbaren Infektionen und Tuberkulose bei wohnungslosen Personen treffen zu können. Mit den gewonnenen Daten sollen Präventions- und Versorgungsangebote ausgestaltet sowie internationale Strategien zur Eliminierung der untersuchten Infektionen unterstützt werdenPeer Reviewe

Empfehlungen zur Erhebung und Analyse migrationsbezogener Determinanten in der Public-Health-Forschung

Hintergrund: Etwa jede vierte in Deutschland lebende Person hat nach Definition des Statistischen Bundesamts einen sogenannten Migrationshintergrund (MH), d. h. die Person selbst oder mindestens ein Elternteil wurde ohne die deutsche Staatsangehörigkeit geboren. Allerdings wurde der MH in vielen Studien unterschiedlich definiert. Auch werden durch den MH Personen in unterschiedlichen Lebenslagen zusammengefasst und differenzierte gesundheitswissenschaftliche Analysen sind mit dem MH erschwert. Der Beitrag formuliert Empfehlungen zur Erhebung und Auswertung migrationsbezogener sowie sozialer und struktureller Determinanten der Gesundheit. Erfassung relevanter Gesundheitsdeterminanten: Im Rahmen des Projektes „Improving Health Monitoring in Migrant Populations (IMIRA)“ wurden die bisherigen Ansätze zur Operationalisierung und Messung migrationsbezogener Determinanten auf Grundlage von Literaturrecherchen und Austauschformaten, wie Workshops, Arbeitstreffen, Kongressbeiträgen u. ä. überarbeitet. Anstelle des MH sollten als Mindestindikatoren das Geburtsland der Befragten und deren Eltern, die Aufenthaltsdauer, die Staatsangehörigkeit(en), der Aufenthaltsstatus und Kenntnisse der deutschen Sprache erfasst und als Einzelvariablen analysiert werden. Weitere soziale und strukturelle Determinanten wie der sozioökonomische Status, Wohn- und Arbeitsbedingungen oder selbstberichtete Diskriminierung sollten einbezogen werden. Diskussion: Um gesundheitliche Ungleichheit zu beschreiben und gezielt Bedarfe von Menschen mit Migrationsgeschichte zu identifizieren, ist eine gemeinsame und differenzierte Betrachtung migrationsbezogener und sozialer Determinanten unerlässlich

Prävalenz von sexuell und durch Blut übertragenen Infektionen und Tuberkulose bei Menschen in Wohnungs­losigkeit in Berlin – Erste Ergebnisse der Pilotstudie POINT

Das RKI hat in Kooperation mit Fixpunkt e. V. und BeSog Berliner Sozialprojekte gGmbH die Querschnittsstudie POINT initiiert, um valide Aussagen zur Prävalenz von sexuell und durch Blut übertragbaren Infektionen und Tuberkulose bei wohnungslosen Personen treffen zu können. Mit den gewonnenen Daten sollen Präventions- und Versorgungsangebote ausgestaltet sowie internationale Strategien zur Eliminierung der untersuchten Infektionen unterstützt werdenPeer Reviewe

Monitoring for COVID-19 by universal testing in a homeless shelter in Germany: a prospective feasibility cohort study

Background: Living conditions in homeless shelters facilitate the transmission of COVID-19. Social determinants and pre-existing health conditions place homeless people at increased risk of severe disease. Described outbreaks in homeless shelters resulted in high proportions of infected residents and staff members. In addition to other infection prevention strategies, regular shelter-wide (universal) testing for COVID-19 may be valuable, depending on the level of community transmission and when resources permit. Methods: This was a prospective feasibility cohort study to evaluate universal testing for COVID-19 at a homeless shelter with 106 beds in Berlin, Germany. Co-researchers were recruited from the shelter staff. A PCR analysis of saliva or self-collected nasal/oral swab was performed weekly over a period of 3 weeks in July 2020. Acceptability and implementation barriers were analyzed by process evaluation using mixed methods including evaluation sheets, focus group discussion and a structured questionnaire. Results: Ninety-three out of 124 (75%) residents were approached to participate in the study. Fifty-one out of the 93 residents (54.8%) gave written informed consent; thus 41.1% (51 out of 124) of all residents were included in the study. Among these, high retention rates (88.9-93.6%) of a weekly respiratory specimen were reached, but repeated collection attempts, as well as assistance were required. Around 48 person-hours were necessary for the sample collection including the preparation of materials. A self-collected nasal/oral swab was considered easier and more hygienic to collect than a saliva specimen. No resident was tested positive by RT-PCR. Language barriers were the main reason for non-participation. Flexibility of sample collection schedules, the use of video and audio materials, and concise written information were the main recommendations of the co-researchers for future implementation. Conclusions: Voluntary universal testing for COVID-19 is feasible in homeless shelters. Universal testing of high-risk facilities will require flexible approaches, considering the level of the community transmission, the available resources, and the local recommendations. Lack of human resources and laboratory capacity may be a major barrier for implementation of universal testing, requiring adapted approaches compared to standard individual testing. Assisted self-collection of specimens and barrier free communication may facilitate implementation in homeless shelters. Program planning must consider homeless people's needs and life situation, and guarantee confidentiality and autonomy

Soziale Ungleichheit und COVID-19 in Deutschland – Wo stehen wir in der vierten Pandemiewelle?

Für eine Vielzahl von Erkrankungen und Todesursachen ist zwischen der sozioökonomischen und gesundheitlichen Lage ein enger Zusammenhang nachgewiesen. Auch die Ausbreitungsmuster von SARS-CoV-2 über verschiedene soziale Gruppen werden seit Pandemiebeginn international und in Studien des RKI bundesweit untersucht. Im Beitrag werden die zentralen Ergebnisse zum aktuellen Stand zusammengefasst und um Daten aus der dritten und vierten Pandemiewelle ergänzt. Aus den dargestellten Befunden ergeben sich Hinweise auf Möglichkeiten, die Lücken im Infektionsschutz zu schließen.Peer Reviewe

Racism and discrimination in the context of health inequalities—a narrative review

Kajikhina K, Koschollek C, Bozorgmehr K, Sarma N, Hövener C. Rassismus und Diskriminierung im Kontext gesundheitlicher Ungleichheit – ein narratives Review. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2023;66(10):1099-1108.Racism and discrimination as social determinants of health are becoming increasingly recognised in public health research in Germany. Studies show correlations with physical and mental health and even changes at the cellular level. In addition to the adverse health effects of interpersonal and direct discrimination, the relevance of structural and institutional racism for health inequalities has been little explored. This narrative review synthesises and critically discusses relevant and recent research findings and makes recommendations for action in research and practice.Structural and institutional aspects of discrimination and racism are closely linked to health. Systemic discrimination in education, employment, housing and healthcare affects overall, mental and physical health, access to prevention and care, and health behaviour.An analysis of the relationship between living, housing and working conditions and the health situation of people with (and without) ahistory of migration - in general and in relation to racism and discrimination - seems necessary in order to derive targeted measures for structural prevention, rather than focusing on purely behavioural prevention. In addition to practical interventions (trainings, education, and community-based approaches), the further development of methodological aspects in the field of data collection and analysis is important in order to address this issue comprehensively in research and practice. © 2023. The Author(s).Rassismus und Diskriminierung als soziale Determinanten der Gesundheit stehen auch in Deutschland zunehmend im Fokus der Public-Health-Forschung. Studien zeigen Zusammenhänge mit physischer und psychischer Gesundheit bis hin zu Veränderungen auf zellulärer Ebene auf. Neben den gesundheitsschädigenden Effekten interpersoneller und direkter Diskriminierung ist die Relevanz des strukturellen und institutionellen Rassismus für die gesundheitliche Ungleichheit bislang nur wenig beleuchtet. Im Rahmen einer narrativen Übersichtsarbeit werden relevante und aktuelle Forschungsergebnisse zusammengestellt und kritisch diskutiert sowie Handlungsempfehlungen für Forschung und Praxis abgeleitet. Strukturelle und institutionelle Aspekte von Diskriminierung und Rassismus stehen in engem Zusammenhang mit der gesundheitlichen Lage. So steht die systematische Benachteiligung in den Bereichen Bildung, Arbeit, Wohnen sowie Gesundheitsversorgung im Zusammenhang mit der allgemeinen, psychischen und physischen Gesundheit, mit der Inanspruchnahme von Präventions- und Versorgungsleistungen sowie mit dem Gesundheitsverhalten. Eine Analyse der Verschränkung von Lebens‑, Wohn- und Arbeitsbedingungen mit der gesundheitlichen Lage von Menschen mit (und ohne) Migrationsgeschichte – generell und in Verbindung mit Rassismus und Diskriminierung – erscheint notwendig, um gezielte Maßnahmen im Hinblick auf Verhältnisprävention abzuleiten, statt auf bloße Verhaltensprävention zu fokussieren. Neben praktischen Interventionen (Trainings, Aufklärungsarbeit, communitybasierten Ansätzen) ist die Weiterentwicklung methodischer Aspekte im Bereich der Erhebung und Analyse von Daten wichtig, um dieser Problemlage umfassend in Forschung und Praxis zu begegnen

Concepts for migration-sensitive health monitoring

According to microcensus data, nearly one quarter of the German population has a migration background. This means that either themselves or at least one parent was born without German citizenship. Based on the currently available data and due to the underrepresentation of specific population groups, representative findings on the health of the total population residing in Germany are only possible to a limited degree. Against this backdrop, the Robert Koch Institute initiated the Improving Health Monitoring in Migrant Populations (IMIRA) project. The project aims to establish a migration-sensitive health monitoring system and to better represent people with a migration background in health surveys conducted by the Robert Koch Institute. In this context it is crucial to review and further develop relevant migrationsensitive concepts and appropriate surveying instruments. To achieve this, the concepts of acculturation, discrimination, religion and subjective social status were selected. This article theoretically embeds these concepts. Furthermore, we describe their application in epidemiology as well as provide a proposal on how to measure and operationalise these concepts. Moreover, recommendations for action are provided regarding the potential application of these concepts in health monitoring at the Robert Koch Institute.Peer Reviewe