Marked Underreporting of Pertussis Requiring Hospitalization in Infants as Estimated by Capture-Recapture Methodology, Germany, 2013-2015

Background: In Germany, pertussis became notifiable in eastern federal states in 2002 and nationwide in March 2013. Infants are at greatest risk for severe disease, with a high proportion requiring hospitalization. We implemented enhanced hospital-based surveillance to estimate the incidence of pertussis requiring hospitalization among infants in Germany and to determine the proportion of infants hospitalized with pertussis too young to have been vaccinated. Methods: Enhanced surveillance was implemented within a nationwide hospital surveillance network (ESPED). We defined cases as children less than 1 year of age hospitalized due to laboratory-confirmed pertussis with disease onset from 01/07/2013-30/06/2015. We matched cases to those ascertained in the national statutory notification system, and estimated incidence using capture-recapture methodology. Results: The estimated annual incidence of pertussis requiring hospitalization in infants was 52/100,000 infants (95% confidence interval [CI] 48-57/100,000), with 39% under-reporting to the national notification system. During the two epidemiologic years under-reporting decreased from 46% to 32% and was lower in eastern than western federal states (21% vs. 40%). Within ESPED, 154 of 240 infants (64%) were younger than or still at the age recommended for the first vaccine dose;55 (23%) could have received one or more vaccine doses. Median length of hospitalization was 9 days (IQR 5-13 days) and 18% required intensive care treatment. Conclusions: Our study revealed a high burden of pertussis in infants with marked under-reporting, especially in western federal states where notification was only recently established. Strategies for the prevention of severe pertussis

Schulimpfprogramme als Lösung zur Steigerung der HPV-Impfquoten in Deutschland?

Eine HPV-Impfung entsprechend der STIKO-Empfehlung kann nachweislich die Entstehung von Zervixkarzinomen verhindern und potenziell ebenfalls die Inzidenzen anderer HPV-bedingter Karzinome reduzieren. In Deutschland lag die bundesweite Quote für eine vollständige HPV-Impfserie mit zwei Impfstoffdosen unter 15-jährigen Mädchen Ende 2019 bei 47,2 % und unter 15-jährigen Jungen bei 5,1 %. Zur Steigerung der HPV-Impfquote startete 2015 im hessischen Landkreis Bergstraße ein Schulimpfprogramm, wie es in Ländern mit höheren Impfquoten durchgeführt wird. Anhand von Daten der RKI-Impfsurveillance wird der Einfluss dieses Modellprojekts auf die Impfquote analysiert und diskutiert, ob Schulimpfprogramme eine erfolgversprechende Maßnahme zur langfristig geplanten Elimination des Zervixkazinoms als Public Health-Problem darstellen können.Peer Reviewe

PRECEPT: an evidence assessment framework for infectious disease epidemiology, prevention and control

Decisions in public health should be based on the best available evidence, reviewed and appraised using a rigorous and transparent methodology. The Project on a Framework for Rating Evidence in Public Health (PRECEPT) defined a methodology for evaluating and grading evidence in infectious disease epidemiology, prevention and control that takes different domains and question types into consideration. The methodology rates evidence in four domains: disease burden, risk factors, diagnostics and intervention. The framework guiding it has four steps going from overarching questions to an evidence statement. In step 1, approaches for identifying relevant key areas and developing specific questions to guide systematic evidence searches are described. In step 2, methodological guidance for conducting systematic reviews is provided; 15 study quality appraisal tools are proposed and an algorithm is given for matching a given study design with a tool. In step 3, a standardised evidence-grading scheme using the Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) methodology is provided, whereby findings are documented in evidence profiles. Step 4 consists of preparing a narrative evidence summary. Users of this framework should be able to evaluate and grade scientific evidence from the four domains in a transparent and reproducible way.Funding Agencies|European Centre for Disease Prevention and Control (ECDC) [2012/040, 2014/008]</p

Invasive haemophilus influenzae infections in Germany after the introduction of routine childhood immunization, 2001–2016

Background. Haemophilus influenzae (Hi) serotype b (Hib) vaccination was introduced in Germany in 1990. This study presents a comprehensive overview on the burden of invasive Hi infections for 2001–2016, including serotype distribution and ampicillin resistance. Methods. Nationwide data from statutory disease surveillance (2001–2016) were linked with laboratory surveillance data (2009–2016). Besides descriptive epidemiology, statistical analyses included multiple imputation to estimate secular trends. Results. In 2001–2016, 4044 invasive Hi infections were reported. The mean incidence was 3.0 per million inhabitants, higher in males (3.2 vs 2.9 in females) and in the age groups <1 year (15.2) and ≥80 years (15.5). Nontypeable Hi (NTHi) caused 81% (n = 1545) of cases in 2009–2016. Of capsulated cases, 69% were serotype f and 17% serotype b. Of Hib cases eligible for vaccination, 10% (3/29) were fully vaccinated. For 2009–2016, significant increasing trends were observed for NTHi and Hif infections in the age groups <5 years and ≥60 years and for ampicillin resistance in NTHi. Conclusions. This is one of the most comprehensive Hi data analyses since the introduction of Hib vaccines. NTHi and Hif cause an increasing disease burden among elderly patients and infants. Ampicillin resistance in NTHi must be considered in the treatment of invasive Hi infections.Peer Reviewe

Lack of Evidence for Schmallenberg Virus Infection in Highly Exposed Persons, Germany, 2012

Schmallenberg virus, a novel orthobunyavirus, is spreading among ruminants, especially sheep, throughout Europe. To determine the risk for human infection, we conducted a survey among shepherds to assess possible exposure and symptoms. We also performed serologic and molecular assays. No evidence of transmission to humans was detected

Wissenschaftliche Begründung der STIKO zur Grundimmunisierung von Personen ≥ 18 Jahre mit dem COVID-19-Impfstoff Nuvaxovid von Novavax

Nuvaxovid, ein adjuvantierter Proteinimpfstoff der Firma Novavax, ist seit dem 20.12.2021 in der EU für die Grundimmunisierung gegen COVID-19 zugelassen. Die Verfügbarkeit dieses Impfstoffs ist für Ende Februar 2022 angekündigt. Die STIKO empfiehlt die Grundimmunisierung mit Nuvaxovid für Personen ≥ 18 Jahre mit 2 Impfstoffdosen von je 5 μg des SARS-CoV-2-Spikeproteins im Abstand von mindestens 3 Wochen. Der Impfstoff ist bisher nicht für die Auffrischimpfung zugelassen.Peer Reviewe

Current practices in immunisation policymaking in European countries

This report describes and summarises the national processes for vaccine policymaking currently implemented in EU/EEA countries, the roles of the so-called national technical advisory groups (NITAGs) in the Member States and – if applicable – details of the national frameworks, with the aim to assess NITAG collaboration in Europe

Human papillomavirus (HPV) vaccination of girls in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Since 2007, the Standing Committee on Vaccination (STIKO) has recommended that all girls receive vaccinations against the human papillomavirus (HPV) in order to reduce the disease burden of cervical cancer. Persistent infections with high-risk HPV subtypes increase a woman’s risk of developing cancer. In the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), 42% of 2,958 11- to 17-year-old girls reported that they had received at least one HPV vaccination, and 31.4% reported a full HPV vaccination. 45.3% of 14- to 17-year-old girls reported a complete series of HPV vaccinations. Compared to the figures reported in KiGGS Wave 1 five years ago, HPV vaccination coverage has therefore remained stable. A vaccination coverage below 50% in girls is too low to exploit the potential of HPV vaccination to reduce cervical cancer rates in Germany.Peer Reviewe

Effekte der Masern-Mumps-Röteln (MMR)-Impfung auf die Epidemiologie von Mumps in Deutschland

Mumps ist eine akute virale Infektionskrankheit, die durch eine ein- bzw. beidseitige schmerzhafte Parotisschwellung gekennzeichnet ist. Seit 1976 empfiehlt die Ständige Impfkommission (STIKO) in der Bundesrepublik die Mumpsimpfung als Standardimpfung im Kindesalter. In den östlichen Bundesländern wurde die Impfung nach der Wiedervereinigung eingeführt. In Deutschland hat es während der letzten Jahrzehnte kein einheitliches Surveillancesystem zur Überwachung der Mumpsepidemiologie gegeben. Für die ehemalige DDR und die östlichen Bundesländer können Mumpserkrankungen auf der Basis von Daten aus verschiedenen Überwachungssystemen für den Zeitraum von 1968 bis 2012 abgebildet werden. Demnach ist die Mumpsinzidenz von jährlich > 200 Erkrankungen/100.000 Einwohner in der Vorimpfära auf mittlerweile weniger als  95 % gesteigert und bestehende Impflücken unter Erwachsenen geschlossen werden können.Mumps is an acute viral infectious disease characterized by fever and swelling and tenderness of one or more salivary glands, usually the parotid gland. Since 1976, the German Standing Committee on Vaccination (STIKO) has recommended a mumps vaccination as part of the routine immunization schedule in former West Germany. In East Germany, the vaccination was only introduced in 1991 after reunification. In the preceding decades, no comprehensive surveillance system existed in Germany. However, for East Germany and the successional federal states of former East Germany, data on mumps incidence are available from different Eastern surveillance systems for the time period 1968–2012. According to these data, the incidence of mumps has dropped from > 200 cases/100,000 annually in the pre-vaccine era to currentl

Mumps epidemiology in Germany 2007-11

In Germany, mumps has been notifiable until 2013 only in the five Eastern federal states (EFS) of former East Germany. Due to different immunisation policies until 1990 and varying vaccination coverages thereafter, mumps incidences cannot be extrapolated to the 11 Western federal states (WFS). We studied mumps-related International Classification of Diseases (ICD-10) code diagnoses claimed through statutory health insurances between 2007 and 2011 to estimate countrywide mumps incidences in the outpatient sector, and compared them with case numbers from ambulatory notification data. Overall, 32,330 outpatient mumps cases were claimed. Annual incidence ranged between 9.3/100,000 and 11.8/100,000 and showed a significant decreasing trend. Compared with EFS, mumps incidence in WFS was higher and indicated a shift towards older age groups. Notified outpatient case numbers in EFS were 13-fold lower and from voluntary surveillance during an outbreak in the WFS Bavaria 8-fold lower than from insurance data (n=316 versus n=4,217 and n=238 versus 1,995, respectively). Of all notified cases with available information, 75.4% (EFS) and 57.6% (Bavaria) were unvaccinated; 6.8% (EFS) and 19.3% (Bavaria) required hospitalisation. In Germany, mumps is still endemic despite decades of vaccination, with considerable underreporting in the established notification systems