Analysis of Asymptomatic and Presymptomatic Transmission in SARS-CoV-2 Outbreak, Germany, 2020

We determined secondary attack rates (SAR) among close contacts of 59 asymptomatic and symptomatic coronavirus disease case-patients by presymptomatic and symptomatic exposure. We observed no transmission from asymptomatic case-patients and highest SAR through presymptomatic exposure. Rapid quarantine of close contacts with or without symptoms is needed to prevent presymptomatic transmission.Peer Reviewe

Ten years of weekly epidemiological teleconference (EpiLag) – an effective and time-efficient tool for infectious disease event information, Germany, 2009–2018

In 2009, the Robert Koch Institute (RKI) and the 16 German federal state public health authorities (PHAs) established a weekly epidemiological teleconference (EpiLag) to discuss infectious disease (ID) events and foster horizontal and vertical information exchange. We present the procedure, discussed ID topics and evaluation results of EpiLag after 10 years. We analysed attendance, duration of EpiLag and the frequency of reported events. Participants (RKI and state PHA) were surveyed regarding their satisfaction with logistics, contents and usefulness of EpiLag (Likert scales). Between 2009 and 2018, RKI hosted 484 EpiLag conferences with a mean duration of 25 min (range: 4–60) and high participation (range: 9–16; mean: 15 PHAs). Overall, 2975 ID events (39% international, 9% national and 52% subnational) were presented (mean: 6.1 per EpiLag), most frequently on measles (18%), salmonellosis (8%) and influenza (5%). All responding participants (14/16 PHAs and 9/9 at RKI) were satisfied with the EpiLag’s organization and minutes and deemed EpiLag useful for an overview and information distribution on ID events relevant to Germany. EpiLag is time efficient, easily applicable and useful for a low-threshold event communication. It supports PHAs in crises and strengthens the network of surveillance stakeholders. We recommend its implementation to other countries or sectors.Peer Reviewe

Polioimpfung und Stuhlscreening in deutschen Erstaufnahmeeinrichtungen für Asylsuchende, November 2013–Januar 2014

Hintergrund: Aufgrund des Polio-Ausbruchs in Syrien und der steigenden Anzahl von Asylsuchenden aus Syrien in Deutschland 2013 empfahl das Robert Koch-Institut am 1.11.2013 im Rahmen der bestehenden Impfempfehlungen für Asylsuchende vordringlich die Polioimpfung syrischer Asylsuchender. Für syrische Asylsuchende unter drei Jahren wurde zusätzlich ein Stuhlscreening auf Poliovirusausscheidung empfohlen. Ziel: Dieser Beitrag evaluierte die Umsetzung beider Empfehlungen in den deutschen Erstaufnahmeeinrichtungen (EAE), um Erkenntnisse zur Durchführung von Impfungen in EAE gewinnen und zukünftige Empfehlungen anpassen zu können. Methode: Alle deutschen EAE erhielten einen elektronischen Fragebogen, in dem für den Zeitraum vom 1.11.2013 bis 31.1.2014 um folgende Informationen gebeten wurde: allgemeine Angaben zur EAE und zur Durchführung von Impfungen, Haupthindernisse bei der Empfehlungsumsetzung, Zahlen zu in der EAE angekommenen, geimpften und auf Poliovirusausscheidung untersuchten Asylsuchenden sowie Umsetzbarkeit und Bewertung der Empfehlung und der begleitenden mehrsprachigen Informationsblätter. Ergebnisse und Diskussion: Alle 20 identifizierten EAE antworteten. Im Studienzeitraum kamen 33.874 Asylsuchende in den EAE an. Im Mittel besaßen, nach Angaben der EAE, 1,6 % der Asylsuchenden einen Impfpass. Alle EAE begannen zeitnah mit der Polioimpfung syrischer Asylsuchender unter drei Jahren; acht EAE erreichten hier Impfquoten von ≥ 80 %. Beim Stuhlscreening waren dies fünf von 19 EAE. 11 EAE bewerteten beide Empfehlungen als „sehr gut/gut umsetzbar“. Personalmangel und Sprachbarrieren, welche als Haupthindernisse der Umsetzung genannt wurden, könnten in zukünftigen Empfehlungen durch Zusammenarbeit mit Hilfsorganisationen und Einsatz von Informationsmaterial in weiteren Sprachen, wie fünf EAE vorschlugen, gemindert werden

CD4-cell counts and presence of AIDS in HIV-positive patients entering specialized care—a comparison of migrant groups in the German ClinSurv HIV Cohort Study, 1999–2013

Background: Although early presentation to HIV-care is essential to ensure timely initiation of antiretroviral therapy, recent studies have shown that especially migrants present to HIV-care at a later stage of HIV-infection. Currently, thirty percent of all newly diagnosed HIV cases in Germany originate from abroad. So far it is unknown, which specific migrant groups in Germany are particularly at risk for late presentation to HIV-care. Methods: We used data from the Clinical Surveillance of HIV Disease (ClinSurv) cohort, a multi-centre observational cohort (01/01/1999 and 31/07/2013) and included treatment-naïve patients with valid information on country of origin and date of enrolment. Migrants were patients with country of origin outside Germany. We compared time trends for percentage of AIDS (CDC Stage C) and mean CD4-count at enrolment between migrants from Western Europe (WE), Central Europe (CE), Eastern Europe (EE), Sub-Saharan Africa (SSA), South East Asia (SEA) and non-migrants using multivariable regressions. Male non-migrants with mean age of 38-years constituted the reference group. Results: In total, 10,211 patients fulfilled the inclusion criteria, of which 2784 were migrants (SSA: 42%, CE: 17%, WE: 11%, EE: 10%, SEA: 9%). The percentage of patients with AIDS at enrolment was higher in SSA (Odds Ratio (OR)SSA: 1.44, 95%-confidence interval (95%-CI):1.12–1.84) and SEA-migrants (ORSEA:2.16, 95%-CI:1.43–3.27). In addition, female SEA-migrants, were more likely to present with AIDS than their male counterparts (OR:2.22, 95%-CI:1.18–4.17). Mean CD4-count at enrolment was lower for SSA- (Mean CD4-count ratio (IRR):0.72; 95%-CI:0.64-0.82) and SEA-migrants (IRR:0.62, 95%-CI:0.49-0.78). Over time, it increased in non-migrants and CE-migrants (by 1 and 3%/year, respectively), whereas no increase was seen for SEA and SSA. Conclusions: SSA and SEA-migrants in Germany present to HIV-care at a later stage of HIV infection than non-migrants. Additionally, previous research found a higher risk for late HIV-testing for migrants. Collecting information about the arrival date of migrants in Germany in the HIV notification system would help to understand to which extent these problems could be tackled in Germany. Moreover, participatory approaches for HIV-testing and care as well as research regarding knowledge, behaviour and attitudes towards these topics for SSA and SEA migrants should be expanded

Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak Related to a Nightclub, Germany, 2020

We report an outbreak of coronavirus disease with 74 cases related to a nightclub in Germany in March 2020. Staff members were particularly affected (attack rate 56%) and likely caused sustained viral transmission after an event at the club. This outbreak illustrates the potential for superspreader events and corroborates current club closures.Peer Reviewe

Untersuchung von SARS-CoV-2-Ausbrüchen in Deutschland durch Feldteams des Robert Koch-Instituts, Februar–Oktober 2020

The Robert Koch Institute (RKI) offers advice and assistance to local public health agencies on the investigation and management of outbreaks of infectious diseases. Specially trained experts conduct field investigations. During the COVID-19 pandemic, RKI experts participated in the investigation of outbreaks in residential buildings, physicians' offices, nursing homes, hospitals, and asylum seekers' facilities as well as at a night club and on a cruise ship.This report describes some of the field investigations conducted in Germany during the COVID-19 pandemic between February and October 2020. The investigations provided information on the properties of SARS-CoV‑2 and its transmission as a basis for the recommendations on suitable prevention measures. The practical examples demonstrate the variety of support given as well as the opportunities to gather epidemiological evidence.In September 2020, the RKI established a new unit called the 'Focal Point for the Public Health Service,' which now coordinates and is expanding field support. In order to further support the public health system to improve its capability to react to and investigate outbreaks of infectious diseases, interdisciplinary training shall be intensified

Das Lagemanagement des Robert Koch-Instituts während der COVID-19-Pandemie und der Austausch zwischen Bund und Ländern

The Robert Koch Institute (RKI) plays a central role in Germany in the management of health hazards of biological origin. The RKI's crisis management aims to contribute to protecting the health of the population in Germany in significant epidemic situations and to maintain the RKI's working ability over a long period of time even under high load. This article illustrates the crisis management of the RKI in general as well as during the COVID-19 pandemic. The generic RKI crisis management structures and the setup of the RKI emergency operations centre (EOC), their operationalisation in the context of the COVID-19 pandemic and the resulting challenges as of 31 October 2020 are described in this paper. The exchange between the federal and state governments during the pandemic is also described.The COVID-19 pandemic has led to extraordinary circumstances. During the epidemic situation, good communication and coordination has been essential, both within the RKI and with other federal or state authorities and expert groups. Under great pressure, the RKI produces and regularly updates recommendations, statements and assessments on various topics. To provide operational support for all COVID-19 related activities, an EOC was activated at the RKI. During the COVID-19 pandemic, there are various challenges regarding personnel and structures. It became apparent that good preparation (e.g. existing task descriptions and premises) has an important positive impact on crisis management