Migration and health: Moving towards diversity-oriented public health monitoring at the Robert Koch Institute

Summarizing categories, such as migration background or history of migration, do not reflect the diversity and heterogeneity of the population living in Germany and their health. A differentiated description of the health situation of people with a history of migration should consider migrationrelated, social, and structural determinants of health as well as their interactions. The findings obtained in the 'Improving Health Monitoring in Migrant Populations (IMIRA)' projects will help to improve the inclusion of people with a history of migration in future studies as well as in the RKI panel. This will enable an adequate description of the health situation of people with a history of migration and therefore of the general population in Germany. In future studies, the health status of people who have not been well included in health surveys so far, such as people who are not listed at the registration office, should be monitored. For this purpose, continuous development of sampling and survey methods is necessary

Extended-Spectrum Beta-Lactamases Producing E. coli in Wildlife, yet Another Form of Environmental Pollution?

Wildlife is normally not exposed to clinically used antimicrobial agents but can acquire antimicrobial resistant bacteria through contact with humans, domesticated animals and the environment, where water polluted with feces seems to be the most important vector. Escherichia coli, an ubiquitous commensal bacterial species colonizing the intestinal tract of mammals and birds, is also found in the environment. Extended-spectrum beta-lactamases producing E. coli (ESBL-E. coli) represent a major problem in human and veterinary medicine, particular in nosocomial infections. Additionally an onset of community-acquired ESBL-E. coli infections and an emergence in livestock farming has been observed in recent years, suggesting a successful transmission as well as persistence of ESBL-E. coli strains outside clinical settings. Another parallel worldwide phenomenon is the spread of ESBL-E. coli into the environment beyond human and domesticated animal populations, and this seems to be directly influenced by antibiotic practice. This might be a collateral consequence of the community-onset of ESBL-E. coli infections but can result (a) in a subsequent colonization of wild animal populations which can turn into an infectious source or even a reservoir of ESBL-E. coli, (b) in a contribution of wildlife to the spread and transmission of ESBL-E. coli into fragile environmental niches, (c) in new putative infection cycles between wildlife, domesticated animals and humans, and (d) in problems in the medical treatment of wildlife. This review aims to summarize the current knowledge on ESBL-E. coli in wildlife, in turn underlining the need for more large scale investigations, in particular sentinel studies to monitor the impact of multiresistant bacteria on wildlife

Emerging COVID-19 success story: Germany’s push to maintain progress

Throughout the COVID-19 pandemic, Germany has demonstrated elements of success across the four phases of our preparedness and response framework: prevent, detect, contain, and treat. However, starting in October 2020, the country experienced a major surge in cases and deaths that has yet to be brought under control as of January 2021. The country’s strong enabling environment, including a good public health care system and expert scientific institutions, contributed to the early success. Germany’s prevention protocols facilitated the country’s rapid response to the outbreak, with the early development of testing capacity and high levels of testing, an effective containment strategy among older people, and efficient use of ample hospital capacity. With the surge, however, the disease began to spread among older people, and hospital capacity has been stretched.Peer Reviewe

Adhesive threads of extraintestinal pathogenic Escherichia coli

The ability to adhere to host surfaces is by far the most vital step in the successful colonization by microbial pathogens. Colonization begins with the attachment of the bacterium to receptors expressed by cells forming the lining of the mucosa. Long hair like extracellular appendages called fimbriae, produced by most Gram-negative pathogens, mediate specific attachment to the epithelial cell surface. Associated with the fimbriae is a protein called an adhesin, which directs high-affinity binding to specific cell surface components. In the last couple of years, an enormous amount of research has been undertaken that deals with understanding how bacterial pathogens adhere to host cells. E. coli in all probability is one of the best studied free-living organisms. A group of E. coli called Extraintestinal pathogenic E. coli (ExPEC) including both human and animal pathogens like Uropathogenic E. coli (UPEC), Newborn meningitic E. coli (NMEC) and Avian pathogenic E. coli (APEC), have been found to harbour many fimbriae including Type 1 fimbriae, P fimbriae, curli fibres, S fimbriae, F1C fimbriae, Dr fimbriae, afimbrial adhesins, temperature-sensitive haemagglutinin and many novel adhesin gene clusters that have not yet been characterized. Each of these adhesins is unique due to the recognition of an adhesin-specific receptor, though as a group these adhesins share common genomic organization. A newly identified putative adhesin temporarily termed ExPEC Adhesin I, encoded by gene yqi, has been recently found to play a significant role in the pathogenesis of APEC infection, thus making it an interesting candidate for future research. The aim of this review is to describe the role of ExPEC adhesins during extraintestinal infections known till date, and to suggest the idea of investigating their potential role in the colonization of the host gut which is said to be a reservoir for ExPEC

Reflections from the COVID-19 pandemic in Germany: lessons for global health

Trust is crucial to handling any global health crisis; the expertise and sustainability of National Public Health Institutions is the basis for trust building. Public health requires citizens to make the right individual choices that have a positive domino effect on the general population. Communication, therefore, plays an essential role. Public health systems must be strengthened and stronger public health systems must assist weaker ones in an act of global solidarity. Digitalising healthcare and public health will play a fundamental role in strengthening public health systems and thus in handling future crises

Migration und Gesundheit: Auf dem Weg zu einem diversity-orientierten Gesundheitsmonitoring am Robert Koch-Institut

Zusammenfassende Kategorien, wie Migrationshintergrund oder Migrationsgeschichte, bilden die Diversität und Heterogenität der in Deutschland lebenden Bevölkerung nicht ab. Eine differenzierte Beschreibung der gesundheitlichen Lage von Menschen mit Migrationsgeschichte beinhaltet die Berücksichtigung migrationsbezogener, sozialer und struktureller Determinanten der Gesundheit sowie ihrer Wechselwirkungen. Die in IMIRA und IMIRA II gewonnen Erkenntnisse helfen, um in zukünftigen Studien sowie dem RKI-Panel Menschen mit Migrationsgeschichte besser einbeziehen zu können und deren gesundheitliche Lage, sowie die der gesamten Bevölkerung, adäquat beschreiben zu können. Auch Menschen, die bisher nicht gut in Gesundheitssurveys einbezogen wurden, wie z. B. Personen, die nicht beim Einwohnermeldeamt registriert sind, sollten in weiterführenden Studien zu ihrer gesundheitlichen Lage befragt werden; Hierfür ist eine fortwährende Weiterentwicklung der Sampling- und Surveymethoden notwendig

Does Reductive Evolution Correlate with Habitat and Pathotype?

IbeA (invasion of brain endothelium), which is located on a genomic island termed GimA, is involved in the pathogenesis of several extraintestinal pathogenic E. coli (ExPEC) pathotypes, including newborn meningitic E. coli (NMEC) and avian pathogenic E. coli (APEC). To unravel the phylogeny of GimA and to investigate its island character, the putative insertion locus of GimA was determined via Long Range PCR and DNA-DNA hybridization in 410 E. coli isolates, including APEC, NMEC, uropathogenic (UPEC), septicemia-associated E. coli (SEPEC), and human and animal fecal isolates as well as in 72 strains of the E. coli reference (ECOR) collection. In addition to a complete GimA (~20.3 kb) and a locus lacking GimA we found a third pattern containing a 342 bp remnant of GimA in this strain collection. The presence of GimA was almost exclusively detected in strains belonging to phylogenetic group B2. In addition, the complete GimA was significantly more frequent in APEC and NMEC strains while the GimA remnant showed a higher association with UPEC strains. A detailed analysis of the ibeA sequences revealed the phylogeny of this gene to be consistent with that obtained by Multi Locus Sequence Typing of the strains. Although common criteria for genomic islands are partially fulfilled, GimA rather seems to be an ancestral part of phylogenetic group B2, and it would therefore be more appropriate to term this genomic region GimA locus instead of genomic island. The existence of two other patterns reflects a genomic rearrangement in a reductive evolution-like manner

Cyclic-di-GMP signalling and biofilm-related properties of the Shiga toxin- producing 2011 German outbreak Escherichia coli O104:H4

In 2011, nearly 4,000 people in Germany were infected by Shiga toxin (Stx)-producing Escherichia coli O104:H4 with > 22% of patients developing haemolytic uraemic syndrome (HUS). Genome sequencing showed the outbreak strain to be related to enteroaggregative E. coli (EAEC), suggesting its high virulence results from EAEC-typical strong adherence and biofilm formation combined to Stx production. Here, we report that the outbreak strain contains a novel diguanylate cyclase (DgcX)—producing the biofilm-promoting second messenger c-di-GMP—that shows higher expression than any other known E. coli diguanylate cyclase. Unlike closely related E. coli, the outbreak strain expresses the c-di-GMP-controlled biofilm regulator CsgD and amyloid curli fibres at 37°C, but is cellulose-negative. Moreover, it constantly generates derivatives with further increased and deregulated production of CsgD and curli. Since curli fibres are strongly proinflammatory, with cellulose counteracting this effect, high c-di-GMP and curli production by the outbreak O104:H4 strain may enhance not only adherence but may also contribute to inflammation, thereby facilitating entry of Stx into the bloodstream and to the kidneys where Stx causes HUS