BNT162b2 vaccination reduced infections and transmission in a COVID-19 outbreak in a nursing home in Germany, 2021.

BACKGROUND: A SARS-CoV-2 outbreak was detected in a nursing home in February 2021 after residents and staff had received two doses of BNT162b2 vaccine in January 2021. METHODS: Nursing home staff, long-term residents and day-care receivers were included in a retrospective cohort study. We calculated attack rates (AR), secondary AR (SAR) and their 95% binomial confidence interval (CI), and we compared them using Fisher's exact test or chi-squared test, depending on the sample size. We used Poisson regression with robust error estimates to calculate vaccine effectiveness against SARS-COV-2 infections. We selected variables based on directed acyclic graphs. As a proxy for viral load at diagnosis, we compared the mean Ct values at diagnosis using t tests or Mann-Whitney U tests. RESULTS: The adjusted vaccine effectiveness against infection was 56% (95% CI: 15-77%, p = 0.04). Ct values at diagnosis were higher when intervals after receiving the second vaccination were longer (>21 vs. ≤21 days: 4.48 cycles, p = 0.08). The SAR was 67% lower in households of vaccinated (2/9 [22.2%]) than of unvaccinated infected staff (12/18 [66.7%]; p = 0.046). Vaccination rates were lowest among staff with close physical contact to care-receivers (46%). The highest AR in vaccinated staff had those working on wards (14%). CONCLUSIONS: Vaccination reduced the risk for SARS-CoV-2 infection, viral load and transmission; however, non-pharmaceutical interventions remain essential to reduce transmission of SARS-CoV-2 infections, even for vaccinated individuals. Vaccination coverage of staff ought to increase reduction of infections among themselves, their household members and residents.

Corrigendum: Specifically increased rate of infections in children post measles in a high resource setting.

[This corrects the article DOI: 10.3389/fped.2022.896086.].

Specifically Increased Rate of Infections in Children Post Measles in a High Resource Setting.

Objectives: Post-measles increased susceptibility to subsequent infections seems particularly relevant in low-resource settings. We tested the hypothesis that measles causes a specifically increased rate of infections in children, also in a high-resource setting. Methods: We conducted a retrospective cohort study on a large measles outbreak in Berlin, Germany. All children with measles who presented to hospitals in Berlin were included as cases, children with non-infectious and children with non-measles infectious diseases as controls. Repeat visits within 3 years after the outbreak were recorded. Results: We included 250 cases, 502 non-infectious, and 498 infectious disease controls. The relative risk for cases for the diagnosis of an infectious disease upon a repeat visit was 1.6 (95% CI 1.4-2.0, p < 0.001) vs. non-infectious and 1.3 (95% CI 1.1-1.6, p = 0.002) vs. infectious disease controls. 33 cases (27%), 35 non-infectious (12%) and 57 (18%) infectious disease controls presented more than three times due to an infectious disease (p = 0.01, and p = 0.02, respectively). This results in a relative risk of more than three repeat visits due to an infection for measles cases of 1.8 (95% CI 1.3-2.4, p = 0.01), and 1.4 (95% CI 1.0-1.9, p = 0.04), respectively. Conclusion: Our study demonstrates for the first time in a high-resource setting, that increased post-measles susceptibility to subsequent infections in children is measles-specific-even compared to controls with previous non-measles infections.

Seroprevalence of Measles-, Mumps-, and Rubella-specific antibodies in the German adult population - cross-sectional analysis of the German Health Interview and Examination Survey for Adults (DEGS1).

BACKGROUND: The WHO European Region targets the elimination of measles, rubella, and the congenital rubella syndrome and welcomes mumps elimination via the joint MMR vaccine. In a push towards this elimination goal, Germany introduced a recommendation on MMR vaccination for adults in 2010 to prevent increasing numbers of measles cases among adults and to strengthen herd immunity. METHODS: The prevalence of anti-measles, -mumps, and -rubella IgG antibodies was analysed in 7,115 participants between the ages of 18 and 79 years in the German Health Interview and Examination Survey. Risk factors of seronegativity of adults born 1970 or later were determined. FINDINGS: The seroprevalence of anti-measles IgG antibodies was more than 97% in adults born before 1965 and less than 90% in adults born afterwards. Prevalence and GMTs declined with later years of birth. Seronegativity was associated with two-sided migration background and region of residence in East Germany. For anti-mumps IgG antibodies, the seroprevalence was less than 90% in almost all age groups. Prevalence and GMTs declined with later years of birth. Seronegativity was not associated with any socio-demographic factor. Anti-rubella IgG seropositivity was found in more than 90% of adults born before 1985. GMTs declined in younger age groups. Seronegativity was associated with birth between 1980 and 1993 and male gender. High socio-economic status lowered the odds of being seronegative. INTERPRETATION: These data reinforce the implementation of the vaccination recommendation for adults and provide the basis for further evaluation of this measure. FUNDING: The Federal Ministry of Health, Germany.

Cancelled routine vaccination appointments due to COVID-19 pandemic in Germany.

Pandemic measures to mitigate the outbreak of SARS-CoV-2 in Germany led to cancellations of routine vaccination appointments for both adults and children. Survey data indicate that, with easing pandemic restrictions, many cancelled appointments were rescheduled or caught up. Nevertheless, 40% of cancelled appointments were still not rescheduled and were primarily cancelled by patients. Therefore, doctors should regularly remind patients of vaccinations and use every visit to improve their vaccination statuses.

[The global measles crisis-a diversity of causes from armed conflicts to vaccination skepticism]. / Die globale Masernkrise ­ Ursachenvielfalt von bewaffneten Konflikten bis Impfskepsis.

BACKGROUND AND AIM: Despite a safe and effective vaccine being available for many years, the number of measles cases has been increasing again worldwide since 2018. Our report aims to identify putative reasons for this development. METHODS: We conducted a selective literature search. Further, current reports and data from the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and the World Bank were evaluated. RESULTS: According to the WHO, Madagascar, the Ukraine, and Israel had the highest incidences of measles worldwide between 1 July 2018 and 30 June 2019. Measles outbreaks are a sign of inadequate vaccination rates caused by multiple structural and psychological barriers. Structural barriers to measles vaccination, such as a lack of routine vaccination programs, have been identified as the main cause of low measles vaccination rates, particularly in fragile countries e.g. due to armed conflicts, but also in some subpopulations of higher-income countries e.g. due to lacking resources for vaccination services. Psychological barriers leading to vaccination skepticism were prevalent mainly in developed countries with well-functioning health systems and a high standard of living. CONCLUSION: The reasons for the global measles crisis are manifold and in some cases have existed for decades. However, the consequences appear to be accumulating and have had a dramatic impact on case numbers since 2018. The goal of measles elimination and maintenance of the necessary vaccination programs is a constant challenge that requires strict and permanent compliance with WHO recommendations. The number of measles cases reported in Germany is still at a level above the key target for measles elimination specified in the national immunization plan. Timely and/or locally restricted as well as nationwide outbreaks continue to occur. Since infectious agents can be transmitted across borders, the international perspective is an essential component of national health policy in Germany.

Estimating age-specific vaccine effectiveness using data from a large measles outbreak in Berlin, Germany, 2014/15: evidence for waning immunity.

BackgroundMeasles elimination is based on 95% coverage with two doses of a measles-containing vaccine (MCV2), high vaccine effectiveness (VE) and life-long vaccine-induced immunity. Longitudinal analysis of antibody titres suggests existence of waning immunity, but the relevance at the population-level is unknown.AimWe sought to assess presence of waning immunity by estimating MCV2 VE in different age groups (2-5, 6-15, 16-23, 24-30 and 31-42 years) in Berlin.MethodsWe conducted a systematic literature review on vaccination coverage and applied the screening-method using data from a large measles outbreak (2014/15) in Berlin. Uncertainty in input variables was incorporated by Monte Carlo simulation. In a scenario analysis, we estimated the proportion vaccinated with MCV2 in those 31-42 years using VE of the youngest age group, where natural immunity was deemed negligible.ResultsOf 773 measles cases (median age: 20 years), 40 had received MCV2. Average vaccine coverage per age group varied (32%-88%). Estimated median VE was > 99% (95% credible interval (CrI): 98.6-100) in the three youngest age groups, but lower (90.9%, 95% CrI: 74.1-97.6) in the oldest age group. In the scenario analysis, the estimated proportion vaccinated was 98.8% (95% CrI: 96.5-99.8).ConclusionVE for MCV2 was generally high, but lower in those aged 31-42 years old. The estimated proportion with MCV2 should have led to sufficient herd immunity in those aged 31-42 years old. Thus, lower VE cannot be fully explained by natural immunity, suggesting presence of waning immunity.

[Compliance with adult measles and pertussis vaccination recommendations : Analysis of data from the national monitoring system KV-Impfsurveillance]. / Umsetzung der Masern- und Pertussisimpfempfehlungen für Erwachsene : Analyse von Daten des bundesweiten Monitorings der KV-Impfsurveillance.

The Standing Committee on Vaccination recommends adult measles and pertussis vaccination. The measles vaccine has been recommended since 2010 to adults born after 1970 with less than two doses in childhood, and an acellular pertussis vaccine (ap) since 2009 to be administered to all adults, with the next recommended decennial tetanus (T) and diphtheria (d) booster as a Tdap combination vaccine.We aim to determine the annual uptake of the measles vaccine (vaccination incidence) and its proportion in pediatric and gynecological practices as interdisciplinary services (2009-2016). We further aim to calculate the 10-year ap vaccination coverage and missed vaccination opportunities as the proportion vaccinated with Td only among all Td and Tdap vaccinees (2007-2016).Within the national vaccination monitoring system KV-Impfsurveillance of the Robert Koch Institute and all Associations of Statutory Health Insurance Physicians, all persons receiving the relevant vaccinations were identified in nationwide statutory health insurance claims and related to the numbers of insured persons.The measles vaccination incidence in 2009 was 0.4%, increasing to ≥1.0% annually since 2013. It was higher in western than eastern federal states and higher among women than men. Of all measles vaccinations, 6.8% were given by pediatricians. Men received 2.6% of their vaccinations by gynecologists. The ap vaccination coverage was 32.4%. The proportion of exclusively Td vaccinated adults fell from 84% (2007) to 24% (from 2013 onwards).Since their recommendation, the KV-Impfsurveillance system shows increased uptake of measles and pertussis vaccines with regional and sex differences and is thus instrumental in their evaluation. Analyses of interdisciplinary vaccinations and missed vaccination opportunities provide insight into the potential for increasing uptake.

Post-exposure prophylaxis for measles with immunoglobulins revised recommendations of the standing committee on vaccination in Germany.

Passive immunisation with immunoglobulins as post-exposure prophylaxis after contact with measles is recommended by the German Standing Committee on Vaccination (STIKO) particularly for unprotected individuals at high risk of complications for whom active immunization is contraindicated, such as infants <6 months of age, immunocompromised patients and pregnant women. The efficacy of passive immunisation in preventing measles depends on how soon after exposure it is administered, the concentration of measles antibodies in the immunoglobulin products and dosage. Since the global introduction of standard active immunisation against measles and the concomitant reduction in virus circulation, the levels of measles virus (MV)-specific IgG antibodies in the population have dropped. Thus, the concentration of MV-specific antibodies in immunoglobulin products derived from human plasma donors has declined as the proportion of vaccinated donors has increased. The MV-neutralizing capacity of immunoglobulin products is not routinely tested in Germany. No official data exist on the concentrations of MV-specific IgG antibodies in individual batches of immunoglobulins available in Germany and the required minimum level for MV-specific IgG is not stipulated. The STIKO re-evaluated available data and measurements of MV-neutralizing capacities of available immunoglobulin (IgG) products in Germany at the National Reference Centre Measles, Mumps, Rubella at the Robert Koch Institute. Based on the findings, STIKO modified its previous recommendations on the post-exposure use of immunoglobulins (2001), especially with respect to risk groups, application and dosage. STIKO now recommends a single intravenous administration of immunoglobulins (400 mg/kg body weight) as soon as possible, preferably within six days, after exposure to measles, specifically for infants aged <6 months, susceptible pregnant women and immunocompromised patients.

[Measles in Germany: An Epidemiological Analysis and First Measures for Containment]. / Masern in Deutschland ­ Epidemiologie und Management.

Measles are one of the most contagious diseases of mankind. Measles incidence has declined worldwide since the introduction of vaccinations. Due to low numbers of measles cases in countries with high vaccination rates the population is not aware of possible complications of measles any more. Measles elimination is an important goal set by all regions of the World Health Organization. However, it remains a challenge for Germany and other European countries. Because of a high proportion of susceptibles in specific population and age groups outbreaks take place in Germany every year after importation of the virus. More than 50 % of measles cases are 20 years and older. However, the highest incidences have been seen in two-year-olds since several years. In addition to epidemiological findings such as case numbers and risk groups, genotyping permits e. g. an assessment of the endemic circulation of viruses. Suspicion of a measles case should result in immediate and consistent measures.

Measles incidence and reporting trends in Germany, 2007-2011.

OBJECTIVE: We aimed to quantify progress towards measles elimination in Germany from 2007 to 2011 and to estimate any potential underreporting over this period. METHODS: We determined the annual incidence of notified cases of measles - for each year - in northern, western, eastern and southern Germany and across the whole country. We then used measles-related health insurance claims to estimate the corresponding incidence. FINDINGS: In each year between 2007 and 2011, there were 6.9-19.6 (mean: 10.8) notified cases of measles per million population. Incidence decreased with age and showed geographical variation, with highest mean incidence - 20.3 cases per million - in southern Germany. Over the study period, incidence decreased by 10% (incidence rate ratio, IRR: 0.90; 95% confidence interval, CI: 0.85-0.95) per year in western Germany but increased by 77% (IRR: 1.77; 95% CI: 1.62-1.93) per year in eastern Germany. Although the estimated incidence of measles based on insurance claims showed similar trends, these estimates were 2.0- to 4.8-fold higher than the incidence of notified cases. Comparisons between the data sets indicated that the underreporting increased with age and was generally less in years when measles incidence was high than in low-incidence years. CONCLUSION: Germany is still far from achieving measles elimination. There is substantial regional variation in measles epidemiology and, therefore, a need for region-specific interventions. Our analysis indicates underreporting in the routine surveillance system between 2007 and 2011, especially among adults.

Evidence-based decision-making in infectious diseases epidemiology, prevention and control: matching research questions to study designs and quality appraisal tools.

BACKGROUND: The Project on a Framework for Rating Evidence in Public Health (PRECEPT) was initiated and is being funded by the European Centre for Disease Prevention and Control (ECDC) to define a methodology for evaluating and grading evidence and strength of recommendations in the field of public health, with emphasis on infectious disease epidemiology, prevention and control. One of the first steps was to review existing quality appraisal tools (QATs) for individual research studies of various designs relevant to this area, using a question-based approach. METHODS: Through team discussions and expert consultations, we identified 20 relevant types of public health questions, which were grouped into six domains, i.e. characteristics of the pathogen, burden of disease, diagnosis, risk factors, intervention, and implementation of intervention. Previously published systematic reviews were used and supplemented by expert consultation to identify suitable QATs. Finally, a matrix was constructed for matching questions to study designs suitable to address them and respective QATs. Key features of each of the included QATs were then analyzed, in particular in respect to its intended use, types of questions and answers, presence/absence of a quality score, and if a validation was performed. RESULTS: In total we identified 21 QATs and 26 study designs, and matched them. Four QATs were suitable for experimental quantitative study designs, eleven for observational quantitative studies, two for qualitative studies, three for economic studies, one for diagnostic test accuracy studies, and one for animal studies. Included QATs consisted of six to 28 items. Six of the QATs had a summary quality score. Fourteen QATs had undergone at least one validation procedure. CONCLUSIONS: The results of this methodological study can be used as an inventory of potentially relevant questions, appropriate study designs and QATs for researchers and authorities engaged with evidence-based decision-making in infectious disease epidemiology, prevention and control.

Report on the 1st international workshop on procedures for the development of evidence-based vaccination recommendations, Berlin, Germany, 22-23 November 2010.

In November 2010, experts from European and North-American countries met in Berlin, Germany, to discuss improved methods for the development of evidence-based vaccination recommendations. The objectives of the workshop were to (i) review current procedures and experiences of National Immunization Technical Advisory Groups (NITAGs) in developing a framework for evidence-based vaccination recommendations, (ii) discuss the applicability of methods like Grading of Recommendations Assessment, Development and Evaluation (GRADE), and (iii) to identify opportunities for international collaboration to support NITAGs in the development of vaccination recommendations at country-level. Recognizing that a systematic and transparent approach is necessary to promote the quality and acceptance of vaccination recommendations, various decision making frameworks have been implemented by national and international advisory groups addressing common key aspects of knowledge, such as the burden of disease or characteristics of the vaccine. There are several challenges when grading the quality of evidence of some immunization-specific topics (e.g. population-level effects of vaccination). This does not, however, necessitate development of an entirely new systematic methodology. The participants concluded that (i) GRADE or a modification of this methodology is suitable for the grading of quality of evidence related to vaccine effectiveness and safety, and that (ii) international cooperation would be beneficial to develop common framework methodologies for certain aspects of national immunization recommendation developments in order to avoid duplication of efforts, to build on existing strengths, and to support NITAGs worldwide.

Closer to the goal: efforts in measles elimination in Germany 2010.

Increasing 2-dose vaccination coverage has led to an interruption of endemic measles virus circulation in Germany. However, outbreaks after virus importation still occur and contribute to international transmission chains. Between 2003 and 2009, annual measles incidence ranged between 0.2 and 2.8 per 100,000 population. Immunization gaps have been identified especially in secondary-school students and young adults, which is also reflected by a shift in age distribution of reported measles cases toward older age groups. Stronger political commitment and standardized guidelines for outbreak containment were put in place in Germany in the past years, but the last step toward measles elimination cannot be made until the number of susceptible individuals has been further reduced. In addition to routine childhood vaccination, supplementary immunization activities are needed targeting school students and young adults to close critical immunization gaps. Intensification of public awareness and sound information on vaccinations are necessary to convince skeptics and remind the forgetful.

[Perception of continuous medical education by primary care physicians]. / Wahrnehmung von Fortbildungsangeboten aus Sicht von Hausärzten: Eine qualitative Befragung von Allgemeinärzten und hausärztlich tätigen Internisten aus Berlin.

The enormous increase of specific medical knowledge has become a growing challenge also for general practitioners (GPs) in their daily routine. In this study, GPs practising in Berlin were asked about their experience with Continuous Medical Education (CME). The evaluation of this survey may help planning future qualification courses. Thirty GPs from Berlin (14 females, 16 males) participated in a qualitative survey and were interviewed about their experience with and the use of CME programmes offered. The interviews performed were summarised, structured, and analysed according to the qualitative analysis of content by Mayring. The GPs considered lack of time to be the general impediment to their further professional development. The patient-oriented communication with specialised colleagues during working hours was considered an important tool of CME. Traditional educational means, for example professional journals, were appreciated because of their flexible use in terms of time and location. Due to the lack of time, GPs may favour types of CME that can be used flexibly. The implementation of professional medical networks between GPs and specialty consultants may have a major impact on future CME programmes.

Diagnostic work-up of rectal bleeding in general practice.

BACKGROUND: GPs have many patients with gastrointestinal discomfort. Among bowel-related complaints, the sign of rectal bleeding is of particular importance in patients aged 50 years and above, as it can be an early sign for serious bowel diseases such as colon carcinoma. Despite many guidelines offered to GPs for screening and early detection of colorectal carcinomas, there is very little information about the actual diagnostic approach to the sign of rectal bleeding. AIM: The aim of the study was to collect data concerning treatment strategies used by GPs who treat patients presenting with rectal bleeding. DESIGN OF STUDY: Prospective data collection. SETTING: General practices in Germany. METHOD: Over the course of a year, GPs recorded their treatment strategies in patients presenting with rectal bleeding and associated symptoms. Using a digital practice patient file, physicians participating in the study were able to continuously transmit data electronically to the researchers of the study about diagnostics, referrals, hospital admissions, and final diagnoses. RESULTS: During the course of 1 year, 94 participating physicians collected data on 1584 patients. Information about treating rectal bleeding was recorded for 422 patients; 60% of the patients were referred to specialists in internal medicine or gastroenterologists for further diagnostics. A colonoscopy was the most frequently performed diagnostic procedure (46.2%). Twenty-two per cent (n = 93) of the patients--54 of them aged 50 years and above--were exclusively treated by their GP without conducting a colonoscopy or cooperating with specialists. For these patients, GPs diagnosed less severe diseases like haemorrhoids or other proctologic diseases. CONCLUSION: By using a study that allows GPs to transmit electronically their findings and data, it is possible to draw a picture of treatment strategies of GPs in patients presenting with rectal bleeding. The high percentage of patients who received medical treatment in consultation with specialists underscores the significance of the sign of rectal bleeding in general practice. The need for further diagnostic measures in patients who have been treated exclusively by GPs has to be discussed.