[Networks of National Reference Centers and associated Consiliary Laboratories in Germany]. / Referenznetzwerke aus Nationalen Referenzzentren mit assoziierten Konsiliarlaboratorien in Deutschland.

Since 1995, the Robert Koch-Institute in agreement with the Federal Ministry of Health in Germany has increased the funding of National Reference Centers (NRC) and Consiliary Laboratories (CL) for laboratory-based surveillance of selected infection pathogens and infectious disease syndromes. Their goal is to improve efficient protection from infections and to supplement infectious disease surveillance by monitoring selected pathogens. Currently there are 19 NRC and 48 CL, nominated for a duration of 3 years. In order to enhance the effectiveness and cooperation of the system, ten National Networks were launched in 2009. The aim of these networks is to facilitate exchange on diagnostic methods and prevention concepts and to improve the geographic coverage of the services. Furthermore, the networks provide an opportunity to work on issues beyond single pathogens more productively and efficiently. In addition, the inclusion of external and international specialists should to be included more often in the future. The activities of the networks are evaluated by the commission for infectious disease epidemiology. The commission develops promotion modalities to support collaboration between NRC and CL and to adapt it to more closely meet the requirements at the national and international levels.

[Establishment of Networks of National Reference Centres and associated Consiliary Laboratories in Germany]. / Etablierung von Referenznetzwerken aus Nationalen Referenzzentren mit assoziierten Konsiliarlaboratorien in Deutschland.

The German Federal Ministry of Health has funded National Reference Centres (NRC) for laboratory-based surveillance of selected infection pathogens and infections disease syndromes. This selection is based on the epidemiologic relevance of the pathogens, specific diagnostic requirements, antimicrobial resistance and need for public health measures. Currently there are 18 NRC, nominated for a duration of 3 years. Toward the end of a nomination period, each NRC is evaluated by an expert committee, based on the catalogue of core tasks. In order to expand the spectrum of competencies 47 consiliary laboratories on additional pathogens of special epidemiologic importance have been named. Their main function is to provide information and consultation on special diagnostic issues. In order to further improve the effectiveness and cooperation of the system Networks have been created. The aim of the Networks is to facilitate exchange of diagnostic methods and prevention concepts and to improve the geographic coverage of the services.

Epidemic conjunctivitis in Germany, 2004.

Epidemic conjunctivitis can be associated with viral or bacterial pathogens, whereas epidemic keratoconjunctivitis is caused mainly by adenoviruses type 8,19 and 37. In Germany, the incidence of adenovirus conjunctivitis cases increased from 0.2 per 100,000 inhabitants (in 2001 and 2002) eventually to 0.5 in 2003 and 0.8 in 2004. The detection of adenovirus in conjunctival swabs is notifiable to the local health departments. Data about cases with positive conjunctival swabs are then transmitted to the Robert Koch-Institut. Quality control of data takes place and national surveillance data of confirmed cases with adenovirus conjunctivitis are published. From January to April 2004 the national surveillance system captured an outbreak with 1024 cases (131 laboratory confirmed). Analysis of the national surveillance data showed that in March 2004 the group primarily affected by epidemic keratoconjunctivitis was young men between 18-29 years old followed by an increased number of notifications from women in the same age group. Meanwhile the German Armed Forces experienced an outbreak of conjunctivitis, almost exclusively without laboratory confirmation, affecting 6378 soldiers. Despite the small number of laboratory confirmed cases it became clear from the analysis of the national surveillance data that person-to-person transmission between young men and similar age groups of the population did occur. Whether the outbreak started within the garrisons of the German Armed Forces or whether it was triggered within these accommodations, there is clearly a need for the national and the military public health institutions to work together on guidelines to handle future challenges.

Epidemic conjunctivitis in Germany, 2004.

Epidemic conjunctivitis can be associated with viral or bacterial pathogens, whereas epidemic keratoconjunctivitis is caused mainly by adenoviruses type 8,19 and 37. In Germany, the incidence of adenovirus conjunctivitis cases increased from 0.2 per 100 000 inhabitants (in 2001 and 2002) eventually to 0.5 in 2003 and 0.8 in 2004. The detection of adenovirus in conjunctival swabs is notifiable to the local health departments. Data about cases with positive conjunctival swabs are then transmitted to the Robert Koch-Institut. Quality control of data takes place and national surveillance data of confirmed cases with adenovirus conjunctivitis are published. From January to April 2004 the national surveillance system captured an outbreak with 1024 cases (131 laboratory confirmed). Analysis of the national surveillance data showed that in March 2004 the group primarily affected by epidemic keratoconjunctivitis was young men between 18 -29 years old followed by an increased number of notifications from women in the same age group. Meanwhile the German Armed Forces experienced an outbreak of conjunctivitis, almost exclusively without laboratory confirmation, affecting 6378 soldiers. Despite the small number of laboratory confirmed cases it became clear from the analysis of the national surveillance data that person-to-person transmission between young men and similar age groups of the population did occur. Whether the outbreak started within the garrisons of the German Armed Forces or whether it was triggered within these accommodations, there is clearly a need for the national and the military public health institutions to work together on guidelines to handle future challenges.

[The National Reference Centres and Reference Laboratories. Importance and tasks]. / Die Nationalen Referenzzentren und Konsiliarlaboratorien. Bedeutung und Aufgaben.

Since 1995, the German Federal Ministry for Health and Social Security funds National Reference Centres (NRC) for the laboratory surveillance of important pathogens and syndromes. Which pathogens or syndromes are selected to be covered by a NRC depends on their epidemiological relevance, the special diagnostic tools, problems with antimicrobial resistance and necessary infection control measures. Currently, there are 15 NRC, which are appointed for a period of 3 years (currently from January 2005 through December 2007). Towards the end of their appointment all NRC are evaluated by a group of specialists. The assessment of their achievements is guided by a catalogue of tasks for the NRC. In addition to the NRC, a total of 50 laboratories are appointed which provide specialist expertise for additional pathogens in order to have a broad range of pathogens for which specialist laboratories are available. Their predominant task is to give advice and support for special diagnostic problems. Both NRC and the specialist laboratories are important parts of the network for infectious disease epidemiology.

Radioiodine therapy during an unknown remained pregnancy and radiation exposure of the fetus. A case report.

PURPOSE: A papillary thyroid cancer staged as p T2N3M0 was treated in a 28-year-old woman by surgery, percutaneous radiation and radioiodine therapy (10 single applications ranging from 3300 to 3840 MBq with an average radioactivity of 3350 MBq). In the course of radioiodine therapy an attended gynaecologist found the woman pregnant in the 24th week of gravidity. Because the pregnancy remained unknown until this time radioiodine was administered during the 2nd and the 22nd week of pregnancy, each time 3700 MBq. Because of the risk of malformations this pregnancy was interrupted after consultation and taking the recommendations of the so-called Danish rule as a basis for the decision. METHODS: Ovarian and fetal doses as well as the fetal thyroid exposure has been estimated as exactly as possible using data at hand. The fetus was studied with regard to possible consequences of radiation exposure by pathologico-anatomical, cytogenetic and radiobiological methods. RESULTS: The accumulated ovarian doses resulting from the radioiodine administrations before pregnancy was estimated to 2200 mGy, the fetal doses resulting from the two administrations during pregnancy to 250 mGy in each case, and the fetal thyroid dose to between 90 Gy and 900 Gy for the 2nd therapy during pregnancy. In the fetus the most important changes were found within the thyroid gland (atrophy, sclerosis, subcapsular interstitial fibrosis, necrobiosis of follicular epithelial cells). On the other hand, analysing the karyotype using dermal fibroblastic cell cultures, no radiation induced chromosomal aberrations were seen. CONCLUSION: Despite of all precautionary measures it seems to be conceivable that in extremely rare cases--in our 35-year experience with more than 20,000 radioiodine therapies only the present case--an early pregnancy may remain undetected. The results of these studies give useful information on effects to be expected as a result of radioiodine application during certain periods of pregnancy. They may help to extend the radiobiological knowledge with regard to the fetal period.