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.

[Varicella vaccination in Germany. A provisional appraisal in the context of MMR vaccination]. / Die Varizellenimpfung in Deutschland. Eine Zwischenbilanz mit Blick auf die Masern-Mumps-Röteln- (MMR-)Impfung.

In 2004, a general varicella immunization was introduced in Germany for infants from the age of 11 months, followed by the subsequent recommendation in 2009 of a second vaccine dose. The vaccination is carried out at the same time as the immunization against measles, mumps, and rubella (MMR). Results of the nationwide sentinel surveillance of varicella and herpes zoster implemented by the Varicella Working Group (Arbeitsgemeinschaft Varizellen, AGV) show that the defined goals for varicella immunization (reduction of varicella-related morbidity, complications and hospitalizations) have been reached within a few years owing to the advances in vaccine coverage. Although coverage rates for varicella have not yet reached the same levels as for MMR, varicella immunization seems to have benefited from the established MMR immunization schedule. Moreover, there is no evidence for an adverse effect on the use and acceptance of the MMR vaccine. Lessons learnt in measles epidemiology (such as trends in the incidence of the disease in adolescents and infants), as well as in the history of MMR recommendations, may be useful for the evaluation of future epidemiological changes with respect to varicella and herpes zoster. In view of a rapidly waning immunity against the varicella zoster virus after vaccination with one dose and the lifelong persistence of the virus, achieving a robust and sustainable immunity in the general population seems to be an ambitious goal. However, this accomplishment will be indispensable in preventing breakthrough infections and a shift of varicella to older ages and in avoiding an increase in herpes zoster incidence.

Estimating vaccination coverage in the absence of immunisation registers--the German experience.

Immunisation registers are regarded as an appropriate solution to measure vaccination coverage on a population level. In Germany, a decentralised healthcare system and data protection regulations constrain such an approach. Moreover, shared responsibilities in the process of immunisation and multiple providers form the framework for public health interventions on vaccination issues. On the national level, those interventions consist mainly of conceptualising immunisation strategies, establishing vaccination programmes, and issuing recommendations. This paper provides an overview on sources and methods for collecting appropriate coverage data at national level and their public health relevance in Germany. Methods of data collection and available information on immunisations are described for three approaches: school entrance health examination, population surveys and insurance refund claim data. School entrance health examinations allow regional comparisons and estimation of trends for a specific cohort of children and for all recommended childhood vaccinations. Surveys deliver population based data on completeness and timeliness of selected vaccinations in populations defined by age or socio-demographic parameters and on knowledge and attitudes towards vaccination. Insurance refund claim data inform continuously on immunisation status (e.g. of children aged two years) or on vaccination incidence promptly after new or modified recommendations. In a complex healthcare system, the German National Public Health Institute (Robert Koch Institute, RKI) successfully compiles coverage data from different sources, which complement and validate one another. With the German approach of combining different data sources in the absence of immunisation registers, it is possible to gain solid and reliable data on the acceptance of vaccination programmes and target groups for immunisation. This approach might be of value for other countries with decentralised healthcare systems.

Enhanced surveillance during a large outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/verotoxin-producing Escherichia coli in Germany, May to June 2011.

Germany has a well established broad statutory surveillance system for infectious diseases. In the context of the current outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/ verotoxin-producing Escherichia coli in Germany it became clear that the provisions of the routine surveillance system were not sufficient for an adequate response. This article describes the timeline and concepts of the enhanced surveillance implemented during this public health emergency.

Economics of nuclear power.

With 12 percent of U.S. electricity now being supplied by nuclear power, Commonwealth Edison has found nuclear plants to be good investments relative to other base load energy sources. The country's largest user of nuclear power, Commonwealth Edison, estimates that its commitment to nuclear saved its customers about 10 percent on their electric bills in 1977, compared to the cost with the next best alternative, coal. This advantage is seen as continuing, contrary to criticisms of the economics and reliability of nuclear power and claims that it has hidden subsidies. It is concluded that there is a need for both nuclear and coal and that government policy precluding or restricting either would be unwise.

[Hospital surveillance during major outbreaks of community-acquired diseases. Pandemic Influenza Hospital Surveillance (PIKS) 2009/2010 and Surveillance of Bloody Diarrhea (SBD) 2011]. / Krankenhaus-Surveillance während großer Ausbrüche ambulant erworbener Erkrankungen. Die Pandemische-Influenza-Krankenhaus-Surveillance (PIKS) 2009/2010 und die Surveillance blutiger Durchfälle (SBD) 2011.

BACKGROUND AND OBJECTIVE: During the influenza pandemic 2009/2010 and the outbreak of entero-haemorrhagic Escherichia coli (EHEC)/hemolytic-uremic syndrome (HUS) 2011, the statutory reporting system in Germany was complemented by additional event-related surveillance systems in hospitals. The Pandemic Influenza Hospital Surveillance (PIKS) and the Surveillance of Bloody Diarrhea (SBD) were evaluated, to make experiences available for similar future situations. METHODS: The description and evaluation of our surveillance systems is based on the "Updated Guidelines for Evaluating Public Health Surveillance Systems" published by the U.S. Centers for Disease Control and Prevention in 2001. RESULTS: PIKS and SBD could be implemented quickly and were able to capture resilient data in a timely manner both on the severity and course of the influenza pandemic 2009/2010 and the outbreak of EHEC and HUS 2011. Although lacking in representativeness, sensitive and useful data were generated. CONCLUSION: In large outbreaks of severe diseases, the establishment of specific hospital surveillance should be considered as early as possible. In Germany, the participating hospitals were able to rapidly implement the required measures.