[One Health: a perspective of the informal ministerial network : "What if the One Health approach became the guiding theme of cooperation at the national, European and global level?"] / One Health: Eine Sichtweise des informellen ministeriellen Netzwerkes : "Was wäre, wenn der One-Health-Ansatz zum Leitmotiv von Kooperation auf nationaler, europäischer und globaler Ebene würde?".

In the view of the German government, the One Health approach is a pioneering compass for inter- and transdisciplinary thinking, networking, and action. To protect the health of humans, animals, plants, and ecosystems, it should always receive attention at all its interfaces and activities. The One Health approach has gained political importance in recent years and is being taken into account in several strategies.This article reports on the current strategies using a One Health approach. These include the German Antibiotic Resistance Strategy, the German Strategy for Adaptation to Climate Change, the global initiative Nature for Health, and the international pandemic agreement, which is currently being drafted and in which prevention also plays an important role. The issues of biodiversity loss and climate protection must be placed in a common context that takes into account the interdependencies of the health status of humans, animals, plants, and ecosystems. By involving relevant disciplines at different levels as a matter of course, we can succeed in making a joint contribution to sustainable development, as required by the United Nations' Agenda 2030. This perspective guides Germany's global engagement in global health policy toward greater stability, freedom, diversity, solidarity, and respect for human rights. Thus, a holistic approach such as One Health can contribute to achieving sustainability and strengthening democratic principles.

Continued vigilance - development of an online evaluation tool for assessing preparedness of medical facilities for biological events.

OBJECTIVE: Effective response to biological events necessitates ongoing evaluation of preparedness. This study was a bilateral German-Israeli collaboration aimed at developing an evaluation tool for assessing preparedness of medical facilities for biological events. METHODS: Measurable parameters were identified through a literature review for inclusion in the evaluation tool and disseminated to 228 content experts in two modified Delphi cycles. Focus groups were conducted to identify psychosocial needs of the medical teams. Table-top and functional exercises were implemented to review applicability of the tool. RESULTS: One hundred seventeen experts from Germany and Israel participated in the modified Delphi. Out of 188 parameters that were identified, 183 achieved a consensus of >75% of the content experts. Following comments recommended in the Delphi cycles, and feedback from focus groups and hospital exercises, the final tool consisted of 172 parameters. Median level of importance of each parameter was calculated based on ranking recommended in the Delphi process. Computerized web-based software was developed to calculate scores of preparedness for biological events. CONCLUSION: Ongoing evaluation means, such as the tool developed in the study, can facilitate the need for a valid and reliable mechanism that may be widely adopted and implemented as quality assurance measures. The tool is based on measurable parameters and indicators that can effectively present strengths and weaknesses in managing a response to a public health threat, and accordingly, steps can be implemented to improve readiness. Adoption of such a tool is an important component of assuring public health and effective emergency management.

Injection anthrax--a new outbreak in heroin users.

BACKGROUND: Injection anthrax is a rare disease that affects heroin users and is caused by Bacillus anthracis. In 2012, there were four cases in Germany, one of which was fatal, as well as a small number of cases in other European countries, including Denmark, France, and the United Kingdom. Three cases among drug users occurred in Germany in 2009/2010, in the setting of a larger outbreak centered on Scotland, where there were 119 cases. CASE PRESENTATION AND CLINICAL COURSE: We present three cases of injection anthrax, two of which were treated in Regensburg and one in Berlin. One patient died of multi-organ-system failure on the day of admission to the hospital. The others were treated with antibiotics, one of them also with surgical wound debridement. The laboratory diagnosis of injection anthrax is based on the demonstration of the pathogen, generally by culture and/or by polymerase chain reaction, in material removed directly from the patient's wound. The diagnosis is additionally supported by the detection of specific antibodies. CONCLUSION: Injection anthrax may be viewed either as an independent disease entity or as a special type of cutaneous anthrax with massive edema, necrotizing fasciitis in many cases, and about 30% mortality. It has appeared in recent years among heroin users in various European countries. In patients with suggestive clinical presentation and a history of heroin use, anthrax infection must be suspected early, so that the appropriate diagnostic tests can be performed without delay. Timely treatment can be life-saving. It is therefore important that physicians--and the individuals at risk--should be well-informed about this disease.