RESUMO
OBJECTIVES: Viral hepatitis co-infection among people living with HIV is known to accelerate the progression of liver disease and AIDS. An increased prevalence and incidence of hepatitis B virus (HBV) infection among people living with HIV demands continuous monitoring to adapt targeted prevention strategies to reach the global goals of eliminating viral hepatitis as a public health threat. METHODS: We determined the prevalence and incidence of HBV for the years 1996-2019 from yearly blood sample testing and questionnaire reports among people living with HIV belonging to a nationwide, multicentre observational, prospective cohort study. RESULTS: Among this study population of 3479 participants, the majority (87%) indicated that being men who have sex with men (MSM) was their likely HIV transmission route; 51% were recruited from Berlin. HBV prevalence for acute/chronic and resolved infections decreased from 4.1% and 45% in 1996-1999 to 1.3% and 16% in 2019, respectively. Simultaneously, participants with a serological status indicating HBV vaccination increased from 25% in 1996-1999 to 69% in 2019. Among vaccinated participants with relevant information (n = 1135), 38% received their first HBV vaccination after HIV infection. The HBV incidence rate in 565 eligible participants decreased from 6.9/100 person-years in 2004-2007 to 0.45/100 person-years in 2015. CONCLUSION: Increasing vaccination coverage because of a general HBV vaccination recommendation and catch-up vaccination efforts among risk groups decreased HBV infection prevalence over time among this study population of people living with HIV, primarily MSM and from Berlin. Despite this success, the prevalence and incidence of HBV remains higher than in the general population in Germany. This emphasizes the need for continued HBV prevention by promoting HBV vaccination and HBV screening at regular intervals based on the individual risk behaviour.
Assuntos
Coinfecção , Infecções por HIV , Soropositividade para HIV , HIV-1 , Hepatite B , Minorias Sexuais e de Gênero , Masculino , Humanos , Feminino , Homossexualidade Masculina , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/diagnóstico , Estudos de Coortes , Estudos Prospectivos , Prevalência , Cobertura Vacinal , Coinfecção/epidemiologia , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Vírus da Hepatite B , VacinaçãoRESUMO
OBJECTIVES: Germany has a mandatory surveillance system for acute hepatitis B (AHB) with the Protection against Infection Act as the legal basis in place since 2001. An amendment was introduced in 2013. We aimed at evaluating the surveillance systems' performance regarding timeliness, data quality, and simplicity from 2005 to 2014 and at assessing the effect of the amendment on timeliness of AHB surveillance. STUDY DESIGN: This study is a trend analysis of surveillance data. METHODS: Aspects of simplicity versus complexity of the surveillance system were assessed by describing data flow, levels of reporting, and data management procedures. Data quality, in terms of data completeness, was evaluated by quantitative indicators, and timeliness was measured in days between different levels of the surveillance system, notification delay, and reporting delay. Trends over time in data quality were analyzed by logistic regression, while negative binomial regression was used to test for trend over time regarding mean notification and reporting delay. RESULTS: Between January 2005 and December 2014, a total of 22,549 AHB infections were reported at the national level. The data flow of the German AHB surveillance system showed structural characteristics of a complex system. Over the 10-year period, completeness of reporting sex, age, probable route of transmission, and hepatitis B virus (HBV) vaccination were 99%, 100%, 25%, and 73%, respectively. However, data quality decreased over the evaluation period. Although notification delay improved over time (incident rate ratio [IRR] = 0.95, 95% confidence interval [CI] = 0.95-0.96; P < 0.05), reporting delay improved only since the amendment (IRR = 0.76, 95% CI = 0.70-0.82; P < 0.05). In total, mean notification and reporting delay were 3.0 days and 14.3 days, respectively. CONCLUSIONS: The German AHB surveillance system is operating in a timely manner. Although timeliness improved over the evaluation period and the amendment to the Protection against Infection Act succeeded in reducing reporting time, data quality in terms of completeness of information decreased considerably. As improved data completeness is required to adequately design prevention activities, reasons for this decrease should further be explored.
Assuntos
Hepatite B/epidemiologia , Vigilância da População/métodos , Confiabilidade dos Dados , Notificação de Doenças/estatística & dados numéricos , Alemanha/epidemiologia , Humanos , Fatores de TempoRESUMO
Recent years have seen a world-wide increase in antimicrobial resistance (AMR) in cases of infection with Neisseria gonorrhoeae (NG). NG infection is not notifiable in Germany and there is a lack of information available about the spread and AMR of NG infections. The objective of the study was to provide information on diagnostic methods and AMR testing in cases of NG infections in German laboratories. A cross-sectional survey was undertaken in Germany between June and August 2013 using an online questionnaire. Laboratories performing NG diagnostics were identified and described with regard to the diagnostic methods used, the number of tests performed, the antibiotics tested and the AMR observed, in addition to general laboratory information. In total, 188 of the 521 participating laboratories performed NG diagnostics; these were included in the further statistical analysis. 92.6 % of the 188 laboratories performed culture. A median of 60 (IQR 15-270) samples per quarter (SPQ) were tested, with an overall positivity rate of 4.1 and 6.9 % among men. Most (82.1 %) of the 151 laboratories performing NG culture tested for AMR as well. The most frequently tested antibiotics were ciprofloxacin (94.8 %), penicillin (93.1 %), doxycycline (70.0 %) and ceftriaxone (67.2 %). The most frequently observed AMR ever were those against ciprofloxacin (87.1 %), penicillin (78.3 %), doxycycline (56.6 %) and azithromycin (35.1 %; all percentages refer to laboratories). The laboratories used different standards regarding susceptibility criteria. The emergence and spread of AMR shows that it is crucial to assess and monitor the scope and trends of multidrug-resistant gonorrhea. The data collected on diagnostic methods and AMR testing in cases of NG infections in German laboratories constitute an important basis for future monitoring.
Assuntos
Antibacterianos/uso terapêutico , Técnicas de Tipagem Bacteriana/estatística & dados numéricos , Farmacorresistência Bacteriana/efeitos dos fármacos , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Neisseria gonorrhoeae/isolamento & purificação , Adolescente , Adulto , Idoso , Técnicas de Tipagem Bacteriana/métodos , Técnicas de Laboratório Clínico , Feminino , Alemanha/epidemiologia , Gonorreia/microbiologia , Pesquisas sobre Atenção à Saúde , Humanos , Ensaio de Proficiência Laboratorial/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Currently, no information is available about the number of Chlamydia trachomatis (CT) tests performed, testing facilities available or diagnostic methods used in Germany. This study aimed to map CT diagnostic facilities so that representative laboratories can be recruited for CT sentinel surveillance. METHODS: Using a questionnaire, we collected information about population coverage, the number of tests performed, accreditation and current testing methods and systems for German facilities that potentially offer CT diagnostics. RESULTS: Overall, 725/1,504 (48%) facilities responded; of the respondents, 143 reported that they perform CT diagnostics. Of the laboratories performing diagnostics, 45% were privately owned, and 42% were located in a hospital. Of the laboratories that provided information about their catchment area, 61% received samples from at least one federal state and therefore covered more than their surrounding area. The median length of time that CT diagnostics had been performed was 11.5 years. Over half (54%) of the laboratories that provided information on their accreditation status were accredited, for a median duration of 6 years. In accordance with national guidelines, 77% used nucleic acid amplification tests (NAAT) for acute CT infections. CONCLUSIONS: The long duration since Ct diagnostics have been performed and laboratories have been accredited can be seen as an indication of the high diagnostic quality of German laboratories. Additionally, laboratories mostly serviced doctors and patients from a large region and are not representative for people living in the area where the lab is located. This has to be considered when sampling representative labs for CT sentinel surveillance and further epidemiological studies.
Assuntos
Técnicas Bacteriológicas/estatística & dados numéricos , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Padrões de Prática Médica/estatística & dados numéricos , Técnicas Bacteriológicas/tendências , Infecções por Chlamydia/microbiologia , Alemanha , Humanos , Padrões de Prática Médica/tendências , Inquéritos e QuestionáriosRESUMO
Infections with Chlamydia trachomatis (CT) can lead to severe sequelae; however, they are not notifiable in Germany. We tested urine samples from participants of KiGGS (German Health Interview and Examination Survey for Children and Adolescents) for CT infections and linked the results to demographic and behavioural data from 1,925 participants (girls aged 15-17 years and boys aged 16-17 years) to determine a representative prevalence of CT infection in adolescents in Germany and to assess associated risk factors. Prevalence of CT infection was 2.2% (95% CI: 1.4-3.5) in girls and 0.2% (95% CI: 0.1-0.7) in boys. CT infection in girls was associated with higher use of alcohol, marijuana and cigarettes, lower social status, oral contraceptive use, pregnancy, repeated lower abdominal pain and higher rates of doctors' consultations within the preceding three months and consultation of gynaecologists within the last 12 months. In multiple logistic regression, we identified two predictors for CT infection: marijuana consumption often or several times within the last 12 months (F(1,164)=7.56; p<0.05) and general health status less than 'very good' (F(1,164)=3.83; p=0.052). Given our findings, we recommend enhancing sex education before sexual debut and promoting safe sex practices regardless of the contraceptive method used. Well-informed consumption of alcohol should be promoted, the risky behaviour of people intoxicated through consumption of marijuana highlighted and doctors' awareness of CT screening enhanced.
Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Comportamentos Relacionados com a Saúde , Comportamento Sexual , Adolescente , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Feminino , Alemanha/epidemiologia , Humanos , Modelos Logísticos , Masculino , Reação em Cadeia da Polimerase , Vigilância da População , Prevalência , Estudos Retrospectivos , Fatores de Risco , Assunção de Riscos , Distribuição por Sexo , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
The number of people living with HIV infection has been increasing since the mid 1990s and is expected to rise further in the coming years. The HIV epidemic in Germany is still most affected by developments in the group of men who have sex with men (MSM). In this group, the number of newly diagnosed HIV infections has increased in recent years especially in large cities. Despite increased efforts to motivate HIV-infected people, who were not previously diagnosed, to be tested as early as possible and to seek medical treatment, the number of undiagnosed HIV-infected persons has increased. There are more people infected with HIV than those who have been tested positive for HIV and subsequently receive antiretroviral treatment. However, early testing and treatment alone are not sufficient to effectively contain the infection. Increased efforts are required to more effectively prevent new HIV infections by combining all the available options. In Germany as in all other developed countries, a stronger increase in the number of syphilis infections among MSM is reported, which is primarily due to a higher willingness to risk unprotected contacts, whereby the risk of HIV infection is also increased. The public prevention messages available for HIV are only partially effective against syphilis. More frequent examinations and optimized therapy management are necessary in addition to the use of condoms to prevent the spread of syphilis, gonorrhea, and Chlamydia trachomatis. Sustainable containment of new HIV infections must, therefore, be accompanied by both containment of sexually transmitted infections (STI) and use of public prevention messages for HIV/STI.
Assuntos
Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Sexo sem Proteção/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Vigilância da População , Fatores de Risco , Sexo sem Proteção/prevenção & controleRESUMO
In Germany, local health authorities (LHA) offering counseling and testing for sexually transmitted infections or human immunodeficiency virus (STI/HIV) routinely collect data. The study's objective was to get an overview of the activities and data collected by the LHA so as to investigate the possibility of harvesting these data at a national level. We performed a cross-sectional survey among all LHA with STI/HIV counseling and testing by using an electronic questionnaire with information on the type of STI/HIV services offered, groups reached, and data collected. Among the 374 LHA, 250 (67 %) responded. Half of them offered common counseling for STI and HIV; 20% conducted outreach work among sex workers and other groups. While HIV tests were available in all LHA, 62 and 56 % also offered hepatitis B and C testing, respectively. Other available tests included syphilis (56 %), gonorrhea (28 %), and chlamydia (27 %). Only 13 % of LHA offer gynecological examinations. While 98 % of LHA reported collecting data, two thirds of these records were paper-based. Although 77 % analyzed their data, 58 % reported their data to the regional level. Standardization of the STI/HIV data seems feasible for most of the LHA. This would allow annual statistics to be compiled at municipal, regional, and national levels.
Assuntos
Aconselhamento/estatística & dados numéricos , Mineração de Dados/estatística & dados numéricos , Bases de Dados Factuais , Notificação de Doenças/estatística & dados numéricos , Infecções por HIV/epidemiologia , Educação em Saúde/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Feminino , Alemanha/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Humanos , Masculino , Notificação de Abuso , Vigilância da População , Prevalência , Comportamento Sexual , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/prevenção & controleRESUMO
In June 2012 the "Sexual Health" section of the German STI Society (DSTIG) adopted a set of indicators for sexual health in order to depict the sexual health status of people in Germany, as well as to plan and evaluate activities for the improvement of sexual health as a whole. The compiled indicators are measures for determining sexual health in Germany. A logical, convincingly conclusive and yet manageable list of indicators is presented on the basis of the draft submittals of the World Health Organization (WHO). The selected indicators reflect the German situation and are at the same time highly comparable internationally. Potential users of the document are health experts, policy developers, researchers, and other health care professionals.
Assuntos
Planejamento em Saúde/organização & administração , Indicadores Básicos de Saúde , Programas Nacionais de Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Saúde Reprodutiva , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Feminino , Alemanha , Humanos , Masculino , Avaliação de Programas e Projetos de SaúdeRESUMO
In Germany, syphilis is notified anonymously. In 2011, 3,698 cases (incidence 4.5/100,000 inhabitants) were notified, an increase of 22% over 2010. The increase was higher in men (23%) than women (13%) and 94% of the cases were male. Information on the possible way of transmission was available for 72% of cases. Of these, 84% were men who have sex with men, who seem to play a major role in the renewed increase in syphilis cases.
Assuntos
Sífilis/epidemiologia , Adulto , Distribuição por Idade , Idoso , Notificação de Doenças , Feminino , Alemanha/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Fatores de Risco , Distribuição por Sexo , Adulto JovemRESUMO
Strengthening capacity in intervention epidemiology is key to the overall goal of responding to the challenge to detect and counter threats posed by outbreaks of infectious diseases in the European Union (EU). Since its founding in 1995, the European Programme for Intervention Epidemiology Training (EPIET) has become a core resource in training in intervention epidemiology in the EU. EPIET was integrated into the European Centre for Disease Prevention and Control (ECDC) on 1 November 2007 and this has resulted in an increased sustainability of the programme, allowing for long-term planning. Also, a new training programme, the European public health microbiology training (EUPHEM), was set up in 2008 to increase the response capacity for microbiology. Collaboration with EU Member States and other training programmes has been further intensified. Merging EPIET and other training activities in the ECDC training section has created the opportunity to develop an integrated multilevel approach to training in applied field epidemiology. An integrated approach to training activities on EU level, and increasing the number of EPIET and EPIET-associated fellows are essential to respond to the training needs of EU Member States, particularly new Member States. An external evaluation of EPIET in 2009 will provide guidance for a future strategy for the programme. This article examines the achievements of the EPIET programme after its transition to ECDC and provides an outlook on its future.
Assuntos
Controle de Doenças Transmissíveis/tendências , Epidemiologia/educação , União Europeia/organização & administração , Programas Governamentais/tendências , Microbiologia/educação , Vigilância da População , HumanosRESUMO
From 1994 to 2009, national field epidemiology training programmes (FETP) have been installed in Spain, Germany, Italy, France and Norway. During their two year duration, different components of the FETP are devised as follows: 63-79 weeks are spent on projects in hosting institutes, 2-26 weeks in outside projects, 9-30 weeks in courses and modules, and 1-2 weeks in scientific conferences. A considerable proportion of the Spanish FETP has is provided conventional class room training . The content of the modules is very similar for all programmes. Except from the Italian programme, all focus on infectious disease epidemiology. The German and Norwegian programmes are so called EPIET-associated programmesas their participants are integrated in the modules and the supervision offered by EPIET, but salaries, facilitators, and training sites are provided by the national programme. These EPIET-associated programmes require strong communications skills in English. Alumni of all five FETP are generally working within the public health work force in their respective countries or at international level, many of them in leading functions. Although three new FETP have been installed since the last published Euroroundup in Eurosurveillance on European FETP in 2001, the progress with respect to the establishment of national FETP or EPIET-associated programmes has been slow. Member States should be aware of how much support EPIET can offer for the establishment of national FETP or EPIET-associated programmes. However, they also need to be ready to provide the necessary resources, the administrative environment and long-term dedication to make field epidemiology training work.
Assuntos
Controle de Doenças Transmissíveis/tendências , Epidemiologia/educação , União Europeia/organização & administração , Programas Governamentais/tendências , Microbiologia/educação , Vigilância da População , HumanosRESUMO
BACKGROUND: People who inject drugs (PWID) are at high risk of hepatitis B virus (HBV) infection by sharing needles and drug use paraphernalia. In Germany, no routine surveillance of HBV prevalence and vaccination coverage among PWID exists. METHODS: Socio-demographic and behavioural data were collected between 2011 and 2014 through face-to-face interviews, during a bio-behavioural survey of PWID recruited in eight German cities. Dried blood spots (DBS) prepared with capillary blood were tested for HBV markers. Factors associated with past/current HBV infection and vaccination status were analysed by univariable and multivariable analysis using logistic regression. The validity of self-reported HBV infection and vaccination status was analysed by comparison to the laboratory results. RESULTS: Among 2077 participants, the prevalence of current HBV infection was 1.1%, of past HBV infection was 24%, and of vaccine-induced HBV antibodies was 32%. No detectable HBV antibodies were found in 43%. HBV infection status was significantly associated with study city, age, years of injecting, use of stimulants, migration status, and homelessness; HBV vaccination status was significantly associated with study city, age, and level of education. Correct infection status was reported by 71% and correct vaccination status by 45%. CONCLUSIONS: HBV seroprevalence among PWID was about five times higher than in the general population in Germany, confirming PWID as an important risk group. Targeted information campaigns on HBV and HBV prevention for PWID and professionals in contact with PWID need to be intensified. Routinely offered HBV vaccination during imprisonment and opioid substitution therapy would likely improve vaccination rates among PWID.
Assuntos
Hepatite B/etiologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Cidades , Suscetibilidade a Doenças , Feminino , Alemanha/epidemiologia , Hepatite B/complicações , Hepatite B/epidemiologia , Anticorpos Anti-Hepatite B/análise , Vacinas contra Hepatite B/administração & dosagem , Humanos , Modelos Logísticos , Masculino , Uso Comum de Agulhas e Seringas , Prevalência , Fatores de Risco , Assunção de Riscos , Estudos SoroepidemiológicosRESUMO
A resurgence of lymphogranuloma venereum (LGV) has been observed in several European countries. LGV is not a mandatorily notifiable disease in Germany. Reports of LGV cases have actively been collected by the Robert Koch-Institut since 2004 to describe the outbreak and estimate the extent of the LGV problem in Germany. Updates on the LGV outbreak were published in the German national epidemiological bulletin. Physicians were asked to send their samples to a laboratory for genotyping. A possible case was defined as a person with symptoms of proctitis and/or inguinal lymph node swelling and a positive chlamydia serology. A probable case had in addition a positive chlamydia rectal or urinary PCR test. A case was confirmed if the genotype L1-L3 was identified based on sequence analysis of omp1 gene sequences. Since 2003, LGV has been reported in 78 male patients in Germany. Of these, 61 patients were confirmed as genotype L2. Fifty eight out of 78 patients (74%) are known to be men who have sex with men (MSM). Fifty five patients (71%) had rectal symptoms and 49 (63%) knew they were HIV positive. Sixty two (79%) of the patients were residents of Berlin or Hamburg. LGV has emerged in MSM in Germany at the same time as in other European countries. It is thought that LGV may become endemic in the MSM community in German metropolitan areas, because the number of reported patients with LGV continues to increase. The increase in the number of LGV cases and the high HIV prevalence in LGV patients are of great public health concern. Clinicians and MSM may not be sufficiently aware of the disease, and existing efforts to promote awareness and prevention of sexually transmitted infections and HIV need to be strengthened.
Assuntos
Homossexualidade Masculina , Linfogranuloma Venéreo/epidemiologia , Surtos de Doenças , Alemanha/epidemiologia , Humanos , Linfogranuloma Venéreo/transmissão , Masculino , Vigilância de Evento Sentinela , Sexo sem ProteçãoRESUMO
A resurgence of lymphogranuloma venereum (LGV) has been observed in several European countries. LGV is not a mandatorily notifiable disease in Germany. Reports of LGV cases have actively been collected by the Robert Koch-Institut since 2004 to describe the outbreak and estimate the extent of the LGV problem in Germany. Updates on the LGV outbreak were published in the German national epidemiological bulletin. Physicians were asked to send their samples to a laboratory for genotyping. A possible case was defined as a person with symptoms of proctitis and/or inguinal lymph node swelling and a positive chlamydia serology. A probable case had in addition a positive chlamydia rectal or urinary PCR test. A case was confirmed if the genotype L1-L3 was identified based on sequence analysis of omp1 gene sequences. Since 2003, LGV has been reported in 78 male patients in Germany. Of these, 61 patients were confirmed as genotype L2. Fifty eight out of 78 patients (74%) are known to be men who have sex with men (MSM). Fifty five patients (71%) had rectal symptoms and 49 (63%) knew they were HIV positive. Sixty two (79%) of the patients were residents of Berlin or Hamburg. LGV has emerged in MSM in Germany at the same time as in other European countries. It is thought that LGV may become endemic in the MSM community in German metropolitan areas, because the number of reported patients with LGV continues to increase. The increase in the number of LGV cases and the high HIV prevalence in LGV patients are of great public health concern. Clinicians and MSM may not be sufficiently aware of the disease, and existing efforts to promote awareness and prevention of sexually transmitted infections and HIV need to be strengthened.
RESUMO
BACKGROUND: HIV testing and counselling is offered free of charge in most local health offices in Germany. During 2003, a survey was performed among German-speaking clients of the Cologne local health office to look at socio-demographic background, reasons for testing and sexual risk behaviour. METHODS: All German-speaking clients attending the HIV counselling office from March to July 2003 were asked to fill in an anonymous standardised questionnaire. Questions included demographic characteristics, social status, STI history, reasons for HIV testing, sexual orientation and number of sexual partners. Data were compared to the general Cologne population regarding demographic characteristics. Female respondents were compared to heterosexual men and men who have sex with men (MSM); German respondents were compared to migrants using SPSS 14.0. RESULTS: A total of 457 female and 488 male clients participated (response rate 93.9 %). Average age was 28.4 years. Of all participants, 17.7 % were of non-German origin. The respondents had a high school degree in 80.8 % of the cases compared to 33.5 % in the general Köln population (p < 0.001). Among men, 30.2 % were MSM. Having a "new partner" or "unprotected sex with a person with unknown HIV status" were reported by 483 (39.8 %) and 373 (30.8 %) as reasons for testing. 38.7 % of the respondents reported choosing the local health office for HIV testing because it was free of charge and 24.5 % because it was anonymous. Women and heterosexual men had a median of 1, MSM a median of 3 sexual partners within the past 6 months (p < 0.001). Vaccination against hepatitis B was reported by 34.4 % of the clients, the proportion was higher among MSM (46.9 % p < 0.001) and lower among migrants. 112 (11.9 %) persons reported having had a previous STI. CONCLUSIONS: With the exception of MSM, the offer of free and anonymous HIV testing and counselling does not reach persons who carry a higher risk for HIV. As the risk for STI is higher than for HIV in Germany and there is a low public awareness, HIV counselling should be used for comprehensive sexual health counselling and include the offer for STI testing, Further outreaching efforts and other settings are necessary to reach persons with a low education level and highly vulnerable persons.
Assuntos
Testes Anônimos/estatística & dados numéricos , Aconselhamento/estatística & dados numéricos , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Medição de Risco/métodos , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
Outbreaks of gastroenteritis have been repeatedly associated with the consumption of raw meat and raw meat products. To assess the potential of this problem in Germany, frequency of consumption and knowledge about and handling of raw meat during food preparation in the German population was estimated. We conducted a population-based nationwide cross-sectional survey in private households in March 2001 by random telephone numbers. Consenting German-speaking persons were randomly chosen among household members for standardized interviews. Proportions were standardized by age, sex, and region (eastern and western Germany). A total of 510 people were interviewed (response 45.1%), including 62.3% women and 31.8% considered at high risk (children younger than 10 years old, elderly more than 65 years old, and chronically ill persons). The mean age was 45.7 years. Of those who ate raw ground meat at least once a week, 17.8% lived in eastern Germany and 5.1% in western Germany, (chi-square test, P < 0.001). Teewurst was eaten by 50.8% of all respondents and 53.8% of respondents in the high-risk group. That salami or Teewurst were raw meat products was known to 58.1 and 36.3% of the respondents, respectively. Respondents reported not washing their hands (46.6%) or cleaning their cutting boards with soap (48.1%) after preparing raw meat. A total of 10.3% of the respondents had diarrhea during the last 3 months. Although knowledge is poor, consumption of raw meat products is widespread in Germany, even among high-risk persons. More information is necessary on which products contain raw meat, the potential risk of diarrhea after raw meat products are consumed, and appropriate handling of raw meat products.
Assuntos
Manipulação de Alimentos/métodos , Microbiologia de Alimentos , Gastroenterite/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Carne/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Qualidade de Produtos para o Consumidor , Estudos Transversais , Coleta de Dados , Surtos de Doenças , Feminino , Contaminação de Alimentos , Gastroenterite/etiologia , Gastroenterite/prevenção & controle , Alemanha/epidemiologia , Promoção da Saúde , Humanos , Higiene , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
In December 2001, the Robert Koch-Institut (RKI) was informed about a cluster of 10 Shigella sonnei infections in men who have sex with men (MSM), diagnosed in Berlin since September 2001. A retrospective investigation on sexual risk factors for infection in all shigella cases from Berlin from 2001 was initiated by sending a questionnaire to all patients without known travel history. Simultaneously laboratories were asked to send new shigella isolates from patients to the National Reference Centre at the RKI. Out of 29 responders, 24 self-identified as MSM. Seventeen of these reported sexual contacts as the most likely potential risk of infection. Almost all MSM reported direct or indirect oral-anal sexual contacts in the week before they fell ill. Fifteen of 27 shigella isolates collected during the prospective sampling period showed identical plasmid profiles, PFGE- and resistance patterns and can therefore be regarded as clonally identical. Asymptomatic and/or prolonged shedding in the reconvalescent phase may contribute to the transmission risk of shigella infection during oral-anal sexual practices. Awareness among practitioners and among MSM about the risk of sexual transmission of orally transmitted agents needs to be raised.
Assuntos
Surtos de Doenças , Disenteria Bacilar/epidemiologia , Homossexualidade Masculina , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Disenteria Bacilar/etiologia , Disenteria Bacilar/prevenção & controle , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Prontuários Médicos , Estudos Prospectivos , Estudos Retrospectivos , Assunção de Riscos , Infecções Sexualmente Transmissíveis/etiologia , Infecções Sexualmente Transmissíveis/prevenção & controleRESUMO
Recent surveillance reports from Europe and the United States show an increase in syphilis cases. Accurate epidemiological information about the distribution of syphilis is important for targeting screening and intervention programmes. The German syphilis notification system changed in 2001 from physician to laboratory-based reporting, which is complemented by a newly introduced sexually transmitted infection (STI) sentinel system. After reaching an all time low during the 1990s, syphilis notifications have increased significantly since 2001, coinciding with the introduction of the new reporting system. However, the increased reported incidence is reflecting a true rise in the number of cases and is not predominantly determined by more underreporting through the previous reporting system. The increase reflects syphilis outbreaks among men who have sex with men (MSM). The first of these outbreaks was observed in Hamburg in 1997. In 2003, incidence in men was ten times higher than in women. An estimated 75% of syphilis cases are currently diagnosed among MSM. A high proportion (according to sentinel data, up to 50%) of MSM diagnosed with syphilis are HIV positive. The continuously high number of syphilis cases diagnosed among heterosexuals in Germany in recent years compared with other western European countries may reflect the higher population movement between Germany and syphilis high incidence regions in south-east and eastern Europe.
Assuntos
Redes Comunitárias/organização & administração , Surtos de Doenças/estatística & dados numéricos , Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Vigilância da População/métodos , Medição de Risco/métodos , Sífilis/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Alemanha/epidemiologia , Infecções por HIV/diagnóstico , Humanos , Incidência , Masculino , Notificação de Abuso , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Sífilis/diagnósticoRESUMO
Recent surveillance reports from Europe and the United States show an increase in syphilis cases. Accurate epidemiological information about the distribution of syphilis is important for targeting screening and intervention programmes. The German syphilis notification system changed in 2001 from physician to laboratory-based reporting, which is complemented by a newly introduced sexually transmitted infection (STI) sentinel system. After reaching an all time low during the 1990s, syphilis notifications have increased significantly since 2001, coinciding with the introduction of the new reporting system. However, the increased reported incidence is reflecting a true rise in the number of cases and is not predominantly determined by more underreporting through the previous reporting system. The increase reflects syphilis outbreaks among men who have sex with men (MSM). The first of these outbreaks was observed in Hamburg in 1997. In 2003, incidence in men was ten times higher than in women. An estimated 75% of syphilis cases are currently diagnosed among MSM. A high proportion (according to sentinel data, up to 50%) of MSM diagnosed with syphilis are HIV positive. The continuously high number of syphilis cases diagnosed among heterosexuals in Germany in recent years compared with other western European countries may reflect the higher population movement between Germany and syphilis high incidence regions in south-east and eastern Europe.
RESUMO
Effects of S from wet or dry distillers grains with solubles (DGS) containing 0.82 or 1.16% S on animal growth performance, carcass characteristics, apparent total tract digestibility, and ruminal parameters were evaluated. In Exp. 1, crossbred beef steers (n = 120; 345 ± 34 kg BW) were individually fed ad libitum using Calan gates. Treatments were applied as a 2 × 2 × 3 + 1 factorial treatment arrangement with factors of DGS type (wet or dry), S content in DGS (0.82 or 1.16% DM basis), and DGS inclusion (20, 30, and 40%, DM basis), as well as a corn control diet (no DGS). In Exp. 2, ruminally cannulated crossbred beef steers (n = 6; 381 ± 31 kg BW) were assigned to 1 of 5 diets in a 5 × 6 unbalanced Latin Square design and fed ad libitum through five 14-d periods. A 2 × 2 + 1 factorial treatment arrangement was used with the factors of DGS type and S content in DGS (similar to Exp. 1). Inclusion of DGS was 40%, except for a MATCH diet containing wet 1.16% S DGS included at 31.4% (DM basis). Intake of DM decreased linearly (P < 0.01) and quadratically (P < 0.01) for steers fed wet and dry DGS that was 1.16% S, respectively. In addition, steers fed dry DGS consumed 9% more DM (P < 0.01) than those fed wet. Gain decreased linearly (P = 0.02) when wet 1.16% S DGS increased in the diet, representing a 12% drop in ADG between the Control and 40% DGS inclusion. A quadratic (P = 0.02) improvement in G:F was observed for steers fed wet DGS compared with dry, regardless of S content (P = 0.52). Feeding diets with wet 1.16% S DGS linearly decreased (P = 0.03) HCW. In Exp. 2, molar proportion of propionate declined (P = 0.01) 9% and A:P ratio tended (P = 0.13) to be greater when 1.16 compared with 0.82% S DGS was fed. Apparent total tract DMD was not affected (P > 0.16) and only subtle changes (P < 0.01) in ruminal pH parameters were observed. Greater (P = 0.02) ruminal H2S concentration for steers fed wet compared with dry DGS was observed, while 1.16% S DGS tended (P = 0.12) to produce greater ruminal H2S than 0.82% S. Sulfur in wet DGS appears to be more prone to be converted to ruminal H2S, because feeding 1.16% S as wet DGS had a greater impact on ADG, DMI, and ruminal H2S compared with dry DGS.