Practical usage of computer-supported outbreak detection in five European countries.

This paper discusses computer-supported outbreak detection using routine surveillance data, as implemented at six institutes for infectious disease control in five European countries. We give an overview of the systems used at the Statens Serum Institut (Denmark), Health Protection Agency (England, Wales and Northern Ireland), Robert Koch Institute (Germany), Governmental Institute of Public Health of Lower Saxony (Germany), National Institute for Public Health and the Environment (the Netherlands) and Swedish Institute for Infectious Disease Control (Sweden). Despite the usefulness of the algorithms or the outbreak detection procedure itself, all institutes have experienced certain limitations of the systems. The paper therefore concludes with a list of recommendations for institutes planning to introduce computer-supported outbreak detection, based on experiences on the practical usage of the systems. This list--which concerns usability, standard operating procedures and evaluation--might also inspire improvements of systems in use today.

[Surveillance of infectious diseases at the EU level]. / Surveillance von Infektionskrankheiten auf europäischer Ebene.

The basis for EU wide surveillance was Decision 2119/98/EC of the European Parliament and the Council in 1998. Since May 2005 it is the task of the European Centre for Disease Prevention and Control to coordinate and further develop this network. One key function of the ECDC is to standardise European surveillance and especially to harmonise the procedures of the surveillance networks that developed independently of each other. As a first step, the EU case definitions have been revised jointly with the Member States and the Commission. All surveillance networks are evaluated with a standard protocol before a decision is made at the ECDC on the continuation of the individual network activities. Simultaneously, the development of The European Surveillance System (TESSy) progressed. Since the beginning of 2008 data users have been trained and TESSy has been in use since April 2008. In the future the main focus must be the improvement of the quality and comparability of the data as such data are the essential prerequisite for decision making in public health.

SurvNet@RKI--a multistate electronic reporting system for communicable diseases.

In 2001 Germany implemented a new electronic reporting system for surveillance of notifiable infectious diseases (SurvNet@RKI). The system is currently being used in all 431 local health departments (LHD), the 16 state health departments (SHD) and the Robert Koch-Institut (RKI), the national agency for infectious disease epidemiology. The SurvNet@RKI software is written in MS Access 97 and Visual Basic and it supports MS Access as well as MS SQL Server database management systems as a back-end. The database is designed as a distributed, dynamic database for 73 reporting categories with more than 600 fields and about 7000 predefined entry values. An integrated version management system documents deletion, undeletion, completion and correction of cases at any time and entry level and allows reproduction of previously conducted queries. Integrated algorithms and help functions support data quality and the application of case definitions. RKI makes the system available to all LHDs and SHDs free of charge. RKI receives an average of 300,000 case reports and 6240 outbreak reports per year through this system. A public web-based query interface, SurvStat@RKI, assures extensive and timely publication of the data. During the 5 years that SurvNet@RKI has been running in all LHDs and SHDs in Germany it has coped well with a complex federal structure which makes this system particularly attractive to multinational surveillance networks. The system is currently being migrated to Microsoft C#/.NET and transport formats in XML. Based on our experiences, we provide recommendations for the design and implementation of national or international electronic surveillance systems.

SurvNet@RKI - a multistate electronic reporting system for communicable diseases.

In 2001 Germany implemented a new electronic reporting system for surveillance of notifiable infectious diseases (SurvNet@RKI). The system is currently being used in all 431 local health departments (LHD), the 16 state health departments (SHD) and the Robert Koch-Institut (RKI), the national agency for infectious disease epidemiology. The SurvNet@RKI software is written in MS Access 97 and Visual Basic and it supports MS Access as well as MS SQL Server database management systems as a back-end. The database is designed as a distributed, dynamic database for 73 reporting categories with more than 600 fields and about 7000 predefined entry values. An integrated version management system documents deletion, undeletion, completion and correction of cases at any time and entry level and allows reproduction of previously conducted queries. Integrated algorithms and help functions support data quality and the application of case definitions. RKI makes the system available to all LHDs and SHDs free of charge. RKI receives an average of 300 000 case reports and 6240 outbreak reports per year through this system. A public web-based query interface, SurvStat@RKI, assures extensive and timely publication of the data. During the 5 years that SurvNet@RKI has been running in all LHDs and SHDs in Germany it has coped well with a complex federal structure which makes this system particularly attractive to multinational surveillance networks. The system is currently being migrated to Microsoft C#/.NET and transport formats in XML. Based on our experiences, we provide recommendations for the design and implementation of national or international electronic surveillance systems.

Human immunodeficiency virus, hepatitis C and hepatitis B infections among blood donors in Germany 2000-2002: risk of virus transmission and the impact of nucleic acid amplification testing.

Blood and plasma donations in Germany are collected by several institutions, namely the German Red Cross, community and hospital-based blood services, private blood centres, commercial plasma donation sites and transfusion services of the army. All blood donation centres are required to report quarterly data on infection markers to the Robert Koch Institute, thus providing current and accurate epidemiological data. The prevalence and incidence of relevant viral infections are low in the blood donor population in Germany, with a decreasing trend for hepatitis C infections in new and repeat donors since 1997. The implementation of mandatory nucleic acid amplification technique (NAT) testing for hepatitis C virus (HCV) in 1999 has markedly improved transfusion safety. HIV-NAT became mandatory in 2004 but was done voluntarily by the majority of the blood donation services before then. The potential benefit of hepatitis B virus (HBV) minipool NAT is not as clear because chronic HBV carriers with very low virus levels might donate unidentified. The residual risk of an infectious window period donation inadvertently entering the blood supply can be estimated using a mathematic model which multiplies the incidence rate by the number of days during which an infection may be present but not detectable, i.e. the length of the window period. The risk of an undetected infection without NAT testing was estimated to be 1 in 2 770 000 for HIV, 1 in 670 000 for HCV and 1 in 230 000 for HBV in 2001/2002. This contrasts with 1 in 5 540 000 for HIV, 1 in 4 400 000 for HCV and 1 in 620 000 for HBV with minipool NAT testing. This demonstrates that NAT testing can further reduce the already very small risk of infectious donations entering the blood supply.

Human immunodeficiency virus, hepatitis C and hepatitis B infections among blood donors in Germany 2000-2002: risk of virus transmission and the impact of nucleic acid amplification testing.

Blood and plasma donations in Germany are collected by several institutions, namely the German Red Cross, community and hospital-based blood services, private blood centres, commercial plasma donation sites and transfusion services of the army. All blood donation centres are required to report quarterly data on infection markers to the Robert Koch Institute, thus providing current and accurate epidemiological data. The prevalence and incidence of relevant viral infections are low in the blood donor population in Germany, with a decreasing trend for hepatitis C infections in new and repeat donors since 1997. The implementation of mandatory nucleic acid amplification technique (NAT) testing for hepatitis C virus (HCV) in 1999 has markedly improved transfusion safety. HIV-NAT became mandatory in 2004 but was done voluntarily by the majority of the blood donation services before then. The potential benefit of hepatitis B virus (HBV) minipool NAT is not as clear because chronic HBV carriers with very low virus levels might donate unidentified. The residual risk of an infectious window period donation inadvertently entering the blood supply can be estimated using a mathematic model which multiplies the incidence rate by the number of days during which an infection may be present but not detectable, i.e. the length of the window period. The risk of an undetected infection without NAT testing was estimated to be 1 in 2,770,000 for HIV, 1 in 670,000 for HCV and 1 in 230,000 for HBV in 2001/2002. This contrasts with 1 in 5,540,000 for HIV, 1 in 4,400,000 for HCV and 1 in 620,000 for HBV with minipool NAT testing. This demonstrates that NAT testing can further reduce the already very small risk of infectious donations entering the blood supply.

[Infection epidemiological data among blood donors in Germany 2003-2004. Report of the Robert Koch Institute in accordance with Article 22 of the Transfusion Act]. / Infektionsepidemiologische Daten von Blutspendern 2003-2004. Bericht des Robert Koch-Instituts zu den Meldungen nach [section sign] 22 Transfusionsgesetz.

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany in accordance with Article 22 of the Transfusion Act. This surveillance permits an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2003 and 2004. Altogether 7.09 million and 6.37 million donations or blood samples from prospective donors were screened in 2003 and 2004, respectively. In 2003 the prevalence rates of the relevant infections (per 100,000 donations) were 8.2 for HIV, 99.3 for HCV, 158.9 for HBV and 34.4 for syphilis. In 2003 the rates of seroconversion (per 100,000 donations) were 0.8 for HIV, 1.2 for HCV, 1.0 for HBV and 1.5 for syphilis in 2003. In 2004 the prevalence rates (per 100,000 donations) were 4.8 for HIV, 85.3 for HCV, 156.3 for HBV and 36.8 for syphilis. In 2004 the rates of seroconversion (per 100,000 donations) were 0.9 for HIV, 1.3 for HCV, 0.6 for HBV and 2.0 for syphilis. The analysis showed a very low incidence of infections with a decreasing trend for HCV infections and an increase in HIV and syphilis infections. The latter needs to be monitored carefully and possible causes evaluated. The quality of the reported data has improved compared to previous years. Still, some problems remain with the differentiation of the data according to sex, age and interdonation interval as well as reporting by individual blood donation centres as required by the Transfusion Act.

[Report of the Robert Koch Institute according to Article 22 of the Transfusion Act for the years 2001 and 2002]. / Bericht des Robert Koch-Instituts zu den Meldungen nach (section sign) 22 Transfusionsgesetz für die Jahre 2001 und 2002.

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany according to Article 22 of the Transfusion Act. The surveillance permits an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2001 and 2002. Altogether 5.71 million and 6.63 million donations or blood samples from prospective donors were screened in 2001 and 2002, respectively. The analysis showed a very low incidence of infections with a decreasing trend for HCV infections since 1997 but a slight increase in HIV infections in 2001-2002 compared to 1999-2000. The prevalence of the relevant infections/100,000 donations was 4.7 for HIV, 94.7 for HCV, 159.0 for HBV and 33.4 for syphilis in 2001. The rate of seroconversions/100,000 donations was 0.5 for HIV, 1.6 for HCV, 1.4 for HBV and 1.6 for syphilis in 2001. In 2002 the prevalence/100,000 donations was 7.5 for HIV, 97.4 for HCV, 164.1 for HBV and 31.9 for syphilis. The rate of sero-conversions/100,000 donations in that year was 0.7 for HIV, 1.5 for HCV, 1.2 for HBV and 1.9 for syphilis. The quality of the reported data has improved significantly compared to previous years. Still, some problems remained with the differentiation of the data according to sex, age and interval between donations and the reporting by individual blood donation centres as required by the Transfusion Act.

Operant conditioning of antennal muscle activity in the honey bee (Apis mellifera L.).

Antennal movements of the honey bee can be conditioned operantly under laboratory conditions. Using this behavioural paradigm we have developed a preparation in which the activity of a single antennal muscle has been operantly conditioned. This muscle, the fast flagellum flexor muscle, is innervated by an identified motoneuron whose action potentials correlate 1:1 with the muscle potentials. The activity of the fast flagellum flexor muscle was recorded extracellularly from the scapus of the antenna. The animal was rewarded with a drop of sucrose solution whenever the muscle activity exceeded a defined reward threshold. The reward threshold was one standard deviation above the mean spontaneous frequency prior to conditioning. After ten conditioning trials, the frequency of the muscle potentials had increased significantly compared to the spontaneous frequency. The conditioned changes of frequency were observed for 30 min after conditioning. No significant changes of the frequency were found in the yoke control group. The firing pattern of the muscle potentials did not change significantly after conditioning or feeding. Fixing the antennal joints reduces or abolishes associative operant conditioning. The conditioned changes of the frequency of muscle potentials in the freely moving antenna are directly comparable to the behavioural changes during operant conditioning.