RESUMEN
BACKGROUND: Tracing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission chains is still a major challenge for public health authorities, when incidental contacts are not recalled or are not perceived as potential risk contacts. Viral sequencing can address key questions about SARS-CoV-2 evolution and may support reconstruction of viral transmission networks by integration of molecular epidemiology into classical contact tracing. METHODS: In collaboration with local public health authorities, we set up an integrated system of genomic surveillance in an urban setting, combining a) viral surveillance sequencing, b) genetically based identification of infection clusters in the population, c) integration of public health authority contact tracing data, and d) a user-friendly dashboard application as a central data analysis platform. RESULTS: Application of the integrated system from August to December 2020 enabled a characterization of viral population structure, analysis of 4 outbreaks at a maximum care hospital, and genetically based identification of 5 putative population infection clusters, all of which were confirmed by contact tracing. The system contributed to the development of improved hospital infection control and prevention measures and enabled the identification of previously unrecognized transmission chains, involving a martial arts gym and establishing a link between the hospital to the local population. CONCLUSIONS: Integrated systems of genomic surveillance could contribute to the monitoring and, potentially, improved management of SARS-CoV-2 transmission in the population.
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COVID-19 , SARS-CoV-2 , COVID-19/epidemiología , Trazado de Contacto , Brotes de Enfermedades/prevención & control , Genómica , Humanos , SARS-CoV-2/genéticaRESUMEN
BackgroundTracking person-to-person SARS-CoV-2 transmission in the population is important to understand the epidemiology of community transmission and may contribute to the containment of SARS-CoV-2. Neither contact tracing nor genomic surveillance alone, however, are typically sufficient to achieve this objective.AimWe demonstrate the successful application of the integrated genomic surveillance (IGS) system of the German city of Düsseldorf for tracing SARS-CoV-2 transmission chains in the population as well as detecting and investigating travel-associated SARS-CoV-2 infection clusters.MethodsGenomic surveillance, phylogenetic analysis, and structured case interviews were integrated to elucidate two genetically defined clusters of SARS-CoV-2 isolates detected by IGS in Düsseldorf in July 2021.ResultsCluster 1 (n = 67 Düsseldorf cases) and Cluster 2 (n = 36) were detected in a surveillance dataset of 518 high-quality SARS-CoV-2 genomes from Düsseldorf (53% of total cases, sampled mid-June to July 2021). Cluster 1 could be traced back to a complex pattern of transmission in nightlife venues following a putative importation by a SARS-CoV-2-infected return traveller (IP) in late June; 28 SARS-CoV-2 cases could be epidemiologically directly linked to IP. Supported by viral genome data from Spain, Cluster 2 was shown to represent multiple independent introduction events of a viral strain circulating in Catalonia and other European countries, followed by diffuse community transmission in Düsseldorf.ConclusionIGS enabled high-resolution tracing of SARS-CoV-2 transmission in an internationally connected city during community transmission and provided infection chain-level evidence of the downstream propagation of travel-imported SARS-CoV-2 cases.
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COVID-19 , Enfermedades Transmisibles Importadas , Humanos , SARS-CoV-2/genética , Viaje , Enfermedades Transmisibles Importadas/epidemiología , COVID-19/epidemiología , Filogenia , Trazado de Contacto , Alemania/epidemiología , GenómicaRESUMEN
COVID-19 has been challenging our society since January 2020. Due to global travel, the new coronavirus has rapidly spread worldwide. This article aims to provide an overview of the challenges in implementing measures in the air and maritime transport sector from the perspective of the German Public Health Service (Öffentlicher Gesundheitsdienst, ÖGD). Significant events and measures for air and maritime transport between January and August 2020 were selected. Lessons learned are discussed.During the COVID-19 pandemic, the ÖGD has been operating in a field of tension between the dynamics of scientific knowledge, political decision-making, social acceptance and consent.There are specific challenges at points of entry such as airports and seaports. These include staff shortages and the need to implement measures with a high organisational effort at very short notice such as health authority passenger checks carried out on aircraft, the establishment of test centres at points of entry and control of compliance with quarantine measures. Aggravating the situation, passenger lists, which are necessary for effective contact tracing, are often not available or incomplete. There is also a lack of digital tools for contact tracing but also, for example, the exchange of personal data within the ÖGD. Further difficulties in outbreak management arise from the cramped conditions on board ships and from the potential psychological stress on crew members and passengers, which have not yet been sufficiently considered.In view of all these challenges, it is paramount to strengthen the German Public Health Service in general and at points of entry and to intensify the exchange between the national, federal state and local levels.
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COVID-19 , Pandemias , Alemania/epidemiología , Servicios de Salud , Humanos , Pandemias/prevención & control , Salud Pública , Cuarentena , SARS-CoV-2RESUMEN
BACKGROUND: The local health authority (Gesundheitsamt) in Düsseldorf, Germany aimed to investigate the current immunization status of nursery school children and pedagogues in Düsseldorf, Germany. Furthermore, analysing the association between Düsseldorf's 5 social environment clusters and immunization status was of interest. Especially due to recent changes in the German Infection Protection Act closely monitoring adverse immunization trends becomes increasingly important. METHODS: Weighted cluster random sampling was used in order to draw a sample of 50 nursery schools from the 5 social environment clusters. Questionnaires were sent to the nursery schools and data were subsequently analysed using descriptive statistics. RESULTS: The results indicate that 76.0% of the children were immunized in time against MMR, 68.2% against varicella and 75.4% against meningococcal serogroup C. Data indicated a higher number of immunized children among older age groups. 96.4% of staff members born after 1970 were not vaccinated against varicella, 17.9% were not immunized against MMR and 82.1% were not vaccinated against meningococcal serogroup C. CONCLUSION: Immunization rates of children in nursery schools in Düsseldorf are far lower compared to local, federal and nationwide data of children's school entrance health examination. Especially in nursery schools that care for children younger than 12 months, herd immunity is crucial. Therefore, administering vaccines with a delay is considered to be precarious. Due to low response rates, inferential statistics could not be used and conclusions about the staff members' data are limited.
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Inmunización , Escuelas de Párvulos , Instituciones Académicas , Niño , Estudios Transversales , Alemania , HumanosRESUMEN
BACKGROUND: Additional scientific surveys within the compulsory school entrance examination (SEE) have become increasingly popular, partly because the SEE potentially reaches all socioeconomic groups. However, it has not been sufficiently explored whether selective participation in voluntary supplementary surveys actually results in no selection bias along socioeconomic characteristics. Therefore, the aim of this study is to analyze the participation of potentially hard-to-reach families in a parent survey at the SEE. MATERIALS AND METHODS: The parent survey on the utilization of community prevention has been linked to the SEE in a community in North Rhine-Westphalia. We compared families with low and higher education (CASMIN classification), families with and without migration background (at least one parent was not born in Germany), as well as single-parent and two-parent families. Using logistic regression we analyzed whether survey participation (nâ¯= 3410) and non-participation (nâ¯= 346) was different along all three indicators. RESULTS: Families with low education were slightly more often among the group of participants compared to non-participants (11.2 vs. 8.8%; odds ratio (OR) 1.29; 95% confidence interval (CI) 0.85-1.95) and single-parent families slightly less often (14.1 vs. 17.7%; OR 0.75; 95% CI 0.55-1.02). Families with migration background participated significantly more often (52.9 vs. 46.1%; OR 1.27; 95% CI 1.01-1.60). CONCLUSIONS: Hard-to-reach families could be recruited for a voluntary parent survey in the SEE to a satisfying degree. This illustrates the potential of the SEE for population-based basic and evaluation research.
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Padres , Criterios de Admisión Escolar , Instituciones Académicas , Clase Social , Alemania , Humanos , Oportunidad Relativa , Encuestas y CuestionariosRESUMEN
Kaposi's sarcoma in HIV-infected patients is a sign of progressive immunodeficiency. It is therefore classified as an AIDS-defining disease according to the CDC classification of 1993. Before antiretroviral therapy became available, disseminated Kaposi's sarcoma was a common therapeutic problem in HIV-infected patients. Therapeutic interventions were limited and in spite of interferon, irradiation or cytostatic drugs, chances of a definitive healing were minimal.Today, disseminated Kaposi's sarcoma is rare even in specialized clinics for infectious diseases. An exception are patients who are not aware of their HIV serostatus until they are diagnosed HIV-positive and who present already with a progressive immunodeficiency.
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Infecciones por VIH/complicaciones , Sarcoma de Kaposi/complicaciones , Neoplasias Cutáneas/complicaciones , Anciano , Anciano de 80 o más Años , Terapia Antirretroviral Altamente Activa , Biopsia , Diagnóstico Diferencial , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/patología , Piel/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Insuficiencia Venosa/diagnósticoRESUMEN
Malaria due to Plasmodium ovale is uncommon outside West Africa. A 37-year-old male German who had returned from Malawi four months previously presented in September 2003 because of fever recurring every two days. The patient had never been to West Africa. Microscopy of stained thick and thin blood films revealed P. ovale. This is the first report of a P. ovale infection acquired in Malawi, East Africa. Malaria surveillance centres should monitor the possible emergence of autochtonous transmission of P. ovale in the area.
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Malaria/diagnóstico , Plasmodium ovale/aislamiento & purificación , Adulto , Humanos , Malaria/transmisión , Malaui , Masculino , ViajeRESUMEN
BACKGROUND: Dengue is a mosquito-borne viral infection endemic throughout the tropics and subtropics. The global prevalence of dengue has grown dramatically in recent years and it has been recognized as a potential hazard to tourists. OBJECTIVE: In this study, we analyzed the epidemiology, clinical manifestations, laboratory features and serological/virological results in a series of German travellers returning to Berlin with acute dengue virus infection. STUDY DESIGN: Laboratory-confirmed dengue virus infections among German travellers returning to Berlin were studied retrospectively during the period of 1993-2001. Seventy-one patients tested positive for dengue fever and were included in this study. RESULTS: The majority of patients (77.5%) contracted the disease in South Central and South East Asia. The most important clinical characteristics were fever and prostration (100%), headache, predominantly frontal or retroorbital (86%), arthralgia (79%), morbilliform rash (66%) and myalgia (48%). The most meaningful laboratory results were: marked leucopenia (72%), thrombocytopenia (70-89%), hyponatremia (41%) and increased hepatic enzymes ALAT (41%), ASAT (45%) and LDH (62%). Dengue virus infection was diagnosed by means of a matching clinico-epidemiological history and positivity of specific serology and/or virus isolation. Hemorrhagic phenomena appeared in 10 of the 71 patients (14%), out of which one was diagnosed with DHF according to WHO criteria. All patients recovered fully. CONCLUSION: Pretravel advice should be given to all travellers to dengue-endemic areas. DF must be included in the differential diagnosis of patients returning febrile from tropical areas.
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Virus del Dengue/aislamiento & purificación , Dengue/epidemiología , Viaje , Adolescente , Adulto , Anciano , Berlin/epidemiología , Dengue/sangre , Dengue/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
In a prospective study amongst febrile travellers returning from malaria-endemic areas to Berlin, Germany, two rapid malarial antigen detection tests were compared for the diagnosis of vivax malaria with routine microscopy. With ICT Malaria P.f./P.v.((R)), 664 samples of 492 patients were examined. 17 patients had vivax malaria, out of which 11 infections were missed (35.3% sensitivity). With OptiMal((R)), 659 samples of 539 patients were examined. 22 patients had vivax malaria, and all infections were identified correctly (100% sensitivity). Specificity was 100% with both tests. The ICT Malaria P.f./P.v.((R)) is advertised for layman use during travel, and the literature was reviewed with respect to the question of suitability of these devices for self-testing. It is concluded that with the ICT Malaria P.f./P.v.((R)), the detection of non-falciparum (i.e. predominantly vivax) malaria is unreliable, and test interpretation for medically untrained individuals particularly in distress might be too complicated even after proper instruction.
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Malaria Falciparum/complicaciones , Malaria Falciparum/diagnóstico , Enfermedad de Tangier/complicaciones , Enfermedad de Tangier/diagnóstico , Adulto , Animales , Antimaláricos/uso terapéutico , Alemania , Humanos , Malaria Falciparum/tratamiento farmacológico , Masculino , Plasmodium falciparum/aislamiento & purificación , Quinina/uso terapéutico , Enfermedad de Tangier/fisiopatologíaRESUMEN
Sonographers increasingly face imported diseases such as subcutaneous myiasis. In myiasis, some fly species such as the American Dermatobia hominis and the African Cordylobia anthropophaga use humans as intermediate hosts for the maturation of their larvae. High-resolution gray-scale and color Doppler sonography enabled us to identify D hominis larvae in 2 travelers to Central America by visualizing their typical shape, segmentations, and the continuous fluid transport inside the larval body cavity and spiracles. The small C anthropophaga larva in an individual returning from Namibia was initially not detected. Only when using color Doppler sonography was the larva discerned by its intralarval fluid transport. Sonography enables clinicians to locate viable subcutaneous larvae in suspected cases of myiasis.
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Dípteros , Miasis/diagnóstico , Tejido Subcutáneo/diagnóstico por imagen , Tejido Subcutáneo/parasitología , Adulto , Animales , Femenino , Humanos , Larva , Masculino , Persona de Mediana Edad , Miasis/parasitología , Miasis/cirugía , Tejido Subcutáneo/cirugía , Viaje , Ultrasonografía Doppler en ColorRESUMEN
Plasmodium malariae is regarded as usually being susceptible to all anti-malarials whether applied for prophylaxis or treatment. We report on three cases of P. malariae infection which occurred 12-14 weeks after anti-malarial chemoprophylaxis or treatment with mefloquine or atovaquone/proguanil. The most likely explanation for the failure of mefloquine and atovaquone/proguanil to prevent quartan malaria occurring some months later is the insufficient effect on the particularly long-lasting pre-erythrocytic development stages of P. malariae.
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Antimaláricos/uso terapéutico , Malaria/diagnóstico , Plasmodium malariae/patogenicidad , Adulto , Animales , ADN Protozoario/genética , ADN Protozoario/aislamiento & purificación , Alemania , Ghana , Humanos , Kenia , Malaria/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Plasmodium malariae/genética , Reacción en Cadena de la Polimerasa , ViajeRESUMEN
Cerebral malaria, the most frequent complication of falciparum malaria, is usually predicted by an increased count of asexual parasites in peripheral blood. We report a case of a female returnee from Ghana who developed cerebral malaria in spite of parasite clearance in peripheral blood after therapy with atovaquone/proguanil.
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Antimaláricos/uso terapéutico , Atovacuona/uso terapéutico , Malaria Cerebral/tratamiento farmacológico , Malaria Cerebral/parasitología , Plasmodium falciparum/efectos de los fármacos , Proguanil/uso terapéutico , Adulto , Animales , Artemisininas/uso terapéutico , Artesunato , Femenino , Humanos , Plasmodium falciparum/aislamiento & purificación , Quinina/uso terapéutico , Sesquiterpenos/uso terapéuticoRESUMEN
A 44-year old West-African living in Germany since 18 years presented because of persistent painful swelling of both ankle joints and diffuse lymphoedema of feet occurring after a trip to Morocco. Laboratory tests revealed inflammation and eosinophilia. HLA-B27 was positive. Antinuclear antibodies and rheuma factors were not found. There was no evidence of an infection with bacteria or viruses known to cause arthritis. Filariasis was excluded. Microscopy of fresh stool revealed larvae of Strongyloides stercoralis. Symptoms resolved after specific antihelminthic therapy with ivermectin 0.2 mg kg(-1) day(-1) for 2 days and non-steroidal anti-inflammatorials. Reactive arthritis is known to be caused by various bacterial agents. In some individuals, arthritis may be due to helminths, such as S. stercoralis. Patients with strongyloidiasis may respond to non-steroidal anti-inflammatorials but must not undergo treatment with corticosteroids before having received antihelminthic therapy because immunosuppression may result in life-threatening strongyloides hyperinfection syndrome.
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Artritis Reactiva/patología , Población Negra/genética , Antígeno HLA-B27/genética , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/complicaciones , Adulto , Animales , Antiinflamatorios no Esteroideos/uso terapéutico , Antinematodos/uso terapéutico , Artritis Reactiva/tratamiento farmacológico , Heces/parasitología , Alemania , Humanos , Ivermectina/uso terapéutico , Masculino , Marruecos , Sierra Leona/etnología , Estrongiloidiasis/tratamiento farmacológico , Estrongiloidiasis/parasitología , Estrongiloidiasis/patología , ViajeRESUMEN
OBJECTIVES: The success of highly active antiretroviral therapy (HAART) in HIV infection may be influenced by numerous host factors. There is a lack of data presenting a combined assessment of a variety of these parameters for treatment efficacy in clinical routine practice. METHODS: Different indices of therapeutic drug monitoring (TDM) were evaluated prospectively in the context of self-reported adherence, health-related quality of life and social determinants, as measured by a questionnaire. RESULTS: A total of 210 individuals were studied between 2002 and 2004, 77% were males, mean age was 44 years, mean CD4 count was 336 cells/mm3 and 63% had a viral load < 50 copies/mL. In univariate analysis, baseline viral load, unscheduled drug levels, a 4 h pharmacokinetic profile (PK-P) at a scheduled visit and self-reported complete adherence within the previous 2 weeks were significantly associated with virological success of HAART at 12 weeks. At 24 weeks, only baseline viral load, the 4 h PK-P and adherence were significantly associated with HAART efficacy. In multivariate analysis, baseline viral load, adherence, unscheduled drug levels, trough levels at a visit with appointment as well as the 4 h PK-P were significantly associated with virological success at 12 weeks. At 24 weeks, only adherence was significantly linked to outcome. The other parameters were not found to have an impact on treatment efficacy. CONCLUSIONS: TDM and self-reported adherence were independently predictive of short-term HAART success in this prospective study. Unscheduled drug measurements provided similar diagnostic information as a 4 h PK-P. Thus, we propose the use of unscheduled drug level monitoring and self-reported adherence to help identify patients with elevated risk of virological failure.
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Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Adulto , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/sangre , Esquema de Medicación , Monitoreo de Drogas , Femenino , Infecciones por VIH/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Cooperación del Paciente , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Carga ViralRESUMEN
Falciparum Malaria is hyperendemic in southern Nigeria and chloroquine resistance is an increasing problem. Therefore, the parasitological and haematological response to treatment with amodiaquine was studied in children under 5 years during a 14-day follow-up. Of 105 children who accomplished the study (out of 114 who were enrolled), 95.3% were parasite-negative on thick blood film on day 7, which decreased to 89.5% on day 14. The haemoglobin levels increased on average by 1.3% on day 14 (+/-1.9) and more pronounced in children with anaemia<10 g/dl on enrollment. The number of patients with adverse events (mainly pruritus and nausea) was few. This study shows that amodiaquine is effective, safe and affordable in an area with high resistance to chloroquine.
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Amodiaquina/farmacología , Amodiaquina/uso terapéutico , Antimaláricos/uso terapéutico , Cloroquina/farmacología , Malaria Falciparum/tratamiento farmacológico , Plasmodium falciparum/efectos de los fármacos , Pirimetamina/farmacología , Sulfadoxina/farmacología , Amodiaquina/efectos adversos , Animales , Antimaláricos/farmacología , Preescolar , Combinación de Medicamentos , Resistencia a Medicamentos , Femenino , Hemoglobinas/análisis , Humanos , Lactante , Malaria Falciparum/parasitología , Masculino , Nigeria , ParasitemiaRESUMEN
Dengue is a mosquito-borne viral infection endemic throughout the tropics and subtropics. The global prevalence of dengue has grown dramatically in recent years and it has become a major international public health concern. The close taxonomic relationships between yellow fever and dengue viruses gave rise to concerns that previous vaccination against yellow fever could modify the course of dengue infection and contribute to the development of dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). This study reports the clinical and laboratory features of dengue virus-infected travellers previously vaccinated against yellow fever.
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Dengue/diagnóstico , Dengue/inmunología , Vacuna contra la Fiebre Amarilla/inmunología , Adulto , Virus del Dengue , Femenino , Humanos , Masculino , Persona de Mediana Edad , ViajeRESUMEN
The immunochromatographic test (ICT) for the rapid diagnosis of malaria has been marketed for several years. In a study in which three Centres of Tropical Medicine participated and data were pooled, performance of the test varied considerably when comparing the results between each centre. The sensitivity of ICT in 2,343 patients tested in our services was 100% and the specificity 99.74%. Moreover, two patients with a positive ICT would initially have been missed by expert microscopy, with Plasmodium falciparum malaria being confirmed microscopically some hours later. The principal reasons for the better performance of the test in our series appear to be blood collection in EDTA vials and considerable experience with handling and interpreting the ICT test.
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Malaria Falciparum/diagnóstico , Plasmodium falciparum/aislamiento & purificación , Proteínas Protozoarias/análisis , Juego de Reactivos para Diagnóstico , Animales , Recolección de Muestras de Sangre , Cromatografía , Humanos , Técnicas Inmunológicas , Parasitemia , Plasmodium falciparum/química , Proteínas/análisis , Sensibilidad y EspecificidadRESUMEN
The combined immuno-chromographic-malaria dipstick (ICT) for the rapid diagnosis of malaria detects both Plasmodium falciparum (P.f.)-specific, histidine-rich protein 2 (HRP-2) and a plasmodial aldolase expressed by all Plasmodium species pathogenic to humans. ICT was applied in 674 febrile returnees from malaria-endemic regions attending our Tropical Diseases Unit. Microscopy confirmed malaria in 69/674 cases, of whom 67/69 had returned from Africa or Madagascar, and 2/69 from the Caribbean. Monoparasitic P.f. infection occurred in 52/69, mixed infection was due to P.f.+ P. ovale (P.o.) in 3/69, and P.f.+P. malariae (P.m.) in 1/69 cases. Monoparasitic P. vivax (P.v.) infection occurred in 8/69 , P.o. in 3/69, and P.m. in 2/69 cases . Whereas a positive HRP-2 band on the test was a highly sensitive indicator for P.f. infection (52/52 patients; sensitivity 100%), this was not the case for a positive aldolase band (25/52 patients; sensitivity 48.1%). Sensitivity of aldolase band for non-falciparum plasmodia was even lower: aldolase was positive in only 3/8 (37.5%) of patients with vivax malaria, and in 0/5 cases with P.o.- or P.m. infection. Co-reaction of both bands occurred more frequently in patients with P.f. parasitaemia of > or =40,000/microl (20/25, 80.0%) as compared to patients with P.f. parasitaemia <40,000/microl (5/27, 18.5%; P<0.00005), and to patients with mixed infection (P.f.+ P.o., P.f.+ P.m.: 2/4, 50.0%; diff. n.s.). In our series, co-reaction of HRP-2 and aldolase indicated monoparasitic falciparum malaria with high P.f. parasitaemia, rather than mixed infection. Whereas the aldolase band is not a reliable qualitative marker for malaria, co-reaction of HRP-2 and aldolase band may have a potential for indicating high parasitaemia in falciparum malaria.