Effectiveness of the AS03-adjuvanted vaccine against pandemic influenza virus A/(H1N1) 2009--a comparison of two methods; Germany, 2009/10.

During the autumn wave of the pandemic influenza virus A/(H1N1) 2009 (pIV) the German population was offered an AS03-adjuvanted vaccine. The authors compared results of two methods calculating the effectiveness of the vaccine (VE). The test-negative case-control method used data from virologic surveillance including influenza-positive and negative patients. An innovative case-series methodology explored data from all nationally reported laboratory-confirmed influenza cases. The proportion of reported cases occurring in vaccinees during an assumed unprotected phase after vaccination was compared with that occurring in vaccinees during their assumed protected phase. The test-negative case-control method included 1,749 pIV cases and 2,087 influenza test-negative individuals of whom 6 (0.3%) and 36 (1.7%), respectively, were vaccinated. The case series method included data from 73,280 cases. VE in the two methods was 79% (95% confidence interval (CI) = 35-93%; P = 0.007) and 87% (95% CI = 78-92%; P<0.001) for individuals less than 14 years of age and 70% (95% CI = -45%-94%, P = 0.13) and 74% (95% CI = 64-82%; P<0.001) for individuals above the age of 14. Both methods yielded similar VE in both age groups; and VE for the younger age group seemed to be higher.

SurvNet electronic surveillance system for infectious disease outbreaks, Germany.

In 2001, the Robert Koch Institute (RKI) implemented a new electronic surveillance system (SurvNet) for infectious disease outbreaks in Germany. SurvNet has captured 30,578 outbreak reports in 2001-2005. The size of the outbreaks ranged from 2 to 527 cases. For outbreaks reported in 2002-2005, the median duration from notification of the first case to the local health department until receipt of the outbreak report at RKI was 7 days. Median outbreak duration ranged from 1 day (caused by Campylobacter) up to 73 days (caused by Mycobacterium tuberculosis). The most common settings among the 10,008 entries for 9,946 outbreaks in 2004 and 2005 were households (5,262; 53%), nursing homes (1,218; 12%), and hospitals (1,248; 12%). SurvNet may be a useful tool for other outbreak surveillance systems because it minimizes the workload of local health departments and captures outbreaks even when causative pathogens have not yet been identified.

SARS outbreak in Germany 2003: workload of local health departments and their compliance in quarantine measures--implications for outbreak modeling and surge capacity?

OBJECTIVE: Public health management of severe acute respiratory syndrome epidemic must be evaluated to improve contingency planning for epidemics. METHODS: Standardized questionnaires on case management were sent to local health departments of 15 of 16 states in Germany. RESULTS: Of the 384 local health departments who received the questionnaire, 280 (72%) completed them. They reported 271 suspect or probable severe acute respiratory syndrome cases under investigation (average 4.7). The average duration of quarantine was 5.4 days. Contacts without professional activity were 2.78 times more likely to stay under 10-day quarantine than those with professional activity (CI: 0.80-9.86). Local health departments with at least one case under investigation had invested an average of 104.5 working hours. CONCLUSIONS: Our contact-case ratios may serve for planning for modeling in epidemics. We found discrepancies between local and national surveillance figures; home quarantine was frequently not applied as recommended and the burden on urban health departments was disproportionally higher. Flexibility of the national surveillance system and surge capacity for the prevention of future epidemics need improvement, particularly in urban health departments.