[Immunity against measles among healthcare personnel at the University Hospital Frankfurt, 2003-2013]. / Immunität gegen Masern beim medizinischen Personal des Universitätsklinikums Frankfurt, 2003-2013.

BACKGROUND: Despite aiming for the elimination of measles by 2015, the current epidemiological situation in Germany shows that there is still insufficient vaccination coverage among the population. During the present pre-elimination period, nosocomial measles are gaining in importance. AIM: The purpose of our study was to determine the immune status of measles among healthcare personnel and medical students at the University Hospital Frankfurt. Moreover, the knowledge of study participants regarding the WHO's goal of the elimination of measles and the general attitude towards vaccination recommendations were investigated. METHODS: A retrospective study of measles seroprevalence was conducted among healthcare personnel and students at the University Hospital Frankfurt with an observation period of 11 years. In spring 2014, medical students were asked to complete an anonymous questionnaire regarding vaccination status, knowledge of measles and acceptance of measles vaccination recommendations. RESULTS: In total, 9,933 serologies were evaluated and 85.7% of the participants had sufficient immunity against measles. Significant changes in immunity to measles over time were not observed. However, a significant difference in the immunity rate of participants born before 1970 and those born after1970 was found. Participants born before 1970 significantly more often showed sufficient immunity against measles compared to those born later (96.4 vs. 83.3 %, p < 0.0001). Almost 20 % of the medical students were not aware of their measles vaccination status and merely 70.7 % indicated that they had received two measles vaccinations. Furthermore, only 45.4 % of the medical students were familiar with the WHO's goal of eliminating measles by 2015; however 95 % could be classified as vaccination-supporters on the basis of the questionnaire. CONCLUSIONS: Overall, the immunity rate of measles determined by serology within the study population did not reach the WHO goal of ≥ 95 %, and this gap was even greater in group of medical students. Despite the medical students' positive attitude towards vaccination guidelines, the awareness in this field awaits improvement.

Measles outbreak spreading from the community to an anthroposophic school, Berlin, 2011.

Between April and July 2011 there was an outbreak of measles virus, genotype D4, in Berlin, Germany. We identified 73 case-patients from the community and among students of an anthroposophic school, who participated in a 4-day school trip, as well as their family and friends. Overall, 27% were aged ≥ 20 years, 57% were female and 15% were hospitalized. Of 39 community case-patients, 38% were aged ≥ 20 years, 67% were female and 63% required hospitalization. Unvaccinated students returning from the school trip were excluded from school, limiting transmission. Within the group of 55 school-trip participants, including 20 measles case-patients, a measles vaccine effectiveness of 97.1% (95% confidence interval 83.4-100) for two doses was estimated using exact Poisson regression. Our findings support school exclusions and the recommendation of one-dose catch-up vaccination for everyone born after 1970 with incomplete or unknown vaccination status, in addition to the two-dose routine childhood immunization recommendation.

[Hot spot: epidemiology of measles and rubella in Germany and the WHO European region]. / Hot Spot: Epidemiologie der Masern und Röteln in Deutschland und Europa.

The elimination of measles and rubella by 2015 is an important goal set by the World Health Organization European Region (WHO/Europa). Since 1991, the incidence of measles in WHO/Europa declined owing to routine childhood vaccination and supplementary immunization activities in the region. However, in many countries of Western Europe elimination of measles and rubella remains a challenge, and every year there are outbreaks with partly long-lasting transmission chains and dissemination of the virus internationally. In Germany, outbreaks occur because of the high proportion of susceptible individuals in specific population groups. In 2011, over 1,600 cases were reported (19.7 per 1,000,000 inhabitants, data from the Robert Koch Institute) whereas in 2012 only 167 cases were reported to the Robert Koch Institute (2 per 1,000,000 inhabitants). It is unclear whether the declining trend will continue in the following years due to improved vaccination coverage or whether number of cases will rise again because of the accumulation of susceptible groups. In Germany, there are currently no representative, country-wide data on rubella; however, data from the eastern federal states provide important epidemiological insights. Outbreaks are seldom reported, but statutory notification of rubella and congenital rubella syndrome was implemented in March 2013. As a result, it will be possible to better assess the epidemiology of rubella in Germany, although a considerable underreporting of rubella cases is anticipated.

[The German National Verification Committee for Measles and Rubella Elimination]. / Quo vadis Germania? Die Nationale Kommission zur Verifizierung der Elimination der Masern und Röteln.

BACKGROUND: Since 1984, the World Health Organization (WHO) European Region has pursued the goal of eliminating measles. In 2005, it was decided to also stop the endemic transmission of rubellavirus, thereby eliminating congenital rubella syndrome. Both infections are to be eliminated by 2015. To document the progress and verify the elimination at country level, national verification committees should be established in WHO EU memberstates. PROCEDURE: In December 2012, the German Ministry of Health appointed the German National Verification Committee for Measles and Rubella Elimination. The commission meets at least twice a year to compile and analyze data on the epidemiology of measles and rubella in Germany and on the vaccination coverage/ immunity of the German population against these infections to assess progress in the elimination goals. Furthermore, the commission indicates whether the available data are sufficient or contain inconsistencies, evaluates the success of key strategies implemented, and advises on activities related to the verification of the elimination process in the country. A scientific report on the commission's findings is to be submitted annually to the WHO regional office. FUTURE PROSPECTS: Germany is committed to the aim of eliminating measles and rubella. Thus, every possible effort should be made to reach this goal by the responsible players in the German immunization system. The commission - as an independent group of experts - will critically accompany and evaluate this process.

[Pertussis vaccination coverage among adults in Germany]. / Pertussis-impfquoten bei erwachsenen in Deutschland.

BACKGROUND: Pertussis vaccination for risk-groups (e. g. healthcare workers, employees of communal facilities, or persons with close contact to infants) has been recommended in Germany since 2001. In 2009, single-dose acellular pertussis (ap) vaccination was recommended for all adults at the next tetanus-diphtheria (Td) booster. Study aims were to assess 1) pertussis vaccination coverage in adults, and 2) use of tetanus-containing combination vaccines in hospitals. METHODS: For 1) we analysed data from two population-based telephone surveys conducted among adults in Germany in 2009/2010 (GEDA09: n = 21,262; GEDA10: n = 22,050). Factors associated with vaccination were identified by logistic regression analyses. For 2) a questionnaire survey of 133 hospital pharmacies serving 454 German hospitals was undertaken for the year 2007. RESULTS: Overall, 5.9% (95% confidence interval [CI] 5.5-6.3%) of GEDA10 participants reported up-to-date pertussis vaccination (ap-vaccination in past 10 years). In risk-groups, vaccination coverage was 10.7% (95%-CI 9.8-11.7%). Residence in former East-Germany and younger age were independently associated with an adequate vaccination status. Contrary to prevailing recommendations, ~75% of tetanus vaccines were administered as monovalent rather than Td- (or Tdap-)combination vaccines in hospitals. CONCLUSIONS: In light of high pertussis-incidence and low vaccination coverage in German adults, improvement of pertussis vaccine uptake is vital, e. g. through awareness campaigns targeting both physicians in private practice and hospitals.

Cohort profile: the German ClinSurv HIV project--a multicentre open clinical cohort study supplementing national HIV surveillance.

BACKGROUND: New forms of HIV/AIDS therapy require new surveillance instruments to meet shifting public health demands. The Clinical Surveillance of HIV Disease (ClinSurv HIV) project was established in 1999 as a collaboration between major HIV treatment centres in Germany and the Robert Koch Institute (RKI). The project contributes to national HIV surveillance and focuses on the changing epidemiology of HIV/AIDS after the introduction of new therapies in 1995. METHODS: ClinSurv HIV is designed as an open multicentre observational cohort study of HIV-infected patients. Anonymized data on diagnoses, treatment and laboratory parameters are collected in a standardized format. Data are currently sampled biannually via 11 centres specializing in HIV diagnosis and care within the legal framework of the German Protection against Infection Act [Infektionsschutzgesetz (IfSG)]. RESULTS: A total of 14874 patients were enrolled in the study by 30 June 2009. Of these, 10221 patients (68.7%) were enrolled after 1 January 1999 and 6006 patients (40.4%) were known to have been diagnosed as positive for HIV before 1999. Evaluation indicators, such as the number of newly enrolled patients per half-year period, loss to follow-up, completeness of data per case, availability of data per possible clinical contact, and internal quality control parameters, show a very stable evolution in the cohort, which although open, can be observed. Comparison with the national HIV surveillance data suggests a high degree of representativeness according to major demographic variables. CONCLUSION: Bearing in mind the obvious strengths and weaknesses discussed, the German ClinSurv HIV cohort provides a broad range of research opportunities in the field of HIV/AIDS both within Germany and in international collaborative research.

Comparative varicella vaccine effectiveness during outbreaks in day-care centres.

BACKGROUND: Routine varicella vaccination for children >11 months was introduced in Germany in 2004 with three different vaccine brands available. In 2008 and 2009, we investigated seven varicella outbreaks in day-care centres (DCC). METHODS: Varicella disease and vaccination status of 1084 children was reviewed to evaluate vaccination coverage (VC), brand-specific varicella vaccine effectiveness (VE), and risk factors of breakthrough varicella (BV, >42 days after vaccination). A case was defined as a child with acute onset of varicella attending one of the respective DCC at the time of outbreak. Children with a previous history of varicella, age<11 months, vaccinated at age<11 months or <42 days before disease onset or during the outbreak were excluded from VE and BV risk factors analyses (adjusted for gender, age and DCC). FINDINGS: Of 631 children with available vaccination information, 392 (62%) were vaccinated at least once. Overall VE among 352 children eligible was 71% (95% confidence interval (CI) 57-81, p<0.001) and differed significantly by disease severity and number of doses administered. Risk for BV was higher for 1 dose of Varilrix (RR=2.8, 95%CI 1.0-7.8, p=0.05) or Priorix-Tetra (RR=2.4, 95%CI 0.7-8.3, p=0.18) but lower for 2 doses of Priorix-Tetra (RR=0.5, 95%CI 0.1-2.7, p=0.41) than for 1 dose of Varivax. INTERPRETATION: Enhanced efforts to increase VC in Germany and 2 doses varicella vaccine might be successful to reduce the risk for BV. The evidence that VE and risk of BV are associated with vaccine brand needs further investigation.

[Costs of ambulant care for patients with inflammatory bowel disease in general practice]. / Kosten der allgemeinmedizinischen Versorgung von Patienten mit chronisch-entzündlichen Darmerkrankungen.

BACKGROUND: Outpatient care managed by general practitioners plays an important role in diagnostic and treatment of inflammatory bowel diseases (IBD). The chronic recurrent course often requires intensive and costly medical care. OBJECTIVE: To measure the costs of outpatient care for patients with IBD provided by general practitioners (GPs). MATERIAL AND METHODS: The analysis is based on an electronic data base implemented in 100 general practices in different parts of Germany. 191 patients with altogether 705 consultations over a period of one year were included in the analysis. Costs of care were measured using German fee schedules for health care delivery and market prices for drugs. RESULTS: In a 12-months-period the mean number GP-contacts was 3.6. Mean costs were 23.61 euro; per visit and annual costs were 87.15 euro; per patient. Pharmacotherapy was used by 147 patients (77%) and caused costs of 613.40 euro; per year, with 64% due to the use of salicylates. 66 patients (35%) also had diagnostic services provided from specialists, 7 patients (4%) required psychotherapeutic care. CONCLUSION: The presented study is the first to analyse in detail the costs for medical care of IBD in general practices in Germany. Results can be used in economic assessment of the disease and in cost-effectiveness-analyses of intervention strategies. They may support treatment guidelines and treatment decisions from an economic point of view.