[The 2015 edition of case definitions for the surveillance of notifiable infectious diseases in Germany]. / Falldefinitionen für die Surveillance meldepflichtiger Infektionskrankheiten in Deutschland, Ausgabe 2015.

Case definitions ensure standardised criteria for the surveillance of infectious diseases in Germany. Since its last revision in 2007, an update of the complete case definition edition became necessary due to new scientific insights, changes in legislature, terminology and classification systems. At the same time, the case definition should be further standardised and work at local public health authorities should be simplified. The department for infectious disease epidemiology at the Robert Koch Institute (RKI) coordinated the revision of the case definitions. During several feedback sessions, internal RKI experts and external experts from different levels of the German public health system, as well as from medical associations and laboratories, were involved in the revision process. The new edition and an annotated version are published on the RKI website (www.rki.de/falldefinitionen). The new case definitions will become effective on 1st January 2015. The most important changes are summarised in this article.

Autochthonous dengue virus infection in Japan imported into Germany, September 2013.

In September 2013, dengue virus (DENV) infection was diagnosed in a German traveller returning from Japan. DENV-specific IgM and IgG and DENV NS1 antigen were detected in the patient's blood, as were DENV serotype 2-specific antibodies. Public health authorities should be aware that autochthonous transmission of this emerging virus may occur in Japan. Our findings also highlight the importance of taking a full travel history, even from travellers not returning from tropical countries, to assess potential infection risks of patients.

Increase in malaria cases imported from Pakistan to Germany in 2012.

A significant increase of malaria cases imported to Germany from Pakistan was observed in 2012. As of 14 November, Pakistan was the country of infection in 32 out of 434 malaria cases in 2012, compared to zero to eight annual malaria cases (out of over 500 cases) in previous years. Physicians and public health authorities should consider malaria in febrile patients returning or migrating from Pakistan.

[The historical development of immunization in Germany. From compulsory smallpox vaccination to a National Action Plan on Immunization]. / Vom Zwang zur Pockenschutzimpfung zum Nationalen Impfplan. Die Entwicklung des Impfwesens vom Deutschen Kaiserreich bis heute.

In the German Reich, smallpox vaccinations were organized by the state. A mandatory vaccination throughout the empire was introduced in 1874, which was continued in the Federal Republic of Germany (FRG) and the German Democratic Republic (GDR) until 1982/1983. From 1935, health departments were responsible for vaccinations. In the GDR, immunization was tightly organized: The state made great efforts to achieve high vaccination rates. Responsibilities were clearly defined at all levels and for all ages. While vaccination was initially mandatory only at the regional level, the legally mandated immunization schedule later contained compulsory vaccinations, e.g., against measles. In the beginning there were mandatory vaccinations in the FRG at the Länder level. Since 1961, the Federal Epidemics Act has impeded obligatory vaccinations. Instead, voluntary vaccinations based on recommendations were stressed. Since the 1980s, vaccinations have been shifted from the public health service sector to office-based physicians. Today, public health authorities offer mainly supplementary vaccinations. In 2007, protective immunizations were introduced as compulsory benefits of the statutory health insurance (SHI). Recently, the German federal states developed a National Vaccination Plan to support immunization strategies.

Increasing case numbers of adenovirus conjunctivitis in Germany, 2010.

In 2010 (as of 13 October 2010), the number of adenovirus conjunctivitis cases reported to the Robert Koch Institute in Berlin, Germany, has increased by more than 250% compared with same period in the previous two years. An investigation was initiated to identify spatial or temporal clusters, possible sources of infection and potential connections to cases abroad. The analysis did not show a disproportionately affected sex or age group, but many infections were preceded by exposure to ophthalmological facilities, communal facilities or public places.

Dengue virus infection in a traveller returning from Croatia to Germany.

Dengue virus (DENV) is endemic in south-east Asia and Central to South America. In August 2010, a DENV infection was diagnosed in a German traveller returning from a trip to Croatia in south-east Europe. The patient presented with fever and other typical symptoms of DENV-infection. Virological investigation revealed the presence of DENV-specific IgM, a rise in DENV-specific IgG and the presence of DENV NS1 antigen in the patient's blood.

Preliminary case report of fatal anthrax in an injecting drug user in North-Rhine-Westphalia, Germany, December 2009.

A fatal case of anthrax occurred in an injecting drug user in Germany, in December 2009. A potential link to similar cases in Scotland in the same time period is currently under investigation.

[Rare infectious diseases in Germany. Obligatory notification results]. / In Deutschland selten auftretende Infektionskrankheiten : Ergebnisse aus der Meldepflicht.

Rare infectious diseases are of great importance in Germany: Some of them require special measures and precautions to prevent spreading (e.g. virus caused hemorrhagic fevers). For others, e.g. infectious diseases that can be prevented by vaccination, the prevention aspects are important. Summarizing descriptions for several rare diseases which together describe the situation in Germany are only possible on the basis of the notification requirements. The legal obligation for notification represents a good prerequisite to register diseases occurring in Germany. With the introduction of the Protection against Infection Act in 2001 the quality of the available data was improved by using case definitions. The evaluation of existing information indicates: On the basis of the available data there is no evidence that in the foreseeable future a noticeable increase of isolated rare diseases could pose a threat in Germany.

[Imported malaria in Germany--countries of infection and parasite species, 1993-2007]. / Importierte Malaria in Deutschland--Infektionsländer und Erregerspezies von 1993-2007.

From 1993 to 2007, a total of 11,605 malaria cases were reported to the Robert Koch-Institut. For 9 593 of these cases information on the possible country of infection is available. Analysis of the data indicates that the malaria cases were imported to Germany from 96 countries. The majority of the malaria cases were acquired in Africa, followed by distinctly fewer cases from Asian countries. More than half of all cases were imported from only 6 countries (Ghana, Kenya, Nigeria, Cameroon, Gambia, and India). The number of cases imported from, e.g., Kenya and India has declined, whereas infections from Ghana, Nigeria, and Cameroon have increased during the last years. For more than two-thirds of all infections the predominant parasite species was P. falciparum; this is consistent with the predominance of the African continent as the main source of infection.

[Malaria in Germany 1993 to 2003. Data from the Robert Koch Institute on affected groups of people, countries traveled to and treatment]. / Malaria in Deutschland 1993 bis 2003. Daten des Robert Koch-Instituts zu betroffenen Personengruppen, Reiseländern und zur Behandlung.

BACKGROUND AND OBJECTIVE: In Germany, malaria is a major imported disease. The national surveillance data from 1993 to 2003 were analysed to assess epidemiologic trends in imported malaria. METHODS: Malaria is a notifiable disease in Germany. Laboratory and epidemiologic data are obtained for each malaria case in a standardised way and reported to the Robert Koch-Institut where the central database exists for statistical analysis. RESULTS: From 1993 to 2003, a total of 9148 malaria cases were reported to the Robert Koch-Institut. The annual cases ranged from 598 (1993) to 1045 (2001). No clear trend over the years was observed. The proportion of malaria cases of German origin declined significantly over the years to 50 % in 2003. The proportion of cases aged 40 to 49 years increased over time. However, in each year the highest malaria incidence was found in the age group 20 to 39 years. Case fatality decreased substantially in recent years. In about 25 % of patients malaria diagnosis and treatment start were delayed. This is of great concern since 70 to 80 % of all cases were caused by Plasmodium falciparum. In recent years atovaquone + proguanil as well as arthemether + lumefantrin were increasingly used for treatment (both combination therapies made up for 35 % of treatments in 2003). CONCLUSIONS: Further improvements in counselling and adequate use of malaria prophylaxis in travelers and in timely malaria diagnosis and treatment are necessary.

[Malaria surveillance in Germany 2000/2001--results and experience with a new reporting system]. / Erfassung der Malaria in Deutschland--Daten und Fakten zu den Erkrankungen in Deutschland 2000/2001. Ubergang zu einem neuen Meldesystem.

In Germany, malaria is one of the most frequently imported infectious diseases. In January 2001, the newly implemented Infektionsschutzgesetz (Law for Protection Against Infectious Diseases) brought some important changes in surveillance case notification procedures. After one year, experience shows that the changes did not affect the continuity and representative nature of malaria reporting in Germany. In the years 2000 and 2001, 836 and 1,040 malaria cases, respectively, were reported. In both years, most of the patients were between 30 and 49 years old. 82 % of the infections had been acquired in Africa, and 11 % in Asia. The predominant parasite species was P. falciparum (70 %), followed by P. vivax (12 % in 2000, and 16 % in 2001, respectively). The majority of infections occurred among tourists, fewer in immigrants or business travellers. About two thirds of all patients had not taken any chemoprophylactics. Compared to previous years a decrease in the number of fatal cases was observed (1998: 21, 1999: 18, 2000: 8, 2001: 8). To ameliorate the situation of imported malaria intensified prevention activities are necessary, including efforts to improve choice and compliance of chemoprophylaxis and to facilitate timely diagnosis and treatment.

Malaria and tourism: retrospective analysis of German malaria cases imported from the Dominican Republic.

We report on malaria acquired by German tourists to formerly non-endemic tourist resorts in the Dominican Republic between July 1999 and March 2000. Falciparum malaria is endemic in the western provinces and the hinterland of the Dominican Republic. By contrast, the risk of contracting malaria has always been considered so low in the main tourist resorts in the eastern part of the country that antimalarial chemoprophylaxis was not recommended.

[Malaria incidence in Germany 1998/99--results of single case studies of the Robert Koch Institute]. / Erkrankungen an Malaria in Deutschland 1998/99--Ergebnisse der Einzelfallerhebungen des Robert-Koch-Institutes.

Malaria is a common imported infectious disease in Germany. A total of 931 cases of malaria were reported in Germany in 1999 (1998: 1,008 cases). Most of the infected patients were 24-45 years of age. Eighty per cent of the cases acquired infection in Africa, in Asia (8.5%) and in Central and South America (5%). Plasmodium falciparum accounted for the largest number of cases (80%) followed by Plasmodium vivax (12%). In 1999 60% of all malaria cases were Germans. Most of them travelled for holidays or study purposes. 20 deaths, all attributed to falciparum malaria, were notified in 1999, most of them (19) were German citizens. In 1999 61% of the patients had not taken chemoprophylaxis at all while travelling abroad. Improving prophylactic measures is the only way to reduce the incidence of malaria cases in Germany.

[Typhus morbidity in Germany. Individual case reports 1996-2000]. / Erkrankungen an Typhus in Deutschland. Einzelfallmeldungen von 1996 bis 2000.

The number of cases of typhoid fever has decreased in recent years in Germany. In 2000 77 cases were reported (in 1999:111). Most of the cases (84%) were imported from abroad. Travellers can contract the infection when travelling under conditions of poor hygiene in endemic regions. The risk of contracting typhoid fever is high on the Indian subcontinent. Adequate prophylactic measures are the only way to reduce the importation of typhoid fever to Germany.

[Malaria incidence and mortality in Germany 1993-1997]. / Malaria-Erkrankungen und Sterbefälle in Deutschland 1993-1997.

Worldwide incidence of malaria has increased. This may result in an increasing risk for tourists in different areas of the world. Malaria is an important travellers' disease in Germany. Most cases imported to Germany originated from Africa (77%). Plasmodium falciparum caused 67% of all malaria cases. 63% of all cases were Germans, 76% of whom travelled for holidays or study trips. From 1993 to 1996 89 people died from malaria in Germany. Most cases of fatal malaria were reported among German citizens. The case fatality rate increases with age. About 50% of all patients had not undergone sufficient prophylaxis against malaria. Only 22% of the patients who started prophylactic treatment took chemoprophylactics regularly while travelling abroad. Adequate prophylaxis against malaria is the only way to reduce the incidence of imported cases of malaria.

[Vaccinations for travelers in Germany--1971-1990 adverse vaccine effects caused by travel vaccinations]. / Reiseimpfungen in der Bundesrepublik Deutschland--Impfschadensfälle nach Reiseimpfungen 1971-1990.

Adequate prophylaxis should always be the order of the day if anyone plans to visit a foreign country where he may be at risk of being exposed to infectious diseases. Numerous protective vaccinations are available for this purpose in Germany. Basing on the incidence of recorded damage caused by such vaccinations 1971-1990 we must conclude that the risk of damage to health as a result of such vaccinations is very remote. Hence, the protective vaccinations carried out in Germany are of vital importance in respect of keeping down the number of infections.

[Nosocomial infection as the cause of death]. / Die nosokomiale Infektion als Todesursache.

Hospital-acquired infections are a worldwide problem especially in hospitals for the treatment of acute cases. These infections are among the leading causes of death. Certificates of death of 4656 patients who died in hospitals were analysed. Of these, 564 deaths were caused by nosocomial infections (12.1%). It was estimated that annually around 40,000 deaths in the Federal Republic of Germany are attributable to infections acquired in the hospital.

[Malaria importation into Germany in 1989/90]. / Malariaeinschleppungen nach Deutschland 1989/90.

Malaria was in 1989/90 the most important imported disease in Germany. Most of all cases were imported by German tourists (about 75%). Africa was the most prominently represented geographic region (about 75%). Kenia and Ghana represented there the biggest share. About 33% of all patients had not done a sufficient prophylaxis against malaria. An adequate prophylaxis against malaria taking into consideration the recommendations for medicaments for different geographical areas is imperative before the number of importations of malaria into Germany can be reduced.