Host weight, seasonality and anthropogenic factors contribute to parasite community differences between urban and rural foxes.

Pathogens often occur at different prevalence along environmental gradients. This is of particular importance for gradients of anthropogenic impact such as rural-urban transitions presenting a changing interface between humans and wildlife. The assembly of parasite communities is affected by both the external environmental conditions and individual host characteristics. Hosts with low body weight (smaller individuals or animals with poor body condition) might be more susceptible to infection. Furthermore, parasites' mode of transmission might affect their occurrence: rural environments with better availability of intermediate hosts might favour trophic transmission, while urban environments, typically with dense definitive host populations, might favour direct transmission. We here study helminth communities (141 intestinal samples) within the red fox (Vulpes vulpes), a synanthropic host, using DNA metabarcoding of multiple marker genes. We analysed the effect of urbanisation, seasonality and host-intrinsic (weight, sex) variables on helminth communities. Helminth species richness increased in foxes with lower body weight and in winter and spring. Season and urbanisation, however, had strong effects on the community composition, i.e., on the identity of the detected species. Surprisingly, transmission in two-host life cycles (trophic transmission) was more pronounced in urban Berlin than in rural Brandenburg. This disagrees with the prevailing hypothesis that trophically transmitted helminths are less prevalent in urban areas than in rural areas. Generally, co-infestations with multiple helminths and high infection intensity are associated with lighter (younger, smaller or low body condition) animals. Both host-intrinsic traits and environmental drivers together shape parasite community composition and turnover along urban-rural gradients.

Comparison of the Influence of Supportive and Sensorimotor Insoles on Flat Feet in Children - a Double-Blind, Prospective, Randomized, Controlled Trial.

BACKGROUND: Besides arch-supportive insoles, sensorimotor insoles are used for the treatment of flatfoot in children. The aim of this study was to compare the effect of both types of insoles on the arch-supporting muscles and clinical aspects in children with flexible flatfoot. MATERIAL AND METHODS: 52 children with flexible flatfoot (mean age of 8.22.7 years) were enrolled. Supportive, sensorimotor, and placebo insoles were compared. Muscle activity was detected by surface electromyography during the midstance phase. Valgus index, foot and ankle disability index (FADI) and pain were assessed at enrolment and after 6 and 12 months. Mixed-design ANOVA was used for statistical evaluation. RESULTS: Supportive and sensorimotor insoles caused significantly lower activity in the tibialis anterior in comparison to placebo insoles regarding the parameter Mean. No significant differences could be detected between both types of therapeutic insoles. Supportive insoles showed a significant decrease regarding the parameter Amplitude of the peroneus longus. Placebo insoles produced an increase in the valgus index, while both therapeutic insoles did not induce any changes. The sensorimotor insoles induced an increase in FADI, while the supportive and placebo insoles had no significant effect on this parameter. CONCLUSIONS: 1. Supportive and sensorimotor insoles potentially influence muscle activity in the lower leg. 2. Both could influence the longitudinal arch in flat feet. 3. While placebo insoles caused a deterioration of the valgus index, both kinds of therapeutic insoles could possibly prevent the progression of the flatfoot. 4. Clinical studies including more clinical aspects and long-term observations are necessary.

Suid alphaherpesvirus 1 of wild boar origin as a recent source of Aujeszky's disease in carnivores in Germany.

BACKGROUND: The high susceptibility of carnivores to Suid Alphaherpesvirus 1 [SuAHV1, synonymous pseudorabies virus (PrV)], renders them inadvertent sentinels for the possible occurrence of Aujeszky's disease (AD) in domestic and wild swine populations. The aim of this study was to epidemiologically analyse the occurrence of PrV infections in domestic and wild animals in Germany during the last three decades and to genetically characterise the causative PrV isolates. METHODS: PrV in dogs was detected using standard virological techniques including conventional and real time PCR, virus isolation or by immunohistochemistry. Available PrV isolates were characterized by partial sequencing of the open gC reading frame and the genetic traits were compared with those of archived PrV isolates from carnivores and domestic pigs from Germany before the elimination of AD in the domestic pig population. RESULTS: During 1995 and 2022, a total of 38 cases of AD in carnivores, e.g. dogs and red foxes, were laboratory confirmed. Sequencing and subsequent phylogenetic analysis of PrV isolates established a strong connection between AD cases in carnivores and the occurrence of PrV infections in European wild boars in the end phase of and after elimination of AD from the domestic pig population. While PrV infections occur at low numbers but regularly in hunting dogs, interestingly, PrV was not observed in grey wolves in Germany. In none of 682 dead-found grey wolves and wolf-dog hybrids tested from Germany during 2006-2022 could PrV infection be detected by molecular means. CONCLUSIONS: Although PrV has been eliminated from domestic pigs, spillover infections in domestic and wild carnivores should always be expected given the endemic presence of PrV in wild pig populations. Since detection of PrV DNA and virus in carnivores is sporadic even in areas with high seroprevalence of PrV in wild pigs, it may not reflect the full diversity of PrV.

[Proximal femoral fracture with bony ankylosis of the hip joint : Case report of difficult surgical treatment]. / Proximale Femurfraktur bei knöcherner Ankylose des Hüftgelenks : Fallbericht einer erschwerten operativen Versorgung.

A 78-year-old female patient sustained a left-sided proximal femoral fracture due to a fall. Since childhood the patient had suffered from ankylosis of unknown origin in the ipsilateral hip joint. The recommended intramedullary osteosynthesis could restore the original status quo before the fracture. It needs less time in the operating room (OR) and includes a lower risk for intraoperative complications than a hip joint endoprosthesis. Arthroplasty can lead to a significant improvement in mobility of the hip joint but requires more time in the OR for the surgical procedure and anesthesia time and includes a higher risk for intraoperative and postoperative complications. The antetorsion angle of 76° in this patient deviated extremely from the standard and made the intramedullary osteosynthesis for this type of fracture a challenge. Using improvised techniques led to a load-stable fracture treatment that ultimately led to a satisfactory result.

[Analysis of Sickness-Related Days of Absence among Soldiers of the German Armed Forces from 2008 to 2018 Part 1: Retrospective Analysis with Comparison to the Statutory Health Insurance System]. / Analyse der krankheitsbedingten Fehltage von Soldatinnen und Soldaten der Bundeswehr von 2008 bis 2018 Teil 1: Retrospektive Analyse mit Vergleich zur Gesetzlichen Krankenversicherung.

BACKGROUND: Sickness-related absences are of particular importance both in the German armed forces and in the civilian sector. THE AIM OF THIS STUDY: was to analyze the incidence of sick leave among soldiers in comparison to the working population covered by the statutory health insurance (SHI) system. METHOD: According to the systematics of the SHI, the key figures on incapacity to work in the period 2008-2018 are calculated in an age- and gender-standardized manner. Likewise, a list of the TOP 20 ICD-10 diagnoses in relation to incapacity to work was determined, and their average annual rates of change were calculated for trend analysis. RESULTS: The annual rate of sick leave among soldiers was between 1.5 and 2.3%, which was lower than that of the SHI (3.1 to 5.0%). The duration of illness (sick days per case) among soldiers was between 9.0-15.6 days per year, compared with 10.9-14.4 days in the SHI system. The sickness frequency (cases per 100 persons) was lower among soldiers (48.2-75.0 cases) than in the SHI (96.8-131.0 cases). Most days of absence among soldiers were due to "respiratory infections (J06)" with 13.2%, "stress reactions (F43)" with 8.7%, "other infectious gastroenteritis and colitis (A09)" with 6.5%, "back pain (M54)" with 4.4% and "depressive episode (F32)" with 4.0% of all days of absence and were comparable to the values in SHI. "Depressive episode (F32)", "injuries (T14)", sreactions (F43)", "respiratory infections (J06)" and "pregnancy complaints (O26)" showed the highest rates of increase of+6.1% to+3.6% of days off work. CONCLUSION: For the first time, it was possible to compare the sickness rate of soldiers with that of the general population in Germany, which may also provide indications for further measures for primary, secondary and tertiary prevention. The lower sickness rate among soldiers compared with the general population is mainly due to a lower incidence of illness, with a similar duration and pattern of illness, but with an overall upward trend. The ICD-10 diagnoses "Depressive episode (F32)," "injuries (T14)," "stress reactions (F43)," "acute upper respiratory tract infections (J06)" and "pregnancy complaints (O26)," which are increasing at an above-average rate in relation to the number of days absent, require further analysis. This approach seems promising, for example, to generate hypotheses and ideas for further improvement of health care.

Subacromial impingement syndrome: association of multiple magnetic resonance imaging parameters with shoulder function and pain.

INTRODUCTION: Shoulder pain is one of the most common complaints in orthopaedics. This study focusses on the relationship between shoulder function in subacromial impingement syndrome and imaging criteria in magnetic resonance imaging (MRI). MATERIALS AND METHODS: This prospective clinical trial included 69 patients treated for subacromial impingement syndrome. Shoulder function (Constant Score, range of abduction, abduction force) and pain were correlated with the following MRI parameters: tendinosis of the rotator cuff, "halo-sign" around the biceps tendon, subacromial distance, critical shoulder angle, size of subacromial osteophytic spurs and maximum width of subacromial and subdeltoid bursa. Statistical analyses included Pearson's and Spearman's coefficients of correlation, multiple regression analysis and Student's t-test. RESULTS: The Constant Score was correlated positively with the critical shoulder angle (r = 0.313; p = 0.009) and inversely with a "halo-sign" around the biceps tendon (rho = -0.384; p = 0.001). There was no significant correlation between spur size and shoulder function, but the size of the subacromial and subdeltoid bursae was positively correlated with the subacromial spur's size (subacromial bursa: coronal plane: r = 0.327; p = 0.006; sagittal view: r = 0.305; p = 0.011; subdeltoid bursa coronal view: r = 0.333 p = 0.005). The width of the subdeltoid bursa in coronal plane was positively correlated with shoulder pain (r = 0.248; p = 0.004) and negatively with the range of abduction (r = -0.270; p = 0.025), as well as the mean (r = -0.332; p = 0.005) and maximum (r = -0.334; p = 0.005) abduction force. CONCLUSIONS: Shoulder function and pain in subacromial impingement are best predicted by the width of the subdeltoid bursa measured in the coronal MRI plane as an indicator of bursitis as well as the presence of a "halo-sign" around the biceps tendon indicating glenohumeral joint effusion. Presence of a subacromial spur could lead to subacromial and subdeltoid bursitis, which impairs shoulder function. Shoulder function seems not to be compromised by the presence of a subacromial spur in absence of bursitis. This study was registered at the German Clinical Trials Register on 08 February 2013 (ID: DRKS00011548).

[Treatment of trauma-related vertebral body fractures of the thoracic and lumbar spine with orthotic devices : A review]. / Orthetische Behandlung traumatisch bedingter Wirbelkörperfrakturen der thorakalen und lumbalen Wirbelsäule : Ein Review.

BACKGROUND: Trauma-related fractures of the thoracic and lumbar spine occur after exposure to high kinetic energy. To assign patients to the correct kind of treatment the AO spine classification is used. OBJECTIVE: The aim was to describe the role of orthotic devices in the treatment of thoracic and lumbar fractures in the nondegenerative spine. MATERIAL AND METHODS: A review of the literature was carried out according to the PRISMA protocol (Preferred Reporting Items for Systematic reviews and Meta-Analyses) in PubMed, ScienceDirect, Cochrane and Google.Scholar. A total of 118 potentially important publications were found and 16 studies with a prospective study design could be included in this analysis. RoB 2 (Cochrane Risk of Bias tool in the second Version) in the case of randomized studies and the ROBINS­I (Risk Of Bias In Nonrandomised Studies of Interventions) for nonrandomized studies were used to assess publication quality. The level of evidence was determined according to AHCPR (Agency for Health Care Policy and Research). RESULTS: In the case of fractures (AO types A0-A3) without degenerative changes in the bone structure of the thoracic and lumbar spine without indications for operative procedure, conservative treatment with analgesia, physiotherapy and early mobilization is recommended and orthotic treatment is not superior. Surgical treatment, even in cases where conservative treatment was possible, led to improved functionality and pain sensation faster but there were no differences in the long-term results. Assessing the neurological functional deficit, the functional success of the treatment and the kyphosis angle were measured in different ways, reducing the extent of comparability. Although mainly a level of evidence Ib-IIa could be assigned, nearly all included studies had a high risk of bias. CONCLUSION: In individual cases treatment with an orthotic device could be a helpful add-on in conservative treatment of fractures in the thoracic and lumbar spine. A treatment with orthotic devices alone cannot be recommended in these cases.

Rehabilitation of Patients with Osseointegrated Prosthesis after Transfemoral Amputation - Literature-based Recommendation for Postoperative Rehabilitative Procedure. / Rehabilitation bei Patienten mit osseointegrierten Prothesen nach transfemoraler Amputation ­ literaturbasierte Nachbehandlungsempfehlung.

BACKGROUND: Osseointegrative implantation after amputation of the lower extremity is a special treatment option. Physiotherapeutic treatment is important for the functional outcome. This study systematically evaluated existing follow-up treatment protocols to establish a literature-based recommendation for postoperative rehabilitation procedures. METHODOLOGY: A PubMed literature search was conducted on December 10, 2020, using the following search terms: (osseo-integrat* OR endo-exo OR boneanchored OR bone anchored) AND (prosthe*) AND (leg OR lower limb* OR lower extremit* OR transfem* OR transtib*) AND (rehabilitation). 113 publications were found in this context. 10 of them met inclusion criteria. The Cochrane risk of bias tool was used to determine the publications' quality. RESULTS: Three systematic rehabilitation protocols have been described: Osseointegrated Prostheses for the Rehabilitation of Amputees protocol, Osseointegration Group of Australia Accelerated protocol and Radboud Amputation: rehabilitation protocol for endo-exo femoral prosthesis. There are clear differences in the duration of the rehabilitation protocols. The quality of published studies is limited due to the high risk of bias and low evidence levels (mainly III - V). A concept for long-term rehabilitation has not been described yet. CONCLUSIONS: There are various protocols for rehabilitation after treatment with osseointegrative prosthesis. Gradually increasing axial weight bearing started shortly after surgery; step-by-step gait training, adaptation of the prosthesis to the new biomechanics and critical patient selection and pre-operative training have been proven useful for successful rehabilitation. Controlled comparative studies, standardised outcome measurements or comparative studies between different protocols are not available. Models for multi-level long-term care have not been described in the literature so far.

[Conservative treatment of trauma-associated fractures of the cervical spine with orthoses-A review]. / Konservative Behandlung traumatisch bedingter Frakturen der Halswirbelsäule mit Orthesen ­ ein Review.

BACKGROUND: Traumatic injuries of the cervical spine are common and can significantly differ in the prognosis and treatment depending on the structure affected. We present the current evidence for conservative treatment of these fractures with orthoses in this review. METHODOLOGY: The literature search followed the PRISMA protocol. The risk of bias was assessed using ROBINS­I and evidence levels were determined according to AHCPR. RESULTS: A total of 22 studies were identified. The level of evidence according to AHCPR is limited (IIb, III and IV) and every study had a serious risk of bias in at least one subdivision. Of the authors 11 presented conservative treatment concepts for C2 dens fractures, 7 studies focussed on vertebral arch fractures and 9 on vertebral body fractures. Radiological parameters (kyphosis angle, bone consolidation) and the neurological status were frequently reported as endpoints. CONCLUSION: Stable C2 dens fractures without relevant clinical restrictions allow conservative treatment in a rigid cervical orthosis under radiological monitoring every 1-4 weeks. Type II fractures require special attention due to the risk of instability. Hangman's fractures can be safely treated in rigid cervical orthoses. The current state of knowledge does not allow any recommendation for conservative treatment of Hangman's fractures with orthoses. Stable vertebral body fractures without involvement of the spinal canal can also be treated conservatively with orthotic devices. Randomized controlled studies are required to develop a secure state of evidence and are currently not available.

The Relationship between Ergometric Treadmill or Bicycle Performance and Isokinetic Trunk Strength - A Retrospective Analysis.

The relationship between trunk strength and athletic performance is well known. In the past, trunk strength and athletic performance were measured in field tests. Previous studies encouraged sport-specific analyses. The goal of this study was to investigate whether there is a relation between ergometrically measured treadmill or bicycle endurance and isokinetic trunk strength. This retrospective analysis included 1334 bicycle and 1838 treadmill ergometry examinations in 1149 subjects. Bicycle and treadmill ergometer performance were analysed in relation to isokinetic trunk strength. Statistics were performed by Pearson correlation and mixed or generalised linear models. Higher treadmill and bicycle power correlated with higher isokinetic trunk strength, with highest absolute trunk strength in the treadmill group. For both running and cycling endurance, a positive correlation with trunk strength could be quantified in regression models. Increased ergometry endurance and lower flexion/extension ratios are connected weakly. Ergometry performance had the strongest correlation with extension trunk strength (r=0.312-0.398 for bicycle ergometry and r=0.168-0.229 for treadmill ergometry, p<0.001). We encourage prospective studies using both kinds of ergometry to evaluate the effect of trunk strengthening to enhance sport-specific endurance performance. Weight-adapted trunk strength values showed overall greater correlation to trunk strength and we recommend the use of weight-adapted values.

Comparison of the influence of supportive and sensorimotor insoles in the muscle activity of tibialis anterior and peroneus longus in combat boots.

INTRODUCTION: Flatfoot is a very common static deformity. It occurs frequently in soldiers and causes problems in the lower extremities. There is a lack of data regarding therapy with insoles, especially with sensorimotor insoles. The objective of this study was to investigate the influence in muscle activity of supporting/correcting and sensorimotor insoles in combat boots in the muscles of the lower limb and thus to draw conclusions according to the benefits of insole therapy in military footwear. METHODS: 73 patients (12 female, 61 males; average age: 30.8 ± 7.9 years) with pes planovalgus deformity were included in this prospective randomized placebo-controlled study. For intervention supporting (N = 23), sensorimotor (N = 28) and placebo insoles (N = 22) were used. During gait analysis muscle activity was measured by means of surface electromyography (EMG) of the tibialis anterior and peroneus longus muscle in combat boots with and without insoles. Statistical evaluation was performed using two-factor ANOVA with repeated measures. RESULTS: EMG measures (amplitude, integral, maximum, mean) showed mainly activating effects in the peroneus longus muscle in the case of sensorimotor and activity reductions in supporting insoles. Comparing effects of different kinds of insoles to the peroneus longus muscle, significant differences could be shown. No significant differences in muscular activation were observed for the tibialis anterior muscle. CONCLUSION: Even in combat boots effects of sensorimotor insoles on the peroneus longus muscle can be detected. The expected effects, attributed to the different kinds of insole, could be observed, too. While sensorimotor insoles had an activating kind of effect, supportive insoles reduced muscular activity of the peroneus longus. In contrast for the tibialis anterior muscle no clear conclusion could be drawn. Its muscular activity seems not to be influenced by insoles in combat boots. However, it remains unclear whether clinical long term effects, e.g. pain and function, can be improved.

Animal Histoplasmosis in Europe: Review of the Literature and Molecular Typing of the Etiological Agents.

Histoplasmosis has been previously diagnosed in animals from Europe. The aim of this study is to review the literature on these reports, to analyze cases diagnosed at our laboratory (2000-2022) and to improve molecular typing of Histoplasma capsulatum directly from tissue to study the molecular epidemiology of Histoplasma capsulatum causing animal infections in Europe. Including 15 cases studied in our laboratory, we identified 39 cases of animal histoplasmosis between 1968 and 2022. They were diagnosed mostly in superficial tissue biopsies from cats and badgers from Central Europe. Using phylogenetic analyses of six partial genes, we were able to classify eight of the etiological agents as belonging to a highly supported lineage within the Eurasian clade. This study confirms the occurrence of autochthonous histoplasmosis in animals in Central Europe and proposes the addition of new loci to the MLST scheme to study the molecular epidemiology of histoplasmosis using either formalin-fixed paraffin-embedded tissue and fresh or cadaveric biopsies.

Fixing a Subtrochanteric Femoral Fracture with a Humerus Nail.

A 17-year-old paraplegic patient sustained a subtrochanteric femoral fracture due to inadequate trauma. The unusual anatomical conditions associated with his congenital paraplegia did not allow treatment with a standard intramedullary implant for the femur. Because his soft tissues were already compromised, alternative options like plate osteosynthesis were considered unfavourable as a salvage procedure. Therefore, we used an implant designed for the humerus. A satisfactory result of osteosynthesis was achieved despite varus deformity, shortening and rotational error.

Sportmedizinische Beratung nach akuter Rhabdomyolyse bei erblicher Myopathie ­ eine herausfordernde Leistungsdiagnostik.

INTRODUCTION: Increased serum creatinine kinase after physical activity is well known and there is currently no cut-off value. We present the systematic diagnosis after rhabdomyolysis in a rare cause. HISTORY: A 36-year-old soldier developed acute kidney failure due to rhabdomyolysis after intense physical exertion. FINDINGS AND DIAGNOSIS: Sporty habitus, CK elevation and highly normal kidney values. Massive CK increase after step loading on the bicycle ergometer. We stopped further physical stress and initiated diagnostics. THERAPY AND COURSE: The genetic diagnosis found a hereditary myopathy of the lipid metabolism (VLCAD deficiency). We used individualized performance analysis to determine the safe load limit. In the ordinary athletic testing of these performance limits, no excessive CK activation could be determined. CONCLUSION: Recurrent rhabdomyolyses characterize the late onset of VLCAD, which can occur after intense physical activity, periods of fasting or dehydration. Patients can continue physical exercise safely after determining the individual tolerance.

Participatory research in times of COVID-19 and beyond: Adjusting your methodological toolkits.

Solving grand environmental societal challenges calls for transdisciplinary and participatory methods in social-ecological research. These methods enable co-designing the research, co-producing the results, and co-creating the impacts together with concerned stakeholders. COVID-19 has had serious impacts on the choice of research methods, but reflections on recent experiences of "moving online" are still rare. In this perspective, we focus on the challenge of adjusting different participatory methods to online formats used in five transdisciplinary social-ecological research projects. The key added value of our research is the lessons learned from a comparison of the pros and cons of adjusting a broader set of methods to online formats. We conclude that combining the adjusted online approaches with well-established face-to-face formats into more inclusive hybrid approaches can enrich and diversify the pool of available methods for postpandemic research. Furthermore, a more diverse group of participants can be engaged in the research process.

[Cerebral fat embolism syndrome after polytrauma : Complication after fracture treatment of several long bones of the lower extremities]. / Zerebrales Fettemboliesyndrom nach Polytrauma : Komplikation bei Frakturversorgung mehrerer langer Röhrenknochen der unteren Extremität.

In consequence of a car accident a 20-year-old woman with bilateral fractures of the femur and an unilateral lower leg fracture was treated with external fixation. Afterwards she was soporific with signs of impaired consciousness and required intubation and intensive medical care surveillance. A cerebral fat embolism syndrome could be detected as the reason, which was characterized by acute respiratory insufficiency, neurological symptoms and petechiae. Subsequently, definitive treatment was performed by intramedullary nailing. After neurological and orthopedic rehabilitation no performance inhibiting limitations remained.

Re-Emergence and Spread of Haemorrhagic Septicaemia in Germany: The Wolf as a Vector?

Since 2010, outbreaks of haemorrhagic septicaemia (HS) caused by Pasteurella (P.) multocida capsular type B (PmB) emerged in Germany. In 2017, we noticed a close spatiotemporal relationship between HS outbreak sites and wolf (Canis lupus) territories. Thus, the main objectives of our study were to investigate the molecular epidemiology of German PmB-HS-isolates and to assess the role of wolves as putative vectors of this pathogen. We collected 83 PmB isolates from HS outbreaks that occurred between 2010 and 2019 and sampled 150 wolves, which were found dead in the years 2017 to 2019, revealing another three PmB isolates. A maximum-likelihood-based phylogeny of the core genomes of 65 PmB-HS-isolates and the three PmB-wolf-isolates showed high relatedness. Furthermore, all belonged to capsular:LPS:MLST genotype B:L2:ST122RIRDC and showed highly similar virulence gene profiles, but clustered separately from 35 global ST122RIRDC strains. Our data revealed that German HS outbreaks were caused by a distinct genomic lineage of PmB-ST122 strains, hinting towards an independent, ongoing epidemiologic event. We demonstrated for the first time, that carnivores, i.e., wolves, might harbour PmB as a part of their oropharyngeal microbiota. Furthermore, the results of our study imply that wolves can carry the pathogen over long distances, indicating a major role of that animal species in the ongoing epidemiological event of HS in Germany.

Public Health Leadership in a VUCA World Environment: Lessons Learned during the Regional Emergency Rollout of SARS-CoV-2 Vaccinations in Heidelberg, Germany, during the COVID-19 Pandemic.

The purpose of this work is to share methods used and lessons learned during a comprehensive inter-institutional pandemic disaster response in Heidelberg, Germany, conveying experiences of the regional SARS-CoV-2 vaccination rollout campaign for up to 1,000,000 vaccines in the year 2020. In this volatile, uncertain, complex, and ambiguous (VUCA) environment, the following five strategic elements were pertinent for institutional arrangements so that specific contributions of the various project partners would be available fast without the necessity of extensive negotiations or information exchange: (1) robust mandate, (2) use of established networks, (3) fast onboarding and securing of commitment of project partners, (4) informed planning of supply capacity, and (5) securing the availability of critical items. Planning tools included analyses through a VUCA lens, analyses of stakeholders and their management, possible failures, and management of main risks including mitigation strategies. The method of the present analysis (VUCA factors combined with analyses of possible failures, and management of stakeholders and risks) can theoretically be adjusted to any public health care emergency anywhere across the globe. Lessons learned include ten tactical leadership priorities and ten major pitfalls.