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Background Internet‐based participatory surveillance systems, such as the German GrippeWeb, monitor the frequency of acute respiratory illnesses on population level. In order to interpret syndromic information better, we devised a microbiological feasibility study (GrippeWeb‐Plus) to test whether self‐collection of anterior nasal swabs is operationally possible, acceptable for participants and can yield valid data. Methods We recruited 103 GrippeWeb participants (73 adults and 30 children) and provided them with a kit, instructions and a questionnaire for each sample. In the first half of 2016, participants took an anterior nasal swab and sent it to the Robert Koch Institute whenever an acute respiratory illness occurred. Reporting of illnesses through the GrippeWeb platform continued as usual. We analysed swabs for the presence of human c‐myc‐DNA and 22 viral and bacterial pathogens. After the study, we sent participants an evaluation questionnaire. We analysed timeliness, completeness, acceptability and validity. Results One hundred and two participants submitted 225 analysable swabs. Ninety per cent of swabs were taken within 3 days of symptom onset. Eighty‐nine per cent of swabs had a corresponding reported illness in the GrippeWeb system. Ninety‐nine per cent of adults and 96% of children would be willing to participate in a self‐swabbing scheme for a longer period. All swabs contained c‐myc‐DNA. In 119 swabs, we identified any of 14 viruses but no bacteria. The positivity rate of influenza was similar to that in the German physician sentinel. Conclusion Self‐collection of anterior nasal swabs proofed to be feasible, was well accepted by participants, gave valid results and was an informative adjunct to syndromic data.

Objectives. To investigate whether the imposition of fines can mitigate the spread of COVID-19. Methods. We used quasi-experimental difference-in-difference models. On March 20, 2020, Bavaria introduced fines as high as €25 000 (US $28 186) against citizens in violation of the Bundesland’s (federal state’s) lockdown policy. Its neighboring Bundesländer (federal states), on the other hand, were slow to impose such clear restrictions. By comparing 38 Landkreise (counties) alongside Bavaria’s border from March 15 to May 11 using data from the Robert Koch Institute, we produced for each Landkreis its (1) time-dependent reproduction numbers (Rt) and (2) growth rates in confirmed cases. Results. The demographics of the Landkreise were similar enough to allow for difference-in-difference analyses. Landkreise that introduced fines on March 20 reduced the Rt by a further 0.32 (95% confidence interval [CI] = −0.46, −0.18; P Conclusions. Imposing fines may slow down the spread of COVID-19. Public Health Implications. Lockdowns may work better when governments introduce penalties against those who ignore them.

Knowledge on the mechanisms of viral spread, of time-related changes, and age-specific factors of severe acute respiratory syndrome coronavirus 2 infections is important to develop recommendations aimed at controlling the pandemic. In this context, longitudinal data on proportions of positive results in different age groups are rare. Data on total positive counts and on shares of positive counts deriving from a private (MVZ) and a University (RWTH) laboratory were analyzed retrospectively and compared with public data on total positive counts of the Robert Koch Institute (RKI). Data were covered for Weeks 9-24 of the year 2020 and all patient ages. Total positive counts were lower in children compared to adults. Proportions of children and adults tested positive were 3%-5% and 5%-7%, respectively. RKI and MVZ data showed similar time-related patterns. Patients of 20-60 years of age did account for the initial virus spread (maximum infection rates at Weeks 9-11). Thereafter, infection rates decreased in older patients whereas children did not show a comparable time-related decrease. Pediatric data generated in outpatient settings and hospitals differed markedly which should be considered in further studies. In summary, compared with adults children are less affected by severe acute respiratory syndrome coronavirus 2 infections and are unlikely to account for the initial viral spread. However, children show sustained viral activity and may serve as a viral reservoir.

BackgroundThere is uncertainty about the role of different age groups in propagating the SARS-CoV-2 epidemics in different countries, particularly under current social distancing practices.MethodsWe used the Robert Koch Institute data on weekly COVID-19 cases in different age groups in Germany. To minimize the effect of changes in healthcare seeking behavior (e.g. for older adults) and testing practices, we included the following eight 5-year age groups in the analyses: 10-14y through 45-49y. For each age group g, we considered the proportion PL(g) of individuals in age group g among all detected cases aged 10-49y during weeks 13-14, 2020 (later period), as well as corresponding proportion PE(g) for weeks 10-11, 2020 (early period), and defined the relative risk RR(g) for the age group g to be the ratio RR (g) = PL(g)/PE(g). For each pair of age groups g1, g2, a higher value of RR(g1) compared to RR(g2), or, alternatively, a value above 1 for the odds ratio OR (g1, g2) = RR(g1)/RR(g2) for a COVID-19 case to be in group g1 vs. g2 for the later vs. early periods is interpreted as the relative increase in the population incidence of SARS-Cov-2 in the age group g1 compared to g2 for the later vs. early period.ResultsThe relative risk RR(g) was highest for individuals aged 20-24y (RR=1.4(95% CI (1.27,1.55))), followed by individuals aged 15-19y (RR=1.14(0.99,1.32)), aged 30-34y (RR= 1.07(0.99,1.16)), aged 25-29y (RR= 1.06(0.98,1.15)), aged 35-39y (RR=0.95(0.87,1.03)), aged 40-44y (RR=0.9(0.83,0.98)), aged 45-49y (RR=0.83(0.77,0.89)) and aged 10-14y (RR=0.78(0.64,0.95)). For the age group 20-24y, the odds ratio relative to any other age group for a case to be during the later vs. early period was significantly above 1. For the age group 15-19y, the odds ratio relative to any other age group either above 35y or 10-14y for a case to be during the later vs. early period was significantly above 1.ConclusionsThe observed relative increase with time in the prevalence of individuals aged 15-34y (particularly those aged 20-24y) among detected COVID-19 cases in Germany is unlikely to be explained by increases in the likelihood of seeking medical care or the likelihood of being tested for individuals in those age groups compared to individuals aged 35-49y or 10-14y, and should be indicative of the actual increase in the prevalence of individuals aged 15-34y among SARS-CoV-2 infections in the German population. That increase likely reflects elevated mixing among individuals aged 15-34y (particularly those aged 20-24y) compared to other age groups, possibly due to lesser adherence to social distancing practices.

Summary: The development of an educational concept of a training programme for infection prevention and control (IPC) was seen as a key issue to successfully address the complexity of change processes of professional IPC routines in clinical procedures. Therefore, the Nigeria Centre for Disease Control (NCDC), Nigeria, and the Robert Koch Institute (RKI), Germany established an interdisciplinary project framework, involving knowledge and competences from different disciplines and professions like health professionals, epidemiologists and educators (MAURICE project). A multi-module training programme for health care workers to improve IPC standards was developed and implemented based on the participatory approach and a systemic view for organizational change. Keywords: Nigeria, Infection prevention and control (IPC), Training programme, Participatory approach, Systemic view, Inter- and transdisciplinary approach

There is considerable uncertainty as to the effectiveness of Neisseria gonorrhoeae (NG) screening in men who have sex with men. It is important to ensure that screening has benefits that outweigh the risks of increased antibiotics resistance. We develop a mathematical model to estimate the effectiveness of screening on prevalence. Separable Temporal Exponential family Random Graph Models are used to model the sexual relationships network, both with main and casual partners. Next, the transmission of Gonorrhoea is simulated on this network. The models are implemented using the R package ‘statnet’, which we adapted among other things to incorporate infection status at the pharynx, urethra and rectum separately and to distinguish between anal sex, oral sex and rimming. The different screening programmes compared are no screening, 3.5% of the population screened, 32% screened and 50% screened. The model simulates day-by-day evolution for 10 years of a population of 10 000. If half of the population would be screened, the prevalence in the pharynx decreases from 11.9% to 10.2%. We conclude that the limited impact of screening on NG prevalence may not outweigh the increased risk of antibiotic resistance.

In 1995, in agreement with the German Federal Ministry of Health, the Robert Koch Institute established a public health microbiology system consisting of national reference centers (NRCs) and consultant laboratories (CLs). The goal was to improve the efficiency of infection protection by advising the authorities on possible measures and to supplement infectious disease surveillance by monitoring selected pathogens that have high public health relevance. Currently, there are 19 NRCs and 40 CLs, each appointed for three years. In 2009, an additional system of national networks of NRCs and CLs was set up in order to enhance effectiveness and cooperation within the national reference laboratory system. The aim of these networks was to advance exchange in diagnostic methods and prevention concepts among reference laboratories and to develop geographic coverage of services. In the last two decades, the German public health laboratory reference system coped with all major infectious disease challenges. The European Union and the European Centre for Disease Prevention and Control (ECDC) are considering implementing a European public health microbiology reference laboratory system. The German reference laboratory system should be well prepared to participate actively in this upcoming endeavor.

This report outlines the evidence and main conclusions presented at an expert workshop on Cryptosporidium genotyping held on 16 and 17 June 2016, hosted by the Robert Koch Institute, Berlin, and funded by EU COST Action FA1408 “A European Network for Foodborne Parasites: Euro-FBP” (http://www.euro-fbp.org).

Zusammenfassung Wissenschaftliche Politikberatung ist eine originäre Aufgabe der Ressortforschung. Der Beratungsprozess ist im Idealfall eine Gemeinschaftsaufgabe von Wissenschaft und Politik, die Entscheidung liegt letztlich bei der Politik. Für eine erfolgreiche Politikberatung ist das Verständnis der Unterschiede zwischen Wissenschaft und Politik notwendig. Aufseiten der Politik und der Öffentlichkeit muss Vertrauen vorhanden sein. Die Wissenschaft muss sich durch Kompetenz, Anerkennung und Kommunikationsfähigkeit qualifizieren, politische Neutralität und persönliche Integrität müssen hinzutreten. Aus diesen Anforderungen lassen sich Kriterien für die Qualitätssicherung der Politikberatung ableiten. Dauerhaft wissenschaftliche Expertise auf international wettbewerbsfähigem Niveau vorzuhalten erfordert eigenständige, qualifizierte und ausreichend finanzierte Forschung. Ressortinstitute haben eine Antennenfunktion, sie müssen frühzeitig erkennen, ob Risiken zunehmen, ob Handlungsbedarf besteht und ob die Politik informiert werden muss. Um die Leistungsfähigkeit der Ressortforschungseinrichtungen zu sichern, sind qualitätssichernde Maßnahmen auf mehreren Ebenen notwendig. Hinweise zur Qualität der Politikberatung ergeben sich z. B. aus dem guten Ruf einer Einrichtung und ihrer profilierten Vertreter. Forschungserfolge sind ein indirektes Qualitätskriterium. Der Einfluss der Beratungstätigkeit auf politische Entscheidungen ist ein direkter Beleg für Beratungsqualität. Ein klassisches Beispiel für höchst erfolgreiche Politikberatung ist die Entwicklung der deutschen AIDS-Politik.

Everyday factors like diet, exercise, alcohol consumption, stress management have a lifelong bearing on blood pressure, which we can help to shape both as individuals and as a society. There is significant potential here for preventing high blood pressure through careful analysis of the possible causes, providing advice and support for changing habits and creating favourable conditions for this kind of improvement in lifestyle habits, if possible throughout the entire population. This edition of GBE kompakt presents current figures and trends regarding blood pressure in Germany and focusses on two topics: the distribution of blood pressure measurements in the general population and the treatment of hypertension.

All in all, people in Germany are fine. About three quarters consider their health as good or very good. Life expectancy is rising, and thanks to improvements in prevention, diagnostics and therapy, less people are dying from cardiovascular diseases and cancer. However, the growing numbers of obesity and diabetes mellitus are of major concern; mental disorders also need more attention. These are some of the conclusions of the new report "Health in Germany". It provides a profound overview of the status and development of human health in our country. A broad database was included in order to represent the most important diseases and risk factors, changes in the disease spectrum, the use of prevention and the quality of health care (also compared to the rest of Europe). The report shows that there are two major developments essentially determining health and healthcare in Germany: the demographic changes which, among other things, lead to more chronical diseases and the strong influence of the social situation on health. It provides crucial information and orientation for politicians, doctors, scientists and everyone who shapes the processes and measures to improve health. It hence supports evidence-based decisions for more health in Germany. It is the third comprehensive report of this kind in the Federal Health Reporting; the two former reports have been published in 1998 and 2006 (English translation in 2008).

Regular alcohol consumption endangers health and is associated with an increased risk of a variety of physical illnesses and mental disorders. This issue's interest is focused on alcohol consumption during adolescence since young people may be viewed as the most important target group for alcohol prevention measures. Attitudes toward alcohol, drinking motives and consumption patterns that form during adolescence often still exist in adulthood. Studies suggest that starting to drink early and excessive consumption of alcohol at a young age increases the probability of problematic alcohol consumption later in life and increases the risk of alcohol dependency.

Noise is defined as sound which is disruptive or unwanted. It can lead to a variety of negative effects. This issue presents results on noise annoyance in the living environment of the general population in Germany from various noise sources. The analysis focuses on examining the relationship between noise annoyance and selected demographic and socioeconomic factors, as well as self-reported physical and mental health problems. The results are taken from the “German Health Update” study (GEDA) of the Robert Koch Institute from 2012.

On the occasion of the 25th anniversary of the fall of the Berlin Wall, this issue deals with the question of how and to what extent health in Germany developed in the last 25 years. It firstly considers data on mortality and the average life expectancy. Issues of cardiovascular diseases, cancer and mental health problems are addressed. The authors take a closer look at significant health determinants such as obesity, tobacco and alcohol consumption, and physical activity. In addition, the topic of health care, particularly the range of outpatient services, is covered. A wide variety of data is used, which include official statistics as well as data from the health surveys of the Robert Koch Institute, and the Federal Centre for Health Education, among others.

BACKGROUND: In August 2011, the German Protection against Infection Act was amended, mandating the reporting of healthcare associated infection (HAI) outbreak notifications by all healthcare workers in Germany via local public health authorities and federal states to the Robert Koch Institute (RKI). OBJECTIVE: To describe the reported HAI-outbreaks and the surveillance system's structure and capabilities. METHODS: Information on each outbreak was collected using standard paper forms and notified to RKI. Notifications were screened daily and regularly analysed. RESULTS: Between November 2011 and November 2012, 1,326 paper forms notified 578 HAI-outbreaks, between 7 and 116 outbreaks per month. The main causative agent was norovirus (n = 414/578; 72%). Among the 108 outbreaks caused by bacteria, the most frequent pathogens were Clostridium difficile (25%) Klebsiella spp. (19%) and Staphylococcus spp. (19%). Multidrug-resistant bacteria were responsible for 54/108 (50%) bacterial outbreaks. Hospitals were affected most frequently (485/578; 84%). Hospital outbreaks due to bacteria were mostly reported from intensive care units (ICUs) (45%), followed by internal medicine wards (16%). CONCLUSION: The mandatory HAI-outbreak surveillance system describes common outbreaks. Pathogens with a particular high potential to cause large or severe outbreaks may be identified, enabling us to further focus research and preventive measures. Increasing the sensitivity and reliability of the data collection further will facilitate identification of outbreaks able to increase in size and severity, and guide specific control measures to interrupt their propagation.

The first issue of 2014 focuses on hysterectomy. The removal of the uterus currently ranks among the most frequent gynaecological procedures both in Germany and internationally. Medical indications for a hysterectomy other than malignant diseases of the uterus or ovaries include a variety of benign conditions of the uterus. The most important underlying illnesses and the medical reasons for a hysterectomy will be presented in this article by Franziska Prütz and Elena von der Lippe. The authors will go into detail regarding their frequency and factors that can possibly influence the intervention. The base data is sourced primarily from the results of the German Health Interview and Examination Survey for Adults (DEGS1) conducted by the Robert Koch Institute. Additional sources of data are official statistics as well as data from external in-patient quality assurance and the Centre for Cancer Registry Data.

The Commission for Hospital Hygiene and Infection Control (KRINKO) at the Robert Koch-Institute Berlin published the “Recommendations for Preventing and Controlling Methicillin-Resistant Staphylococcus aureus (MRSA) Strains in Hospitals and Other Medical Facilities“ in the Federal Health Gazette in 1999 [ref:21]. These recommendations were translated for the current edition of GMS Krankenhaushygiene Interdisziplinär by the German Society of Hospital Hygiene. KRINKO's work is legitimated by § 23 para. 2 of the Infection Protection Act. Regarding the legal nature of the KRINKO recommendations, it should be noted that they are neither a formal act or an administrative regulation. The KRINKO recommendations are instead an evidence-based consensus of particularly qualified experts. The consensus is reached by including the Federal States' authorities and all competent professional bodies and associations. This is to guarantee that the KRINKO recommendations reflect the state-of-the-art of medical science, and are met with a high degree of user acceptance. The recommendations are published in the Federal Health Gazette and on the RKI's Internet pages ([link:http://www.rki.de/#http://www.rki.de/]). [link:Link to the German original edition of the MRSA recommendations#http://www.rki.de/cln_100/nn_201414/DE/Content/Infekt/Krankenhaushygiene/Kommission/Downloads/MRSA__Rili,templateId=raw,property=publicationFile.pdf/MRSA_Rili.pdf], GMS Krankenhaushygiene Interdisziplinär; 4(1):Doc01; ISSN 1863-5245

SUMMARYThe incidence of invasive meningococcal disease (IMD) in Germany in 2003 was estimated by the two-source capture–recapture method. As a unique personal identifier was unavailable, cases with IMD tested at the National Reference Centre for Meningococci (NRZM) were matched with cases reported to the Robert Koch Institute (RKI) through the statutory surveillance system by using demographic and disease-specific variables common to both datasets. The estimated overall incidence was 1·1 IMD cases/100 000 inhabitants, with a sensitivity of ascertainment of 64·8% for NRZM and 89·4% for RKI. Case-fatality rate was estimated at 8·8%. Adjustment for heterogeneity of capture according to age, region and serogroup observed in the NRZM (but not RKI) source had minimal effect on the estimated incidence. The IMD incidence estimated by capture–recapture analysis is thus only slightly higher than through statutory surveillance data. As a degree of positive dependence between the systems cannot be ruled out, this estimate may still be an underestimate. However, under ascertainment appears insufficient to explain the low incidence of IMD in Germany compared to other European countries.