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The Standing Committee on Vaccination recommends adult measles and pertussis vaccination. The measles vaccine has been recommended since 2010 to adults born after 1970 with less than two doses in childhood, and an acellular pertussis vaccine (ap) since 2009 to be administered to all adults, with the next recommended decennial tetanus (T) and diphtheria (d) booster as a Tdap combination vaccine.We aim to determine the annual uptake of the measles vaccine (vaccination incidence) and its proportion in pediatric and gynecological practices as interdisciplinary services (2009-2016). We further aim to calculate the 10-year ap vaccination coverage and missed vaccination opportunities as the proportion vaccinated with Td only among all Td and Tdap vaccinees (2007-2016).Within the national vaccination monitoring system KV-Impfsurveillance of the Robert Koch Institute and all Associations of Statutory Health Insurance Physicians, all persons receiving the relevant vaccinations were identified in nationwide statutory health insurance claims and related to the numbers of insured persons.The measles vaccination incidence in 2009 was 0.4%, increasing to ≥1.0% annually since 2013. It was higher in western than eastern federal states and higher among women than men. Of all measles vaccinations, 6.8% were given by pediatricians. Men received 2.6% of their vaccinations by gynecologists. The ap vaccination coverage was 32.4%. The proportion of exclusively Td vaccinated adults fell from 84% (2007) to 24% (from 2013 onwards).Since their recommendation, the KV-Impfsurveillance system shows increased uptake of measles and pertussis vaccines with regional and sex differences and is thus instrumental in their evaluation. Analyses of interdisciplinary vaccinations and missed vaccination opportunities provide insight into the potential for increasing uptake.Die Ständige Impfkommission empfiehlt Erwachsenen Masern- und Pertussisimpfungen. Eine Masernimpfung sollen seit 2010 alle nach 1970 Geborenen mit weniger als zwei Impfungen in der Kindheit erhalten, einen azellulären Pertussisimpfstoff (ap) seit 2009 alle Erwachsenen mit der nächsten, alle 10 Jahre empfohlenen Tetanus(T)-Diphtherie(d)-Impfung als Tdap-Kombinationsimpfung.Ein Ziel der Arbeit ist die Bestimmung der jährlichen Inanspruchnahme der Masernimpfung (Impfinzidenz) und ihres Anteils in pädiatrischen und gynäkologischen Praxen als fachgebietsfremde Leistungen (2009–2016). Zudem sollen die 10-Jahres-ap-Impfquote sowie verpasste Impfchancen als der Anteil ausschließlich Td- an allen Td- und Tdap-Geimpften (2007–2016) berechnet werden.In der KV-Impfsurveillance des Robert Koch-Instituts und der Kassenärztlichen Vereinigungen (KVen) wurden in bundesweiten vertragsärztlichen Abrechnungsdaten Personen mit den relevanten Impfungen erfasst und auf die Versichertenzahlen bezogen.Die Masernimpfinzidenz lag 2009 bei 0,4 % und stieg mit 2013 auf jährlich ≥1,0 %. Sie war in den westlichen Bundesländern höher als in den östlichen und bei Frauen höher als bei Männern. 6,8 % aller Impfungen wurden in pädiatrischen Praxen gegeben. Männer erhielten 2,6 % ihrer Impfungen in gynäkologischen Praxen. Die ap-Impfquote betrug 32,4 %. Der Anteil ausschließlich Td-Geimpfter sank von 84 % (2007) auf 24 % (ab 2013).Die KV-Impfsurveillance zeigt eine seit den Impfempfehlungen gestiegene Inanspruchnahme von Masern- und Pertussisimpfungen mit regionalen und geschlechtsspezifischen Unterschieden und liefert damit wichtige Daten zur Evaluation. Analysen zum fachgebietsübergreifenden Impfen und zu verpassten Impfchancen bieten einen Einblick in das Steigerungspotenzial von Impfquoten.

Background Carbapenem resistance in Klebsiella pneumoniae is of significant public health concern and recently spread across several countries. We investigated the extent of carbapenem non-susceptibility in K. pneumoniae isolates in Germany. Methods We analysed 2011–2016 data from the German Antimicrobial Resistance Surveillance (ARS) System, which contains routine data of antimicrobial susceptibility testing from voluntarily participating German laboratories. Klebsiella pneumoniae isolates tested resistant or intermediate against an antibiotic were classified as non-susceptible. Results We included 154,734 isolates from 655 hospitals in the analysis. Carbapenem non-susceptibility in K. pneumoniae isolates was low in Germany 0.63% (95% CI 0.51–0.76%). However, in continuously participating hospitals the number of K. pneumoniae isolates almost doubled and we found evidence for a slowly increasing trend for non-susceptibility (OR = 1.20 per year, 95% CI 1.09–1.33, p

Background In Germany, 3-dose human papillomavirus (HPV) vaccination is recommended for 12–17 year-old females. Countrywide monitoring of HPV vaccination coverage (VC) does not exist, but small-scale surveys suggested suboptimal uptake. There is currently no concerted implementation strategy in place, and approaches for improved vaccine delivery are needed. Our objectives were to analyze health insurance claims data to estimate HPV VC in the target population and to assess the association of the routine adolescent health check-up ‘J1’ (offered to 12–14 year-olds) with HPV vaccine uptake. Methods We sampled a subset of 12–16 year-old females from claims data in 15 of the 16 German federal states. Sampling was based on documented physician contacts flanking the follow-up period 2008–2012. We reconstructed age- and region-stratified histories of individual-level HPV vaccination series and J1 utilization and calculated country-level estimates. Results The study sample represented 54% ( n = 1.04 million) of the total target population. VC estimates for starting (and completing) HPV vaccination series ranged from 6.1% (1.2%) among 12-year-olds to 47.6% (36.2%) among 16-year-olds. J1 utilization was 50% at maximum. In J1-attendees, 42.0% had received ≥1 vaccine doses, translating into a significant association of J1 utilization and vaccine uptake with a 6.9-fold higher likelihood in 12-year-olds and 1.4-fold higher likelihood in 16-year-olds of receiving HPV vaccination. Conclusion HPV VC in Germany is low. Adolescent check-up J1 is associated with increased and accelerated HPV vaccine uptake securing immunization before sexual debut and should be used as a tool to improve VC in the target population. However, J1 utilization is only moderate and more than half of attendees had not received HPV vaccination, which represents a substantial proportion of missed opportunities. This indicates that J1 needs both further promotion through legislative structures already in place for other health check-ups and more awareness as an opportunity to offer HPV vaccinations.

In Germany, routine childhood varicella vaccination was implemented in 2004 with two doses recommended since 2009. We used an immunisation information system based on countrywide health insurance claims data to analyse vaccine effectiveness (VE) and factors influencing VE. We applied proportional hazard models to estimate VE under various conditions and compared the risk of acquiring varicella among unvaccinated children in regions with high vs low vaccination coverage (VC). Among 1.4 million children we identified 29,404 varicella cases over a maximum follow-up of 8 years post-vaccination. One-dose VE was 81.9% (95% confidence interval (CI): 81.4–82.5), two-dose VE 94.4% (95% CI: 94.2–94.6). With dose one given 1–27 days after measles-containing vaccine (MCV), one-dose VE was 32.2% (95% CI: 10.4–48.6), two-dose VE 92.8% (95% CI: 84.8–96.6). VE was not associated with age at vaccination (11–14 vs ≥ 15 months), time since vaccination, or vaccine type. Unvaccinated children had a twofold higher risk of acquiring varicella in low VC regions. Our system generated valuable data, showing that two-dose varicella vaccination provides good protection for at least 8 years. Unvaccinated children benefit from herd effects. When the first varicella vaccine dose is given shortly after MCV, a second dose is essential.

Data from the German Antibiotic Resistance Surveillance system (ARS) and statutory notification of methicillin-resistant Staphylococcus aureus (MRSA) in blood cultures are presented. ARS is a voluntary laboratory-based surveillance system providing resistance data of all clinical pathogens and sample types from hospitals and ambulatory care. Statutory notification includes MRSA detected in blood and cerebrospinal fluid by microbiological laboratories. Resistance data from 2008 to 2010 and MRSA-bacteraemia incidences from 2010 are presented. From 2008 to 2010, resistance data from 70,935 Staphylococcus aureus isolates were transferred to the national health institution. MRSA proportions in hospitals and outpatient care account for 19.2% and 10.6%, respectively. In hospital care high proportions of MRSA were found in nephrological, geriatric, neurological general wards and surgical ICUs (49.4%, 45.8%, 34.2%, and 27.0%, respectively), while in community outpatient care urological practices (29.2%) account for the highest values. In both healthcare settings urinary tract samples stand out with high proportions of MRSA (hospitals, 32.9%; outpatients, 20.5%). In 2010, 3900 cases of MRSA bacteraemia were reported, accounting for an incidence of MRSA bacteraemia of 4.8/100,000 inhabitants/year. Stratification by federal states shows considerable regional differences (range, 1.0-8.3/100,000 inhabitants/year). Vulnerable areas in hospitals and outpatient care have been pointed out as subjects for further inquiries.

Data on resistance from ambulatory care are rarely available, since surveillance systems cover mostly isolates come from inpatient care. The outpatient setting is of interest, however, since it is where hospitalized patients with resistant pathogens are also treated as outpatients, and where patients are seen who have resistant pathogens from other sources, such as food. In addition, 85% of the antibiotics used in human medicine, are used in ambulatory care. Using data from the Antibiotic Resistance Surveillance System (ARS), we show the development of resistance of Staphylococcus aureus to oxacillin and of Escherichia coli and Klebsiella pneumoniae to cefotaxime in outpatient care between 2008 and 2012 and corresponding socio-demographic differences in the resistance rate. According to our analyses, the proportion of MRSA in S. aureus since 2009 in the outpatient sector decreased (all materials: 2009 11.5%, 2012 9.8%), which is similar to inpatient care, while the proportion of ESBL in E. coli (2008 2.7%, 2012 5.6%), and K. pneumoniae (2008 2.7%, 2012 6.6%) increased over the total period. At the same time resistance for the three pathogens in both sexes over the age groups continuously increased, women still hold a lower proportion of resistance than men. The resistance levels of S. aureus and K. pneumoniae in ambulatory care are reflected at a lower level than in hospital care. In contrast, the high proportion of resistant E. coli in children suggests another source in ambulatory care.

In Germany, the national routine childhood immunization schedule comprises 12 vaccinations. Primary immunizations should be completed by 24 mo of age. However, nationwide monitoring of vaccination coverage (VC) is performed only at school entry. We utilized health insurance claims data covering ~85% of the total population with the objectives to (1) assess VC of all recommended childhood vaccinations in birth-cohorts 2004-2009, (2) analyze cross-sectional (at 24 and 36 mo) and longitudinal trends, and (3) validate the method internally and externally. Counting vaccine doses in a retrospective cohort fashion, we assembled individual vaccination histories and summarized VC to nationwide figures. For most long-established vaccinations, VC at 24 mo was at moderate levels (~73-80%) and increased slightly across birth-cohorts. One dose measles VC was high (94%), but low (69%) for the second dose. VC with a full course of recently introduced varicella, pneumococcal, and meningococcal C vaccines increased across birth-cohorts from below 10% above 60%, 70%, and 80%, respectively. At 36 mo, VC had increased further by up to 15 percentage points depending on vaccination. Longitudinal analysis suggested a continued VC increase until school entry. Validation of VC figures with primary data showed an overall good agreement. In conclusion, analysis of health insurance claims data allows for the estimation of VC among children in Germany considering completeness and timeliness of vaccination series. This approach provides valid nationwide VC figures for all currently recommended pediatric vaccinations and fills the information gap between early infancy and late assessment at school entry.

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