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ZusammenfassungDie Erfassung von Daten zu SARS-CoV-2-Testungen in Deutschland sind für die Einschätzung des Infektionsgeschehens im Rahmen der COVID-19-Pandemie von zentraler Bedeutung. Am Robert Koch-Institut (RKI) werden dazu die Daten aus verschiedenen Systemen zur Erfassung von Labortestungen zusammengeführt. In diesem Beitrag werden zunächst bedeutsame Aspekte der Testverfahren erläutert. Nachfolgend werden die unterschiedlichen Systeme zur Erfassung von Labortestungen erläutert und Testzahlen aus der RKI-Testlaborabfrage und der laborbasierten Surveillance SARS-CoV‑2 sowie die Abrechnungsdaten der kassenärztlichen Vereinigungen zu SARS-CoV-2-Labortestungen dargestellt.Mit der RKI-Testlaborabfrage und der laborbasierten Surveillance SARS-CoV‑2 stand früh in der Pandemie eine Surveillance zur Verfügung, mit der unter den teilnehmenden Laboren Daten zu durchgeführten Testungen und Testkapazitäten ausgewertet werden können. Durch die Erfassung von positiven und negativen Testergebnissen sind Aussagen zur Gesamtzahl der durchgeführten Testungen sowie dem Anteil der positiven Testergebnisse möglich. Während die aggregierten Testzahlen bundesweit weitestgehend repräsentativ sind, ist die Repräsentativität auf Bundesland- und Landkreisebene aber nicht immer gegeben. Die Abrechnungsdaten der Kassenärztlichen Vereinigungen können die Labordaten im Nachhinein ergänzen. Sie erlauben eine retrospektive Einschätzung der Gesamtzahl von SARS-CoV-2-Tests in Deutschland, da die Leistungen der vertragsärztlichen Versorgung aller gesetzlich Krankenversicherten (ca. 85 % der Bevölkerung) enthalten sind.Die verschiedenen Systeme zur Erfassung von Labortestungen ergänzen sich gegenseitig. Die Auswertungen fließen in die Maßnahmenempfehlungen zur Pandemiebewältigung ein.

Die Standige 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 azellularen Pertussisimpfstoff (ap) seit 2009 alle Erwachsenen mit der nachsten, alle 10 Jahre empfohlenen Tetanus(T)-Diphtherie(d)-Impfung als Tdap-Kombinationsimpfung. Ein Ziel der Arbeit ist die Bestimmung der jahrlichen Inanspruchnahme der Masernimpfung (Impfinzidenz) und ihres Anteils in padiatrischen und gynakologischen Praxen als fachgebietsfremde Leistungen (2009–2016). Zudem sollen die 10-Jahres-ap-Impfquote sowie verpasste Impfchancen als der Anteil ausschlieslich Td- an allen Td- und Tdap-Geimpften (2007–2016) berechnet werden. In der KV-Impfsurveillance des Robert Koch-Instituts und der Kassenarztlichen Vereinigungen (KVen) wurden in bundesweiten vertragsarztlichen Abrechnungsdaten Personen mit den relevanten Impfungen erfasst und auf die Versichertenzahlen bezogen. Die Masernimpfinzidenz lag 2009 bei 0,4 % und stieg mit 2013 auf jahrlich ≥1,0 %. Sie war in den westlichen Bundeslandern hoher als in den ostlichen und bei Frauen hoher als bei Mannern. 6,8 % aller Impfungen wurden in padiatrischen Praxen gegeben. Manner erhielten 2,6 % ihrer Impfungen in gynakologischen Praxen. Die ap-Impfquote betrug 32,4 %. Der Anteil ausschlieslich 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 fachgebietsubergreifenden Impfen und zu verpassten Impfchancen bieten einen Einblick in das Steigerungspotenzial von Impfquoten.

Objectives The features of a newly established, web-based surveillance system for hospital antibiotic consumption are described and data on broad-spectrum antibiotic use in German acute care hospitals are presented. Methods The watch- and reserve-group antibiotics, two categories of antibiotics derived from the WHO Essential Medicines List comprising key agents for antimicrobial stewardship, were used as a framework for data analysis. The median antibiotic consumption densities (ACDs; DDD/100 patient days) for the years 2015/16 based on data from 137 acute care hospitals have been calculated for whole facilities, ICUs and medical and surgical departments, stratified by type of care. Results The new web-based system provides real-time surveillance at unit and facility levels, accessible to all relevant stakeholders. User-defined reports are available via an interactive database, various report types support different approaches to analysis, and different complementing quantification measures of antimicrobial consumption are available. Watch- and reserve-group antibiotics accounted for 42% and 2% of total antibiotic use, respectively. Surgical services presented with considerably lower median ACDs of the watch-group antibiotics compared with medical services. Tertiary care hospitals exhibited higher ACDs of the reserve-group antibiotics and carbapenems than primary/secondary care hospitals, while the ACDs of the watch-group antibiotics as a whole did not differ significantly. Comparing the proportional use with other European countries revealed a relatively high use of the watch-group, ranking beyond the 75th percentile. Conclusions Because of its particular features the new web-based surveillance system is a valuable tool for antimicrobial stewardship. The WHO categories of watch- and reserve-group antibiotics proved to be a useful framework for the analysis of hospital antibiotic consumption data.

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: Routine urine culture testing is not recommended for uncomplicated urinary tract infections (UTIs). As a result, the antibiotic resistance patterns or the organisms causing UTIs are not adequately reflected in routine data. We studied the sensitivity of Escherichia coli (E. coli) to trimethoprim (TMP) and to cotrimoxazole (i.e., trimethoprim/sulfamethoxazole, TMP/SMX) in community-acquired UTI and compared the findings with the resistance data of the Antimicrobial Resistance Surveillance System (ARS). Methods: General practitioners and internists in private practice prospectively recruited all of their adult patients with symptoms of a urinary tract infection from May 2015 to February 2016. Urine specimens from all patients were tested (including urine culture testing and antibiotic susceptibility) and infections were defined as uncomplicated or complicated UTIs. Results: 1245 participants from 58 medical practices were enrolled in the study. Pathogenic organisms were found in the urine of 877 patients, of whom 74.5% had E. coli infections. Among the E.-coli-positive UTIs, 52.4% were classified as uncomplicated and 47.6% as complicated. The prevalence of E. coli that was resistant to TMP and to TMP/SMX in uncomplicated UTIs was 15.2% and 13.0%, respectively, compared to 25.3% and 24.4%, respectively, from all UTIs in ARS in 2015. Study participants who had previously taken antibiotics had the highest prevalence of E. coli resistance (30.9%), followed by those who had two or more UTIs within the past six months (28.9%). Conclusion: E. coli with resistance to TMP was significantly less prevalent among the study patients with uncomplicated UTIs than in the routine data of the ARS. Accordingly, TMP should still be considered as an option for the treatment of uncomplicated UTIs. TMP/SMX is considered the agent of second choice because of its side effects. Surveillance systems based on routine data do not yield a representative sample for the evaluation of the resistance situation in patients with uncomplicated UTIs.

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.

Im Jahr 2007 wurde am Robert Koch-Institut (RKI) die Infrastruktur von ARS – „Antibiotika-Resistenz-Surveillance in Deutschland“ – entwickelt und installiert. Laboratorien, die Proben aus medizinischen Versorgungseinrichtungen mikrobiologisch untersuchen, ubermitteln die in der Routinediagnostik erhobenen Resistenzergebnisse bakterieller Erreger in standardisierter Form zur zentralen Auswertung an das RKI. Die Datenbasis fur die Jahre 2008 bis 2011 umfasst ca. 1,3 Mio. Proben aus der stationaren Versorgung sowie Daten zu annahernd 800.000 Proben aus der ambulanten Versorgung. Auf Basis der kategorialen Bewertungen der Empfindlichkeit als sensibel (S), intermediar (I) bzw. resistent (R) werden Trends der Methicillin-Resistenz bei Staphylococcus aureus (MRSA) sowie der Cefotaxim-Nicht-Empfindlichkeit als Indikator fur das mogliche Vorliegen einer Extended-Spektrum-β-Laktamase (ESBL) bei Escherichia (E.) coli und Klebsiella (K.) pneumoniae in 4 verschiedenen Versorgungsbereichen bzw. Kategorien analysiert: fur die stationare Versorgung, fur die ambulante Versorgung insgesamt, fur Intensivstationen sowie fur Isolate aus Blutkulturen. Die Haufigkeit von MRSA in der stationaren Versorgung zeigt nach stagnierenden Werten oberhalb der 20% sowohl insgesamt als auch auf Intensivstationen und bei Blutkulturen erstmals von 2010 auf 2011 eine Abnahme. Dagegen sind in der ambulanten Versorgung, soweit diese durch Routinediagnostik abgebildet wird, MRSA-Raten zwischen 11 und 13% in den Jahren 2008 bis 2011 zu beobachten. Die Nicht-Empfindlichkeit gegenuber Cefotaxim als Indikator fur das mogliche Vorliegen einer ESBL bei E. coli zeigt im betrachteten Zeitraum in der stationaren Versorgung ansteigende Tendenz, die auf Intensivstationen oberhalb der 10%-Marke verlauft, hingegen tritt die Cefotaxim-Nicht-Empfindlichkeit bei K. pneumoniae haufiger auf ohne eindeutige Tendenz. In der ambulanten Versorgung finden sich bei beiden Spezies von Jahr zu Jahr steigende Haufigkeiten von Cefotaxim-Nicht-Empfindlichkeit, die nahezu zu einer Verdopplung auf 6,0% fuhren.

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.

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.

Influenza is a viral disease that is transmitted mainly via large-droplets. The pandemic potential of influenza viruses was illustrated by the subtype influenza A (H1N1), which occurred de novo in 2009. The seasonal influenza wave usually starts in January or February and lasts for about 8 to 10 weeks. Severe disease courses and complications usually affect elderly patients or persons with chronic underlying conditions (1). Since the German Protection against Infection Act (Infektionsschutzgesetz, IfSG) was introduced in 2001, an average of 8400 cases per year of confirmed influenza virus were reported to the Robert Koch Institute (RKI) in the context of the law on notifiable diseases (2), but it can be assumed that the actual number of influenza patients is much higher than that (3). To lower the overall disease burden due to influenza, the German Standing Vaccination Committee (Standige Impfkommission, STIKO) therefore recommends annual vaccination against the currently circulating influenza strain for persons older than 60 and particular risk groups. These include persons with an increased health risk owing to underlying conditions, medical personnel, persons in institutions with comprehensive contacts with the public, or persons who might act as possible sources of infection for other, unvaccinated individuals under their care who are at increased risk of infection and developing severe disease (4). The RKI and Paul Ehrlich Institute recommend the months of October and November for the vaccination campaigns (5). Germany is following the recommendations of the World Health Organization (WHO), which aim to achieve vaccination coverage of 50% of the elderly population by 2006 and 75% by 2010 (6). Influenza vaccinations undertaken by doctors are not centrally captured. The main method to determine the vaccination rate for influenza that has been available thus far are cross sectional telephone surveys, whose results are published regularly (7, 8). Compared with France, Italy, Spain, and the United Kingdom, Germany had the lowest vaccination rate (50.2%) in people older than 65 in the 2006/07 influenza season (9). The rates for the four other countries were between 60.5% and 69.5%. In a comparison with 10 European countries, Germany reached the 6th place for those older than 65 in the 2007/08 influenza season (10). Further, the number of doses of influenza vaccine is used to estimate vaccination rates (11). Thus far it is not exactly known how many people are vaccinated against influenza every year and how many people are vaccinated at irregular intervals. The latter are part of a target group for a recall system, which doctors can use to remind their patients of the required vaccinations and thus increase influenza vaccination rates (12). All vaccinations conducted in members of statutory health insurance schemes are billed to the associations of statutory health insurance physicians (Kassenarztliche Vereinigungen, KV). The associations’ data therefore represent a hitherto unused data source that can be used to determine age specific vaccination rates. This is relevant not only for influenza vaccination but for all other types of vaccinations that are recommended by the Standing Vaccination Committee. Since 2004, the German associations of statutory health insurance physicians have been reporting pseudonymized data on billed vaccinations to the Robert Koch-Institute in the context of a sentinel project. Our secondary analysis of these data aims to determine vaccination rates in the population of persons older than 60 in the areas covered by 14 (of 17) associations of statutory health insurance physicians for the seasons 2004/05, 2005/06, and 2006/07. We investigated in which months vaccine uptake is highest and which proportions of people are regularly vaccinated against influenza every year.

Background: The KV-Sentinel, established in 2004, is a joint project of the Robert Koch Institute and the 17 associations of statutory health insurance physicians (ASHIPs) in Germany. The ASHIPs provide anonymous physicians billing data to the Robert Koch Institute. The aim of this article is to describe methodological approaches for processing these routine data to determine vaccination coverage and incidence of vaccine preventable diseases. Furthermore, we discuss limitations in interpreting these data. Methods: The ASHIPs perform a data query of all vaccinations and of ICD-10 codes for pertussis, measles, mumps, varicella and herpes zoster and send anonymous data to the Robert Koch Institute. We perform routine tests to ensure data quality. Study population is the statutory health insured population (85.5% of the German population). Vaccination coverage is determined by the number of vaccinated persons and the number of statutory health insured persons. Incidence is calculated by the number of diseased persons per 100000 statutory health insured persons. Results: All 17 ASHIPs participate in the project. In total, 95905605 data records for vaccinations and 4570919 data records for pertussis, measles, mumps, varicella and herpes zoster were provided from 2004 to 2007. After performing routine tests with regard to structure and content of data, more than 99% of the data records can be analysed. In 2007, the majority of given vaccinations were monovalent vaccinations against influenza (39%) and tick-borne encephalitis (17 %). In 2006 and 2007, 1893 790 data records for diagnoses were provided. Of these, 75% were acute diagnoses and of these 70% were confirmed diagnoses. Most often, ICD-10 codes for herpes zoster (57 %) and varicella (35 %) were reported. Conclusion: Nationwide vaccination coverage of statutory health insured persons by age group can be determined by using billing data. It is possible to validate billing data of vaccinations with available data from other studies. Interpretation of billing data of acute vaccine preventable diseases remains challenging because it is difficult to assess potential under- or overestimation without the possibility of external validation. Therefore, further research is needed.

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

Background Since July 2004, routine varicella vaccination is recommended by the German Standing Vaccination Committee in Germany. Health Insurance Funds started to cover vaccination costs at different time points between 2004 and 2006 in the Federal States. Nationwide representative data on vaccination coverage against varicella of children under two years of age are not available. We aimed to determine varicella vaccination coverage in statutory health insured children under two years of age in twelve German Federal States using data from associations of statutory health insurance physicians (ASHIPs), in order to investigate the acceptance of the recommended routine varicella vaccination programme. Methods We analysed data on varicella vaccination from 13 of 17 ASHIPs of the years 2004 to 2007. The study population consisted of all statutory health insured children under two years of age born in 2004 (cohort 2004) or 2005 (cohort 2005) in one of the studied regions. Vaccination coverage was determined by the number of children vaccinated under 2 years of age within the study population. Results Varicella vaccination coverage of children under two years of age with either one dose of the monovalent varicella vaccine or two doses of the measles, mumps, rubella, and varicella vaccine increased from 34% (cohort 2004) to 51% (cohort 2005) in the studied regions (p < 0.001). More than half of the vaccinated children of cohort 2004 and two third of cohort 2005 were immunised at the recommended age 11 to 14 months. The level of vaccination coverage of cohort 2004 was significantly associated with the delay in introduction of cost coverage since the recommendation of varicella vaccination (p < 0.001). Conclusions Our study shows increasing varicella vaccination coverage of young children, indicating a growing acceptance of the routine varicella vaccination programme by the parents and physicians. We recommend further monitoring of vaccination coverage using data from ASHIPs to investigate acceptance of the routine vaccination programmes over time.