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BACKGROUND In accordance with worldwide data, the Robert Koch Institute (RKI) has reported a constant increase of syphilis cases in Germany over the past decade. METHODS We analysed the data of all patients, referred to a Department of Ophthalmology in a tertiary referral centre in Dusseldorf, Germany between 2008 and 2019, who were tested for syphilis. The epidemiologic, demographic, clinical, diagnostic and therapeutic data were retrieved from the records and evaluated in a retrospective, descriptive, non-comparative study. RESULTS Syphilis serology was positive in 32/1840 (1.7%) patients, and was evenly distributed over this period. 26 (81.3%) were male, 19 (59.4%) belonged to a risk group. Ocular syphilis was the primary diagnosis for 29 patients (90.6%). The most frequent manifestation was uveitis (n = 20, 62.5%). By the end of therapy, 19 patients (59.4%) had an improved visual acuity. CONCLUSION The incidence of ocular syphilis cases has remained stable over the last decade.

Vaccination is considered one of the most important achievements of modern medicine and has saved millions of lives. As a result, the age-old fear of severe or fatal infectious diseases has largely been forgotten in society; however, the pandemic triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shows how quickly this fear can return. Also, many people have reservations about medical measures, especially if they are directed against vague dangers. Paradoxically, the success of vaccinations jeopardizes the acceptance. To counteract this development, this article provides information on basic vaccination principles, legal frameworks and components of vaccines. It explains the most important categories, goals, core elements of vaccination programs and the most important recommendations of the Standing Committee on Vaccination at the Robert Koch Institute (STIKO). It explains the current state of knowledge with respect to required resources, assessment of vaccine reactions, complication management and possible vaccine damage.

ZusammenfassungDas Robert Koch-Institut (RKI) bietet den Gesundheitsämtern in Deutschland bei Ausbrüchen von Infektionserkrankungen Beratung und praktische Unterstützung vor Ort an. Die Feldeinsätze werden von speziell geschultem Personal durchgeführt. Auch im Rahmen der COVID-19-Pandemie leistet das RKI regelmäßig diese Form der Amtshilfe in unterschiedlichen Settings. Dabei handelt es sich beispielsweise um Ausbrüche in Wohngebäuden, Arztpraxen, Alten- und Pflegeheimen, Kliniken, Erstaufnahmeeinrichtungen für Asylsuchende, aber auch in einem Nachtclub oder auf einem Kreuzfahrtschiff.Der vorliegende Beitrag berichtet exemplarisch von Feldeinsätzen, die im Zeitraum Februar bis Oktober 2020 im Rahmen der COVID-19-Pandemie stattgefunden haben. Die daraus gewonnenen Erkenntnisse tragen dazu bei, das Wissen zu SARS-CoV‑2 zu erweitern, z. B. zur Übertragung und Ausbreitung des Erregers, RKI-Empfehlungen zu formulieren oder zu untermauern und das Management komplexer Situationen zu unterstützen. Die Praxisbeispiele zeigen, wie vielfältig die RKI-Teams nicht nur vor Ort unterstützen, sondern auch die epidemiologische Evidenzbasis bereichern.Im September 2020 wurde im RKI die „Kontaktstelle für den öffentlichen Gesundheitsdienst (ÖGD)“ eingerichtet, die unter anderem die Amtshilfe durch Feldeinsätze koordiniert und erweiterte Beratungsmöglichkeiten bietet. Damit der ÖGD langfristig noch besser auf Ausbrüche von Infektionserregern reagieren kann, soll das interdisziplinäre Trainingsangebot intensiviert werden.

We analyse the temporal and regional structure in mortality rates related to COVID-19 infections. We relate the fatality date of each deceased patient to the corresponding day of registration of the infection, leading to a nowcasting model which allows us to estimate the number of present-day infections that will, at a later date, prove to be fatal. The numbers are broken down to the district level in Germany. Given that death counts generally provide more reliable information on the spread of the disease compared to infection counts, which inevitably depend on testing strategy and capacity, the proposed model and the presented results allow to obtain reliable insight into the current state of the pandemic in Germany., Comment: 22 pages, 9 Figures

BackgroundThe effective reproduction number,Rt, is a tool to track and understand epidemic dynamics. This investigation ofRtestimations was conducted to guide the national COVID-19 response in Qatar, from the onset of the epidemic until August 18, 2021.MethodsReal-time “empirical”was estimated using five methods, including the Robert Koch Institute, Cislaghi, Systrom-Bettencourt and Ribeiro, Wallinga and Teunis, and Cori et al. methods.Rwas also estimated using a transmission dynamics model. Uncertainty and sensitivity analyses were conducted. Agreements between differentRtestimates were assessed by calculating correlation coefficients.Resultscaptured the evolution of the epidemic through three waves, public health response landmarks, effects of major social events, transient fluctuations coinciding with significant clusters of infection, and introduction and expansion of the B.1.1.7 variant. The various estimation methods produced consistent and overall comparableestimates with generally large correlation coefficients. The Wallinga and Teunis method was the fastest at detecting changes in epidemic dynamics.estimates were consistent whether using time series of symptomatic PCR-confirmed cases, all PCR-confirmed cases, acute-care hospital admissions, or ICU-care hospital admissions, to proxy trends in true infection incidence.correlated strongly withand provided an average.ConclusionsRtestimations were robust and generated consistent results regardless of the data source or the method of estimation. Findings affirmed an influential role forRtestimations in guiding national responses to the COVID-19 pandemic, even in resource-limited settings.

For SARS-CoV-2, R0 calculations report usually 2-3, biased by PCR testing increases. Covid-19-induced excess mortality is less biased.We used data from Robert Koch Institute on Covid incidence, deaths, and PCR tests and excess mortality to determine early, policy-free R0 estimates with a serial interval of 4.7 days.The PCR-based R0 value was 2.56 (95% CI 2.52-2.60) for Covid-19 cases and 2.03 (95%CI 1.96-2.10) for Covid-19-related deaths. As the number of PCR tests increased, R0 values were corrected accordingly, yielding 1.86 for Covid-19 cases and 1.47 for Covid-19 deaths, excess deaths were 1.34 (95% CI 1.32-1.37).R0 is much lower than previously thought. This fits the observed seasonal pattern of infection across Europe in 2020-2021, including emergence of more contagious escape variants such as delta.One-Sentence SummaryExcess mortality reveals infection speed in Covid-19 is surprisingly low with seasonal infection patterns and escape variants.

Syphilis, caused by the bacteria Treponema pallidum subspecies pallidum, is an infectious disease transmitted through direct, most frequently sexual, contact with infected mucosal lesions. In the last two decades the numbers of cases reported to the Robert Koch Institute (RKI) increased from around 2000 cases in 2000 to 7889 cases in 20191 . Syphilis is much more common in men than in women. In 2018, only 6.1% of the reported cases in Germany and 14% in the USA were female patients1,2 .

According to the Robert Koch Institute, the estimated HIV prevalence in Germany is 86 100. On-third of the affected persons is over 50 years old. Overall, the prognosis of patients with HIV infection depends crucially on the time of diagnosis. The unfounded stigmatization of affected patients stands in the way of today's treatment options as it did 30 years ago. Every practice of primary care must also take into consideration the medical care of HIV-infected people. The purpose of this article is to make the general practitioner aware of this topic and to prepare for the necessary procedure in everyday practice in this rare but not unlikely situation.

BACKGROUND Perioperative antibiotic prophylaxis (PAP) is recommended for the prevention of postoperative infections by the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. However, how PAP is currently used in the field of dermatosurgery in Germany is unclear. METHODS All members of the German Society for Dermatosurgery (DGDC) were asked to participate in a web-based survey in order to investigate the use of PAP by German dermatological surgeons. RESULTS 78 DGDC members completed the questionnaire. Of these, 89.7 % (70/78) were medical specialists with a median work experience of 15 years in the field of dermatosurgery, and 53.8 % (42/78) of the respondents regularly use PAP in dermatosurgery. Of these, 35.7 % (15/42) reported that they perform PAP for immunocompromised patients. Only a small proportion of skin surgeons stated that they administer PAP parenterally (5.9 %, 4/67). The most commonly used drug was cephalosporin cefuroxime. The duration of the PAP varied between single-dose and prolonged administration for more than five days. CONCLUSION Currently, the use of PAP in dermatosurgical procedures in Germany is not standardized. Prospective randomized dermatosurgical studies are needed in order to investigate whether the PAP recommendations of KRINKO are applicable to the field of dermatological surgery.

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.

Background: The influence of the working environment on the back health of employees is well-documented. Many companies have begun to offer employees access to services to promote back health. Factors affecting the use of these offers at the population level have received little investigation to date. The current study examined the socio-demographic factors, physical activity and health-related factors, and work-related factors associated with the use of offers of workplace health promotion for back health in Germany.Materials and Methods: In the representative population-based cross-sectional survey “German Health Update” (GEDA 2014/2015-EHIS) conducted by the Robert Koch Institute, 12,072 employees aged 18–64 years old were surveyed from November 2014 to July 2015 regarding the use of back health services in their companies. In addition to socio-demographic factors, the survey examined working hours, physical activity in leisure time, health awareness, and subjective complaints in the lower back or other chronic back problems in the last 12 months. The interaction of these factors with the utilization of back health services was tested using multiple logistic regression models.Results: Women used back health services more often than men (women: 25.5%; men: 18.1%). Female gender was associated with part-time employment (OR 0.72) and a strong to very strong level of health awareness (OR 1.40). Male gender was associated with age between 30 and 44 years (OR 1.99) and 45–64 years (OR 2.02), low socioeconomic status (OR 0.48), endurance activity of Conclusion: The present study is the first to provide findings regarding the factors associated with the utilization of workplace health promotion to promote back health at the population level, and from the perspective of employees in Germany. The results revealed that the relevant factors for participating in offers differ for women and men. To reach more employees, workplace health promotion offers for back health should be designed specifically for each individual, considering gender and age, working hours, health awareness and behavior, and health state.

Since January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread to become a global pandemic [1]. Active case finding, early detection and isolation of cases and their contacts are essential for breaking transmission chains. A modelling study showed that 70% of contacts should be traced in order to control the outbreak, assuming a baseline reproduction rate of 2.5 [2]. Early warning systems for the serious cross-border spread of infectious pathogens include the International Health Regulations (IHR) 2005 and the Early Warning and Response System (EWRS) for the European Union/European Economic Area (EU/EEA) countries [3,4]. Within Germany, communication channels have been established in accordance with the German Infection Protection Act (Infektionsschutzgesetz; IfSG). Cross-border contact tracing at the national level is operated by the Robert Koch Institute (RKI), the federal public health institute in Germany. The first cases of coronavirus disease 2019 (COVID-19) in Germany occurred in Bavaria at the end of January 2020 [5]. The first SARS-CoV-2 cluster also led to cross-border contacts and exposures on flights since close contacts and suspected cases travelled to Austria and Spain after exposure. This required intensive international communication to identify and share the information on contacts with the responsible health authorities. An international communication and contact tracing team (RKI IC-Team) was rapidly created in the RKI COVID-19 Emergency Operations Centre (EOC) including members of all units of the department for infectious disease epidemiology and other departments at the RKI. The core task of the team was to collect and communicate information on confirmed COVID-19 cases and their contacts to other countries in the event of cross-border relevance. In addition, incoming information on German citizens exposed abroad was communicated through the federal state health authorities to the responsible local health authorities in Germany. The spread of SARS-CoV-2 in Germany triggered the introduction of various measures: (i) mass gatherings with more than 1,000 participants were banned after calendar week 10, (ii) schools and public places were closed in several federal states, (iii) physical distancing measures of at least 1.5 m to another person were recommended, (iv) it was recommended to cancel non-essential travel and (v) quarantine measures for travellers from high risk areas entering Germany were introduced in calendar week 15. Because of the federal structure in Germany, the measures and their implementation varied between the states. This work aimed to describe the extent and course of activities resulting from information on COVID-19 exposure events with a cross-border context. Further, we discuss the challenges experienced and possible workflow improvements.

At the beginning of the COVID-19 pandemic, the German Robert Koch Institute (RKI) published several guidelines addressing the medical health services helping to detect SARS CoV‑2. Needing an available and specific test strategy regarding SARS-CoV‑2, our own test strategy strictly followed these testing criteria.Using a retrospective analysis, we verified if such a test strategy was an effective tool in the context of infection prevention control and as reliable SARS-CoV‑2 detection. Therefore, we analysed our own test results of suspected SARS-CoV‑2 cases between 26 February and 6 April 2020. Additionally, we used a geovisualisation tool to visualise test frequencies and positive test results within different districts of Mannheim based on people's addresses.There were on average 7% positive test results of SARS-CoV‑2 within a population with typical symptoms of COVID-19 (n = 2808). There was no positive test result within an asymptomatic population (n = 448). However, one positive test result turned out to be a nosocomial infection. Finally, geovisualisation highlighted a shift of test frequencies and local positive rates for SARS-CoV‑2 from one district of Mannheim to another.In conclusion, our test strategy strictly based on testing criteria suggested by the Robert Koch Institute resulted in a steady rate of positive tests and allowed us to increase test capacity without causing numbers of nosocomial infections of COVID-19. Geovisualisation tools can offer support in analysing an ongoing spread of transmissible diseases. In the future, they could be used as helpful tools for infection prevention control, for example in the context of vaccination programs.HINTERGRUND: Zu Beginn der COVID-19-Pandemie in Deutschland veröffentlichte das Robert Koch-Institut (RKI) Orientierungshilfen für eine bedarfsadaptierte und zielgerichtete Teststrategie auf SARS-CoV‑2. In der Universitätsmedizin Mannheim (UMM) wurde von Beginn an eine RKI-konforme Teststrategie, basierend auf den RKI-Orientierungshilfen angewendet. Ziel dieser Arbeit ist es, zu klären, ob sich diese RKI-konforme Teststrategie als lohnenswert erwiesen hat.Es erfolgte eine retrospektive Auswertung aller SARS-CoV-2-Untersuchungen im Zeitraum 26.02.–06.04.2020. Mithilfe der Adressinformationen der getesteten Personen erfolgte zudem eine Geovisualisierung der SARS-CoV-2-Testhäufigkeiten und der positiven Testergebnisse im Stadtgebiet Mannheim.Der Anteil SARS-CoV-2-positiver Befunde bei den diagnostischen Proben (n = 2808) lag durchschnittlich bei 7 %. Ein Mitarbeiterscreening (n = 448) blieb ohne positiven Befund. Es erfolgte lediglich ein nosokomialer SARS-CoV-2-Nachweis, Ausbruchsgeschehen gab es nicht. Die Geovisualisierung zeigte innerhalb des Untersuchungszeitraumes eine Verschiebung der Testhäufigkeiten und der lokalen Häufigkeit positiver SARS-CoV-2-Befunde im Stadtgebiet Mannheim.Die festgelegte RKI-konforme Teststrategie führte sowohl zu einem stabilen Anteil positiver Ergebnisse als auch zu einer bedarfsadaptierten Anpassung der Testkapazitäten. Dadurch hat sich diese Strategie unter Praxisbedingungen aus infektionshygienischer und -präventiver Sicht als effektiv erwiesen. Geovisualisierungen können dabei helfen, innerhalb eines Stadtgebietes Verschiebungen von Infektionsherden deutlich zu machen, was im Sinne gezielter infektionspräventiver Maßnahmen (z. B. Impfkampagnen) sinnvoll eingesetzt werden kann.

The German Environmental Survey (GerES) is a population-representative, cross-sectional study on environmental exposures of the general population of Germany. GerES has repeatedly been conducted since 1985 by the German Environment Agency (UBA) in close collaboration with the Health Interview and Examination Surveys of the Robert Koch Institute (RKI). In the German Environmental Survey for Children and adolescents 2014–2017 (GerES V) pollutants and other environmental stressors were measured in human samples as well as in the homes of 3- to 17-year-old children and adolescents. Interviews were conducted about health-related behaviors and living conditions. The GerES V basic program encompassed examinations of whole blood, blood plasma, morning urine and drinking water samples, measurements of ultrafine particles and noise levels, comprehensive standardized interviews, and self-administrated questionnaires. Additional modules on volatile organic compounds and aldehydes, particulate matter (PM2.5) in indoor air, organic compounds in drinking water and pollutants in house dust were conducted in subsamples. Potential GerES V participants were identified and attained by the RKI from those participants who were examined and interviewed for the cross-sectional component of the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2). The gross sample of GerES V comprised 3031 children and adolescents of which 2294 finally took part in the survey. This equals a total response rate of 75.7 %. Response rates varied, depending on region, type of municipality, age and sex, from 66.0 % to 78.3 %. By calculating individual case weights, discrepancies due to sample design and non-response between the GerES V sample and the whole population could be considered in statistical analysis. Therefore, the representativeness of the GerES V results with regard to age, sex, community size and region was assured.

Assessing the infection fatality rate (IFR) of SARS-CoV-2 is one of the most controversial issues during the pandemic. Due to asymptomatic or mild courses of COVID-19, many infections remain undetected. Reported case fatality rates - COVID-19-associated deaths divided by number of detected infections - are therefore poor estimates of the IFR. Endogenous changes of the population at risk of a SARS-CoV-2 infection, changing test practices and an improved understanding of the pathogenesis of COVID-19 further exacerbate the estimation of the IFR. Here, we propose a strategy to estimate the IFR of SARS-CoV-2 in Germany that combines official data on reported cases and fatalities supplied by the Robert Koch Institute (RKI) with data from seroepidemiological studies in two infection hotspots, the Austrian town Ischgl and the German municipality Gangelt, respectively. For this purpose, we use the law of total probability to derive an approximate formula for the IFR that is based on a set of assumptions regarding data quality and test specificity and sensitivity. The resulting estimate of the IFR in Germany of 0.83% (95% CI: [0.69%; 0.98%]) that is based on a combination of the RKI and Ischgl data is notably higher than the IFR estimate reported in the Gangelt study (0.36% [0.29%; 0.45%]). It is closer to the consolidated estimate based on a meta-analysis (0.68% [0.53%; 0.82%]), where the difference can be explained by Germany's disadvantageous age structure. As a result of virus mutations, vaccination strategies, and improved therapy, a re-estimation of the IFR will eventually be mandated; the proposed method is able to account for such developments.

The COVID-19 pandemic has kept the world in suspense for the past year. In most federal countries such as Germany, locally varying conditions demand for state- or county-level decisions to adapt to the disease dynamics. However, this requires a deep understanding of the mesoscale outbreak dynamics between microscale agent models and macroscale global models. Here, we use a reparameterized SIQRD network model that accounts for local political decisions to predict the spatiotemporal evolution of the pandemic in Germany at county resolution. Our optimized model reproduces state-wise cumulative infections and deaths as reported by the Robert Koch Institute and predicts the development for individual counties at convincing accuracy during both waves in spring and fall of 2020. We demonstrate the dominating effect of local infection seeds and identify effective measures to attenuate the rapid spread. Our model has great potential to support decision makers on a state and community politics level to individually strategize their best way forward during the months to come. Supplementary Information The online version contains supplementary material available at 10.1007/s10237-021-01520-x.

We analyze the Covid-19 epidemic curve from March to end of April 2020 in Germany. We use statistical models to estimate the number of cases with disease onset on a given day and use back-projection techniques to obtain the number of new infections per day. The respective time series are analyzed by a Poisson trend regression model with change points. The change points are estimated directly from the data without further assumptions. We carry out the analysis for the whole of Germany and the federal state of Bavaria, where we have more detailed data. Both analyses show a major change between March 9th and 13th for the time series of infections: from a strong increase to a stagnation or a slight decrease. Another change was found between March 24th and March 31st, where the decline intensified. These two major changes can be related to different governmental measures. On March, 11th, Chancellor Merkel appealed for social distancing in a press conference with the Robert Koch Institute (RKI) and a ban on major events with more than 1000 visitors (March 10th) was issued. The other change point at the end of March could be related to the shutdown in Germany. Our results differ from those by other authors as we take into account the reporting delay, which turned out to be time dependent and therefore changes the structure of the epidemic curve compared to the curve of newly reported cases.

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.

Using data on coronavirus disease (COVID-19) cases in Germany from the Robert Koch Institute, we found a relative increase with time in the prevalence in 15–34 year-olds (particularly 20–24-year-olds) compared with 35–49- and 10–14-year-olds (we excluded older and younger ages because of different healthcare seeking behaviour). This suggests an elevated role for that age group in propagating the epidemic following the introduction of physical distancing measures.

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.

The increasingly frequent use of immunomodulatory agents in dermatology requires the observance of specific recommendations for immunization. These recommendations are developed and regularly updated by the German Standing Committee on Vaccination (STIKO), an independent advisory group at the Robert Koch Institute. Dermatological patients on immunosuppressive treatment should ideally receive all vaccinations included in the standard immunization schedule. Additionally, it is recommended that they also undergo vaccination against the seasonal flu, pneumococci, and herpes zoster (inactivated herpes zoster subunit vaccine for patients ≥ 50 years). Additional immunizations against Haemophilus influenzae type B, hepatitis B and meningococci may be indicated depending on individual comorbidities and exposure risk. Limitations of use, specific contraindications and intervals to be observed between vaccination and immunosuppression depend on the immunosuppressive agent used and its dosing. Only under certain conditions may live‐attenuated vaccines be administered in patients on immunosuppressive therapy. Given its strong suppressive effect on the humoral immune response, no vaccines – except for flu shots – should be given within six months after rituximab therapy. This CME article presents current recommendations on immunization in immunocompromised individuals, with a special focus on dermatological patients. Its goal is to enable readers to provide competent counseling and to initiate necessary immunizations in this vulnerable patient group.

Knowledge about the daily number of new infections of Covid-19 is important because it is the basis for political decisions resulting in lockdowns and urgent health care measures. We use Germany as an example to illustrate shortcomings of official numbers, which are, at least in Germany, disclosed only with several days of delay and severely underreported on weekends (more than 40%). These shortcomings outline an urgent need for alternative data sources. The other widely cited source provided by the Center for Systems Science and Engineering at Johns Hopkins University (JHU) also deviates for Germany on average by 79% from the official numbers. We argue that Google Search and Twitter data should complement official numbers. They predict even better than the original values from Johns Hopkins University and do so several days ahead. These two data sources could also be used in parts of the world where official numbers do not exist or are perceived to be unreliable., 15 pages, 5 figures

Diabetes mellitus and other noncommunicable diseases (NCDs) represent an emerging global public health challenge. In Germany, about 6.7 million adults are affected by diabetes according to national health surveys, including 1.3 million with undiagnosed diabetes. Complications of diabetes result in an increasing burden for individuals and society as well as enormous costs for the health care system. In response, the Federal Ministry of Health commissioned the Robert Koch Institute (RKI) to implement a diabetes surveillance system and the Federal Center for Health Education (BZgA) to develop a diabetes prevention strategy. In a two-day workshop jointly organized by the RKI and the BZgA, representatives from public health institutes in seven countries shared their expertise and knowledge on diabetes prevention and surveillance. Day one focused on NCD surveillance systems and emphasized both the strengthening of sustainable data sources and the timely and targeted dissemination of results using innovative formats. The second day focused on diabetes prevention strategies and highlighted the importance of involving all relevant stakeholders in the development process to facilitate its acceptance and implementation. Furthermore, the effective translation of prevention measures into real-world settings requires data from surveillance systems to identify high-risk groups and evaluate the effect of measures at the population level based on analyses of time trends in risk factors and disease outcomes. Overall, the workshop highlighted the close link between diabetes prevention strategies and surveillance systems. It was generally stated that only robust data enables effective prevention measures to encounter the increasing burden from diabetes and other NCDs.

Politicians and doctors in Germany have called for urgent action to control the spread of covid-19 after a record number of cases were reported on 11 November. Germany had 50 196 new confirmed covid cases on 11 November,1 up from 39 676 cases on 10 November and 9658 on 1 November, showed figures from the Robert Koch Institute, the federal agency responsible for disease control and prevention.2 A total of 235 covid related deaths were reported on 11 November, up from 23 on 1 November. Speaking in the Bundestag, Germany’s lower house of parliament, the federal vice chancellor, Olaf Scholz, said that immediate steps must be taken to “winterproof” Germany against what is being described as the nation’s fourth wave of covid-19. Scholz, who is …

There is only limited data available on the utilization of gynecological services in Germany. Based on data from the German Health Survey for Children and Adolescents (KiGGS) of the Robert Koch Institute, a survey carried out across all of Germany, this study aimed to examine the utilization of gynecological services by girls in Germany. Data from the KiGGS Wave 1 survey (2009 - 2012) was used to analyze the factors which affect utilization. The KiGGS baseline study (2003 - 2006) was used to analyze trends. The database consisted of a subsample from the KiGGS Wave 1 survey (n = 2575), the initial follow-up survey conducted by telephone after the baseline study. Data are shown as prevalence and mean with 95% confidence intervals. Correlations with selected influencing factors were calculated using multivariate logistic regression models. Differences between study populations were considered significant if p 0.05. At the time of the KiGGS Wave 1 survey, 53.9% of girls aged 14 to 17 years had visited a gynecologist at least once. This percentage increased significantly with each additional year of life. For 61.9% of 17-year-old girls who had previously visited a gynecologist at least once, the first visit to a gynecologist occurred at the age of 15 or 16 years. Growing up with siblings was associated with a lower prevalence of utilization, while middle socioeconomic status, risky alcohol consumption and daily consumption of tobacco, and the utilization of general medical services were associated with a higher 12-month prevalence for the utilization of gynecological services. The utilization of gynecological services has increased significantly compared to the KiGGS baseline survey. Among girls there is a high need for information on issues of sexual health. Gynecologists are important but they are not the only port of call. Information needs should be covered as part of a coordinated approach which includes the involvement of all relevant stakeholders. Initiatives such as the WHO Action Plan for Sexual and Reproductive Health and its recommendations should be incorporated.In Deutschland sind nur wenige Daten zur Nutzung frauenärztlicher Leistungen verfügbar. Basierend auf Daten der bundesweiten „Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland“ (KiGGS) des Robert Koch-Instituts wird die Inanspruchnahme von Frauenärztinnen und Frauenärzten durch Mädchen untersucht. Anhand der Daten aus KiGGS Welle 1 (2009 – 2012) wird analysiert, welche Faktoren die Nutzung beeinflussen. Für Trendanalysen wird die KiGGS-Basiserhebung (2003 – 2006) herangezogen. Datenbasis ist eine Teilstichprobe aus KiGGS Welle 1 (n = 2575), der ersten telefonischen Folgebefragung nach der Basiserhebung. Berichtet werden Prävalenzen und Mittelwerte mit 95%-Konfidenzintervallen. Zusammenhänge mit ausgewählten Einflussfaktoren wurden mit multivariaten logistischen Regressionsmodellen berechnet. Unterschiede zwischen den Studienpopulationen werden bei p 0,05 als signifikant ausgewiesen. Zum Befragungszeitpunkt von KiGGS Welle 1 haben 53,9% der 14- bis 17-jährigen Mädchen mindestens einmal frauenärztliche Leistungen in Anspruch genommen. Dieser Anteil nimmt mit jedem Lebensjahr deutlich zu. Bei 61,9% der 17-jährigen Mädchen, die bereits eine gynäkologische Praxis besucht haben, fand der erste Kontakt mit 15 oder 16 Jahren statt. Das Aufwachsen mit Geschwistern geht mit einer geringeren, ein mittlerer sozioökonomischer Status, ein riskanter Alkohol- und täglicher Tabakkonsum sowie die Inanspruchnahme allgemeinärztlicher Leistungen mit einer höheren 12-Monats-Prävalenz der Inanspruchnahme einher. Im Vergleich zur KiGGS-Basiserhebung hat die Inanspruchnahme deutlich zugenommen. Bei Mädchen besteht ein großer Bedarf an Informationen zu Fragen der sexuellen Gesundheit. Frauenärztinnen und Frauenärzte sind dabei wichtige, aber nicht die einzigen Anlaufstellen. Der Informationsbedarf sollte evidenzbasiert im Rahmen eines abgestimmten Vorgehens unter Beteiligung der relevanten Akteure gedeckt werden. Dabei sollten Initiativen wie der WHO Action Plan for Sexual and Reproductive Health und dessen Empfehlungen berücksichtigt werden.

The vast majority of IgE-mediated food allergies in adults are based on sensitization to pollen, followed by reactions to structurally related, often unstable allergens, in particular in fruit (including edible nuts), vegetables, and spices. This article provides an up-to-date overview of selected scientific works on pollen-related food allergy and has been drawn-up on the basis of PubMed research, the German Study on Adult Health (Studie zur Gesundheit Erwachsener in Deutschland, DEGS) conducted by the Robert Koch Institute, as well as the national and international guideline registries. Birch pollen-related symptoms are generally the commonest form of pollen-related allergy observed in Northern Europe. The types of fruit that most frequently cause symptoms belong to the Rosaceae (e. g., apple, cherry) and Fagales families (hazelnut). Reactions to legumes (e. g., peanut, soy) and vegetables, including celery, carrot, tomato, and bell pepper, are also worthy of note. In addition to oropharyngeal contact urticaria, the clinical symptoms of pollen-related food allergy can range from the involvement of other organ systems to anaphylactic shock. The main plant food allergens belong to a handful of protein families: Bet v 1 homologs, profilins, lipid transfer proteins, storage proteins, and thaumatin-like proteins. The diagnosis of pollen-related food allergy has seen significant advances in recent years in the wake of component-resolved/molecular allergology, thereby, enabling reliable identification. Treatment comprises dietary counseling and the prescription of emergency medication. In addition, allergen-specific immunotherapy for cross-reactive pollen allergens appears to positively affect concomitant food allergies in some patients.