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Background: Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection. Annually, sepsis leads to approx. 90.000 deaths in Germany. Risk factors include amongst others older age (>60), innate or acquired dysfunction of the immune system, and underlying chronic diseases of the lung, heart, liver, or kidneys. The manifestation of sepsis is a medical emergency, and patient outcomes depend on timely diagnosis and immediate treatment. In addition, vaccinations e.g., against pneumococci or influenza virus, are a highly effective public health tool to prevent the most common underlying infections that may lead to sepsis. However, a lack of public awareness for the relevance of vaccination and detecting sepsis as an emergency underlines the need for public health interventions that address these issues. SepWiss aims to evaluate the effects of a multimodal information campaign designed to address this lack of awareness among the risk population in Germany. Methods: SepWiss is an intervention at state level, consisting of a multimodal information campaign targeting risk groups in the German federal states of Berlin and Brandenburg (intervention region). Based on available evidence, various information formats were developed and implemented by outdoor advertising, social media, educational formats and through stakeholders' platforms, starting in August 2021. The control region comprises of the remaining 14 German federal states. We will analyze vaccination coverage (primary outcome), and sepsis knowledge, the ability to detect sepsis as an emergency, and attitude towards vaccination (secondary outcomes) amongst the risk population in a controlled before-after comparison. The implementation is accompanied by a mixed-method process evaluation. Discussion: SepWiss is the first project of its kind to evaluate a complex multi-faceted evidence-based information campaign with regards to the topics of vaccination coverage, and the importance of sepsis detection and prevention for the most vulnerable populations in Germany. Results will be valuable for informing further nationwide campaigns. Trial registration: German Registry for Clinical Trials: DRKS00024475. Registered February 24th, 2021. [ABSTRACT FROM AUTHOR]

Objective We aimed to quantify progress towards measles elimination in Germany from 2007 to 2011 and to estimate any potential underreporting over this period. Methods We determined the annual incidence of notified cases of measles--for each year--in northern, western, eastern and southern Germany and across the whole country. We then used measles-related health insurance claims to estimate the corresponding incidence. Findings In each year between 2007 and 2011, there were 6.9-19.6 (mean: 10.8) notified cases of measles per million population. Incidence decreased with age and showed geographical variation, with highest mean incidence--20.3 cases per million--in southern Germany. Over the study period, incidence decreased by 10% (incidence rate ratio, IRR: 0.90; 95% confidence interval, CI: 0.85- 0.95) per year in western Germany but increased by 77% (IRR: 1.77; 95% CI: 1.62-1.93) per year in eastern Germany. Although the estimated incidence of measles based on insurance claims showed similar trends, these estimates were 2.0- to 4.8-fold higher than the incidence of notified cases. Comparisons between the data sets indicated that the underreporting increased with age and was generally less in years when measles incidence was high than in low-incidence years. Conclusion Germany is still far from achieving measles elimination. There is substantial regional variation in measles epidemiology and, therefore, a need for region-specific interventions. Our analysis indicates underreporting in the routine surveillance system between 2007 and 2011, especially among adults. [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Evaluer les progres realises dans l'elimination de la rougeole en Allemagne entre 2007 et 2011, et estimer toute sous-declaration potentielle au cours de cette periode. Methodes Nous avons determine l'incidence annuelle des cas declares de rougeole (pour chaque annee) dans le nord, l'ouest, l'est et le sud de l'Allemagne et dans tout le pays. Nous avons ensuite utilise les demandes de remboursement a l'assurance maladie liees a la rougeole pour estimer l'incidence correspondante. Resultats Chaque annee entre 2007 et 2011, il y a eu entre 6,9 et 19,6 (moyenne: 10,8) cas declares de rougeole par million d'habitants. L'incidence diminuait avec l'age et montrait une variation geographique, avec l'incidence moyenne la plus elevee (20,3 cas par million d'habitants) dans le sud de (Allemagne. Pendant la periode de (etude, (incidence a diminue de 10% (rapport de taux d'incidence, RTI: 0,90; intervalle de confiance a 95%, IC 95%: 0,85-0,95) par an dans l'ouest de (Allemagne mais a augmente de 77% (RTI: 1,77; IC 95%: 1,62-1,93) par an dans (est de l'Allemagne. Bien que l'incidence estimee de la rougeole basee sur les demandes de remboursement a l'assurance maladie ait montre des tendances similaires, ces estimations etaient 2,0 a 4,8 fois superieures a l'incidence des cas declares. Les comparaisons entre les ensembles de donnees ont indique que la sous-declaration augmentait avec l'age et etait generalement plus faible les annees ou l'incidence de la rougeole eta it elevee, que lors des annees a incidence faible. Conclusion l'Allemagne est toujours loin d'avoir elimine la rougeole. Il existe des variations regionales substantielles en matiere d'epidemiologie de la rougeole et, par consequent, un besoin d'interventions spedfiques aux regions. Notre analyse indique une sous-declaration dans le systeme de surveillance de routine entre 2007 et 2011, en particulier chez les adultes. Objetivo Pretendimos cuantificar el progreso hacia la elimination del sarampion en Alemania de 2007 a 2011 y estimar cualquier falta de notification en el periodo. Metodos Se determino la incidencia anual de casos notificados de sarampion para cada ano en el norte, el oeste, el este y el sur de Alemania, asf como en todo el pais. A continuation, se emplearon las reclamaciones de seguros medicos relacionadas con el sarampion para estimar la incidencia correspondiente. Resultados Cada ano entre 2007 y 2011, hubo entre 6,9 y 19,6 (media: 10,8) casos notificados de sarampion por millon de habitantes. La incidencia disminuyo con la edad y mostro variation geografica, con mayor incidencia media (20,3 casos por millon) en el surde Alemania. Durante el periodo del estudio, la incidencia se redujo en un 10 % (razon de tasas de incidencia, IRR: 0,90; Intervalo de confianza del 95 %, IC: 0,85-0,95) al ano en el oeste de Alemania, pero aumento en un 77 % (IRR: 1,77; IC del 95 %: 1,62-1,93) al ano en el este de Alemania. Si bien la incidencia estimada del sarampion basada en las reclamaciones de seguros mostro tendencias similares, estas estimaciones eran de 2,0 a 4,8 veces mas elevadas que la incidencia de casos notificados. Las comparaciones entre los conjuntos de datos indicaron que la falta de notificacion aumento con la edad y que fue generalmente menor durante los anos en que la incidencia del sarampion fue alta que en los anos de incidencia baja. Conclusion Alemania sigue lejos de lograr la eradication del sarampion. Existe una variation regional considerable en la epidemiologia del sarampion y, por lo tanto, se requieren intervenciones especfficas en cada region. Nuestro analisis senala una falta de notificacion en el sistema de vigilancia sistematica entre 2007 y 2011, sobre todo entre los adultos., Introduction Measles is a viral disease that can lead to severe complications such as encephalitis, pneumonia and death. (1) All of the countries within the World Health Organization (WHO) European [...]

Abstract Background Herpes zoster (HZ) is caused by a reactivation of the varicella-zoster-virus (VZV) and mainly affects individuals aged ≥ 50 years. Vaccines have been licensed or are under development that can protect against HZ and its main complication postherpetic neuralgia (PHN). In Germany, the burden of disease caused by HZ is not well known. To support the decision making process related to a potential vaccination recommendation, we estimated annual HZ disease burden in people aged ≥ 50 years in Germany by utilizing various data sources. Methods We assessed for 2007 and 2008 HZ-outpatient incidence (number of cases per 1,000 person-years, PY) by utilizing the Association of Statutory Health Insurance Physicians (ASHIP) database, which contains nationwide routine outpatient data. For the same time period annual number of HZ-inpatients and HZ-associated deaths were identified by using the Federal Health Monitoring System (FHM). PHN-incidence and loss of quality-adjusted life years (QALYs) caused by HZ were calculated by multiplying number of identified HZ-patients with upper and lower limit estimates for proportion of HZ-cases developing PHN and HZ-related QALY, respectively. Results For the study period we identified an annual average of 306,511 HZ-outpatients aged 50+, resulting in a HZ-incidence of 9.6/1,000 PY. A total 14,249 HZ-associated inpatients and 66 deaths were reported in both years on average. HZ-incidence increased by age from 6.21 in people 50-54 years to 13.19 per 1,000 PY in people aged ≥ 90 years. Females were significantly more frequently affected than males in terms of outpatient HZ-incidence (11.12 vs. 7.8 per 1,000 PY), inpatient HZ-incidence (0.51 vs. 0.38 per 1,000 PY) and mortality (0.29 vs. 0.10 per 100,000 PY). PHN-incidence was estimated to range between 0.43 and 1.33 per 1,000 PY. Based on these figures, there were between 3,065 to 24,094 QALYs lost due to HZ in persons aged ≥ 50 years in Germany per annum. Conclusion Our study provides important baseline estimates for HZ-related disease burden in Germany. HZ poses a considerable burden on the health care system in Germany both in terms of outpatient and inpatient services. Follow-up assessments of HZ disease burden are needed to monitor the impact of VZV-vaccinations in Germany.

Malaria rapid diagnostic tests (RDTs), which detect Plasmodium falciparum (Pf)-specific histidine-rich protein-2 (HRP2), have increasing importance for the diagnosis and control of malaria, especially also in regions where routine diagnosis by microscopy is not available. HRP2-based RDTs have a similar sensitivity to expert microscopy, but their reported low specificity can lead to high false positivity rates, particularly in high-endemic areas. Despite the widespread use of RDTs, models investigating the dynamics of HRP2 clearance following Pf treatment focus rather on short-term clearance of the protein. The goal of this observational cohort study was to determine the long-term kinetic of HRP2-levels in peripheral blood after treatment of uncomplicated malaria cases with Pf mono-infection using a 3-day course of artesunate/amodiaquine. HRP2 levels were quantified at enrollment and on days 1, 2, 3, 5, 7, 12, 17, 22, and 28 post-treatment initiation. The findings reveal an unexpectedly prolonged clearance of HRP2 after parasite clearance from capillary blood. Terminal HRP2 half-life was estimated to be 9 days after parasite clearance using a pharmacokinetic two-compartmental elimination model. These results provide evidence that HRP2 clearance has generally been underestimated, as the antigen remains detectable in capillary blood for up to 28 days following successful treatment, influencing RDT-based assessment following a malaria treatment for weeks. A better understanding of the HRP2 clearance dynamics is critical for guiding the diagnosis of malaria when relying on RDTs., Importance: Detecting Plasmodium falciparum , the parasite responsible for the severest form of malaria, typically involves microscopy, polymerase chain reaction (PCR), or rapid diagnostic tests (RDTs) targeting the histidine-rich protein 2 or 3 (HRP2/3). While microscopy and PCR quickly turn negative after the infection is cleared, HRP2 remains detectable for a prolonged period. The exact duration of HRP2 persistence had not been well defined. Our study in Gabon tracked HRP2 levels over 4 weeks, resulting in a new model for antigen clearance. We discovered that a two-compartment model accurately predicts HRP2 levels, revealing an initial rapid reduction followed by a much slower elimination phase that can take several weeks. These findings are crucial for interpreting RDT results, as lingering HRP2 can lead to false positives, impacting malaria diagnosis and treatment decisions., Competing Interests: The authors declare no conflict of interest.

The collection of data on SARS-CoV‑2 tests is central to the assessment of the infection rate in the context of the COVID-19 pandemic. At the Robert Koch Institute (RKI), data collected from various laboratory data recording systems are consolidated. First, this article aims to exemplify significant aspects regarding test procedures. Subsequently the different systems for recording laboratory tests are described and test numbers from the RKI test laboratory query and the laboratory-based SARS-CoV‑2 surveillance as well as accounting data from the Association of Statutory Health Insurance Physicians for SARS-CoV‑2 laboratory tests are shown.Early in the pandemic, the RKI test laboratory query and the laboratory-based SARS-CoV‑2 surveillance became available and able to evaluate data on performed tests and test capacities. By recording the positive and negative test results, statements about the total number of tests and the proportion of positive test rates can be made. While the aggregate test numbers are largely representative nationwide, they are not always representative at the state and district level. The billing data of the Association of Statutory Health Insurance Physicians can complement the laboratory data afterwards. In addition, it can provide a retrospective assessment of the total number of SARS-CoV‑2 numbers in Germany, because the services provided by statutory health insurers (around 85% of the population in Germany) are included. The various laboratory data recording systems complement one another and the evaluations flow into the recommended measures for the pandemic response.

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.