Search

A zoonotic A/sw/H1 av N1 1C.2.2 influenza virus infection was detected in a German child that presented with influenza-like illness, including high fever. There was a history of close contact with pigs 3 days before symptom onset. The child recovered within 3 days. No other transmissions were observed. Serological investigations of the virus isolate revealed cross-reactions with ferret antisera against influenza A(H1N1)pdm09 virus, indicating a closer antigenic relationship with A(H1N1)pdm09 than with the former seasonal H1N1 viruses.

During the recent outbreak of Shiga toxin-producing Escherichia coli (STEC) O104:H4 in Germany most cases notified in the State of Hesse (6 million inhabitants) were linked to satellite clusters or had travelled to the outbreak area in northern Germany. Intensified surveillance was introduced to rapidly identify cases not linked to known clusters or cases and thus to obtain timely information on possible further contaminated vehicles distributed in Hesse, as well to describe the risk of secondary transmission among known cases. As of 2 August 2011* [corrected], 56 cases of haemolytic uraemic syndrome (HUS) including two fatal cases, and 124 cases of STEC gastroenteritis meeting the national case definitions have been reported in Hesse. Among the 55 HUS and 81 STEC gastroenteritis cases thatmet the outbreak case definition, one HUS case and eight STEC gastroenteritis cases may have acquired their infection through secondary transmission. They include six possible transmissions within the family, two possible nosocomial and one possible laboratory transmission. Our results do not suggest an increased transmissibility of the outbreak strain compared to what is already known about E. coli O157 and other STEC serotypes.

Campylobacter infection is the most common cause of bacterial gastroenteritis worldwide. This study examines the association between campylobacteriosis incidence and degree of urbanicity in Hesse, Germany, by age and Campylobacter species. During a one-year period (July 2005–June 2006), Hessian local health authorities provided information on municipality of residence for 3,315 campylobacteriosis cases. We calculated age- and Campylobacter species-specific incidences for six levels of urbanicity, as defined by population density and accessibility of centres. For children under five years old, living in inner rural areas (incidence rate ratio (IRR): 2.9; 95% confidence interval (CI): 1.9 to 4.4) and for children aged 5–14 years living in inner rural (IRR: 2.1; 95% CI: 1.3 to 3.1) or intermediate areas (inner intermediate area IRR: 1.8; 95% CI: 1.2 to 2.7; outer intermediate area IRR: 2.1; 95% CI: 1.3 to 3.3) was associated with a statistically significantly higher campylobacteriosis risk (reference category: inner urban area). Calculations by Campylobacter species showed a higher risk of gastroenteritis due to C. coli for inhabitants (all ages) of non-urban areas. This study suggests that differences in risk factors by age, Campylobacter species and degree of urbanicity do exist. For children contact with animals or the environment may be responsible for a substantial proportion of sporadic Campylobacter infections.

From January 2008 to April 2009, 72 cases of severe Clostridium difficile infection were reported from 18 different districts in the state of Hesse, Germany. A total of 41 C. difficile isolates from 41 patients were subjected to PCR ribotyping. PCR ribotype (RT) 027 was the most prevalent strain accounting for 24 of 41 (59%) of typed isolates, followed by RT 001 (eight isolates, 20%), RT 017 and 042 (two isolates each), and RT 003, 066, 078, 081, and RKI-034 (one isolate each). Eighteen patients had died within 30 days after admission. C. difficile was reported as underlying cause of or contributing to death in 14 patients, indicating a case fatality rate of 19%. The patients with lethal outcome attributable to C. difficile were 59-89 years-old (median 78 years). Ribotyping results were available for seven isolates associated with lethal outcome, which were identified as RT 027 in three and as RT 001 and 017 in two cases each. Our data suggest that C. difficile RT 027 is prevalent in some hospitals in Hesse and that, in addition to the possibly more virulent RT 027, other toxigenic C. difficile strains like RT 001 and 017 are associated with lethal C. difficile infections in this region.

For the next influenza season (winter 2009-10) the relative contributions to virus circulation and influenza-associated morbidity of the seasonal influenza viruses A(H3N2), A(H1N1) and B, and the new influenza A(H1N1)v are still unknown. We estimated the chances of seasonal influenza to circulate during the upcoming season using data of the German influenza sentinel scheme from 1992 to 2009. We calculated type and subtype-specific indices for past exposure and the corresponding morbidity indices for each season. For the upcoming season 2009-10 our model suggests that it is unlikely that influenza A(H3N2) will circulate with more than a low intensity, seasonal A(H1N1) with more than a low to moderate intensity, and influenza B with more than a low to median intensity. The probability of a competitive circulation of seasonal influenza A with the new A(H1N1)v is low, increasing the chance for the latter to dominate the next influenza season in Germany.