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Timely registration of fatalities is important for the assessment of course, extent, risk of age groups, and magnitude or severity of health threats. Nevertheless, timely data of casualties are not available on the state or national level. The current paper describes the implementation and structure of a surveillance system for the timely registration of casualties in the state of Hesse (Germany) and the experience obtained during the pandemic 2009/10. The delay of the case-based registration appears tolerable and after 2 weeks more than 80% of all deaths for a given week are registered. In 2008, the forwarding of the electronically registered data from the registry offices (95% of all cases) to the state statistical office (HSL) had been accelerated from a monthly to a weekly base. The HSL provides--on a weekly basis--this case-based data in accordance with data protection rules to the Hesse State Health Office (HLPUG, "Hessischer Landesprüfungs- und Untersuchungsamt im Gesundheitswesen"). During the pandemic, the data allowed assessment of the excess mortality with a delay of 2 weeks. No significant excess mortality was apparent; however, a slight increase was observed in the age groups 15-34, 35-49, and 50-59. Correlation of time with the severity of the A/H1N1v epidemic was not very strong. Hence, the data did not indicate an excess significantly exceeding the number of death cases registered with the mandatory reporting system of 21 cases for Hesse.

Background: In Germany, listeriosis surveillance is based on mandatory laboratory notification of Listeria monocytogenes. Local public health departments (LPHDs) forward the received reports anonymously to state public health departments (SPHDs) which send them to the national public health centre. For the 28th reporting week (RW) 2003, LPHDs reported four cases of listeriosis to the SPHD of Hesse, cumulating to 19 listeriosis cases in 2003 compared to four cases in RW 1 - 28, 2002., Methods: To investigate this cluster, we asked LPHDs in Hesse and Lower Saxony, where a comparable increase in cases was observed, to collect food histories for the four weeks preceding illness for cases reported from 25. - 29. RW 2003. We performed laboratory-based active case detection by contacting laboratories accepting clinical specimens from Hesse, and evaluated reporting completeness at the state level for the period 1.1.2002 - 31.8.2003., Results: Food histories of the eight cases interviewed did not permit to incriminate any particular food item. Of the 49 listeriosis cases identified through either LPHDs or active case detection, 29 (59 %) were reported, forwarded to the SPHD and identified through active case detection and four (8 %) were reported and forwarded, but not identified through active case detection. Four cases (8 %) were reported to three LPHDs, but not forwarded to the SPHD. These were identified through active case detection. Further twelve cases (24 %) were exclusively identified through active case detection., Conclusions: This assessment of reporting completeness suggests that the number of laboratory confirmed listeriosis cases exceeds the number registered at state level by at least 48 %. Completeness might be improved by electronic, automated reporting.