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Objectives: Men who have sex with men (MSM) are at higher risk for coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis than the general population. HIV infection and these coinfections accelerate disease progression reciprocally. This study evaluated the prevalence and incidence of these coinfections in HIV1-positive MSM in Germany., Materials and Methods: As part of a nationwide, multicenter, prospective cohort study of HIV-infected MSM, plasma samples collected yearly were screened for HBsAg and antibodies to HBc, HBs, HCV, and syphilis. Samples with indications of active HBV or HCV infection were confirmed by polymerase chain reaction. Prevalence and incidence of each infection and incidence rates per study participant were calculated, and incidences over 4-year time intervals compared., Results: This study screened 5,445 samples from 1,843 MSM. Median age at HIV seroconversion was 33 years. Prevalences of active, cleared, and occult HBV, and of active/cleared HCV were 1.7%, 27.1%, 0.2%, and 8.2%, respectively, and 47.5% had been effectively vaccinated against HBV. Prevalence of antibodies to Treponema pallidum and of triple or quadruple sexually transmitted infections (STIs) were 39.6% and 18.9%, respectively. Prevalence of STI, cleared HBV, HBV vaccination, and history of syphilis differed significantly among age groups. Incidences of HBV, HCV, and syphilis were 2.51, 1.54, and 4.06 per 100 person-years, respectively. Incidences of HCV and syphilis increased over time. HCV incidence was significantly higher in MSM coinfected with syphilis and living in Berlin, and syphilis incidence was significantly higher for MSM living in Berlin., Discussion: Despite extensive HBV vaccination campaigns, fewer than 50% of screened MSM were effectively vaccinated, with a high proportion of HIV-positive MSM coinfected with HBV. High rates of STI coinfections in HIV-positive MSM and increasing incidences emphasize the need for better tailored campaigns for HBV vaccination and STI prevention.

Background and Objectives: We estimated and compared the residual risks due to window-period donations for pooled and apheresis platelets in Germany using a modification of a previously described statistical model. This model directly utilizes the reported interdonation intervals before a positive donation and reflects in this aspect the look-back procedures used in haemovigilance., Materials and Methods: Data from the German National Blood Donor Surveillance System for the years 2006-2012, including reports about donations from repeat donors with confirmed positive test results for HIV, HCV and HBV, were used to estimate the risk of undetected infectious units for both pooled and apheresis platelets., Results: Demographics of whole-blood and apheresis donors differed in age, gender, catchment area and interdonation interval. These differences impact on the prevalence and incidence of transfusion relevant infections and consequently the residual risk. The estimates for the residual risks for pooled and apheresis platelets were comparable. For HIV, there was no significant difference, for HCV apheresis platelets had a lower residual risk, whereas pooled platelets had a lower risk for undetected HBV infections., Conclusion: These findings do not support calls for a shift to an apheresis platelets-only policy in Germany., (© 2014 International Society of Blood Transfusion.)

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany according to article 22 of the Transfusion Act. This report includes data from all blood donation services in Germany for 2008-2010. The prevalence for HIV ranged from 6.6-7.0/100,000, for HCV from 68.9-81.6/100,000, for HBV from 116.2-136.6/100,000 and for syphilis from 31.0-42.1/100,000 donations. The proportion of incident infections per 100,000 donations ranged from 0.8-0.9 for HIV, 0.8-1.0 for HCV, 0.3-0.5 for HBV and 1.4-1.6 for syphilis. Since 2001 the prevalence and incidence of HBV and HCV among blood has declined whereas incident HIV infections reached a peak in 2008 and 2010 and show an increasing trend. Also, the proportion of syphilis infections among first time donors was highest in 2010. Significant differences in infection prevalence and incidence were found between the sexes, different age groups and different donation types. In order to optimise donor selection a validated donor questionnaire should be used and confidentiality in all steps of donation should be assured. The possibility of a confidential self-exclusion should be explicitly pointed out to donors.

Background: Data on hepatitis B (HB) infection prevalence among children and adolescents in Germany are scarce. We estimated seroprevalence of HB infection and assessed determinants for HB infection among children and adolescents in Germany from a representative population sample., Methods: From 2003 to 2006, the Robert Koch Institute conducted a nationwide cross-sectional Health Interview and Examination Survey for Children and Adolescents in Germany. Data on age, gender, migration background, and socioeconomic status were collected through questionnaires. A child was defined as having a 2-sided migration background if both parents, or the child and 1 parent, immigrated, and a 1-sided migration background if only 1 parent immigrated. Among children with migration background, a first-generation migrant was defined as born outside Germany; a second-generation migrant was born in Germany. Information on HB vaccination status was obtained from vaccination cards. Serologic samples from participants were tested for anti-hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen. We performed weighted univariable and multivariable logistic regression analyses to assess determinants for HB infection., Results: Of 13,065 participants (3-17 years), 0.5% (95% confidence interval [CI], 0.4-0.7) were anti-HBc positive, among whom 38.7% (95% CI, 20.0-57.5) were hepatitis B surface antigen positive. Two-sided migration background and being a first- or second-generation migrant were significantly associated with anti-HBc positivity (odds ratio [OR]: 8.3, 95% CI: 4.0 –17.4; OR: 11.0, 95% CI: 3.5-35.0; OR: 3.0, 95% CI: 1.2-7.3). No further determinants were found., Conclusions: HB infection is rare among children and adolescents in Germany. First- and second-generation migrant children can be considered to be at risk for HB infection, 2-sided migration background or being a first-generation migrant carried the greatest risk. Targeted testing for HB infection and early HB vaccination should be provided to immigrants' children.

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV), and syphilis infections among blood and plasma donors in Germany according to §22 of the Transfusion Act ("Transfusiongesetz"). The surveillance data permit an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2007. Due to the revision of the Transfusion Act in 2005, not only the number of donations but also the number of donors is now available for analysis. Nearly 550,000 donations or blood samples from new donors and more than 6.24 million donations collected from approximately 2.43 million repeat donors were tested for transfusion-relevant infections in 2007. The prevalence for HIV was 8.0/100,000, for HCV 70.0/100,000, for HBV 132.5/100,000, and for syphilis 36.8/100,000 donations. The proportion of seroconversions/100,000 donations was 0.6 for HIV, 1.1 for HCV, 0.6 for HBV, and 1.7 for syphilis. The analysis showed a very low incidence of HIV, HBV, and syphilis with marginal changes compared to previous years. The prevalence and incidence of HCV among blood donors was once again declining.

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany according to Article 22 of the Transfusion Act. The surveillance data permit an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2006. Due to the revision of the Transfusion Act in 2005 not only the number of donations but also the number of donors has become available for analysis. More than 500,000 donations or blood samples from new donors and about 6 million donations collected from ca. 2.3 million repeat donors were screened in 2006. The prevalence for HIV was 6.2/100,000, for HCV 76.2/100,000, for HBV 150.2/100,000 and for syphilis 34.4/100,000 donations. The rate of seroconversions/100,000 donations was 0.8 for HIV, 1.1 for HCV, 0.7 for HBV and 1.6 for syphilis. The analysis showed a very low incidence of HIV, HBV und syphilis with marginal changes compared to previous years. The prevalence and incidence of HCV among blood donors was once again declining.

Background: In Germany, vaccination against hepatitis B is recommended for infants, children and adolescents since 1995 and for specific target groups since 1982. Little is known about knowledge about viral hepatitis and attitudes toward hepatitis B vaccination-factors likely to influence vaccine uptake., Methods: In order to estimate vaccination coverage in adult target groups and in the overall adult population and to assess knowledge and attitudes, we conducted a nationwide cross-sectional telephone survey among 412 persons in November 2004. We defined participants as being vaccinated if they reported at least one previous vaccination against hepatitis B., Results: Vaccination coverage (vc) standardised for age, sex and residence was 29.6% in the general population and 58.2% in target groups for hepatitis B vaccination. Particular gaps in vaccine coverage were detected among health care workers (vc: 69.5%) and chronically ill persons (vc: 22.0%). Knowledge on risk factors and transmission was far below expectations, whereas the acceptance of vaccination in the majority of the population (79.0%) was good., Conclusion: We conclude that educational measures could lead to a higher vaccination uptake in adult target groups.

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany according to article 22 of the Transfusion Act. The surveillance data permit an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2005. In total, 6.26 million donations or blood samples from prospective donors were screened. The prevalence of the relevant infections was 6.1/100,000 for HIV, 81.2/100,000 for HCV, 143.9/100,000 for HBV and 35.6/100,000 donations for syphilis. The rate of seroconversions/100,000 donations was 0.9 for HIV, 1.4 for HCV, 0.9 for HBV and 2.3 for syphilis. The analysis showed a very low incidence of infections with a decreasing trend for HCV infections among first time donors and an increase in incident HIV and syphilis infections since 1999. The latter has to be monitored carefully and possible causes need to be evaluated.

Collection of risk factor data is part of the national surveillance of hepatitis B and C in Germany. After modifications of risk factor surveillance had been implemented in September 2003, the response rate for data on risk factors increased markedly. For the period between September 2003 and August 2004, information on risk factors (at least one "yes" or "no" answer) was available for 66% (1853) of all notified hepatitis B cases and for 67% (5813) of all notified hepatitis C cases. More than 30% of those hepatitis B cases occurred among risk groups for whom hepatitis B immunisation is recommended by the German Advisory Committee on Immunisation (STIKO). Of the hepatitis C cases with risk factor data, 40% reported previous or continuing injecting drug use (IDU). IDU was predominant among young men (78% among men, aged 15 to 29 years) and can explain the comparatively high incidence observed in young adults, especially among men. The impact of other risk factors (e. g. medical interventions) cannot be quantified without a proper control group. The results of this study demonstrate that--in addition to the hepatitis B immunisation of children and adolescents--vaccination coverage of specific risk groups, as defined by the STIKO, should be increased. Measures to prevent hepatitis C have to focus on intravenous drug users and clearly have to be intensified.

Blood and plasma donations in Germany are collected by several institutions, namely the German Red Cross, community and hospital-based blood services, private blood centres, commercial plasma donation sites and transfusion services of the army. All blood donation centres are required to report quarterly data on infection markers to the Robert Koch Institute, thus providing current and accurate epidemiological data. The prevalence and incidence of relevant viral infections are low in the blood donor population in Germany, with a decreasing trend for hepatitis C infections in new and repeat donors since 1997. The implementation of mandatory nucleic acid amplification technique (NAT) testing for hepatitis C virus (HCV) in 1999 has markedly improved transfusion safety. HIV-NAT became mandatory in 2004 but was done voluntarily by the majority of the blood donation services before then. The potential benefit of hepatitis B virus (HBV) minipool NAT is not as clear because chronic HBV carriers with very low virus levels might donate unidentified. The residual risk of an infectious window period donation inadvertently entering the blood supply can be estimated using a mathematic model which multiplies the incidence rate by the number of days during which an infection may be present but not detectable, i.e. the length of the window period. The risk of an undetected infection without NAT testing was estimated to be 1 in 2,770,000 for HIV, 1 in 670,000 for HCV and 1 in 230,000 for HBV in 2001/2002. This contrasts with 1 in 5,540,000 for HIV, 1 in 4,400,000 for HCV and 1 in 620,000 for HBV with minipool NAT testing. This demonstrates that NAT testing can further reduce the already very small risk of infectious donations entering the blood supply.

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