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Background: A SARS‐CoV‐2 outbreak was detected in a nursing home in February 2021 after residents and staff had received two doses of BNT162b2 vaccine in January 2021. Methods: Nursing home staff, long‐term residents and day‐care receivers were included in a retrospective cohort study. We calculated attack rates (AR), secondary AR (SAR) and their 95% binomial confidence interval (CI), and we compared them using Fisher's exact test or chi‐squared test, depending on the sample size. We used Poisson regression with robust error estimates to calculate vaccine effectiveness against SARS‐COV‐2 infections. We selected variables based on directed acyclic graphs. As a proxy for viral load at diagnosis, we compared the mean Ct values at diagnosis using t tests or Mann–Whitney U tests. Results: The adjusted vaccine effectiveness against infection was 56% (95% CI: 15–77%, p = 0.04). Ct values at diagnosis were higher when intervals after receiving the second vaccination were longer (>21 vs. ≤21 days: 4.48 cycles, p = 0.08). The SAR was 67% lower in households of vaccinated (2/9 [22.2%]) than of unvaccinated infected staff (12/18 [66.7%]; p = 0.046). Vaccination rates were lowest among staff with close physical contact to care‐receivers (46%). The highest AR in vaccinated staff had those working on wards (14%). Conclusions: Vaccination reduced the risk for SARS‐CoV‐2 infection, viral load and transmission; however, non‐pharmaceutical interventions remain essential to reduce transmission of SARS‐CoV‐2 infections, even for vaccinated individuals. Vaccination coverage of staff ought to increase reduction of infections among themselves, their household members and residents. [ABSTRACT FROM AUTHOR]

Objective To determine morbidity and costs related to a large measles outbreak in Germany and to identify ways to improve the country&apos;s national measles elimination strategy. Methods We investigated a large outbreak of measles in the federal state of North Rhine-Westphalia (NRW) that occurred in 2006 after 2 years of low measles incidence (< 1 case per 100 000). WHO&apos;s clinical case definition was used, and surveillance data from 2006 and 2001 were compared. AII cases notified in Duisburg, the most severely affected city, were contacted and interviewed or sent a questionnaire. Health-care provider costs were calculated using information on complications, hospitalization and physician consultations. Findings In NRW, 1749 cases were notified over a 48-week period. Compared with 2001, the distribution of cases shifted to older age groups (especially the 10-14 year group). Most cases (n = 614) occurred in Duisburg. Of these, 81% were interviewed; 15% were hospitalized and two died. Of the 464 for whom information was available, 80% were reported as unvaccinated. Common reasons for non-vaccination were parents either forgetting (36%) or rejecting (28%) vaccination. The average cost per measles case was estimated at 373 [euro]. Conclusion An accumulation of non-immune individuals led to this outbreak. The shift in age distribution has implications for the effectiveness of measles control and the elimination strategy in place. Immediate nationwide school-based catch-up vaccination campaigns targeting older age groups ate needed to close critical immunity gaps. Otherwise, the elimination of measles in Germany and thus in Europe by 2010 will not be feasible. Objectif Determiner la morbidite et les couts lies a une vaste flambee de rougeole en Allemagne et identifier les moyens permettant d&apos;ameliorer la strategie nationale allemande d&apos;elimination de la rougeole. Methodes Nous avons enquete sur une vaste flambee de rougeole dans I&apos;Etat federal de Rhenanie-Du-Nord-Westphalie (NRW), survenue en 2006 apres 2 annees de faible incidence de cette maladie (< 1 cas pour 100 000 habitants). On a utilise la definition du cas clinique de I&apos;OMS et compare les donnees de surveillance de 2006 et 2001. Tous les cas notifies a Duisbourg, la ville la plus severement touchee, ont ete contactes et soumis a un entretien ou a. un questionnaire. Les couts lies aux prestateurs de soins ont ete calcules & partir d&apos;informations sur les complications, les hospitalisations et les consultations medicales. Resultats En Rhenanie-Du-Nord-Westphalie, 1749 cas ont ete notifies sur une periode de 48 semaines. Par comparaison avec 2001, la distribution de cas s&apos;est deplacee vers les tranches d&apos;ages superieures (en particulier la tranche 10-14 ans). La majorite des cas (n = 614) se sont produits a Duisbourg. Parmi les cas apparus a Duisbourg, 81% ont subi un entretien, 15 % ont ete hospitalises et deux sont decedes. Sur les 464 cas pour lesquels on disposait d&apos;informations, 80 % ont ete signales comme non vaccines. Les motifs courants de I&apos;absence de vaccination etaient I&apos;oubli (36 %) ou le refus (28 %) de cette vaccination par les parents. Le cout moyen par cas de rougeole a ete estime a 373 euros. Conclusion Cette flambee etait due a un regroupement d&apos;individus non immuns. Le decalage de la distribution par ages a des implications pour I&apos;efficacite de la lutte antirougeoleuse et pour la strategie d&apos;elimination en place. Pour combler des lacunes immunitaires critiques, il faudrait lancer immediatement, a I&apos;echelle nationale, des campagnes de vaccination de rattrapage en milieu scolaire visant les classes d&apos;ages superieures. Faute de quoi, I&apos;elimination de la rougeole en Allemagne, et par consequent en Europe, ne serait pas realisable d&apos;ici 2010. Objetivo Determinar la morbilidad y los costos asociados a un extenso brote de sarampion declarado en Alemania e identificar la manera de mejorar la estrategia nacional aplicada en ese pais para eliminar dicha enfermedad. Metodos Investigamos un extenso brote de sarampion que se produjo en el estado federal de Renania del Norte-Westfalia (RNW) en 2006 tras dos anos de baja incidencia de sarampion (< 1 caso por 100 000 habitantes). Usando la definicion de caso clinico de la OMS, se compararon los datos de vigilancia de 2006 y 2001. Se establecio contacto con todos los casos notificados en Duisburgo, la ciudad mas gravemente afectada, a los que se entrevisto o se envio un cuestionario. Los costos de la dispensacion de salud se calcularon a partir de diversos datos sobre las complicaciones, las hospitalizaciones y las consultas al medico. Resultados En RNW se notificaron 1749 casos a lo largo de un periodo de 48 semanas. En comparacion con 2001, la distribucion de los casos se desplazo hacia los grupos de mas edad (especialmente hacia el grupo de 10-14 anos). La mayoria de los casos (n = 614) se dieron en Duisburgo. De ellos, un 81% fueron entrevistados, un 15% fueron hospitalizados y dos fallecieron. De los 464 respecto a los que se disponia de informacion, el 80% no habian sido vacunados. Las razones mas frecuentes de que no se hubiera vacunado a los ninos es que los padres habian olvidado hacerlo (36%) orechazaban la vacunacion (28%). El costo medio por caso de sarampion se estimo en 373 euros. Conclusion La acumulacion de individuos no inmunizados es lo que provoco la aparicion de este brote. El desplazamiento de la distribucion de edades tiene implicaciones en lo tocante a la eficacia del control del sarampion y la estrategia de eliminacion aplicada. A fin de cerrar la critica brecha de inmunidad aparecida, es preciso emprender de inmediato en todo el pais campanas de vacunacion escolar de puesta al dia centradas en los grupos de mas edad. De lo contrario, no sera posible eliminar el sarampion en Alemania, y por tanto en Europa, para 2010., Background Germany, with 82 million inhabitants, is committed to the WHO goal of eliminating indigenous measles transmission in the European Region by 2010. (1,2) WHO recommends that at least 95% [...]

Meningococci can cause clusters of disease. Specimens from 1,616 patients in Germany obtained over 42 months were typed by serogrouping and sequence typing of PorA and FetA and yielded a [...]

The epidemiology of Q fever in Germany was examined by reviewing revelant studies since 1947 and by analyzing available surveillance data since 1962. The average annual Q fever incidence nationwide [...]

Abstract Background We performed a case–control study to estimate vaccine effectiveness (VE) for prevention of hospitalization due to pandemic influenza A(H1N1)pdm09 (pH1N1) and to identify risk factors for pH1N1 and acute respiratory infection (ARI) in 10 hospitals in Berlin from December 2009 to April 2010. Methods Cases were patients aged 18–65 years with onset of ARI ≤10 days before admission testing positive for pH1N1 by PCR performed on nasal and throat swabs or by serological testing. Cases were compared to (1) matched hospital controls with acute surgical, traumatological or other diagnoses matched on age, sex and vaccination probability, and (2) ARI patients testing negative for pH1N1. Additionally, ARI cases were compared to matched hospital controls. A standardized interview and chart review elicited demographic and clinical data as well as potential risk factors for pH1N1/ARI. VE was estimated by 1-(Odds ratio) for pH1N1-vaccination ≥10 days before symptom onset using exact logistic regression analysis. Results Of 177 ARI cases recruited, 27 tested pH1N1 positive. A monovalent AS03-adjuvanted pH1N1 vaccine was the only pandemic vaccine type identified among cases and controls (vaccination coverage in control group 1 and 2: 15% and 5.9%). The only breakthrough infections were observed in 2 of 3 vaccinated HIV positive pH1N1 patients. After exclusion of HIV positive participants, VE was 96% (95%CI: 26-100%) in the matched multivariate analysis and 46% (95%CI: -376-100%) in the test-negative analysis. Exposure to children in the household was independently associated with hospitalization for pH1N1 and ARI. Conclusions Though limited by low vaccination coverage and number of pH1N1 cases, our results suggest a protective effect of the AS03-adjuvanted pH1N1 vaccine for the prevention of pH1N1 hospitalization. The use of hospital but not test-negative controls showed a statistically protective effect of pH1N1-vaccination and permitted the integrated assessment of risk factors for pH1N1-infection. To increase statistical power and to permit stratified analyses (e.g. VE for specific risk groups), the authors suggest pooling of future studies assessing effectiveness of influenza vaccines for prevention of severe disease from different centres.

Abstract Background Surveillance of severe acute respiratory infections (SARI) in sentinel hospitals is recommended to estimate the burden of severe influenza-cases. Therefore, we monitored patients admitted with respiratory infections (RI) in 9 Berlin hospitals from 7.12.2009 to 12.12.2010 according to different case definitions (CD) and determined the proportion of cases with influenza A(H1N1)pdm09 (pH1N1). We compared the sensitivity and specificity of CD for capturing pandemic pH1N1 cases. Methods We established an RI-surveillance restricted to adults aged ≤ 65 years within the framework of a pH1N1 vaccine effectiveness study, which required active identification of RI-cases. The hospital information-system was screened daily for newly admitted RI-patients. Nasopharyngeal swabs from consenting patients were tested by PCR for influenza-virus subtypes. Four clinical CD were compared in terms of capturing pH1N1-positives among hospitalized RI-patients by applying sensitivity and specificity analyses. The broadest case definition (CD1) was used for inclusion of RI-cases; the narrowest case definition (CD4) was identical to the SARI case definition recommended by ECDC/WHO. Results Over the study period, we identified 1,025 RI-cases, of which 283 (28%) met the ECDC/WHO SARI case definition. The percentage of SARI-cases among internal medicine admissions decreased from 3.2% (calendar-week 50-2009) to 0.2% (week 25-2010). Of 354 patients tested by PCR, 20 (6%) were pH1N1-positive. Two case definitions narrower than CD1 but -in contrast to SARI- not requiring shortness of breath yielded the largest areas under the Receiver-Operator-Curve. Heterogeneity of proportions of patients admitted with RI between hospitals was significant. Conclusions Comprehensive surveillance of RI cases was feasible in a network of community hospitals. In most settings, several hospitals should be included to ensure representativeness. Although misclassification resulting from failure to obtain symptoms in the hospital information-system cannot be ruled out, a high proportion of hospitalized PCR-positive pH1N1-patients (45%) did not fulfil the SARI case-definition that included shortness of breath or difficulty breathing. Thus, to assess influenza-related disease burden in hospitals, broader, alternative case definitions should be considered.

Abstract Background Current and past pertussis epidemiology in the two parts of Germany is compared in the context of different histories of vaccination recommendations and coverage to better understand patterns of disease transmission. Methods Available regional pertussis surveillance and vaccination coverage data, supplemented by a literature search for published surveys as well as official national hospital and mortality statistics, were analyzed in the context of respective vaccination recommendations from 1964 onwards. Results Routine childhood pertussis vaccination was recommended in the German Democratic Republic (GDR) from 1964 and in former West German states (FWG) from 1969, but withdrawn from 1974–1991 in FWG. Pertussis incidence declined to Conclusion The shift in pertussis morbidity to older age groups observed in FEG is similar to reports from other countries with longstanding vaccination programs and suggests that additional booster vaccination may be necessary beyond adolescence. The high proportion of fully vaccinated cases in older children in FEG suggests waning immunity 5–10 years after primary immunisation in infancy. The higher incidence of pertussis hospitalisations in infants suggests a stronger force of infection in FWG than FEG. Nationwide pertussis reporting is required for better evaluation of transmission patterns and vaccination policy in both parts of Germany.

Abstract Background In May 2003 the Soest County Health Department was informed of an unusually large number of patients hospitalized with atypical pneumonia. Methods In exploratory interviews patients mentioned having visited a farmers' market where a sheep had lambed. Serologic testing confirmed the diagnosis of Q fever. We asked local health departments in Germany to identiy notified Q fever patients who had visited the farmers market. To investigate risk factors for infection we conducted a case control study (cases were Q fever patients, controls were randomly selected Soest citizens) and a cohort study among vendors at the market. The sheep exhibited at the market, the herd from which it originated as well as sheep from herds held in the vicinity of Soest were tested for Coxiella burnetii (C. burnetii). Results A total of 299 reported Q fever cases was linked to this outbreak. The mean incubation period was 21 days, with an interquartile range of 16–24 days. The case control study identified close proximity to and stopping for at least a few seconds at the sheep's pen as significant risk factors. Vendors within approximately 6 meters of the sheep's pen were at increased risk for disease compared to those located farther away. Wind played no significant role. The clinical attack rate of adults and children was estimated as 20% and 3%, respectively, 25% of cases were hospitalized. The ewe that had lambed as well as 25% of its herd tested positive for C. burnetii antibodies. Conclusion Due to its size and point source nature this outbreak permitted assessment of fundamental, but seldom studied epidemiological parameters. As a consequence of this outbreak, it was recommended that pregnant sheep not be displayed in public during the 3rd trimester and to test animals in petting zoos regularly for C. burnetii.