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ZusammenfassungDie Risikokommunikation öffentlicher Institutionen soll die Bevölkerung im Falle bestehender Risiken bei der Entscheidungsfindung unterstützen. In gesundheitlichen Notlagen wie der Coronavirus(SARS-CoV-2)-Pandemie spielt sie eine besonders wichtige Rolle. Bereits nach dem SARS-Ausbruch im Jahr 2003 hat die Weltgesundheitsorganisation (WHO) ihre Internationalen Gesundheitsvorschriften (IHR 2005) überarbeitet und gefordert, Risikokommunikation in allen Mitgliedsländern als einen Kernbereich in der Gesundheitspolitik zu etablieren. Während der gesundheitspolitische Akzent begrüßt wurde, konnten die Möglichkeiten der Risikokommunikation in diesem Bereich bisher nicht voll ausgeschöpft werden. Gründe sind u. a. Unstimmigkeiten im Begriffsverständnis der Risikokommunikation und die Vielzahl zur Verfügung stehender Methoden.Der vorliegende Diskussionsartikel soll dazu beitragen, ein neues Verständnis von Risikokommunikation in Public-Health-Notlagen (Emergency Risk Communication – ERC) zu etablieren. Es wird vorgeschlagen, neben den Risiken die Chancen der Krise stärker einzubeziehen und Risikokommunikation noch mehr als einen kontinuierlichen Prozess zu begreifen, der an verschiedenen Stellen optimierbar ist. Der Earlier-Faster-Smoother-Smarter-Ansatz und hierbei insbesondere die frühere Erkennung von Gesundheitsgefahren (Earlier) könnten das Management von Public-Health-Notlagen zukünftig unterstützen.

Die neu aufgetretene Atemwegserkrankung „coronavirus disease 2019“ (COVID-19) hat Deutschland erreicht. Die Erkrankung verlauft in den meisten Fallen leicht, aber der kleinere Anteil an schwer Erkrankten wird stationar und auch intensivmedizinisch behandelt werden. Im Gegensatz zu anderen akuten Infektionskrankheiten zeigen die schweren Verlaufe eine langsame Progredienz von den ersten Symptomen bis zur lebensbedrohlichen Verschlechterung. Die Diagnosestellung erfolgt mithilfe der Polymerase-Kettenreaktion (PCR) aus Proben des Respirationstrakts. Ein schweres „acute respiratory distress syndrome“ (ARDS) ist charakteristisch fur die kritischen Verlaufe. Der Vermeidung nosokomialer Infektionen, insbesondere durch korrekte Anwendung der Schutzausrustung, und der Aufrechterhaltung des Krankenhausbetriebs kommen zentrale Bedeutung zu. Auch in der Anasthesie und Notfallmedizin ist mit erheblichen Herausforderungen zu rechnen.

Purpose Some patients experience long-term sequelae after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, despite a present post-COVID condition, defined as “any symptom lasting longer than 12 weeks,” only a subset of patients search for medical help and therapy. Method We invited all adults with a positive real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 between March 2020 and September 2021 (n = 4091) in the city of Jena to answer a standardized questionnaire including demographic information, the course of the acute infection and current health status. K-means-clustering of quality of life (QoL) was used to explore post-COVID subgroups. Results A total of 909 participants at a median interval of 367 (IQR 291/403) days after acute infection were included in the analysis. Of those, 643 (70.7%) complained of having experienced persistent symptoms at the time of the survey. Cluster analysis based on QoL revealed two subgroups of people with persistent post-COVID symptoms. Whereas 189/643 participants (29.4%) showed markedly diminished QoL, normal QoL was detected in 454/643 individuals (70.6%). Conclusion Despite persistent symptoms being reported by nearly three quarters of participants, only one-third of these described a significant reduction in QoL (cluster 1), whereas the other two-thirds reported a near-normal QoL (cluster 2), thus indicating a differentiation between “post-COVID disease” and “post-COVID condition”. The prevalence of clinically relevant post-COVID disease was at least 20.7%. Health policies should focus on this subset.

Risk communication of public institutions should support the population in the decision-making process in the event of existing risks. It plays a particularly important role in health emergencies such as the SARS-CoV‑2 pandemic. After the SARS outbreak in 2003, the World Health Organization (WHO) revised its International Health Regulations (IHR 2005) and called for risk communication to be established as a core area of health policy in all member countries. While the emphasis on health policy was welcomed, the potential for risk communication in this area has not yet been fully exploited. Reasons include discrepancies in the understanding of risk communication and the large number of available methods.This discussion article is intended to help establish a new understanding of risk communication in public health emergencies (emergency risk communication - ERC). It is suggested that, in addition to the risks, the opportunities of the crisis should be included more and that risk communication should be understood more as a continuous process that can be optimized at various points. The "Earlier-Faster-Smoother-Smarter" approach and in particular the earlier detection of health risks ("Earlier") could support the management of public health emergencies in the future.Die Risikokommunikation öffentlicher Institutionen soll die Bevölkerung im Falle bestehender Risiken bei der Entscheidungsfindung unterstützen. In gesundheitlichen Notlagen wie der Coronavirus(SARS-CoV-2)-Pandemie spielt sie eine besonders wichtige Rolle. Bereits nach dem SARS-Ausbruch im Jahr 2003 hat die Weltgesundheitsorganisation (WHO) ihre Internationalen Gesundheitsvorschriften (IHR 2005) überarbeitet und gefordert, Risikokommunikation in allen Mitgliedsländern als einen Kernbereich in der Gesundheitspolitik zu etablieren. Während der gesundheitspolitische Akzent begrüßt wurde, konnten die Möglichkeiten der Risikokommunikation in diesem Bereich bisher nicht voll ausgeschöpft werden. Gründe sind u. a. Unstimmigkeiten im Begriffsverständnis der Risikokommunikation und die Vielzahl zur Verfügung stehender Methoden.Der vorliegende Diskussionsartikel soll dazu beitragen, ein neues Verständnis von Risikokommunikation in Public-Health-Notlagen (Emergency Risk Communication – ERC) zu etablieren. Es wird vorgeschlagen, neben den Risiken die Chancen der Krise stärker einzubeziehen und Risikokommunikation noch mehr als einen kontinuierlichen Prozess zu begreifen, der an verschiedenen Stellen optimierbar ist. Der Earlier-Faster-Smoother-Smarter-Ansatz und hierbei insbesondere die frühere Erkennung von Gesundheitsgefahren (Earlier) könnten das Management von Public-Health-Notlagen zukünftig unterstützen.

Highlights • Building capacity within communities facilitates earlier detection of public health risks. • Engaging with diverse communities requires significant changes in the governance approach. • Technical capacities were not the greatest challenge, even in low income countries. • A new methodology is introduced to catalyse health policy interventions., The International Health Regulations (IHR 2005) require all Member States to build and maintain the capacities to prevent, detect and respond to public health emergencies. Early detection of public health risks is one of the core functions. In order to improve surveillance and detection, a better understanding of the health system conditions and their influencing factors are needed. The Israeli Ministry of Health/IHR National Focal Point held a workshop to elucidate health system conditions and their influencing factors that enable earlier detection. The workshop methodology employed a stepwise, small working group analysis approach to elucidate the conditions and their influencing factors affecting each stage of recognition, assessment, and reporting of infectious disease outbreaks, at the local, regional and national levels. In order to detect public health risks earlier, the detection process needs to be moved closer to the local communities and start with building capacity within communities. Building capacity and engaging with local and diverse communities requires significant changes in the governance approach and include information sharing, multi-sectoral communication and coordination across various levels before, during and after public health emergencies. Across the regions, low-, mid- and high-income countries seem to struggle more with governance and information sharing rather than with technical capacities and capabilities.

In spring 2016, an updated sepsis definition (Sepsis-3) introduced a new explanation for the clinical picture of sepsis. Until then, sepsis had been understood as a "systemic inflammatory response syndrome (SIRS)" resulting from infection. An improved understanding of the molecular mechanisms and broad epidemiological studies of the clinical appearance shifted the focus from the inflammatory response to the multicausal tissue damage resulting in organ dysfunction. This paradigm shift highlights organ failure as a result of a dysregulated response of an organism to infection. Central to the new definition is the understanding that sepsis patients form a heterogeneous group and that the clinical picture requires alternative explanation patterns: e.g. sepsis is insufficiently explained by an overwhelming inflammatory response, it also comprises "immune paralysis" as another important pattern. Furthermore, severity of sepsis reflects the capacity of an organism to adapt and to mitigate the tissue damage through metabolic changes and repair mechanisms. Consistent with the paradigm of the new sepsis definition, adaptation in the presence of infections is crucial for the organism. Seriously injured or multiple trauma patients represent a patient group at particular risk, as sepsis often complicates the courses of these patients due to nosocomial infections. Along with comorbidities, past infections and age, leakage of skin and intestinal barriers as well as impaired defence and repair mechanism predispose trauma patients for a septic course. New pathophysiological insights suggest that the control of extracellular haem is of paramount significance. Haemolysis, transfusion and the consecutive expression of haem binding (such as haemopexin) or haem catabolic pathways (such as haem oxygenase) impair the ability of an organism to adapt, correlate with the prognosis and/or are strongly influenced by the surgical treatment concepts. Established treatment concepts of early causal and supportive therapy (damage control, antibiotic and fluid therapy) contribute to the reduction of mortality, depending on stringent implementation as part of Standard Operating Procedures (SOPs) and quality management. The paradigm shift in sepsis research offers an improved understanding of the underlying pathogenic factors within complex and heterogeneous patient groups, such as nosocomial sepsis following trauma. These novel approaches will allow developing new treatment strategies potentially contributing to a significant reduction in morbidity and mortality of trauma patients.Key messages1) According to the new paradigm, the ability to adapt to the pathogenic load associated with trauma and infection is crucial for an organism.2) Seriously injured or multiple trauma patients are predisposed for septic courses due to impaired adaptation mechanisms.3) Established treatment concepts of early causal and supportive therapy (damage control, antibiotic treatment, restrictive transfusion, and volume resuscitation) reduce mortality, in particular as part of SOPs and quality management strategies.4) Newly emerging treatment concepts that focus on the control of extracellular haem are promising, but require more evidence for translation into clinical practice.Die im Frühjahr 2016 eingeführte Sepsisdefinition (Sepsis-3) stellt ein neues Erklärungsmuster für das klinische Bild der Sepsis vor. Sepsis wurde bisher als systemische Entzündungsantwort (Systemic Inflammatory Response Syndrome, SIRS) infolge einer Infektion definiert. Besseres Verständnis der molekularen Mechanismen und große epidemiologische Untersuchungen zum klinischen Erscheinungsbild verschoben den Fokus bei der neuen Sepsisdefinition von der Entzündungsantwort auf den Gewebeschaden und die hierdurch induzierte Einschränkung der Organfunktion. Im Zentrum der Betrachtung steht also nicht mehr die systemische Entzündungsantwort, sondern das, was eine Sepsis sowohl in der Erkrankungsdynamik als auch im Outcome so gefährlich macht: das Organversagen aufgrund einer Infektion. Dieser neuen Definition liegt die Beobachtung zugrunde, dass Sepsis heterogene Patientengruppen umfasst und dass das Syndrom nicht allein durch eine „überschießende“ Entzündungsantwort, sondern auch durch eine „Immunparalyse“ erklärt werden kann. Darüber hinaus wird der Erkrankungsverlauf maßgeblich von der Kapazität des Organismus bestimmt, den Gewebeschaden durch metabolische Anpassungs- und Reparaturprozesse zu begrenzen. Für das Überleben der Sepsis ist daher entscheidend, inwieweit der Organismus bei Entwicklung einer Infektion adaptieren kann. Schwerverletzte und Polytraumapatienten stellen in diesem Kontext ein besonders gefährdetes Patientenkollektiv für die Entwicklung einer Organdysfunktion infolge nosokomialer Infektionen dar. Pathophysiologisch sind neben Störungen der Haut- und Darmbarriere bei Schwer- und Mehrfachverletzten die Beeinträchtigungen der Defensiv- und Reparatursysteme für die Infektionsanfälligkeit von besonderer Bedeutung, die daneben durch Begleiterkrankungen, abgelaufene Infektionen und Alter mit beeinflusst wird. Neuere Erkenntnisse legen dabei nahe, dass der Kontrolle des extrazellulären Häms hierfür eine Schlüsselrolle zukommt. Hämolyse, Transfusion und die konsekutive Expression von hämbindenden (wie Hämopexin) oder hämabbauenden Proteinen (wie Hämoxygenase) triggern das Versagen der Wirtsantwort, korrelieren mit der Prognose und/oder werden maßgeblich vom chirurgischen Behandlungskonzept beeinflusst. Daneben haben etablierte Behandlungskonzepte zur früheren kausalen und supportiven Therapie (insbesondere Herdsanierung/„Damage Control“, Antibiose und Volumenersatz) zur Reduktion der Sterblichkeit septischer Patienten beigetragen; allerdings ist die Einbettung in „Standard Operating Procedures“ (SOPs) und Qualitätsmanagementprogramme entscheidend für den Erfolg. Der gegenwärtige Paradigmenwechsel im Sepsisverständnis erlaubt neue Einblicke in die Pathogenese, gerade bei komplexen Patientenkollektiven wie nosokomialer Sepsis nach Trauma. Diese neuen Ansätze tragen zur Entwicklung neuer Behandlungsstrategien bei, die die Morbidität und Mortalität von Traumapatienten maßgeblich reduzieren können.Kernaussagen:1) Bei Entwicklung einer Sepsis ist es für das Überleben entscheidend, inwieweit der Organismus mit Abwehr- und Reparaturprozessen reagieren kann.2) Schwerverletzte und Polytraumapatienten sind durch Störungen dieser Adaptionsmechanismen besonders für septische Verläufe prädisponiert.3) Etablierte Behandlungskonzepte zur früheren kausalen und supportiven Therapie (insbesondere Herdsanierung, Antibiose, restriktive Transfusionsregime und Volumenersatz) reduzieren die Sterblichkeit, insbesondere wenn sie in Qualitätsmanagementprogramme eingebunden werden.4) Neue Behandlungskonzepte zur Kontrolle des extrazellulären Häms bei Schwer- und Mehrfachverletzten sind vielversprechend und sollten weiter erforscht werden, da hieraus neue Therapieoptionen abgeleitet werden können.

The current outbreak of coronavirus disease (COVID-19) has reached Germany. The majority of people infected present with mild disease, but there are severe cases that need intensive care. Unlike other acute infectious diseases progressing to sepsis, the severe courses of COVID19 seemingly show prolonged progression from onset of first symptoms to life-threatening deterioration of (primarily) lung function. Diagnosis relies on PCR using specimens from the respiratory tract. Severe ARDS reflects the hallmark of a critical course of the disease. Preventing nosocomial infections (primarily by correct use of personal protective equipment) and maintenance of hospitals' operational capability are of utmost importance. Departments of Anaesthesia, Intensive Care and emergency medicine will envisage major challenges.Die neu aufgetretene Atemwegserkrankung „coronavirus disease 2019“ (COVID-19) hat Deutschland erreicht. Die Erkrankung verläuft in den meisten Fällen leicht, aber der kleinere Anteil an schwer Erkrankten wird stationär und auch intensivmedizinisch behandelt werden. Im Gegensatz zu anderen akuten Infektionskrankheiten zeigen die schweren Verläufe eine langsame Progredienz von den ersten Symptomen bis zur lebensbedrohlichen Verschlechterung. Die Diagnosestellung erfolgt mithilfe der Polymerase-Kettenreaktion (PCR) aus Proben des Respirationstrakts. Ein schweres „acute respiratory distress syndrome“ (ARDS) ist charakteristisch für die kritischen Verläufe. Der Vermeidung nosokomialer Infektionen, insbesondere durch korrekte Anwendung der Schutzausrüstung, und der Aufrechterhaltung des Krankenhausbetriebs kommen zentrale Bedeutung zu. Auch in der Anästhesie und Notfallmedizin ist mit erheblichen Herausforderungen zu rechnen.

Die Einfuhrung der neuen Sepsisdefinition im Fruhjahr 2016 stellt ein neues Erklarungsmuster fur das klinische Bild der Sepsis vor. Sepsis wurde bisher als systemische Entzundungsantwort („systemic inflammatory response syndrom“, SIRS) infolge einer Infektion definiert. Aufgrund eines besseren Verstandnisses der molekularen Mechanismen ist der Fokus bei der neuen Sepsisdefinition nicht mehr die Entzundungsantwort, sondern der Gewebeschaden und die dadurch induzierte Einschrankung der Organfunktion. Das Paradigma ruckt also von der Infektion und der systemischen Entzundungsantwort zu dem, was eine Sepsis sowohl in der Erkrankungsdynamik als auch im Outcome so gefahrlich macht: dem Organversagen aufgrund einer fehlregulierten Wirtsantwort auf eine Infektion. Dieser Perspektiven- oder Paradigmenwechsel ermoglicht es, – im klinischen Alltag auch auserhalb von Intensivstationen Patienten fruher zu erkennen und schneller zu behandeln, die ein hoheres Risiko haben, eine Sepsis zu entwickeln; und – neue Behandlungsstrategien zu entwickeln, die die Entstehung einer Sepsis besser kausal therapieren konnen.

Objectives Due to a substantial proportion of asymptomatic and mild courses, many severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections remain unreported. Therefore, assessment of seroprevalence may detect the real burden of disease. We aimed to determine and characterize the rate of SARS-CoV-2 infections and the resulting seroprevalence in a defined population. The primary objective of the study was to assess SARS-CoV-2 antibody seroprevalence using six different IgG-detecting immunoassays. Secondary objectives of the study were: (a) to determine potential risk factors for symptomatic versus asymptomatic coronavirus disease 2019 courses, and (b) to investigate the rate of virus RNA-persistence. Methods CoNAN is a population-based cohort study performed in the community Neustadt am Rennsteig, Germany, which was quarantined from 22 March to 5 April after six SARS-CoV-2 cases were detected in the village's population. The SARS-CoV-2 outbreak comprised 51 cases and 3 deaths. The CoNAN study was performed from 13 May to 22 May 2020, 6 weeks after a SARS-CoV-2 outbreak. Results We enrolled a total of 626 participants (71% of the community population) for PCR and antibody testing in the study. All actual SARS-CoV-2 PCR tests were negative. Fifty-two out of 620 (8.4%) participants had antibodies against SARS-CoV-2 in at least two different assays. There were 38 participants with previously PCR-confirmed SARS-CoV-2 infection. Of those, only 19 (50%) displayed anti-SARS-CoV-2 antibodies. We also show that antibody-positive participants with symptoms compatible with a respiratory tract infection had significantly higher antibody levels then asymptomatic participants (EU-assay: median 2.9 versus 7.2 IgG-index, p 0.002; DS-assay: median 45.2 versus 143 AU/mL, p 0.002). Persisting viral replication was not detected. Conclusions Our data question the relevance and reliability of IgG antibody testing to detect past SARS-CoV-2 infections 6 weeks after an outbreak. We conclude that assessing immunity for SARS-CoV-2 infection should not rely on antibody tests alone.

Biological risk management in public health focuses on the impact of outbreaks on health, the economy, and other systems and on ensuring biosafety and biosecurity. To address this broad range of risks, the International Health Regulations (IHR, 2005) request that all member states build defined core capacities, risk communication being one of them. While there is existing guidance on the communication process and on what health authorities need to consider to design risk communication strategies that meet the requirements on a governance level, little has been done on implementation because of a number of factors, including lack of resources (human, financial, and others) and systems to support effective and consistent capacity for risk communication. The international conference on “Risk communication strategies before, during and after public health emergencies” provided a platform to present current strategies, facilitate learning from recent outbreaks of infectious diseases, and discuss recommendation...

Overview International activities to respond to the Ebola crisis in West Africa were mainly developed and focussed around the biomedical paradigm of Western health systems. This approach was often insensitive to societal perception, attitude, and behavioural determinants and clashed with community-based health traditions, narratives, and roles, e.g., of community health workers. In this peer-led capacity-building initiative, these deficiencies were identified and analysed. Innovative, more locally focussed, community-based solutions were articulated. The new approaches described put local people at the centre of all preparedness, response, and recovery strategies. This paradigm shift reframed the role of communities from victims to active managers of their response and reacknowledged the strength of community-based One Health. We conclude that strategies should aim at empowering, not just engaging, communities. Communities can improve short-term crisis management and build longer-term resilience and capacities that are much needed in the current global health climate. Background The Ebola outbreak in West Africa, 2014–2016, was unprecedented in scale, extent, and duration. The international community was slow to step up its assistance in this global public health emergency and then faltered when its infection control management approaches clashed with West African realities [1]. Outbreak response evaluations have identified the need to better integrate social science intelligence [2], better collaborate with communities [3,4], more effectively draw on the strength of community health workers [5], and critically question the paradigm of Western health systems, which focus on imposing ‘evidence-based’ solutions that lack external validity in affected communities; i.e., they too often recommend actions that are inconsistent with, ignore, or violate traditional behaviours [6]. While there appears to be a consensus now on what needs to be done, how to achieve these goals remains a challenge.

Communication interventions during public health emergencies (e.g. infectious disease outbreaks) are increasingly acknowledged as a determinant of success in preparedness, response and recovery. Challenges related to the current outbreak of Ebola virus in West Africa once again reveal the need to strengthen our understanding of the central importance and complexity of risk communication and social mobilisation strategies. There is little hard evidence, however, on the impact of various communication interventions upon the dynamics of public health emergencies to guide our capacity development. This article proposes a new evaluative framework which builds on an understanding of risk communication as an interactive, holistic, continuous and engaging activity that focuses on dialogue, intelligence gathering, building relationships over time with a knowledge base informed by new and accessible communication technologies (e.g. social media and networks) and supportive environments. Our hypothesis is th...

Background The threat posed by Meticillin-resistant Staphylococcus aureus (MRSA) has taken on an increasingly pan-European dimension. This article aims to provide an overview of the different approaches to the control of MRSA adopted in five European countries (Austria, Germany, Netherlands, Spain, and the UK) and discusses data and reporting mechanisms, regulations, guidelines, and health policy approaches with a focus on risk communication. Our hypothesis is that current infection control practices in different European countries are implicit messages that contribute to the health-related risk communication and subsequently to the public perception of risk posed by MRSA. A reporting template was used to systematically collect information from each country. Discussion Large variation in approaches was observed between countries. However, there were a number of consistent themes relevant to the communication of key information regarding MRSA, including misleading messages, inconsistencies in content and application of published guidelines, and frictions between the official communication and their adoption on provider level. Summary The variability of recommendations within, and across, countries could be contributing to the perception of inconsistency. Having inconsistent guidelines and practices in place may also be affecting the level at which recommended behaviors are adopted. The discrepancy between the official, explicit health messages around MRSA and the implicit messages stemming from the performance of infection control measures should, therefore, be a key target for those wishing to improve risk communication.

The term pandemic refers to an international or worldwide outbreak of an infectious disease which is limited in time. Due to their high infectiousness and easy person-to-person transmission, flu viruses repeatedly lead to pandemics (approx. 3 pandemics per century.). In contrast to an epidemic, a pandemic is not restricted to one area. The mortality of an influenza pandemic is greater than the seasonal flu wave, and is not restricted to the classical risk groups: high rates of infection can occur in all age groups, with peaks frequently occurring amongst young adults.The specific virological characteristics of the influenza virus represent a great challenge for the health system. In principle, any influenza virus which has never before - or at least not for a long time - circulated within the population can develop into a pandemic virus. One possible candidate amongst others appears to be the influenza virus A-H5N1. Influenza pandemics usually occur at intervals of 11 to 39 years, and 30 years have now passed since the last pandemic. At the moment, the national and international pandemic plans have in most cases not yet been completely worked out. The co-operation between the individual countries should be intensified, and in Germany in particular, efforts should be made - in view of the different concepts of the individual federal states - to arrive at a uniform action plan.The consequences of a pandemic affect both the economic and the social sphere. Hospitals, practicing doctors and public health services must jointly develop action plans in order to be able to care for large numbers of patients within a very short time. Occupational medical specialists should form a link between health services, companies and doctors and hospitals, and already be developing plans and their communication for the companies under their care.On entend par le terme pandémie l’irruption d’une maladie infectieuse limitée dans le temps et touchant plusieurs pays voire le monde entier. En raison de leur infectiosité importante et la contagion facilitée d’être humain à être humain, les virus de la grippe continuent souvent à entraîner des pandémies (env. 3 pandémies par siècle.). Contrairement à une épidémie, une pandémie n’est pas limitée localement. La mortalité en cas d’une pandémie d’influenza est plus importante que celle par une vague de grippe saisonnière et ne se limite pas aux seuls groupes à risques classiques : Des taux élevés d’infection peuvent survenir dans tous les groupes d’âge. Souvent, on trouve une pointe d’infection parmi les jeunes adultes.La caractéristique virologique spécifique du virus d’influenza constitue un grand défi pour le système de santé. En principe, chaque virus d’influenza qui n’a jamais circulé dans la population ou qui a cessé d’y circuler depuis longtemps pourrait se transformer en virus de pandémie. L’un des candidats possible, parmi d’autres, semble cependant être le virus d’influenza A-H5N1. Jusqu’à présent, les pandémies d’influenza survenaient à des intervalles de 11 à 39 ans, entretemps, plus de 30 ans sont passés depuis la dernière pandémie. À l’heure actuelle, la plupart des plans anti-pandémie nationaux et internationaux n’ont toujours pas été élaborés intégralement. Il convient que la coopération entre les différents états soit intensifiée et notamment en Allemagne il faudrait arriver à une solution uniforme, ceci notamment en vue des concepts variés des différents länder.Les conséquences d’une pandémie concernent à la fois le domaine économique et le domaine social. Les hôpitaux, les médecins travaillant en cabinet et les services de santé publique doivent mettre au point des plans des processus communs pour suivre un grand nombre de malades dans un laps de temps le plus court. Les médecins des entreprises devraient constituer une interface entre les services de santé, les entreprises et les médecins traitants ainsi que les hôpitaux et élaborer des concepts ainsi que la communication de ceux-ci pour les entreprises suivies par eux, à l’heure actuelle déjà.

Summary Background The early detection of infectious disease outbreaks can reduce the ultimate size of the outbreak, with lower overall morbidity and mortality due to the disease. Numerous approaches to the earlier detection of outbreaks exist, and methods have been developed to measure progress on timeliness. Understanding why these surveillance approaches work and do not work will elucidate key drivers of early detection, and could guide interventions to achieve earlier detection. Without clarity about the conditions necessary for earlier detection and the factors influencing these, attempts to improve surveillance will be ad hoc and unsystematic. Methods A systematic review was conducted using the PRISMA framework (Preferred Reporting Items for Systematic Reviews and Meta-analyses) to identify research published between January 1, 1990 and December 31, 2015 in the English language. The MEDLINE (PubMed) database was searched. Influencing factors were organized according to a generic five-step infectious disease detection model. Results Five studies were identified and included in the review. These studies evaluated the effect of electronic-based reporting on detection timeliness, impact of laboratory agreements on timeliness, and barriers to notification by general practitioners. Findings were categorized as conditions necessary for earlier detection and factors that influence whether or not these conditions can be in place, and were organized according to the detection model. There is some evidence on reporting, no evidence on assessment, and speculation about local level recognition. Conclusion Despite significant investment in early outbreak detection, there is very little evidence with respect to factors that influence earlier detection. More research is needed to guide intervention planning.

disease. Objectives To determine the adequacy of the information provided to airport passengers and staff in meeting their information needs in relation to their concerns. Methods At the start of the influenza A ⁄ H1N1 epidemic (29–30 April 2009), qualitative semi-structured interviews (N = 101) were conducted at Frankfurt International Airport with passengers who were either returning from or going to Mexico and with airport staff who had close contact with these passengers. Interviews focused on knowledge about swine flu, information needs and fear or concern about the outbreak. Results The results showed that a desire for more information was associated with higher concern – the least concerned participants did not want any additional information, while the most concerned participants reported a range of information needs. Airport staff in contact with passengers travelling from the epicentre of the outbreak showed the highest levels of fear or concern, coupled with a desire to be adequately briefed by their employer. Conclusions Our results suggest that information strategies should address not only the exposed or potentially exposed but also groups that feel at risk. Identifying what information these different passenger and staff groups wish to receive will be an important task in any future infectious disease outbreak.

A bioterrorist attack may result in a large number of people who have not been exposed coming to medical facilities in search of treatment or reassurance. In this article, we review evidence from 3 previous biological incidents that are analogous to a bioterrorist attack in order to gauge the likely incidence of such "low-risk patients" and to identify possible strategies for coping with this phenomenon. Evidence from the anthrax attacks in the United States suggested that a surge of low-risk patients is by no means inevitable. Data from the SARS outbreak illustrated that if hospitals are seen as sources of contagion, many patients with non-bioterrorism-related healthcare needs may delay seeking help. Finally, the events surrounding the pneumonic plague outbreak of 1994 in Surat, India, highlighted the need for the public to be kept adequately informed about an incident. Although it is impossible to say what the likely incidence of low-risk patients will be during a future bioterrorist incident, several strategies may help to reduce it and to safeguard the well-being of the low-risk patients themselves. These strategies include providing clear information about who should and should not attend hospital; using telephone services to provide more detailed information and initial screening; employing rapid triage at hospital entrances, based, where possible, on exposure history and objective signs of illness; and following up by telephone those judged to be at low risk.

Responses to recent infectious disease outbreaks, such as to Influenza Pandemic 2009 and the on-going Ebola outbreak in West Africa, reveal the need for new and strengthened approaches to risk communication and governance. The article argues for a fundamental re-conceptualisation of current approaches to risk communication, preparedness planning and response. It calls for a reframing of the way we currently identify and respond to outbreaks around a set of core behaviour-based response patterns. This new model moves away from the current risk communication focus on a plethora of agent-specific threats to five generic response patterns that are based on socially relevant response activities such as 1) controlling vectors, 2) enhancing hygiene, 3) isolation of the sick, 4) protection of the well, and 5) systemic protection of people and their environments. Emphasis is placed on gaining relevant insights into the context specific needs of different communities related to these five patterns. Governance structures are then built and evaluated based on their capacity to collect, communicate, share and prepare the public to take appropriate action related to the five different patterns before, during and after an event. Reframing risk communication and preparedness approaches around a better understanding of the determinants of these general behavioural patterns in infectious control could strengthen infection control literacy, response competence and build resilience of both individuals and health systems to address future epidemics, pandemics and other public health threats.

Objectives Multidrug resistant organisms (MDRO), including Meticillin-resistant Staphylococcus aureus (MRSA), and health care associated infections (HCAIs) are pressing issues for health care systems across the world. Information and communication are considered key tools for the prevention and management of infectious diseases. Public Health Authorities (PHA) are in a unique position to communicate with health care professionals, patients and the public regarding the health risks. Study design We used PHA helpdesk interaction data to first ascertain the information requirements of those getting in contact with the service, and secondly to examine the communicative behaviour of the PHA, with a view to improving the quality of communication strategies. Methods Data on helpdesk interactions between 2010 and 2012 were obtained from a MDRO network of nine German PHAs. 501 recordings were coded and descriptive statistics generated for further qualitative thematic analysis. Results Our analysis revealed a similar pattern of questions among different groups. Key areas of need for information were around eradication, cleaning and isolation measures. Reported problems were a lack of expert knowledge and continuity of treatment. The helpdesk response was mainly a conversation offering scientific advice, but also included other communication services that went beyond the provision of scientific facts, such as follow-up calls, referral suggestions and consultations on behalf of the caller. These social communication activities seem to have an important impact on the acceptability of public health recommendations and use of the helpdesk. Conclusions Our findings support a broader discussion about the role of information in the communication process and underline the importance of social elements in the communication process, such as relationship and trust building.

Connecting Organizations for Regional Disease Surveillance (CORDS), together with the Southern African Centre for Infectious Disease Surveillance, organized an emergency meeting (September 1–2, 2014, in Dar es Salaam, Tanzania) to gather and collate first-hand experience from past Ebola outbreaks. The major aim was to identify key lessons that could inform current risk management. This meeting brought together a unique assembly consisting of scientists, policymakers, community and religious leaders, traditional healers, and media representatives from eastern and central Africa. They elucidated 3 major lessons that focus on improving communication, working with communities, and building and strengthening local capacity.

Current risk assessment and risk communication of biosafety and biosecurity concerns lack a convenient metric and conceptual framework. The absence of such a systematic tool makes communication more difficult and can lead to ambiguous public perception of and response to laboratory biosafety incidents and biosecurity threats. A new 7-category scoring scale is proposed for incidents and situations in laboratories related to the handling of human and animal pathogens. The scale aims to help clarify risk categories, facilitate coordination and communication, and improve public understanding of risk related to biosafety and biosecurity.

Background: Health economics preference-based techniques, such as discrete choice experiments (DCEs), are often used to inform public health policy on patients’ priorities when choosing health care. Although there is general evidence about patients’ satisfaction with general-practice (GP) care in Europe, to our knowledge no comparisons are available that measure patients’ preferences in different European countries, and use patients’ priorities to propose policy changes. Methods: A DCE was designed and used to capture patients’ preferences for GP care in Germany, England and Slovenia. In the three countries, 841 eligible patients were identified across nine GP practices. The DCE questions compared multiple health-care practices (including their ‘current GP practice’), described by the following attributes: ‘information’ received from the GP, ‘booking time’, ‘waiting time’ in the GP practice, ‘listened to’, as well as being able to receive the ‘best care’ available for their condition. Results were compared across countries looking at the attributes’ importance and rankings, patients’ willingness-to-wait for unit changes to the attributes’ levels and changes in policy. Results: A total of 692 respondents (75% response rate) returned questionnaires suitable for analysis. In England and Slovenia, patients were satisfied with their ‘current practice’, but they valued changes to alternative practices. All attributes influenced decision-making, and ‘best care’ or ‘information’ were more valued than others. In Germany, almost all respondents constantly preferred their ‘current practice’, and other factors did not change their preference. Conclusion: European patients have strong preference for their ‘status quo’, but alternative GP practices could compensate for it and offer more valued care.

Risk communication has been identified as a core competence for guiding public health responses to infectious disease threats. The International Health Regulations (2005) call for all countries to build capacity and a comprehensive understanding of health risks before a public health emergency to allow systematic and coherent communication, response and management. Research studies indicate that while outbreak and crisis communication concepts and tools have long been on the agenda of public health officials, there is still a need to clarify and integrate risk communication concepts into more standardised practices and improve risk communication and health, particularly among disadvantaged populations. To address these challenges, the European Centre for Disease Prevention and Control (ECDC) convened a group of risk communication experts to review and integrate existing approaches and emerging concepts in the development of a training curriculum. This curriculum articulates a new approach in risk communication moving beyond information conveyance to knowledge- and relationship-building. In a pilot training this approach was reflected both in the topics addressed and in the methods applied. This article introduces the new conceptual approach to risk communication capacity building that emerged from this process, presents the pilot training approach developed, and shares the results of the course evaluation.

ObjectiveRisk communication plays a central role in the management of infectious disease. The World Health Organization's 2005 International Health Regulations have highlighted the need for countries to strengthen their capacities in this area to ensure effective responses to public health emergencies. We surveyed laboratories, hospitals, and public health institutions in Germany to detail the current situation regarding risk communication and crisis management and to identify which areas require further development.MethodsA mixed methods approach was adopted. An initial questionnaire was distributed to relevant persons in laboratories and hospitals, and semistructured interviews were conducted with selected participants. Representatives from state public health authorities, federal agencies, and media also were interviewed to add additional contextual information to the questionnaire responses.ResultsBased on the responses received, the universal sense among key stakeholders was that risk communication and crisis communication measures must be improved. Collaborative working was a consistent theme, with participants suggesting that a partnering strategy could help to improve performance. This approach could be achieved through better coordination between groups, for example, through a knowledge-sharing policy.ConclusionsMore research is needed on how such collaboration might be implemented, along with a general conceptual framework for risk communication to underpin the overall strategy. (Disaster Med Public Health Preparedness. 2014;0:1-6)

Risk communication and crisis communication differ in many aspects and there is terminological and epistemological ambiguity in international fora and discussions regarding definitions and approaches. As a working definition we use time, method and content to distinguish between risk communication and crisis communication. Risk communication differs from crisis communication as risk communication starts before a crisis, is less directive, has more time to explain even difficult and contradicting …

»Biosecurity« - hinter diesem Schlagwort verbirgt sich ein komplexes sicherheitspolitisches Konzept, das seit den Terroranschlägen vom 11. September 2001 in vielen Schattierungen Eingang in unseren Alltag gefunden hat. Die Kulturwissenschaftlerin und Ärztin Petra Dickmann beleuchtet die Bedrohung durch biologische Waffen und möglichen Missbrauch biomedizinischen Wissens im Hinblick auf ihre gesellschaftlichen Auswirkungen. Ihre Analyse wirft ein Schlaglicht auf die biopolitischen Hintergründe der Debatten und beschreibt, wie entsprechende Restriktionsversuche zu einer asymmetrischen Kommunikation führen, die letztlich eine filigrane Militarisierung des öffentlichen Forschungssektors nach sich zieht.