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ZusammenfassungDie COVID-19-Pandemie hat die Vulnerabilität der Alten- und Pflegeheimbewohnenden aufgrund ihres erhöhten Risikos für einen schwerwiegenden oder tödlichen COVID-19-Verlauf verdeutlicht. Um die Bewohnenden in den Einrichtungen in Anbetracht hoher Inzidenzen von severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in der Gesamtbevölkerung zu schützen, wurde eine Reihe von Infektionsschutzmaßnahmen empfohlen, die im Verlauf der Pandemie zu einem Rückgang der COVID-19-Fälle und -Todesfälle in den Einrichtungen geführt haben. Gleichzeitig hat sich jedoch gezeigt, dass in Alten- und Pflegeheimen häufig einige Faktoren existieren, welche die Umsetzung von Infektionsschutzmaßnahmen erschweren und einen erheblichen Einfluss auf die Gesundheit der Bewohnenden ausüben.Herausforderungen ergeben sich vor allem durch die Arbeitsbedingungen (Mangel an Personal grundsätzlich und mit entsprechenden Qualifikationen, arbeitsbedingte Belastungen), durch die Versorgung der Bewohnenden (medizinisch und psychosozial) sowie durch strukturelle und einrichtungsspezifische Faktoren (u. a. Größe von Heimen).Lösungskonzepte für diese Probleme zeigen, dass die Umsetzung von Infektionsschutzmaßnahmen nicht für sich alleine steht, sondern als Teil eines Konzeptes zur Neugestaltung der Arbeits‑, Wohn- und Lebensbereiche der Beschäftigten und der Bewohnenden der Einrichtungen betrachtet werden sollte. Dabei gilt es, den Infektionsschutz in Alten- und Pflegeheimen nicht ausschließlich in Hinblick auf zukünftige Pandemien zu planen, sondern dessen Relevanz auch für bereits jetzt bestehende Gesundheitsgefahren, wie nosokomiale Infektionen, Antibiotikaresistenzen oder Influenza, zu beachten.

Background Antimicrobial resistance (AMR) causes substantial health and economic burden to individuals, healthcare systems and societies globally. Understanding the temporal relationship between antibiotic consumption and antibiotic resistance in hospitalized patients can better inform antibiotic stewardship activities and the time frame for their evaluation. Objectives This systematic review examined the temporal relationship between antibiotic use and development of antibiotic resistance for 42 pre-defined antibiotic and pathogen combinations in hospitalized adults in Europe. Methods Searches in MEDLINE, Embase, Cochrane Library and NIHR Centre for Reviews and Dissemination were undertaken from 2000 to August 2021. Pathogens of interest were Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus faecium, CoNS, Pseudomonas aeruginosa and Acinetobacter baumannii complex. Results Twenty-eight ecological studies and one individual-level study were included. Ecological studies were predominantly retrospective in design (19 studies) and of reasonable (20 studies) to high (8 studies) methodological quality. Of the eight pathogens of interest, no relevant data were identified for S. pneumoniae and CoNS. Across all pathogens, the time-lag data from the 28 ecological studies showed a similar pattern, with the majority of studies reporting lags ranging from 0 to 6 months. Conclusions Development of antibiotic resistance for the investigated antibiotic/pathogen combinations tends to occur over 0 to 6 months following exposure within European hospitals. This information could inform planning of antibiotic stewardship activities in hospital settings.

Background In September 2018, Burkholderia cepacia complex (BCC) infections in 3 patients associated with exposure to a mouthwash solution (MWS) were reported to the Robert Koch Institute (RKI). As the product was still on the market and the scale of the outbreak was unclear, a nation-wide investigation was initiated. Methods We aimed to investigate BCC infections/colonizations associated with MWS. Hospitals, laboratories, and public health services were informed that BCC isolates should be sent to the RKI. These isolates were typed by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) including development of an ad hoc core genome MLST (cgMLST) scheme. Results In total, 36 patients from 6 hospitals met the case definition, the last patient in November 2018. Twenty-nine isolates from 26 of these patients were available for typing. WGS analysis revealed 2 distinct cgMLST clusters. Cluster 1 (Burkholderia arboris) contained isolates from patients and MWS obtained from 4 hospitals and isolates provided by the manufacturer. Patient and MWS isolates from another hospital were assigned to cluster 2 (B. cepacia). Conclusions The combined clinical, epidemiological, and microbiological investigation, including whole-genome analysis, allowed for uncovering a supraregional BCC outbreak in health care settings. Strains of B. arboris and B. cepacia were identified as contaminating species of MWS bottles and subsequent colonization and putative infection of patients in several hospitals. Despite a recall of the product by the manufacturer in August 2018, the outbreak lasted until December 2018. Reporting of contaminated medical products and recalls should be optimized to protect patients.

BackgroundBuilding the European Antimicrobial Resistance Surveillance network in Veterinary medicine (EARS-Vet) was proposed to strengthen the European One Health antimicrobial resistance (AMR) surveillance approach.ObjectivesThe objectives were to (i) define the combinations of animal species, production types, age categories, bacterial species, specimens and antimicrobials to be monitored in EARS-Vet and to (ii) determine antimicrobial test panels able to cover most combinations.MethodsThe EARS-Vet scope was defined by consensus between 26 European experts. Decisions were guided by a survey of the combinations that are relevant and feasible to monitor in diseased animals in 13 European countries (bottom-up approach). Experts also considered the One Health approach and the need for EARS-Vet to complement existing European AMR monitoring systems coordinated by the European Centre for Disease Prevention and Control (ECDC) and the European Food Safety Authority (EFSA).ResultsEARS-Vet would monitor AMR in six animal species (cattle, swine, chicken (broiler and laying hen), turkey, cat and dog), for 11 bacterial species (Escherichia coli, Klebsiella pneumoniae, Mannheimia haemolytica, Pasteurella multocida, Actinobacillus pleuropneumoniae, Staphylococcus aureus, Staphylococcus pseudintermedius, Staphylococcus hyicus, Streptococcus uberis, Streptococcus dysgalactiae and Streptococcus suis). Relevant antimicrobials for their treatment were selected (e.g. tetracyclines) and complemented with antimicrobials of more specific public health interest (e.g. carbapenems). Three test panels of antimicrobials were proposed covering most EARS-Vet combinations of relevance for veterinary antimicrobial stewardship.ConclusionsWith this scope, EARS-Vet would enable to better address animal health in the strategy to mitigate AMR and better understand the multi-sectoral AMR epidemiology in Europe.

Obwohl akute respiratorische Erkrankungen, einschlieslich Influenza und Pneumonie, uberwiegend in der primararztlichen Versorgung behandelt werden, fehlen in Deutschland weitgehend epidemiologische Daten aus dem ambulanten Bereich bezuglich Risikofaktoren sowie Komplikationen dieser Erkrankungen. Im Rahmen der am Robert Koch-Institut (RKI) durchgefuhrten wissenschaftlichen Studie wurden diese Fragestellungen anhand der ICD-10-Diagnosecodes untersucht. Ziele dieses Beitrags sind die Vorstellung der Studienmethodik sowie die deskriptive Darstellung des Patientenkollektivs. Zwischen Januar 2012 und April 2015 wurden mithilfe der im Auftrag des RKI entwickelten Software anonymisierte, fallbasierte Informationen aus der Praxissoftware von 89 Arztpraxen zu allen Patienten erfasst, bei denen eine Influenza, Pneumonie oder andere akute respiratorische Erkrankung (ARE) diagnostiziert wurde. Zu jedem Patienten wurden alle Diagnosen mit Datum retrospektiv sowie prospektiv (jeweils sechs Monate) ubermittelt, sowie Angaben zu Alter, Geschlecht und Influenzaimpfung. 156.803 Patienten mit ARE wurden erfasst, davon 7909 Patienten mit Influenza- (in den Influenzawellen) und 8528 Patienten mit Pneumonie-Diagnose(n). Die dokumentierten Influenza-Diagnosen bildeten deutlich die Influenzawellen in Deutschland ab. 1,6 % der Influenza-Falle hatten eine Pneumonie als Folgediagnose innerhalb von 30 Tagen nach einer Influenza. Im Vergleich zur Allgemeinbevolkerung wurden chronische Erkrankungen (Asthma und Diabetes) im Patientenkollektiv signifikant haufiger diagnostiziert. Die in der Studie erhobenen Routinedaten aus deutschen Hausarztpraxen stellen eine solide Grundlage fur die Untersuchung von Forschungsfragen bezuglich Risikofaktoren und Komplikationen der Influenza und Pneumonie sowie anderer akuter Atemwegserkrankungen im zeitlichen Verlauf dar.

While adverse housing is commonly associated with high respiratory morbidity in urban slum areas, data on prevalence of common respiratory symptoms among adults in urban slums in Bangladesh is limited. We compared the frequency of common respiratory symptoms among men and women in relation to individual socio-demographic and household characteristics using methods of descriptive and analytic epidemiology. Cross-sectional data from 1892 adult respondents collected in the baseline study in 2009 in nine urban slum areas of Dhaka were used. Three month prevalence of coughs and colds was 21.5% (n=1,893). Women were more vulnerable to respiratory symptoms in relation to the frequent exposure to stagnant water bodies near the house (OR: 4.44; 95% CI: 2.49-7.93) and waste disposal (OR: 3.57; 95% CI: 1.37-9.31). Practice of smoking inside dwelling increased the likelihood of having respiratory symptoms for both sexes. Recurrent contact or exposure to stagnant water and unhygienic waste management appeared to be the strongest factors associated with respiratory symptoms, particularly among women. This finding underlines the significance of the improvement of housing quality in slum areas affected by stagnation of water and improper waste management as well as the need for public health intervention to minimize the risk of diseases associated with these factors. DOI: http://dx.doi.org/10.3329/seajph.v3i2.20042 South East Asian Journal of Public Health Vol.3(2) 2013: 58-65

No evidence was found for nosocomial transmission of this coronavirus., On March 19, 2013, a patient from United Arab Emirates who had severe respiratory infection was transferred to a hospital in Germany, 11 days after symptom onset. Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) was suspected on March 21 and confirmed on March 23; the patient, who had contact with an ill camel shortly before symptom onset, died on March 26. A contact investigation was initiated to identify possible person-to-person transmission and assess infection control measures. Of 83 identified contacts, 81 were available for follow-up. Ten contacts experienced mild symptoms, but test results for respiratory and serum samples were negative for MERS-CoV. Serologic testing was done for 53 (75%) of 71 nonsymptomatic contacts; all results were negative. Among contacts, the use of FFP2/FFP3 face masks during aerosol exposure was more frequent after MERS-CoV infection was suspected than before. Infection control measures may have prevented nosocomial transmission of the virus.

Vaccination of immunocompromised patients is recommended in many national guidelines to protect against severe or complicated influenza infection. However, due to uncertainties over the evidence base, implementation is frequently patchy and dependent on individual clinical discretion. We conducted a systematic review and meta‐analysis to assess the evidence for influenza vaccination in this patient group. Healthcare databases and grey literature were searched and screened for eligibility. Data extraction and assessments of risk of bias were undertaken in duplicate, and results were synthesised narratively and using meta‐analysis where possible. Our data show that whilst the serological response following vaccination of immunocompromised patients is less vigorous than in healthy controls, clinical protection is still meaningful, with only mild variation in adverse events between aetiological groups. Although we encountered significant clinical and statistical heterogeneity in many of our meta‐analyses, we advocate that immunocompromised patients should be targeted for influenza vaccination.

Diarrhoeal diseases constitute an important public health problem in many developing countries including Bangladesh. This study aimed to report the household-level determinants of diarrhoea using the baseline information of cohort studies conducted in 2008 and 2009. The variation of diarrhoea by 3-month period was also reported. A total of 3,207 households were systematically selected from 12 slums in Dhaka and three rural villages located nearby. The highest prevalence of diarrhoea was found during the period of September to November (22.7%) and the lowest during December to February (9.2%). Slum households were more affected by diarrhoea as compared with the rural households (OR=1.49; 95% CI=1.06-2.08; p=0.020). Other determinants namely provisional house, sharing water source, and sanitary, and use of surface water were also associated with a higher risk of diarrhoea. In conclusion, slum house holds suffered more from diarrhoea than rural populations. Moreover, the higher burden of diarrhoea were found to be strongly and persistently associated with adverse housing and environmental conditions. Public health strategies based on our findings are required to reduce the burden of diarrhoea in the study population. Particularly multilevel interdisciplinary actions are needed to improving the quality of housing, water, and sanitation facilities in urban slums of Dhaka, and similar settings elsewhere. Copyright (C) 2013 John Wiley & Sons, Ltd.

Influenza and community-acquired pneumonia (CAP) impose a considerable annual burden on the German primary care system. Yet there is a lack of epidemiological data from the country's outpatient sector on groups at risk as well as on the complications of these diseases.The Robert Koch Institute (RKI) initiated the study to identify population groups at increased risk for influenza or CAP as well as related comorbidities and sequelae. We present the methodology of the study and the descriptive analysis of the patients.ICD-10-based data was collected in 89 primary health care practices between January 2012 and April 2015 using a data extraction tool developed on behalf of the RKI. Case-based anonymized information was recorded for all patients in whom influenza, CAP or other acute respiratory infections (ARI) were diagnosed. For each patient information on all diagnoses including the date were retrospectively and prospectively collected (each for six months) as well as age, sex and influenza vaccination.Data on 156,803 patients with ARI was collected, of them 7909 patients with influenza (within influenza waves) and 8528 patients with CAP diagnoses. Influenza diagnoses showed a strong seasonal pattern and captured annual influenza waves in Germany. Of the influenza cases 1.6 % had a following diagnosis of CAP within 30 days. Age-specific prevalence of chronic diseases such as asthma and diabetes was significantly higher in the study population as compared to the German population.The developed tool delivers in a standardized fashion ICD-10-coded epidemiological data on population-based burden of influenza and CAP in Germany. As the descriptive analysis showed, the collected dataset is a reliable and solid basis for the further investigations of the study questions.

The aim of outbreak epidemiology is to study an epidemic in order to gain control over it and to prevent further spread of the disease. Generally outbreak means a “sudden occurrence,” while in the epidemiological sense an outbreak is defined as a sudden increase in the disease frequency, related to time, place, and observed population. Thousands of outbreaks among humans and animals have been reported and investigated during the last two centuries, among them the most numerous being outbreaks of cholera, plague, malaria, smallpox, influenza, SARS, measles, salmonella, chikungunya, and various foodborne outbreaks.

Diarrhoeal diseases constitute an important public health problem in many developing countries including Bangladesh. This study aimed to report the household-level determinants of diarrhoea using the baseline information of cohort studies conducted in 2008 and 2009. The variation of diarrhoea by 3-month period was also reported. A total of 3,207 households were systematically selected from 12 slums in Dhaka and three rural villages located nearby. The highest prevalence of diarrhoea was found during the period of September to November (22.7%) and the lowest during December to February (9.2%). Slum households were more affected by diarrhoea as compared with the rural households (OR=1.49; 95% CI=1.06-2.08; p=0.020). Other determinants namely provisional house, sharing water source, and sanitary, and use of surface water were also associated with a higher risk of diarrhoea. In conclusion, slum house holds suffered more from diarrhoea than rural populations. Moreover, the higher burden of diarrhoea were found to be strongly and persistently associated with adverse housing and environmental conditions. Public health strategies based on our findings are required to reduce the burden of diarrhoea in the study population. Particularly multilevel interdisciplinary actions are needed to improving the quality of housing, water, and sanitation facilities in urban slums of Dhaka, and similar settings elsewhere. Copyright (C) 2013 John Wiley & Sons, Ltd.

BACKGROUND AND OBJECTIVES: Although Bangladesh has already achieved noticeable progress in the field of development and health, disparities in public health indicators for several markers are still reported. To assess public health development in Bangladesh during the last two decades, firstly, we analysed levels, trends and disparities in public-health-related indicators by rural versus urban as well as by the richest versus poorest group of women who have ever been married. Secondly, using the most recent data set we performed multiple analyses to check whether urban-rural and richest-poorest disparities were still significant. METHODS: The analysis was based on six nationally representative data sets from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 1993-94 (n=9,640), 1996-1997 (n=9,127), 1999-2000 (n=10,544), 2004 (n=11,440), 2007 (n=10,996) and 2011 (n=17,749). The outcome variables were six selected public-health-related indicators. We performed various types of analyses, including multiple logistic regressions. RESULTS: The trend of all indicators except being overweight (1993-2011) displayed gradual improvements for both markers. However, the urban and richest groups revealed a better situation than their counterparts in both simple and multiple analyses. Disparities between richest-poorest groups were more pronounced than urban-rural disparities. For instance, the prevalence of delivery at any healthcare facility in 2011 was 20.4% in rural areas and 46.5% in urban areas, whereas it was 9.1% in the poorest group and 57.6% in the richest group. CONCLUSION: The public health sector in Bangladesh has achieved some successes over the last two decades. However, urban-rural and richest-poorest disparities are still considerable and therefore more public health strategies and efforts are clearly needed for the rural and poorest groups of women in order to reduce these gaps further.

Quality of housing plays one of the key roles in a public health research, since inadequate housing may have direct or indirect negative impact on health. Higher satisfaction with housing was shown to be associated with higher income, higher age, a smaller family, higher education, being female and being an owner of a dwelling. The aim of our study is to identify the multiple sources of the satisfaction with housing in population of urban slums and rural areas in Dhaka, Bangladesh. We have used a combined variable “Housing Satisfaction”, containing nine items related to satisfaction with different types of housing facilities (water, electricity, toilet etc.). Ordinal as well as binary multiple logistic regression models were applied to predict housing satisfaction. Rural residents (with 90 % house ownership) were much more satisfied with their housing than urban slum dwellers. Those respondents who perceived their area as “Very bad/Bad” to reach medical care reported significantly higher levels of housing dissatisfaction. Low satisfaction with available facilities (education, health services, etc.) as well as the adjacent neighbourhood being perceived as negative for own health showed as well a strong predictive effect on housing dissatisfaction. The major findings of our study showed a complex relationship between housing satisfaction and the quality of basic facilities including the reachability of medical care. Understanding the factors which lead to satisfaction with housing and residential environment is crucial for planning successful and effective housing policies.

According to World Health Organization (1948), health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. In terms of this definition, urban health is referred to as the health of population living in the city or town (Galea and Vlahov 2005). More than half of the world population currently live in urban areas (approximately one-third of them are estimated to live in marginal settlements or slums (UN-Habitat 2003)) and virtually most of the world population growth from now on will be in cities (Leon 2008). For example, the urban population is projected to increase by 1.6 billion by 2030 while the rural population shrinks by 28 million. Although people migrate to cities for a better life and income (Cohen 2004), urbanisation is also considered as a health hazard for certain vulnerable populations. The demographic shift due to rapid and uncontrolled urbanisation also creates a humanitarian disaster (Patel and Burke 2009).

Introduction/background: Tuberculosis (TB) is one of the major public health problems worldwide, with a high prevalence especially in low- and middle-income countries and with middle-aged men as major risk group [ref:1]. From Ukraine the seventh highest TB rate in the region of Eastern[for full text, please go to the a.m. URL], Mainz//2011; 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi)

BackgroundImmunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events.Methodology/principal findingsElectronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results were synthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I(2) and publication bias was assessed using Begg's funnel plot and Egger's regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR]=0.23; 95% confidence interval [CI]=0.16-0.34; pConclusions/significanceInfection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence reviewed is generally weak, although the directions of effects are consistent. Areas for further research are identified.