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Langer S, Horn J, Gottschick C, Klee B, Purschke O, Caputo M, Dorendorf E, Meyer-Schlinkmann KM, Raupach-Rosin H, Karch A, Rübsamen N, Aydogdu M, Buhles M, Dressler F, Eberl W, von Koch FE, Frambach T, Franz H, Guthmann F, Guzman CA, Haase R, Hansen G, Heselich V, Hübner J, Koch HG, Oberhoff C, Riese P, Schild R, Seeger S, Tchirikov M, Trittel S, von Kaisenberg C, Mikolajczyk R. Symptom Burden and Factors Associated with Acute Respiratory Infections in the First Two Years of Life-Results from the LoewenKIDS Cohort. Microorganisms 2022; 10:microorganisms10010111. [PMID: 35056559 PMCID: PMC8781593 DOI: 10.3390/microorganisms10010111] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 12/10/2022] Open
Abstract
Acute respiratory infections (ARIs) are the most common childhood illnesses worldwide whereby the reported frequency varies widely, often depending on type of assessment. Symptom diaries are a powerful tool to counteract possible under-reporting, particularly of milder infections, and thus offer the possibility to assess the full burden of ARIs. The following analyses are based on symptom diaries from participants of the German birth cohort study LoewenKIDS. Primary analyses included frequencies of ARIs and specific symptoms. Factors, which might be associated with an increased number of ARIs, were identified using the Poisson regression. A subsample of two hundred eighty-eight participants were included. On average, 13.7 ARIs (SD: 5.2 median: 14.0 IQR: 10-17) were reported in the first two years of life with an average duration of 11 days per episode (SD: 5.8, median: 9.7, IQR: 7-14). The median age for the first ARI episode was 91 days (IQR: 57-128, mean: 107, SD: 84.5). Childcare attendance and having siblings were associated with an increased frequency of ARIs, while exclusive breastfeeding for the first three months was associated with less ARIs, compared to exclusive breastfeeding for a longer period. This study provides detailed insight into the symptom burden of ARIs in German infants.
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Affiliation(s)
- Susan Langer
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (S.L.); (J.H.); (B.K.); (O.P.); (R.M.)
| | - Johannes Horn
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (S.L.); (J.H.); (B.K.); (O.P.); (R.M.)
| | - Cornelia Gottschick
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (S.L.); (J.H.); (B.K.); (O.P.); (R.M.)
- Correspondence: ; Tel.: +49-345-5574499
| | - Bianca Klee
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (S.L.); (J.H.); (B.K.); (O.P.); (R.M.)
| | - Oliver Purschke
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (S.L.); (J.H.); (B.K.); (O.P.); (R.M.)
| | - Mahrrouz Caputo
- Helmholtz Centre for Infection Research, Epidemiology Research Group Epidemiological and Statistical Methods, 38124 Braunschweig, Germany; (M.C.); (E.D.); (K.M.M.-S.); (H.R.-R.)
| | - Evelyn Dorendorf
- Helmholtz Centre for Infection Research, Epidemiology Research Group Epidemiological and Statistical Methods, 38124 Braunschweig, Germany; (M.C.); (E.D.); (K.M.M.-S.); (H.R.-R.)
| | - Kristin Maria Meyer-Schlinkmann
- Helmholtz Centre for Infection Research, Epidemiology Research Group Epidemiological and Statistical Methods, 38124 Braunschweig, Germany; (M.C.); (E.D.); (K.M.M.-S.); (H.R.-R.)
| | - Heike Raupach-Rosin
- Helmholtz Centre for Infection Research, Epidemiology Research Group Epidemiological and Statistical Methods, 38124 Braunschweig, Germany; (M.C.); (E.D.); (K.M.M.-S.); (H.R.-R.)
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, 48149 Münster, Germany; (A.K.); (N.R.)
| | - Nicole Rübsamen
- Institute of Epidemiology and Social Medicine, University of Münster, 48149 Münster, Germany; (A.K.); (N.R.)
| | - Mustafa Aydogdu
- Department of Gynecology, Gyneoncology and Senology, Klinikum Bremen-Mitte, 28205 Bremen, Germany;
| | - Matthias Buhles
- Department of Gynecology and Obstetrics, Community Hospital Wolfenbuettel, 38302 Wolfenbuettel, Germany;
| | - Frank Dressler
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hanover Medical School, 30625 Hanover, Germany; (F.D.); (G.H.)
| | - Wolfgang Eberl
- Department of Paediatrics, Hospital Braunschweig, 38118 Braunschweig, Germany; (W.E.); (H.G.K.)
| | - Franz Edler von Koch
- Department of Gynecology and Obstetrics, Hospital Dritter Orden, Munich-Nymphenburg, 80336 Munich, Germany;
| | - Torsten Frambach
- Department of Gynecology and Obstetrics, Hospital St. Joseph Stift Bremen, 80336 Bremen, Germany;
| | - Heiko Franz
- Department of Gynecology and Obstetrics, Hospital Braunschweig, 38118 Braunschweig, Germany;
| | - Florian Guthmann
- Department of Neonatology, Children and Youth Hospital AUF DER BULT, 30173 Hanover, Germany;
| | - Carlos A. Guzman
- Helmholtz Centre for Infection Research, Department Vaccinology and Applied Microbiology, 38124 Braunschweig, Germany; (C.A.G.); (P.R.); (S.T.)
| | - Roland Haase
- Department of Neonatology and Pediatric Intensive Care, Hospital St. Elisabeth und St. Barbara, 06110 Halle (Saale), Germany;
| | - Gesine Hansen
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hanover Medical School, 30625 Hanover, Germany; (F.D.); (G.H.)
| | - Valerie Heselich
- Department of Paediatrics, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Munich, 80337 Munich, Germany; (V.H.); (J.H.)
| | - Johannes Hübner
- Department of Paediatrics, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Munich, 80337 Munich, Germany; (V.H.); (J.H.)
| | - Hans Georg Koch
- Department of Paediatrics, Hospital Braunschweig, 38118 Braunschweig, Germany; (W.E.); (H.G.K.)
| | - Carsten Oberhoff
- Department of Gynecology and Obstetrics, Klinikum Links der Weser, 28277 Bremen, Germany;
| | - Peggy Riese
- Helmholtz Centre for Infection Research, Department Vaccinology and Applied Microbiology, 38124 Braunschweig, Germany; (C.A.G.); (P.R.); (S.T.)
| | - Ralf Schild
- Department of Obstetrics and Perinatal Medicine, DIAKOVERE Henriettenstift Hanover, 30559 Hanover, Germany;
| | - Sven Seeger
- Department of Gynecology and Obstetrics, Hospital St. Elisabeth und St. Barbara, 06110 Halle (Saale), Germany;
| | - Michael Tchirikov
- University Clinic and Outpatient Clinic for Obstetrics and Prenatal Medicine, 06120 Halle (Saale), Germany;
| | - Stephanie Trittel
- Helmholtz Centre for Infection Research, Department Vaccinology and Applied Microbiology, 38124 Braunschweig, Germany; (C.A.G.); (P.R.); (S.T.)
| | - Constantin von Kaisenberg
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, 30625 Hanover, Germany;
| | - Rafael Mikolajczyk
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (S.L.); (J.H.); (B.K.); (O.P.); (R.M.)
- Helmholtz Centre for Infection Research, Epidemiology Research Group Epidemiological and Statistical Methods, 38124 Braunschweig, Germany; (M.C.); (E.D.); (K.M.M.-S.); (H.R.-R.)
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Gottschick C, Raupach-Rosin H, Langer S, Hassan L, Horn J, Dorendorf E, Caputo M, Bittner M, Beier L, Rübsamen N, Schlinkmann K, Zoch B, Guzman CA, Hansen G, Heselich V, Holzapfel E, Hübner J, Pietschmann T, Pieper DH, Pletz M, Riese P, Schmidt-Pokrzywniak A, Hartwig S, von Kaisenberg C, Aydogdu M, Buhles M, Dressler F, Eberl W, Haase R, Edler von Koch F, Feidicker S, Frambach T, Franz HGB, Guthmann F, Koch HG, Seeger S, Oberhoff C, Pauker W, Petry KU, Schild RL, Tchirikov M, Röhrig E, Karch A, Mikolajczyk R. Cohort Profile: The LoewenKIDS Study - life-course perspective on infections, the microbiome and the development of the immune system in early childhood. Int J Epidemiol 2020; 48:1042-1043h. [PMID: 30815674 PMCID: PMC7108547 DOI: 10.1093/ije/dyz001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2019] [Indexed: 12/26/2022] Open
Affiliation(s)
- Cornelia Gottschick
- Institut of Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Susan Langer
- Institut of Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Lamiaa Hassan
- Institut of Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Johannes Horn
- Institut of Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | | | | | - Lea Beier
- Research Group Epidemiological and Statistical Methods
| | | | | | - Beate Zoch
- Research Group Epidemiological and Statistical Methods
| | - Carlos A Guzman
- Department Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Gesine Hansen
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hanover Medical School, Hanover, Germany
| | - Valerie Heselich
- Department of Paediatrics, Dr. von Hauner Children's Hospital, Ludwig- Maximilians-University Munich, Germany
| | - Eva Holzapfel
- Department of Paediatrics, Dr. von Hauner Children's Hospital, Ludwig- Maximilians-University Munich, Germany
| | - Johannes Hübner
- Department of Paediatrics, Dr. von Hauner Children's Hospital, Ludwig- Maximilians-University Munich, Germany
| | - Thomas Pietschmann
- Institute of Experimental Virology, TWINCORE, Centre for Experimental and Clinical Infection Research; a joint venture between the Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI), Hannover, Germany
| | - Dietmar H Pieper
- Research Group Microbial Interactions and Processes, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Mathias Pletz
- Institute for Infectious Diseases and Infection Control, University Hospital Jena, Germany
| | - Peggy Riese
- Department Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Andrea Schmidt-Pokrzywniak
- Institut of Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Saskia Hartwig
- Institut of Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Constantin von Kaisenberg
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Hanover, Germany
| | - Mustafa Aydogdu
- Department of Gynecology, Gyneoncology and Senology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Matthias Buhles
- Department of Gynecology and Obstetrics, Community Hospital Wolfenbüttel, Germany
| | - Frank Dressler
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hanover Medical School, Hanover, Germany
| | - Wolfgang Eberl
- Department of Paediatrics, Hospital Braunschweig, Germany
| | - Roland Haase
- Section for Neonatology and Pediatric Intensive Care, University Hospital Halle (Saale), Germany
| | - Franz Edler von Koch
- Department of Gynecology and Obstetrics, Hospital Dritter Orden, Munich-Nymphenburg, Germany
| | - Susanne Feidicker
- Department of Gynecology and Obstetrics, Diaconical Hospital DIAKO Ev., Bremen, Germany
| | - Torsten Frambach
- Department of Gynecology and Obstetrics, Hospital St. Joseph Stift Bremen, Germany
| | - Heiko G B Franz
- Department of Gynecology and Obstetrics, Hospital Braunschweig, Germany
| | - Florian Guthmann
- Department of Neonatology, Children and Youth Hospital AUF DER BULT, Hanover, Germany
| | - Hans G Koch
- Department of Paediatrics, Hospital Braunschweig, Germany
| | - Sven Seeger
- Department of Gynecology and Obstetrics, Hospital St. Elisabeth und St. Barbara, Halle (Saale), Germany
| | - Carsten Oberhoff
- Department of Gynecology and Obstetrics, Klinikum Links der Weser, Bremen, Germany
| | - Wladimir Pauker
- Department of Gynecology and Obstetrics, Klinikum Bremen-Nord, Bremen, Germany
| | - Karl U Petry
- Department of Gynecology and Obstetrics, Hospital Wolfsburg, Germany
| | - Ralf L Schild
- Department of Obstetrics and Perinatal Medicine, DIAKOVERE Henriettenstift Hanover, Germany
| | - Michael Tchirikov
- University Clinic and Outpatient Clinic for Obstetrics and Prenatal Medicine, Halle (Saale), Germany
| | - Eckhard Röhrig
- Department of Obstetrics, Dr. Geisenhofer Women's Clinic, Munich, Germany
| | - André Karch
- Research Group Epidemiological and Statistical Methods.,Department of Clinical Epidemiology, Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Rafael Mikolajczyk
- Institut of Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.,Research Group Epidemiological and Statistical Methods
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Carman KB, Calik M, Karal Y, Isikay S, Kocak O, Ozcelik A, Yazar AS, Nuhoglu C, Sag C, Kilic O, Dinleyici M, Lacinel Gurlevik S, Yimenicioglu S, Ekici A, Perk P, Tosun A, Isik I, Yarar C, Arslantas D, Dinleyici EC. Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study). Hum Vaccin Immunother 2018; 15:496-502. [PMID: 30235060 PMCID: PMC6422444 DOI: 10.1080/21645515.2018.1526588] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 08/30/2018] [Accepted: 09/15/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Febrile seizure is the most common childhood neurological disorder, is an important health problem with potential short- and long-term complications, also leading to economic burden and increased parental anxiety about fevers and seizures occurring in their children. There are no routine recommendation to detect etiological causes of FS for neurological perspective, further knowledge about the etiological causes of FS in children will support preventive measures and follow-up strategies. The aim of this study is to evaluate the percentage of respiratory viruses in children with FS. METHODS This prospective multicenter study, entitled "Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study)" examined representative populations in eight different cities in Turkey between March 1, 2016 and April 1, 2017. Nasopharyngeal swabs were taken from all children at presentation. A respiratory multiplex array was performed to detect for influenza A and B; respiratory syncytial virus A and B; human parainfluenza virus 1-2-3 and 4; human coronavirus 229E and OC43; human rhinovirus; human enterovirus; human adenovirus; human bocavirus; human metapneumovirus. RESULTS During the study period, at least one virus was detected in 82.7% (144/174) of children with FS. The most frequently detected virus was adenovirus, followed by influenza A and influenza B. Detection of more than one virus was present in 58.3% of the children with FS, and the most common co-existence was the presence of adenovirus and influenza B. In children younger than 12 months, Coronavirus OC43 was the most common, while influenza A was most frequently observed in children older than 48 months (p < 0.05). Human bocavirus was common in children who experienced complex FS, while respiratory syncytial virus (RSV) A was more common in children who experienced simple FS. Influenza B virus was the most common virus identified in children who were experiencing their first incidence of FS (p < 0.05). CONCLUSIONS This study indicates that respiratory viruses are important in the etiology of FS in children. The results show that antibiotics must be prescribed carefully in children with FS since the majority of cases are related to viral causes. Widespread use of the existing quadrivalent influenza vaccine might be useful for the prevention of FS related to the flu. Further vaccine candidates for potential respiratory pathogens, including RSV, might be helpful for the prevention of FS.
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Affiliation(s)
- Kursat Bora Carman
- Faculty of Medicine, Department of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Mustafa Calik
- Faculty of Medicine, Department of Pediatric Neurology, Harran University, Sanliurfa, Turkey
| | - Yasemin Karal
- Faculty of Medicine, Department of Pediatric Neurology, Trakya University, Edirne, Turkey
| | - Sedat Isikay
- Faculty of Medicine, Department of Pediatric Neurology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Ozan Kocak
- Department of Pediatric Neurology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Aysima Ozcelik
- Faculty of Medicine, Department of Pediatric Neurology, Gaziantep University, Gaziantep, Turkey
| | - Ahmet Sami Yazar
- Department of Pediatrics, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Cagatay Nuhoglu
- Department of Pediatrics, Haydarapasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Cigdem Sag
- Department of Pediatrics, Haydarapasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Omer Kilic
- Faculty of Medicine, Pediatric Infectious Disease Unit, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Meltem Dinleyici
- Faculty of Medicine, Department of Social Pediatrics, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sibel Lacinel Gurlevik
- Faculty of Medicine, Department of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sevgi Yimenicioglu
- Department of Pediatric Neurology, Eskisehir Maternity and Children Hospital, Eskisehir, Turkey
| | - Arzu Ekici
- Department of Pediatric Neurology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Peren Perk
- Faculty of Medicine, Department of Pediatric Neurology, Gaziantep University, Gaziantep, Turkey
| | - Ayse Tosun
- Faculty of Medicine, Department of Pediatric Neurology, Adnan Menderes University, Aydin, Turkey
| | - Ilhan Isik
- Department of Pediatric Neurology, Sanliurfa Children’s Hospital, Sanliurfa, Turkey
| | - Coskun Yarar
- Faculty of Medicine, Department of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Didem Arslantas
- Faculty of Medicine, Department of Public Health, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ener Cagri Dinleyici
- Faculty of Medicine, Department of Pediatrics, Eskisehir Osmangazi University, Eskisehir, Turkey
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Schlinkmann KM, Bakuli A, Mikolajczyk R. Incidence and comparison of retrospective and prospective data on respiratory and gastrointestinal infections in German households. BMC Infect Dis 2017; 17:336. [PMID: 28490316 PMCID: PMC5426066 DOI: 10.1186/s12879-017-2434-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/30/2017] [Indexed: 11/29/2022] Open
Abstract
Background Acute respiratory infections (ARI) and acute gastrointestinal infections (AGI) are the most common childhood infections, and corresponding data can either be collected prospectively or retrospectively. The aim of this study was to estimate the incidence of respiratory and gastrointestinal episodes in German households with children attending day care and to compare results of prospective and retrospective data collection. Methods We conducted a 4 months prospective cohort study in the winter period 2014/2015 and recruited parents of children aged 0–6 years in 75 day care centers in Braunschweig, Lower Saxony, Germany. For all household members, we collected information on episodes of ARI and AGI. We applied prospective data collection in one study arm and retrospective data collection with a reporting period of 2 months in the other. Poisson regression was used to model monthly incidence rates for both study arms. Results In total, 100 households (including 404 persons) participated in the retrospective group and 77 households (282 persons) in the prospective group. Incidence estimates for ARI (retrospective group: 0.52 per person month, prospective group: 0.47) were higher than for AGI (retrospective group: 0.14, prospective group: 0.13). The adjusted incidence estimates were similar in both study arms for ARI (incidence rate ratio for retrospective versus prospective data collection: 1.11 [confidence interval (CI) 95% 0.99; 1.24], p = 0.42) as well as for AGI (1.10 [CI 95% 0.89; 1.37], p = 0.27). Conclusion If there is no need to collect biomaterials or data on severity of the diseases, incidence of infections in the household setting over a short time period (2 months) can be assessed retrospectively. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2434-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristin Maria Schlinkmann
- Department for Epidemiology, Helmholtz Centre for Infection Research, ESME - Epidemiological and Statistical Methods Research Group, Inhoffenstraße 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany
| | - Abhishek Bakuli
- Department for Epidemiology, Helmholtz Centre for Infection Research, ESME - Epidemiological and Statistical Methods Research Group, Inhoffenstraße 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany
| | - Rafael Mikolajczyk
- Department for Epidemiology, Helmholtz Centre for Infection Research, ESME - Epidemiological and Statistical Methods Research Group, Inhoffenstraße 7, 38124, Braunschweig, Germany. .,Hannover Medical School, Hannover, Germany. .,German Centre for Infection Research Site (DZIF), Braunschweig-Hannover, Germany. .,Institute for Medical Epidemiology, Medical Faculty of the Martin Luther University Halle-Wittenberg, Biometrics, and Informatics (IMEBI), Halle (Saale), Germany.
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