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van de Berg S, Charles T, Dörre A, Katz K, Böhm S. Epidemiology of common infectious diseases before and during the COVID-19 pandemic in Bavaria, Germany, 2016 to 2021: an analysis of routine surveillance data. Euro Surveill 2023; 28:2300030. [PMID: 37824248 PMCID: PMC10571495 DOI: 10.2807/1560-7917.es.2023.28.41.2300030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/11/2023] [Indexed: 10/14/2023] Open
Abstract
BackgroundUnprecedented non-pharmaceutical interventions to control the COVID-19 pandemic also had an effect on other infectious diseases.AimWe aimed to determine their impact on transmission and diagnosis of notifiable diseases other than COVID-19 in Bavaria, Germany, in 2020 and 2021.MethodsWe compared weekly cases of 15 notifiable infectious diseases recorded in Bavaria between 1 January 2016 and 31 December 2021 in time series analyses, median age and time-to-diagnosis using Wilcoxon rank sum test and hospitalisation rates using univariable logistic regression during three time periods: pre-pandemic (weeks 1 2016-9 2020), pandemic years 1 (weeks 10-52 2020) and 2 (2021).ResultsWeekly case numbers decreased in pandemic year 1 for all diseases assessed except influenza, Lyme disease and tick-borne encephalitis; markedly for norovirus gastroenteritis (IRR = 0.15; 95% CI: 0.12-0.20) and pertussis (IRR = 0.22; 95% CI: 0.18-0.26). In pandemic year 2, influenza (IRR = 0.04; 95% CI: 0.02-0.09) and pertussis (IRR = 0.11; 95% CI: 0.09-0.14) decreased markedly, but also chickenpox, dengue fever, Haemophilus influenzae invasive infection, hepatitis C, legionellosis, noro- and rotavirus gastroenteritis and salmonellosis. For enterohaemorrhagic Escherichia coli infections, median age decreased in pandemic years 1 and 2 (4 years, interquartile range (IQR): 1-32 and 3 years, IQR: 1-18 vs 11 years, IQR: 2-42); hospitalisation proportions increased in pandemic year 1 (OR = 1.60; 95% CI: 1.08-2.34).ConclusionReductions for various infectious diseases and changes in case characteristics in 2020 and 2021 indicate reduced transmission of notifiable diseases other than COVID-19 due to interventions and under-detection.
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Affiliation(s)
- Sarah van de Berg
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Bavarian Health and Food Safety Authority, Munich, Germany
| | - Tanja Charles
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
| | - Katharina Katz
- Bavarian Health and Food Safety Authority, Munich, Germany
| | - Stefanie Böhm
- Bavarian Health and Food Safety Authority, Munich, Germany
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Melchner A, van de Berg S, Scuda N, Feuerstein A, Hanczaruk M, Schumacher M, Straubinger RK, Marosevic D, Riehm JM. Antimicrobial Resistance in Isolates from Cattle with Bovine Respiratory Disease in Bavaria, Germany. Antibiotics (Basel) 2021; 10:antibiotics10121538. [PMID: 34943750 PMCID: PMC8698709 DOI: 10.3390/antibiotics10121538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Patterns of antimicrobial resistance (AMR) regarding Pasteurella multocida (n = 345), Mannheimia haemolytica (n = 273), Truperella pyogenes (n = 119), and Bibersteinia trehalosi (n = 17) isolated from calves, cattle and dairy cows with putative bovine respiratory disease syndrome were determined. The aim of this study was to investigate temporal trends in AMR and the influence of epidemiological parameters for the geographic origin in Bavaria, Germany, between July 2015 and June 2020. Spectinomycin was the only antimicrobial agent with a significant decrease regarding not susceptible isolates within the study period (P. multocida 88.89% to 67.82%, M. haemolytica 90.24% to 68.00%). Regarding P. multocida, significant increasing rates of not susceptible isolates were found for the antimicrobials tulathromycin (5.56% to 26.44%) and tetracycline (18.52% to 57.47%). The proportions of multidrug-resistant (MDR) P. multocida isolates (n = 48) increased significantly from 3.70% to 22.90%. The proportions of MDR M. haemolytica and P. multocida isolates (n = 62) were significantly higher in fattening farms (14.92%) compared to dairy farms (3.29%) and also significantly higher on farms with more than 300 animals (19.49%) compared to farms with 100 animals or less (6.92%). The data underline the importance of the epidemiological farm characteristics, here farm type and herd size regarding the investigation of AMR.
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Affiliation(s)
- Alexander Melchner
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (A.M.); (S.v.d.B.); (N.S.); (A.F.); (M.H.); (M.S.); (D.M.)
| | - Sarah van de Berg
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (A.M.); (S.v.d.B.); (N.S.); (A.F.); (M.H.); (M.S.); (D.M.)
| | - Nelly Scuda
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (A.M.); (S.v.d.B.); (N.S.); (A.F.); (M.H.); (M.S.); (D.M.)
| | - Andrea Feuerstein
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (A.M.); (S.v.d.B.); (N.S.); (A.F.); (M.H.); (M.S.); (D.M.)
| | - Matthias Hanczaruk
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (A.M.); (S.v.d.B.); (N.S.); (A.F.); (M.H.); (M.S.); (D.M.)
| | - Magdalena Schumacher
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (A.M.); (S.v.d.B.); (N.S.); (A.F.); (M.H.); (M.S.); (D.M.)
| | - Reinhard K. Straubinger
- Institute of Infectious Diseases and Zoonoses, Department of Veterinary Sciences, Faculty of Veterinary Medicine, Ludwig-Maximilians-University, 80539 Munich, Germany;
| | - Durdica Marosevic
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (A.M.); (S.v.d.B.); (N.S.); (A.F.); (M.H.); (M.S.); (D.M.)
| | - Julia M. Riehm
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (A.M.); (S.v.d.B.); (N.S.); (A.F.); (M.H.); (M.S.); (D.M.)
- Correspondence:
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van de Berg S, Erkens C, Mulder C. Tuberculosis contact investigation following the stone-in-the-pond principle in the Netherlands – Did adjusted guidelines improve efficiency? Euro Surveill 2021; 26. [PMID: 34763753 PMCID: PMC8646980 DOI: 10.2807/1560-7917.es.2021.26.45.2001828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background
In low tuberculosis (TB) incidence countries, contact investigation (CI) requires not missing contacts with TB infection or disease without unnecessarily evaluating non-infected contacts.
Aim
We assessed whether updated guidelines for the stone-in-the-pond principle and their promotion improved CI practices.
Methods
This retrospective study used surveillance data to compare CI outcomes before (2011–2013) and after (2014–2016) the guideline update and promotion. Using negative binomial regression and logistic regression models, we compared the number of contacts invited for CI per index patient, the number of CI scaled-up according to the stone-in-the-pond principle, the TB and latent TB infection (LTBI) testing coverage, and yield.
Results
Pre and post update, 1,703 and 1,489 index patients were reported, 27,187 and 21,056 contacts were eligible for CI, 86% and 89% were tested for TB, and 0.70% and 0.73% were identified with active TB, respectively. Post update, the number of casual contacts invited per index patient decreased statistically significantly (RR = 0.88; 95% CI: 0.79–0.98), TB testing coverage increased (OR = 1.4; 95% CI: 1.2–1.7), and TB yield increased (OR = 2.0; 95% CI: 1.0–3.9). The total LTBI yield increased from 8.8% to 9.8%, with statistically significant increases for casual (OR = 1.2; 95% CI: 1.0–1.5) and community contacts (OR = 2.0; 95% CI: 1.6–3.2). The proportion of CIs appropriately scaled-up to community contacts increased statistically significantly (RR = 1.8; 95% CI: 1.3–2.6).
Conclusion
This study shows that promoting evidence-based CI guidelines strengthen the efficiency of CIs without jeopardising effectiveness. These findings support CI is an effective TB elimination intervention.
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Affiliation(s)
| | - Connie Erkens
- KNCV Tuberculosis Foundation, The Hague, the Netherlands
| | - Christiaan Mulder
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Center, Amsterdam, the Netherlands
- KNCV Tuberculosis Foundation, The Hague, the Netherlands
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de Vries G, van de Berg S, van Dam A, Hasanova S, Pareek M, van der Werf MJ, Podlekareva DN. Collaborative tuberculosis/HIV activities in the European Region. ERJ Open Res 2021; 7:00721-2020. [PMID: 33532469 PMCID: PMC7836583 DOI: 10.1183/23120541.00721-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/23/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION An estimated 12% of tuberculosis (TB) patients are co-infected with HIV in the World Health Organization European Region (the Region). Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with integrated people-centred models of care. METHODS We collected information on the current models of integration of TB and HIV services in the Region via a comprehensive survey among the TB and HIV National Focal Points, and identified challenges and opportunities. RESULTS 47 out of 55 (85%) countries responded. HIV testing in all TB patients and screening for active TB in all people living with HIV (PLHIV) was recommended in 40 (85%) and 34 (72%) countries, respectively. 30 (64%) countries recommended latent TB infection (LTBI) screening in all PLHIV, while 13 (28%) had a selective approach and four (9%) did not recommend LTBI screening. In most countries, testing for HIV and screening for active TB and LTBI was done by the specialist treating the patient, i.e. TB patients were tested for HIV by a TB specialist in 42 (89%) countries and PLHIV were screened for active TB by an HIV specialist in 34 (72%) countries. CONCLUSIONS TB and HIV care are well integrated in policies of especially high TB and high HIV burden countries; however, implementation needs to be improved. Continuous monitoring of TB and HIV services integration enables assessing the quality of TB/HIV care and to identify where further improvements are needed.
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Affiliation(s)
- Gerard de Vries
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | | | - Sayohat Hasanova
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Manish Pareek
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
| | | | - Daria N. Podlekareva
- CHIP, Dept of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- See the Acknowledgements for a list of the Wolfheze Working Group participants
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van de Berg S, Jansen-Aaldring N, de Vries G, van den Hof S. Patient support for tuberculosis patients in low-incidence countries: A systematic review. PLoS One 2018; 13:e0205433. [PMID: 30304052 PMCID: PMC6179254 DOI: 10.1371/journal.pone.0205433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/25/2018] [Indexed: 01/12/2023] Open
Abstract
Background Patient support during tuberculosis treatment is expected to be more often available and more customized in low tuberculosis incidence, high-resource settings than in lower-resource settings. The aim of this systematic review is to provide an overview of tuberculosis patient support interventions implemented in low-incidence countries and an evaluation of their effects on treatment-related outcomes as well as their acceptability by patients and providers. Methods PubMed, Social Science Citation Index and Cumulative Index to Nursing and Allied Health and Literature were searched for the period 01.2006–05.2016 on publications describing tuberculosis patient support interventions in low-incidence countries (<20 patients per 100,000 population). Results Through our search strategy, 1875 unique publications were identified. Forty publications were included: 17 evaluated patient support quantitatively, 9 qualitatively and 14 only described the patient support. Nineteen publications assessed treatment supervision options only, 21 assessed (combinations of) treatment supervision, socio-economic, psycho-emotional, health-educational and other support. Of eight studies quantitatively evaluating the effects of support with a control group, four showed positive effects: two out of three that used combinations of patient support and two out of five that compared treatment supervision options. Heterogeneity of interventions precluded pooling of results. Qualitative and descriptive studies showed that patients appreciated individualized support including treatment supervision, psycho-emotional and socio-economic support; and digital health interventions. Conclusion Our review shows that a variety of patient support interventions is implemented in low-incidence countries. Although only a few interventions were evaluated quantitatively, we identified potential best practices. The scarcity of evidence on effectiveness, however, indicates the need for further research to evaluate potential best practices.
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Affiliation(s)
| | | | - Gerard de Vries
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Susan van den Hof
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
- Dept. of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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van de Berg S, Erkens C, van Rest J, van den Hof S, Kamphorst M, Keizer S, de Vries G. Evaluation of tuberculosis screening of immigrants in the Netherlands. Eur Respir J 2017; 50:50/4/1700977. [DOI: 10.1183/13993003.00977-2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/11/2017] [Indexed: 11/05/2022]
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Peferoen LAN, Breur M, van de Berg S, Peferoen-Baert R, Boddeke EHWGM, van der Valk P, Pryce G, van Noort JM, Baker D, Amor S. Ageing and recurrent episodes of neuroinflammation promote progressive experimental autoimmune encephalomyelitis in Biozzi ABH mice. Immunology 2016; 149:146-56. [PMID: 27388634 DOI: 10.1111/imm.12644] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 01/02/2023] Open
Abstract
Current therapies for multiple sclerosis (MS) reduce the frequency of relapses by modulating adaptive immune responses but fail to limit the irreversible neurodegeneration driving progressive disability. Experimental autoimmune encephalomyelitis (EAE) in Biozzi ABH mice recapitulates clinical features of MS including relapsing-remitting episodes and secondary-progressive disability. To address the contribution of recurrent inflammatory events and ageing as factors that amplify progressive neurological disease, we examined EAE in 8- to 12-week-old and 12-month-old ABH mice. Compared with the relapsing-remitting (RREAE) and secondary progressive (SPEAE) EAE observed in young mice, old mice developed progressive disease from onset (PEAE) associated with pronounced axonal damage and increased numbers of CD3(+) T cells and microglia/macrophages, but not B cells. Whereas the clinical neurological features of PEAE and SPEAE were comparable, the pathology was distinct. SPEAE was associated with significantly reduced perivascular infiltrates and T-cell numbers in the central nervous system (CNS) compared with PEAE and the acute phase of RREAE. In contrast to perivascular infiltrates that declined during progression from RREAE into SPEAE, the numbers of microglia clusters remained constant. Similar to what is observed during MS, the microglia clusters emerging during EAE were associated with axonal damage and oligodendrocytes expressing heat-shock protein B5, but not lymphocytes. Taken together, our data reveal that the course of EAE is dependent on the age of the mice. Younger mice show a relapsing-remitting phase followed by progressive disease, whereas old mice immediately show progression. This indicates that recurrent episodes of inflammation in the CNS, as well as age, contribute to progressive neurological disease.
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Affiliation(s)
- Laura A N Peferoen
- Pathology Department, VU University Medical Centre, Amsterdam, the Netherlands
| | - Marjolein Breur
- Pathology Department, VU University Medical Centre, Amsterdam, the Netherlands
| | - Sarah van de Berg
- Pathology Department, VU University Medical Centre, Amsterdam, the Netherlands
| | | | - Erik H W G M Boddeke
- Department of Neuroscience, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Paul van der Valk
- Pathology Department, VU University Medical Centre, Amsterdam, the Netherlands
| | - Gareth Pryce
- Neuroimmunology Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - David Baker
- Neuroimmunology Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Amor
- Pathology Department, VU University Medical Centre, Amsterdam, the Netherlands.,Neuroimmunology Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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