scispace - formally typeset
Search or ask a question
Author

Kristin Tolksdorf

Bio: Kristin Tolksdorf is an academic researcher from Robert Koch Institute. The author has contributed to research in topics: Population & Coronavirus disease 2019 (COVID-19). The author has an hindex of 10, co-authored 18 publications receiving 262 citations.

Papers
More filters
Journal ArticleDOI
TL;DR: In Deutschland, a SARS-CoV-2-Infektion diagnostiziert is reported in this article, in which 175.013 Fallen in gesamten Bundesgebiet an were vermehrt.
Abstract: Am 27.01.2020 wurde in Deutschland der erste Fall mit einer SARS-CoV-2-Infektion diagnostiziert. Fur die Beschreibung des Pandemieverlaufs im Jahr 2020 wurden 4 epidemiologisch verschiedene Phasen betrachtet und Daten aus dem Meldesystem gemas Infektionsschutzgesetz (IfSG) sowie hospitalisierte COVID-19-Falle mit schwerer akuter respiratorischer Infektion aus der Krankenhaus-Surveillance eingeschlossen. Phase 0 umfasst den Zeitraum von Kalenderwoche (KW) 5/2020 bis 9/2020, in dem vor allem sporadische Falle <60 Jahre und regional begrenzte Ausbruche beobachtet wurden. Insgesamt wurden 167 Falle ubermittelt, die vorwiegend mild verliefen. Dem schloss sich in Phase 1 (KW 10/2020 bis 20/2020) die erste COVID-19-Welle mit 175.013 Fallen im gesamten Bundesgebiet an. Hier wurden vermehrt Ausbruche in Krankenhausern, Alten- und Pflegeheimen sowie ein zunehmender Anteil an alteren und schwer erkrankten Personen verzeichnet. In Phase 2, dem „Sommerplateau“ mit eher milden Verlaufen (KW 21/2020 bis 39/2020), wurden viele reiseassoziierte COVID-19-Falle im Alter von 15–59 Jahren und einzelne grosere, uberregionale Ausbruche in Betrieben beobachtet. Unter den 111.790 Fallen wurden schwere Verlaufe seltener beobachtet als in Phase 1. Phase 3 (KW 40/2020 bis 8/2021) war gekennzeichnet durch die zweite COVID-19-Welle in Deutschland, die sich zum Jahresende 2020 auf dem Hohepunkt befand. Mit 2.158.013 ubermittelten COVID-19-Fallen und insgesamt deutlich mehr schweren Fallen in allen Altersgruppen verlief die zweite Welle schwerer als die erste Welle. Unabhangig von den 4 Phasen waren v. a. Altere und auch Manner starker von einem schweren Krankheitsverlauf betroffen.

56 citations

Journal ArticleDOI
TL;DR: Overall, EPTB manifestations, including meningitis, which is often fatal, were underestimated by routine analysis and it is recommended to use all information on disease manifestation generated by surveillance to monitor severe forms and to transfer the gained knowledge to TB case management where awareness of E PTB is most important.
Abstract: Tuberculosis (TB) surveillance commonly focuses on pulmonary (PTB) where the main organ affected is the lung. This might lead to underestimate extrapulmonary TB (EPTB) forms, where in addition to the lung other sites are affected by TB. In Germany, TB notification data provide the main site and the secondary site of disease. To gain an overview of all the different EPTB forms, we analysed German TB notification data between 2002 and 2009 using information on both main and secondary disease site to describe all individual EPTB forms. Further, we assessed factors associated with meningitis using multivariable logistic regression. Solely analysing the main site of disease, lead to one third of EPTB manifestations being overlooked. Case characteristics varied substantially across individual extrapulmonary forms. Of 46,349 TB patients, 422 (0.9%) had meningitis as main or secondary site. Of those, 105 (25%) of the 415 with available information had died. Multivariable analysis showed that meningitis was more likely in children younger than five years and between five and nine years-old (odds ratio (OR): 4.90; 95% confidence interval (CI): 3.40–7.07 and OR: 2.65; 95% CI: 1.40–5.00), in females (OR: 1.42; 95% CI: 1.17–1.73), and in those born in the World Health Organization (WHO) regions of south-east Asia (OR: 2.38; 95% CI: 1.66–3.43) and eastern Mediterranean (OR: 1.51; 95% CI: 1.02–2.23). Overall, EPTB manifestations, including meningitis, which is often fatal, were underestimated by routine analysis. We thus recommend using all information on disease manifestation generated by surveillance to monitor severe forms and to transfer the gained knowledge to TB case management where awareness of EPTB is most important.

56 citations

Journal ArticleDOI
TL;DR: There were more case fatalities among COVID-19 patients without comorbidities than in the reference cohort, and hospitals should prepare for high utilisation of ventilation and intensive care resources.
Abstract: Information on severity of coronavirus disease (COVID-19) (transmissibility, disease seriousness, impact) is crucial for preparation of healthcare sectors. We present a simple approach to assess disease seriousness, creating a reference cohort of pneumonia patients from sentinel hospitals. First comparisons exposed a higher rate of COVID-19 patients requiring ventilation. There were more case fatalities among COVID-19 patients without comorbidities than in the reference cohort. Hospitals should prepare for high utilisation of ventilation and intensive care resources.

54 citations

Journal ArticleDOI
TL;DR: The ICD-10-based approach proved to be useful for fulfilling requirements for SARI surveillance and the implemented reporting system are appropriate to provide timely and reliable information on SARI in inpatients in Germany.
Abstract: Syndromic surveillance of severe acute respiratory infections (SARI) is important to assess seriousness of disease as recommended by WHO for influenza. In 2015 the Robert Koch Institute (RKI) started to collaborate with a private hospital network to develop a SARI surveillance system using case-based data on ICD-10 codes. This first-time description of the system shows its application to the analysis of five influenza seasons. Since week 40/2015, weekly updated anonymized data on discharged patients overall and on patients with respiratory illness including ICD-10 codes of primary and secondary diagnoses are transferred from the network data center to RKI. Retrospective datasets were also provided. Our descriptive analysis is based on data of 47 sentinel hospitals collected between weeks 1/2012 to 20/2016. We applied three different SARI case definitions (CD) based on ICD-10 codes for discharge diagnoses of respiratory tract infections (J09 - J22): basic CD (BCD), using only primary diagnoses; sensitive CD (SCD), using primary and secondary diagnoses; timely CD (TCD), using only primary diagnoses of patients hospitalized up to one week. We compared the CD with regard to severity, age distribution and timeliness and with results from the national primary care sentinel system. The 47 sentinel hospitals covered 3.6% of patients discharged from all German hospitals in 2013. The SCD comprised 2.2 times patients as the BCD, and 3.6 times as many as the TCD. Time course of SARI cases corresponded well to results from primary care surveillance and influenza virus circulation. The patients fulfilling the TCD had been completely reported after 3 weeks, which was fastest among the CD. The proportion of SARI cases among patients was highest in the youngest age group of below 5-year-olds. However, the age group 60 years and above contributed most SARI cases. This was irrespective of the CD used. In general, available data and the implemented reporting system are appropriate to provide timely and reliable information on SARI in inpatients in Germany. Our ICD-10-based approach proved to be useful for fulfilling requirements for SARI surveillance. The exploratory approach gave valuable insights in data structure and emphasized the advantages of different CD.

42 citations


Cited by
More filters
Journal ArticleDOI
09 Sep 2020-BMJ
TL;DR: The 4C Mortality Score outperformed existing scores, showed utility to directly inform clinical decision making, and can be used to stratify patients admitted to hospital with covid-19 into different management groups.
Abstract: OBJECTIVE:To develop and validate a pragmatic risk score to predict mortality in patients admitted to hospital with coronavirus disease 2019 (covid-19). DESIGN:Prospective observational cohort study. SETTING:International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO) Clinical Characterisation Protocol UK (CCP-UK) study (performed by the ISARIC Coronavirus Clinical Characterisation Consortium-ISARIC-4C) in 260 hospitals across England, Scotland, and Wales. Model training was performed on a cohort of patients recruited between 6 February and 20 May 2020, with validation conducted on a second cohort of patients recruited after model development between 21 May and 29 June 2020. PARTICIPANTS: Adults (age ≥18 years) admitted to hospital with covid-19 at least four weeks before final data extraction. MAIN OUTCOME MEASURE:In-hospital mortality. RESULTS:35 463 patients were included in the derivation dataset (mortality rate 32.2%) and 22 361 in the validation dataset (mortality rate 30.1%). The final 4C Mortality Score included eight variables readily available at initial hospital assessment: age, sex, number of comorbidities, respiratory rate, peripheral oxygen saturation, level of consciousness, urea level, and C reactive protein (score range 0-21 points). The 4C Score showed high discrimination for mortality (derivation cohort: area under the receiver operating characteristic curve 0.79, 95% confidence interval 0.78 to 0.79; validation cohort: 0.77, 0.76 to 0.77) with excellent calibration (validation: calibration-in-the-large=0, slope=1.0). Patients with a score of at least 15 (n=4158, 19%) had a 62% mortality (positive predictive value 62%) compared with 1% mortality for those with a score of 3 or less (n=1650, 7%; negative predictive value 99%). Discriminatory performance was higher than 15 pre-existing risk stratification scores (area under the receiver operating characteristic curve range 0.61-0.76), with scores developed in other covid-19 cohorts often performing poorly (range 0.63-0.73). CONCLUSIONS:An easy-to-use risk stratification score has been developed and validated based on commonly available parameters at hospital presentation. The 4C Mortality Score outperformed existing scores, showed utility to directly inform clinical decision making, and can be used to stratify patients admitted to hospital with covid-19 into different management groups. The score should be further validated to determine its applicability in other populations. STUDY REGISTRATION:ISRCTN66726260.

742 citations

Journal ArticleDOI
TL;DR: An action framework for countries with low tuberculosis (TB) incidence sets out priority interventions required for these countries to progress first towards “pre-elimination” and eventually the elimination of TB as a public health problem.
Abstract: This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.

627 citations

Journal ArticleDOI
TL;DR: Evidence that frequent exercise enhances—rather than suppresses—immune competency is provided, and key findings from human vaccination studies which show heightened responses to bacterial and viral antigens following bouts of exercise are highlighted.
Abstract: Epidemiological evidence indicates that regular physical activity and/or frequent structured exercise reduces the incidence of many chronic diseases in older age, including communicable diseases such as viral and bacterial infections, as well as non-communicable diseases such as cancer and chronic inflammatory disorders. Despite the apparent health benefits achieved by leading an active lifestyle, which imply that regular physical activity and frequent exercise enhance immune competency and regulation, the effect of a single bout of exercise on immune function remains a controversial topic. Indeed, to this day, it is perceived by many that vigorous exercise can temporarily suppress immune function. In the first part of this review, we deconstruct the key pillars which lay the foundation to this theory – referred to as the ‘open window’ hypothesis – and highlight that: (i) limited reliable evidence exists to support the claim that vigorous exercise heightens risk of opportunistic infections; (ii) purported changes to mucosal immunity, namely salivary IgA levels, after exercise do not signpost a period of immune suppression; and (iii) the dramatic reductions to lymphocyte numbers and function 1-2 hours after exercise reflects a transient and time-dependent redistribution of immune cells to peripheral tissues, resulting in a heightened state of immune surveillance and immune regulation, as opposed to immune suppression. In the second part of this review, we provide evidence that frequent exercise enhances – rather than suppresses – immune competency, and highlight key findings from human vaccination studies which show heightened responses to bacterial and viral antigens following bouts of exercise. Finally, in the third part of this review, we highlight that regular physical activity and frequent exercise might limit or delay ageing of the immune system, providing further evidence that exercise is beneficial for immunological health. In summary, the over-arching aim of this review is to rebalance opinion over the perceived relationships between exercise and immune function. We emphasise that it is a misconception to label any form of acute exercise as immunosuppressive, and, instead, exercise most likely improves immune competency across the lifespan.

392 citations

Journal ArticleDOI
TL;DR: The virological characteristics of SARS-CoV-2 and clinical course of COVID-19 are described with an emphasis on diagnostic challenges, duration of viral shedding, severity markers and current treatment options.

285 citations