Showing papers by "Ole Wichmann published in 2019"

Epidemiology of Tick-Borne Encephalitis (TBE) in Germany, 2001⁻2018.

Abstract: We reviewed tick-borne encephalitis (TBE) surveillance and epidemiology in Germany, as these underlie public health recommendations, foremost vaccination. We performed descriptive analyses of notification data (2001–2018, n = 6063) according to region, demographics and clinical manifestations and calculated incidence trends using negative binomial regression. Risk areas were defined based on incidence in administrative districts. Most cases (89%) occurred in the federal states of Baden-Wurttemberg and Bavaria, where annual TBE incidence fluctuated markedly between 0.7–2.0 cases/100,000 inhabitants. A slight but significantly increasing temporal trend was observed from 2001–2018 (age-adjusted incidence rate ratio (IRR) 1.02 (95% confidence interval (CI): 1.01–1.04)), primarily driven by high case numbers in 2017–2018. Mean incidence was highest in 40–69-year-olds and in males. More males (23.7%) than females (18.0%, p = 0.02) had severe disease (encephalitis or myelitis), which increased with age, as did case-fatality (0.4% overall; 2.1% among ≥70-year-olds). Risk areas increased from 129 districts in 2007 to 161 in 2019. Expansion occurred mainly within existent southern endemic areas, with slower contiguous north-eastern and patchy north-western spread. Median vaccination coverage at school entry in risk areas in 2016–2017 ranged from 20%–41% in 4 states. Increasing TBE vaccine uptake is an urgent priority, particularly in high-incidence risk areas.

A probable case of tick-borne encephalitis (TBE) acquired in England, July 2019.

Abstract: The United Kingdom (UK) has thus far been considered to be free from tick-borne encephalitis (TBE), yet in July 2019, a German infant developed serologically diagnosed TBE following a tick bite in southern England. This first report of a probable human case together with recent findings of TBE virus in ticks in foci in England suggest that TBE may be acquired in parts of England and should be considered in patients with aetiologically-unexplained neurological manifestations.

Influenza and pertussis vaccination during pregnancy – attitudes, practices and barriers in gynaecological practices in Germany

Abstract: In Germany, antenatal influenza vaccination is recommended since 2010, but uptake remains low. Several countries recently introduced antenatal pertussis vaccination, which is currently under consideration in Germany. We conducted a survey among gynaecologists on attitudes, practices and barriers regarding influenza and pertussis vaccination during pregnancy. Gynaecologists were invited to complete a pre-tested, 24-item questionnaire published in the German Professional Association of Gynaecologists’ journal in September 2017 within 2 months. Associations between variables were examined using Chi-Squared, Fischer’s Exact or t-tests. Variables associated with gynaecologists’ self-reported implementation of vaccination in pregnant women were identified using univariate and multivariate logistic regression analyses. Of 867 participants (response 11%), 91.4 and 59.4% reported currently vaccinating pregnant women against influenza and pertussis, respectively. Gynaecologists who reported obtaining annual influenza vaccination and actively informing their patients about these vaccinations were significantly more likely to vaccinate pregnant women against influenza (96.5% vs. 65.7 and 95.1% vs. 62.2%) and pertussis (63.1% vs. 44.3 and 82.4% vs. 12.9%). Performing influenza vaccination was least likely among gynaecologists who perceived logistical difficulties as a vaccination barrier (35.9%), while pertussis vaccination was least likely if the lacking official recommendation (32.0%), logistical difficulties (27.1%), safety concerns (17.5%) and limited vaccine effectiveness (11.1%) were perceived as barriers. Of participants not yet vaccinating pregnant women against pertussis, 86.5% reported they would follow an official recommendation. Including vaccination recommendations in the maternity record (95.2%) and informing the public (88.7%) and health care professionals (86.6%) were considered the most suitable measures to achieve high pertussis vaccination coverage. The large proportion reporting performance of influenza vaccination during pregnancy and high acceptance of a potential recommendation for pertussis vaccination reflected positive attitudes towards vaccination among participants. However, factors associated with failure to vaccinate may be more prevalent among non-participants. Results suggest that gynaecologists’ confidence in vaccination is crucial for implementing vaccination in pregnancy. Thus, doubts on vaccine effectiveness and safety should be allayed among gynaecologists and pregnant women via various communication channels, and solutions for logistical barriers sought. Including antenatal vaccination recommendations in the maternity record would serve as an important reminder for both groups.

Epidemiology and cost of seasonal influenza in Germany - a claims data analysis.

Abstract: Seasonal influenza contributes substantially to the burden of communicable diseases in Europe, especially among paediatric populations and the elderly. The aim of the present study was to estimate the incidence of seasonal influenza in Germany, the probabilities of related complications and the economic burden of influenza per case and on a population level for different age groups. Claims data from 2012 to 2014 from > 8 million insured of a large German sick-ness fund were analysed. A matched case control study was used on a sub-sample of 100,000 influenza cases to calculate complication rates for ear infections/acute otitis media (AOM) and community-acquired pneumonia (CAP) as well as resource use and costs for seven age groups. Incidence of seasonal influenza varies between the years and is highest among infants and children 2 to 5 years of age. AOM is more likely in the younger age groups with up to 14% more patients in the influenza group than in the control group. CAP is more frequently observed in the younger age groups and in influenza patients 60 years and older. The manifestation of one influenza complication (AOM or CAP) significantly in-creases the occurrence of a second complication (AOM or CAP). The economic burden per case is highest in infants (€251.91) and persons over 60 years of age (€131.59). The burden of influenza is highest among infants and young children, which is also reflected in the economic burden. Influenza related costs per case are nearly double for infants compared to persons over 60 years of age.

Umsetzung der Masern- und Pertussisimpfempfehlungen für Erwachsene

Abstract: Die Standige Impfkommission empfiehlt Erwachsenen Masern- und Pertussisimpfungen. Eine Masernimpfung sollen seit 2010 alle nach 1970 Geborenen mit weniger als zwei Impfungen in der Kindheit erhalten, einen azellularen Pertussisimpfstoff (ap) seit 2009 alle Erwachsenen mit der nachsten, alle 10 Jahre empfohlenen Tetanus(T)-Diphtherie(d)-Impfung als Tdap-Kombinationsimpfung. Ein Ziel der Arbeit ist die Bestimmung der jahrlichen Inanspruchnahme der Masernimpfung (Impfinzidenz) und ihres Anteils in padiatrischen und gynakologischen Praxen als fachgebietsfremde Leistungen (2009–2016). Zudem sollen die 10-Jahres-ap-Impfquote sowie verpasste Impfchancen als der Anteil ausschlieslich Td- an allen Td- und Tdap-Geimpften (2007–2016) berechnet werden. In der KV-Impfsurveillance des Robert Koch-Instituts und der Kassenarztlichen Vereinigungen (KVen) wurden in bundesweiten vertragsarztlichen Abrechnungsdaten Personen mit den relevanten Impfungen erfasst und auf die Versichertenzahlen bezogen. Die Masernimpfinzidenz lag 2009 bei 0,4 % und stieg mit 2013 auf jahrlich ≥1,0 %. Sie war in den westlichen Bundeslandern hoher als in den ostlichen und bei Frauen hoher als bei Mannern. 6,8 % aller Impfungen wurden in padiatrischen Praxen gegeben. Manner erhielten 2,6 % ihrer Impfungen in gynakologischen Praxen. Die ap-Impfquote betrug 32,4 %. Der Anteil ausschlieslich Td-Geimpfter sank von 84 % (2007) auf 24 % (ab 2013). Die KV-Impfsurveillance zeigt eine seit den Impfempfehlungen gestiegene Inanspruchnahme von Masern- und Pertussisimpfungen mit regionalen und geschlechtsspezifischen Unterschieden und liefert damit wichtige Daten zur Evaluation. Analysen zum fachgebietsubergreifenden Impfen und zu verpassten Impfchancen bieten einen Einblick in das Steigerungspotenzial von Impfquoten.

Die neue Standardvorgehensweise der Ständigen Impfkommission (STIKO): Entstehung, Struktur und Umsetzung

Abstract: In Deutschland gibt die Standige Impfkommission (STIKO) Empfehlungen zur Durchfuhrung von Schutzimpfungen und zur Durchfuhrung anderer Masnahmen der spezifischen Prophylaxe ubertragbarer Krankheiten. Die Umsetzung dieser Empfehlungen wird durch Mythen und Mutmasungen bis hin zu Verschworungstheorien in der offentlichen Diskussion zu Impfungen gefahrdet. Evidenz und Transparenz der Empfehlungen konnen die Diskussion versachlichen. Im November 2011 wurde eine neue STIKO-Standardvorgehensweise (Standard Operating Procedure [SOP]) fur die Entwicklung evidenzbasierter Impfempfehlungen verabschiedet. Anhand der Vorgaben der SOP werden seit 2011 nicht nur neue Impfempfehlungen erarbeitet, sondern auch bereits bestehende Empfehlungen aktualisiert bzw. erweitert. Der Artikel gibt einen Uberblick uber die Methodik der SOP, beschreibt bisherige Erfahrungen in ihrer Anwendung und gibt einen Ausblick auf kunftige Herausforderungen.