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Infectious Disease Epidemiology Annual Report - 2016

Executive Summary

This Infectious Disease Epidemiology Annual Report provides a summary of notifications of infectious diseases reported to the Robert Koch Institute in 2016.

With the amendment of the German Prevention and Control of Infectious Diseases Act in May 2016, new reporting obligations were introduced and integrated into existing notification regulations:

New/extended notification requirements for doctors:

  • Suspected disease, disease or death from zoonotic influenza
  • Disease or death from a Clostridium-difficile-infection with severe clinical course

New/extended notification requirements for laboratory:

  • Detection of chikungunya virus, dengue virus, West Nile virus, Zika virus and other arboviruses when acute infection is indicated.
  • Direct detection of Methicillin-resistant Staphylococcus aureus (MRSA) from blood or cerebrospinal fluid.
  • Infection or colonization with Carbapenem-resistant Acinetobacter spp. or Enterobacteriaceae.

Data for invasive MRSA infections, Clostridium difficile infections with severe clinical course, chikungunya virus disease and Zika virus disease are already available for the entire year of 2016 due to previously existing notification requirements and can therefore be published in the current Annual Report. For the Carbapenem-resistant pathogens,
on the other hand, new reporting categories were introduced, so these data can only be published in the next Annual Report. No cases of zoonotic influenza were reported in 2016.

In addition to adapting the Annual Report to current changes in the notification system, we also strive to continually improve the Annual Report. For this reason, we conducted an online survey of the readers of the 2015 Annual Report in order to get a better understanding of the users and their needs. In addition to medical practitioners in hospitals and the private sector, as well as employees of the public health service, the Annual Report is read by interested citizens, students and media representatives. The data from the Annual Report are used for various purposes. These range from the preparation of lectures and scientific publications and the acquisition of knowledge for study or training to their use for press and public relations work. As a suggestion for improvement, the desire for additional interactive formats was expressed.

One change has already been introduced to this Annual Report. In order to provide readers with a quick overview of the chapters, we have added an "At a glance" section at the beginning of each long chapter. In this overview, the most important content from the chapter is summarized.

As in the previous year, the gastrointestinal diseases – norovirus gastroenteritis, Campylobacter enteritis and rotavirus gastroenteritis, as well as the vaccine-preventable diseases – influenza and chickenpox, were among the five most commonly reported notifiable diseases.

Rising case numbers of Campylobacter enteritis, hepatitis E and whooping cough were observed in 2016. For other notifiable diseases, a significant drop in the number of cases was observed over the last few years, not least due to effective infection control measures. The improved implementation of hygiene measures in hospitals likely contributed to the reduction in invasive MRSA infections.

Similarly, the implementation of infection control measures in the area of food production probably influenced the declining trend in salmonellosis cases. The significant reduction in rotavirus gastroenteritis cases, particularly among children under 2 years old, can be presumed to be a consequence of increased uptake of rotavirus vaccination as recommended for infants by the Standing Immunization Commission at the RKI (STIKO) since summer 2013.

For a large number of the vaccine-preventable diseases, e.g. tick-borne encephalitis, hepatitis A, chickenpox, disease mostly occurred in non-vaccinated patients, even though effective vaccination is available. The surveillance of serogroup distribution (e.g. of invasive meningococcal infections), vaccination quotas in the population are necessary for the evaluation of the impact of the recommended vaccinations and for the decision on necessary vaccinations
against additional serogroups and essential booster vaccinations.

Molecular surveillance plays an increasingly important role in the detection of outbreaks. For an outbreak of listeriosis, which was ongoing since 2012 with indistinguishable typing profiles (Pulsed-field gel electrophoresis) and identical sequence type (whole genome sequencing), a meatprocessing plant was identified as possible source in 2016. This said, more pathogen isolates should be sent to the National Reference Centers and Consultant Laboratories for all notifiable pathogens.

Other notable outbreaks were: a legionellosis outbreak in Bremen with a total of 24 cases, including 2 deaths; a botulism outbreak probably associated with the consumption of roach involving 4 cases in Germany and 2 in Spain; and an outbreak of 6 tularemia cases which occurred during grape harvesting and was associated with the consumption of contaminated grape juice.

In February 2016, a patient with Lassa fever who had been infected in Togo, West Africa, was treated and died in Germany. After his death, a Lassa virus infection was confirmed in another person with professional contact with the corpse of the deceased. The patient was treated at an isolation facility and survived the disease. This was the first
documented transmission of Lassa virus in Germany. No further infections occurred in the contact persons of both patients.

Next to disease trends and outbreaks, there are other influences on case numbers which need to be taken into account in the interpretation of the case numbers. With the increase in incoming asylum seekers, as well as partly due to their increased disease screening, diseases that occur more frequently in the countries of origin are also more frequently
recorded in the German notification system, e.g. hepatitis B, HIV, malaria and tuberculosis. A proportion of the increase in the number of cases of these diseases in 2015/16 can be attributed to the migratory movements as compared with previous years. However, the change in the case definitions of certain notifiable diseases in 2015 which was only step-wise implemented at local public health authorities also influences the number of cases e.g. for hepatitis B and hepatitis C.

Date: 12.07.2017