The Robert Koch Institute (RKI): main building in Berlin. more
Germany’s Public Health institute RKI monitors the population’s health and wellbeing. more
The Robert Koch Institute is the German government's central institution for the identification, surveillance and prevention of infectious diseases in the Portfolio of the German Ministry of Health. more
The work of Department 34 includes obtaining comprehensive epidemiological data on HIV/AIDS, sexually transmitted infections (STI), viral hepatitis and Creutzfeldt-Jakob disease, as well as on blood donation, in order to better understand the epidemiology of these infections. This data is used to formulate, adapt and evaluate prevention strategies and to develop recommendations for diagnostics and patient care.
Data on infections with HIV and syphilis as well as infections with gonococci with reduced susceptibility to azithromycin, cefixime and ceftriaxone are reported directly to the RKI in accordance with the Infection Protection Act. Since September 2022, all detections of Neisseria (N.) gonorrhoeae and Lymphogranuloma venereum must be reported. The RKI's electronic reporting and information system (DEMIS) is currently being expanded to include the electronic reporting of these pathogens.
Reports on laboratory evidence and infections with hepatitis B, C and D as well as Mpox and Creutzfeldt-Jakob disease are transmitted to the RKI via health authorities and state health authorities, analyzed and published in accordance with the Infection Protection Act. In addition, Unit 34 is responsible for analyzing and evaluating data on infection markers (HIV, syphilis, hepatitis B and C, hepatitis E and West Nile fever) in blood donors in accordance with the Transfusion Act (TUnit).
In addition to routine surveillance, Unit 34 has set up additional surveillance systems. For over 20 years, longitudinal data on the clinical course and treatment of HIV infection has been collected in two multicenter prospective HIV long-term observation studies. As part of the extended HIV surveillance, blood samples are collected from reporting laboratories together with Unit 18, which are sequenced and genotyped at the RKI and examined for transmitted resistance-associated mutations. Also in cooperation with Unit 18 and a Germany-wide laboratory network, gonococcal isolates are collected, tested for the presence of antimicrobial resistance and sequenced as part of molecular surveillance.
In collaboration with other RKI departments, blood donation samples are also used for supplementary surveillance tests, such as for repeated cross-sectional testing of SARS-CoV-2 antibodies during the coronavirus pandemic or for testing rare or newly emerging pathogens such as West Nile virus or Borna virus.
In addition, secondary data from routine medical care (e.g. data from health insurance companies, pharmacy invoices) is used to regularly determine the number of insured persons tested and diagnosed with hepatitis B and C as well as the number and type of HIV and hepatitis B and C treatments. In addition, the implementation of HIV pre-exposure prophylaxis (PrEP) as a statutory health insurance benefit was scientifically monitored and a national PrEP surveillance system (PrEP-Surv) was set up to continuously record the utilisation of PrEP. An important aspect of PrEP surveillance is the strengthening of digitalisation in the healthcare system through the creation of a medical information object (MIO) for PrEP.
For the annual estimation of the incidence of new HIV infections and the prevalence of persons estimated to be living with HIV in Germany, the HIV notification data are used together with the data from the long-term observational studies on HIV, pharmacy invoices data and death notifications. This analysis is used to create the so-called HIV treatment cascade in order to be able to make a statement about the achievement of the UNAIDS 95-95-95 targets for Germany. In this way, existing gaps in the prevention and testing of HIV, access to antiretroviral therapy after diagnosis and the long-term guarantee of successful therapy can be identified. As part of integrated genomic surveillance at the RKI, systems are currently being created to link sample-based data and epidemiological data even more effectively in order to significantly improve surveillance activities.
Unit 34 investigates outbreaks of sexual or blood-borne infections. Together with Unit 35 and ZBS 1, Unit 34 coordinated the activities relating to the Mpox outbreak in 2022. This included setting up surveillance, communicating with numerous national and international stakeholders, coordinating risk communication and preparing and conducting various studies. During the 2016-18 hepatitis A outbreak among men who have sex with men (MSM) in Berlin, close cooperation was maintained with HIV speciality practices and scene clubs in order to increase vaccination coverage among MSM. In the case of a nosocomial outbreak of hepatitis C in a clinic in Bavaria in 2017/18, the local authorities and the clinic concerned initiated an extensive case search, genotyped the samples at the NRZ HCV and sent them to the RKI for further molecular diagnostics. Due to the high homology of the sequenced samples, a single common source of infection could be assumed. In 2022, Unit 34, together with Unit 35 and in cooperation with clinicians, investigated a possible cluster of cases of severe hepatitis in children of unknown aetiology as part of a European outbreak, and was able to rule out the possibility that Germany was affected by this event through intensified surveillance and case search. In addition, Unit34 was supporting in the COVID-19 response with various responsibilities .
An important focus of Unit 34 is the conduct of epidemiological studies on infections, particularly among populations in vulnerable settings. Fig. 1 provides an overview of the populations that potentially have a higher risk of becoming infected with HIV, hepatitis B and C or STIs, as well as the ongoing or recently completed studies in these populations. Studies on so-called integrated biological and behavioural surveillance combine information on the prevalence of certain infectious diseases in a population with data on behaviour.
Figure 1: Overview of the populations that potentially have a higher risk of becoming infected with HIV, hepatitis B and C or STIs, as well as the ongoing or recently completed studies in these populations (in German). Source: RKI
The studies can provide information on indicators that are required for national and international reporting. These indicators can be used to determine how far Germany has progressed with regard to the elimination of HIV, hepatitis B and C and STIs. Examples of the studies are the DRUCK 2.0 and DRUCK-Surv studies among people who inject drugs. DRUCK-Surv is intended to regularly record the prevalence of hepatitis B, C and HIV as well as associated risk and prevention behaviours among people who inject drugs in sentinel cities in various federal states in order to be able to adjust preventive measures. This data will also be used to determine the HIV and HCV care cascade in people who inject drugs, identify gaps in care and report international indicators. Another important indicator of prevention among this group is the distribution of sterile drug paraphernalia, which is determined recurrently in the saferKONSUM study. The TASG and EMIS 2023 studies, on the other hand, are purely survey studies among trans and non-binary people and MSM. The EMIS 2023 study is already the third Europe-wide study to provide comparable results on the sexual health of MSM.
The HepMig preliminary study on the care of hepatitis B and C in people in Germany who have migrated from selected countries is piloting methods for reaching migrants. Due to their origin from countries with a higher prevalence of hepatitis B and C, they are particularly affected by these infections. Data collection from these groups requires special access routes, which can differ depending on the population. One focus of HepMig is also to record the care of these infections in order to be able to recommend targeted adjustments.
In the area of blood donation, studies have been carried out on the sexual infection risks of blood donors, coupled with the development and evaluation of a standardised national donation questionnaire.
International projects on the monitoring of hepatitis B and C are underway with the European Centre for Disease Prevention and Control (ECDC) (work in the European Hepatitis B & C Monitoring Advisory Group) and with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA): Updating the EMCDDA drug-related infectious diseases protocol to meet the monitoring needs of the sustainable development goals for people who inject drugs in the Member States of the EMCDDA (DRID protocol update).
Unit 34 was appointed WHO Collaborating Centre for viral hepatitis and HIV by the World Health Organization on 3 March 2021.
As a WHO Collaborating Centre, the RKI, together with national and international partners, supports the WHO in the fight against viral hepatitis and the elimination of hepatitis B and C as well as the containment of HIV in the WHO European Region. As the WHO Collaborating Centre for viral hepatitis and HIV, the RKI has the following areas of responsibility:
Date: 31.07.2024
