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Abwassersurveillance zu SARS-CoV-2
No full textIm Vorhaben AMELAG werden SARS-CoV-2, Influenzaviren und respiratorische Synzytialviren (RSV) im Abwasser überwacht. Bundesweit nahmen bis zum Jahreswechsel 2024/2025 168 Kläranlagen teil, im Jahr 2025 ist die Teilnahme von bis zu 70 Standorten geplant. Die dabei erhobenen Daten werden in den kommenden Wochen in diesen Bericht integriert. Für die 18. Kalenderwoche liegen Daten aus 60 Kläranlagen für SARS-CoV-2, aus 65 Kläranlagen für das Influenza A-Virus bzw. Influenza B-Virus, aus 36 Kläranlagen für RSV A bzw. RSV B und aus 27 Kläranlagen für RSV A/B (gemeinsame Messungen von RSV A und B) vor. Daten weiterer Kläranlagen werden nachgeliefert.
Die aggregierte SARS-CoV-2-Viruslast im Abwasser befindet sich auf einem niedrigen Niveau. Die Werte der aggregierten Influenza-Viruslast im Abwasser sind seit mehreren Wochen rückläufig und befinden sich für Influenza A und B mittlerweile wieder auf einem niedrigen Niveau. Die Werte der RSV-Last im Abwasser sind für RSV A und RSV B rückläufig. Die aggregierte Viruslast der gemeinsamen Messungen von RSV A und B ist ebenfalls rückläufig. Die Entwicklung der letzten Wochen kann sich aufgrund von Nachmeldungen jedoch noch verändern
Behandlung und Mortalität von Patienten mit nicht-kleinzelligem Lungenkrebs
No full textDie Behandlung von Patienten mit nicht-kleinzelligem Lungenkrebs (NSCLC) insbesondere in fortgeschrittenen/metastasierten Stadien hat sich in den vergangenen Jahren nachhaltig verändert. Primär dafür verantwortlich ist die Einführung von neuen medikamentösen Behandlungsalternativen, die in der Regel molekulare „Targets“ wie EGFR/ALK/ROS1 oder „Targets“ wie PD-L1 und damit Subpopulationen der obigen Patientengruppe adressieren und zumindest in klinischen Trials mit signifikanten Überlebensvorteilen im Vergleich zu einer Chemotherapie verbunden waren. Auf Basis dieser Entwicklungen, die im Übrigen auch mit deutlichen Arzneimittelkostensteigerungen in der Lungenkrebstherapie einhergehen, sollte eine deutliche Verbesserung des medianen Überlebens in den spezifisch behandelten Kohorten, aber auch (durchschnittlich) in der gesamten NSCLC-Kohorte beobachtbar sein. Unser Institut hat bereits einige Studien in dieser Indikation, vor allem auf der Basis von Krankenkassendaten, durchgeführt. Diese Analysen zeichnen sich allerdings durch einige Limitationen aus. Primär können in Kassendaten klinische Charakteristika der Patienten und der Tumorstatus nur sehr bedingt identifiziert werden.
Eine Studie zur Behandlung und dem Überleben von NSCLC Patienten auf der Basis von deutschlandweiten Krebsregisterdaten ist aus Sicht der Antragsteller von zentraler Bedeutung, da diese Daten die erwähnte Limitation zumindest teilweise nicht aufweisen und somit eine überlegene klinische Beschreibung der Fokuspatienten ermöglichen.
Ziel der Studie ist es, Patientencharakteristika, systemische Behandlungen sowie die Mortalität der NSCLC-Patienten zu analysieren. Grundsätzlich erfolgen die Analysen ab dem Zeitpunkt der Erstdiagnose. Dies schließt eine Analyse der Mortalität, die über Kaplan-Meier-Kurven abgebildet wird, für Patienten in verschiedenen Krankheitsstadien und Behandlungsgruppen mit ein. Eine separate Mortalitätsanalyse beobachtet das Überleben ab dem Zeitpunkt des Behandlungsbeginns.
Die Studienziele im einzelnen sind:
1. Beschreibung Overall Survival (OS) von Patienten mit NSCLC ab Datum der Erstdiagnose (Differenzierung nach Stadium bei Erstdiagnose = IIIb, sowie nach Behandlungsgruppen)
2. Beschreibung OS von Patienten mit NSCLC ab Behandlungsbeginn
3. Beschreibung soziodemographischer und klinischer Charakteristika der betrachteten Patientenpopulation
4. Beschreibung der systemischen Behandlung der betrachteten Patientenpopulatio
The role of the (in)accessibility of social media data for infodemic management: a public health perspective on the situation in the European Union in March 2024
Get PDFPublic health institutions rely on the access to social media data to better understand the dynamics and impact of infodemics – an overabundance of information during a disease outbreak, potentially including mis-and disinformation. The scope of the COVID-19 infodemic has led to growing concern in the public health community. The spread of harmful information or information voids may negatively impact public health. In this context, social media are of particular relevance as an integral part of our society, where much information is consumed. In this perspective paper, we discuss the current state of (in)accessibility of social media data of the main platforms in the European Union. The European Union’s relatively new Digital Services Act introduces the obligation for platforms to provide data access to a wide range of researchers, likely including researchers at public health institutions without formal academic affiliation. We examined eight platforms (Facebook, Instagram, LinkedIn, Pinterest, Snapchat, TikTok, X, YouTube) affected by the new legislation in regard to data accessibility. We found that all platforms apart from TikTok offer data access through the Digital Services Act. Potentially, this presents a fundamentally new situation for research, as before the Digital Services Act, few platforms granted data access or only to very selective groups of researchers. The access regime under the Digital Services Act is, however, still evolving. Specifics such as the application procedure for researcher access are still being worked out and results can be expected in spring 2024. The impact of the Digital Services Act on research will therefore only become fully apparent in the future.Peer Reviewe
The burden and treatment of non-communicable diseases among healthcare workers in sub-Saharan Africa: a multi-country cross-sectional study
Get PDFIntroduction:
Non-communicable diseases (NCDs), the leading cause of death globally, are estimated to overtake communicable diseases in sub-Sahara Africa, where healthcare workers (HCWs) play a crucial role in prevention and treatment, but are in extreme shortage, thereby increasing the burden of NCDs among this specific population. To provide evidence for policy-making, we assessed the NCD burden, associated factors and treatment among HCWs in four sub-Saharan African countries.
Materials and methods:
We conducted a cross-sectional study across four sub-Saharan African countries [Côte d'Ivoire (CIV), Democratic Republic of the Congo (DRC), Madagascar (MDG), and Nigeria (NIG)] between February and December 2022. In a standardized questionnaire, sociodemographic, chronic disease and treatment data were self-reported. We estimated the prevalence of (1) at least one chronic disease, (2) hypertension, and used backward elimination logistic regression model to identify risk factors.
Results:
We recruited a total of 6,848 HCWs. The prevalence of at least one chronic disease ranged between 9.7% in NIG and 20.6% in MDG, the prevalence of hypertension between 5.4% in CIV and 11.3% in MDG. At most, reported treatment rates reached 36.5%. The odds of each of both outcomes increased with age (at least one chronic disease adjusted odds ratio: CIV: 1.04; DRC: 1.09; MDG: 1.06; NIG: 1.10; hypertension: CIV: 1.10; DRC: 1.31; MDG: 1.11; NIG: 1.11) and with BMI (at least one chronic disease: CIV: 1.10; DRC: 1.07; MDG: 1.06; NIG: 1.08; hypertension: CIV: 1.10; DRC: 1.66; MDG: 1.13; NIG: 1.07). Odds of both outcomes were lower among males, except in CIV. In NIG, the odds of both outcomes were higher among medical doctors and odds of hypertension were higher among those working in secondary care. In MDG, working in secondary care increased and working as auxiliary staff decreased the odds of at least one chronic disease.
Conclusion:
The prevalence of self-reported chronic disease varied across the four sub-Saharan countries with potentially very low treatment rates. We identified several individual (age, sex, and BMI) and occupational (profession, level of healthcare) factors that influence the odds of NCDs. These factors should be taken into account when developing interventions addressing the burden and management of NCDs among HCWs.Peer Reviewe
NFDI4Health Workflow and Service for Synthetic Data Generation, Assessment and Risk Management
Get PDFIndividual health data is crucial for scientific advancements, particularly in developing Artificial Intelligence (AI); however, sharing real patient information is often restricted due to privacy concerns. A promising solution to this challenge is synthetic data generation. This technique creates entirely new datasets that mimic the statistical properties of real data, while preserving confidential patient information. In this paper, we present the workflow and different services developed in the context of Germany’s National Data Infrastructure project NFDI4Health. First, two state-of-the-art AI tools (namely, VAMBN and MultiNODEs) for generating synthetic health data are outlined. Further, we introduce SYNDAT (a public web-based tool) which allows users to visualize and assess the quality and risk of synthetic data provided by desired generative models. Additionally, the utility of the proposed methods and the web-based tool is showcased using data from Alzheimer’s Disease Neuroimaging Initiative (ADNI) and the Center for Cancer Registry Data of the Robert Koch Institute (RKI).Peer Reviewe
Late Relapse of Previous Pulmonary Cryptococcosis With Symptoms Resembling Cerebral Infarction: A Case Report
Get PDFCryptococcosis, an infection caused by Cryptococcus neoformans and Cryptococcus gattii, predominantly targets the central nervous system (CNS) in patients with AIDS but is not limited to this group. The disease can also occur in individuals with various immunosuppressive conditions, frequently involving the brain or lungs. Cryptococcal meningitis (CM) is the most common form of fungal meningoencephalitis, leading to intracerebral infections, cerebral infarction, or hydrocephalus. The clinical presentation of CM is nonspecific, and imaging features can vary significantly. This case report presents a patient with cerebral infarction, who was HIV-negative but had been on long-term cortisone therapy. Notably, the patient had a history of pulmonary cryptococcosis 15 years prior to cerebral involvement. When initially at our clinic, histology and culture results from brain biopsies were negative and the earlier pulmonary cryptococcosis history was unknown. Subsequently, cryptococcal antigen was detected in both serum and cerebrospinal fluid (CSF), and C. neoformans was cultivated from CSF. This case highlights the critical importance of maintaining a high index of suspicion for CM, particularly in patients with a history of previous cryptococcal infections, and it also demonstrates the possibility of false-negative brain biopsy results due to secondary vascular events associated with CM.Peer Reviewe
Capacity-building during public health emergencies: perceived usefulness and cost savings of an online training on SARS-CoV-2 real-time polymerase chain reaction (qPCR) diagnostics in low- and middle-income settings during the COVID-19 pandemic
Get PDFIntroduction: Upon the onset of the COVID-19 pandemic, the Public Health Laboratory Support Unit (ZIG4) at the Robert Koch Institute (RKI), the German National Public Health Institute, developed and delivered an online training on SARS-CoV-2 qPCR diagnostics to 17 partner countries in low- and middle-income countries (LMIC). This article analyses the usefulness and cost savings of this training.
Methods: The authors performed a concurrent mixed-methodology study based on key informant interviews, interviewer-administered questionnaires, and document reviews. Economic costs were estimated from the perspective of RKI.
Results: Responding participants indicated that the course provided good and comprehensive information on up-to-date scientific knowledge and laboratory practice in PCR diagnostics. Respondents appreciated how the technical content of the training enhanced their ability to apply diagnostic methods in their daily work. Interviewees highlighted that the fast implementation and the low threshold of attending an online training had allowed them to quickly build skills that were crucial during, and beyond, the COVID-19 crisis. The total estimated cost of the online SARS-CoV-2 qPCR training was 61,644 euros. The total estimated cost of the equivalent face-to-face training was estimated at 267,592 euros. Programme weaknesses identified included the top-down approaches taken, lack of interactive components and opportunities to directly engage with other course participants and with teachers.
Conclusions: An online training was developed and implemented to support RKI partner countries in SARS-CoV-2 qPCR diagnostics during the COVID-19 pandemic, thereby strengthening pandemic response and health system resilience. The training incurred in important cost savings compared to the equivalent face-to-face training. Post-pandemic studies could usefully build on these research findings and explore ways to enhance end user involvement and improve interactive features to build stronger communities of learners and facilitate exchange of information and mutual learning.Peer Reviewe
Existing operational standards for field deployments of rapid response mobile laboratories: a scoping review
Get PDFIntroduction:
Rapid response mobile laboratories (RRML) play an important role in responding to emergencies such as outbreaks and humanitarian crises, working in coordination with national authorities. This scoping review aims to provide evidence to support the development of minimum operational standards for the deployment of RRMLs across the five key workstreams: operational support and logistics, biosafety and biosecurity, laboratory information management system, quality management systems and interoperability and coordination.
Methods:
We searched PubMed, MEDLINE, EMBASE and the grey literature focusing on RRML deployment missions. Study characteristics such as year, country, objectives, methods, and findings were extracted and summarized to identify common themes, gaps, and patterns. The results were presented in a narrative format. We ensured methodological rigor by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines throughout the review process.
Results:
Out of 163 full-text studies assessed for eligibility, 46 met the inclusion criteria and were analyzed. Six studies addressed the five RRML workstreams. Operational support and logistics are most commonly addressed during pre-deployment phases with a focus on personnel, transport and cold chain management. The application of biosafety and biosecurity protocols is most addressed during the mission execution phase, particularly in the use of personal protective equipment and the implementation of decontamination and disinfection procedures. The laboratory information management system procedures most frequently reported include sample identification and result dissemination protocols. The quality management system workstream overlaps significantly with the other four workstreams, with a strong emphasis on internal and external quality assurance measures. Coordination and interoperability aspects involve maintaining multiple collaborations, ranging from coordinating with local authorities to establishing international partnerships. Common field challenges included interrupted data transfer in areas characterized by poor connectivity and difficulties caused by extreme weather conditions.
Discussion:
This review highlights RRML deployment procedures and addresses some critical challenges concerning their deployment. It suggests the provision of a pre-deployment logistics checklist, the use of a pre-determined standardized dataset for inputs to reduce data entry errors and the application of standardized internal and external quality assurance measures.Peer Reviewe
Web-based telemedicine approach for treatment of post-COVID-19 in Thuringia (WATCH)
Get PDFObjective:
After infection with SARS-CoV-2, a substantial proportion of patients develop long-lasting sequelae. These sequelae include fatigue (potentially as severe as that seen in ME/CFS cases), cognitive dysfunction, and psychiatric symptoms. Because the pathophysiology of these sequelae remains unclear, existing therapeutic concepts address the symptoms through pacing strategies, cognitive training, and psychological therapy.
Methods:
Here, we present a protocol for a digital multimodal structured intervention addressing common symptoms through three intervention modules: BRAIN, BODY, and SOUL. This intervention includes an assessment conducted via a mobile “post-COVID-19 bus” near the patient's home, as well as the use of wearable devices and mobile applications to support pacing strategies and collection of data, including ecological momentary assessment.
Results:
We will focus on physical component subscore of the SF36 as Quality of Life parameter as the primary outcome parameter for WATCH to take into account the holistic approach that is necessary for care of post-COVID patients
Conclusion:
In the current project, we present a protocol for a holistic and multimodal structured therapeutic concept which is easily accessible, and scalable for post-COVID patients.Peer Reviewe
Measles vaccination – An underestimated prevention measure: Analyzing a fatal case in Hildesheim, Germany
Get PDFMeasles and rubella are targeted for elimination in the WHO region Europe. To reach the elimination goal, vaccination coverage of 95% must be achieved and sustained, the genotype information has to be provided for 80% of all outbreaks and transmission chains of a certain variant must not be detected for >12 months. The latter information is collected at Germany’s National Reference Center Measles, Mumps, Rubella (NRC MMR).
We describe here an outbreak of measles occurring in Hildesheim. The outbreak comprised 43 cases and lasted 14 weeks. Surprisingly, a high number of vaccination failures was observed since 11 cases had received two doses of the MMR vaccine and 4 additional cases were vaccinated once.
A 33-year-old woman passed away during the outbreak. She was the mother of 5 children between 4 and 16 years of age. Two schoolchildren contracted measles and passed it on to the rest of the family. Due to delivery bottlenecks, the vaccination of the mother was delayed. She developed measles-like symptoms 3 days after vaccination and was found dead on the morning of day 8 after vaccination. A post-mortem examination was done to identify the cause of death. Moreover, molecular characterization of the virus was performed to analyze whether she was infected by the wildtype virus circulating at that time in Hildesheim or whether the vaccine may have been a concomitant and aggravating feature of her death.
The result showed that the samples taken from her at the time of death and during necropsy contained the wildtype measles virus variant corresponding to MVs/Gir Somnath.IND/42.16 (WHO Seq-ID D8–4683) that fueled the Hildesheim outbreak and circulated in Germany from March 2018 to March 2020. The vaccine virus was not detected. Moreover, two aspects uncovered by the post-mortem examination were remarkable; the woman died from giant cell pneumonia, which is a complication seen in immune-suppressed individuals and she was actively using cannabis. THC is known to influence the immune system, but literature reports describing the effects are limited.Peer Reviewe