Campylobacteriosis outbreaks in the state of Hesse, Germany, 2005-2011: raw milk yet again
ABSTRACT Background: Campylobacter is the most frequently reported cause of acute infectious diarrhea in Germany. Campylobacter outbreaks are rare events. However, their investigation provides useful information on risks of infection and unused prevention potentials.Methods: We analyzed the Hessian database for notifiable diseases for cases of campylobacteriosis reported from 2005 through 2011. For campylobacter outbreaks including five or more cases we prospectively obtained additional information from local public health authorities.Results: From 2005 through 2011, 29,473 cases of campylobacteriosis were reported in Hesse, Germany (approx. 6 million inhabitants), yielding an annual incidence ranging from 53.4 to 81.4 cases per 100,000 inhabitants. Only 236 cases were part of 16 outbreaks with five or more cases. Among these, six outbreaks occurred among groups traveling outside Germany, four were associated with the consumption of raw milk. For eight outbreaks consumption of poultry was considered a probable or - based on the frequent consumption of poultry during group travel - possible vehicle of infection. Two of the raw-milk associated outbreaks were reported among two groups who visited the same farm within 18 days. Five of 14 members of several families and 77 of 117 students fell sick. The local public health authority was only informed when both groups had visited the farm.Conclusion: The reported outbreaks can be attributed to known risk factors for campylobacteriosis - consumption of raw milk and poultry and international travel. This underlines that prevention possibilities are insufficiently used. These include avoiding the consumption of unpasteurized milk and milk products, the hygienically correct handling of raw poultry and timely identification and notification of outbreaks to public health authorities.
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ABSTRACT: Mandatory notifications of laboratory diagnosed cases of acute gastroenteritis are essential for public health surveillance of food-borne diseases; however, reported cases represent a subset of infection in the community. We aimed to determine the magnitude and distribution of self-reported, acute gastrointestinal illness in Hesse, Germany, and to describe factors associated with seeking medical care. We conducted a retrospective, cross-sectional telephone survey in 4 551 randomly selected households from September 2004 to August 2006. We used a standardised questionnaire to collect data on the interview partner and all children ≤ 15 years living in the household. The case definition was 3 or more loose stools or any vomiting in 24 h, during the 4 weeks preceding the interview, but excluding those with non-infectious causes. Frequency data were weighted to the Hessian population. Among the contacted households, 81% participated. 137 of the 2 100 children ≤ 15 years met the case definition, yielding an adjusted annual incidence rate of 0.86 (95% CI 0.72-1.03) episodes per person-year. 167 of the 4 551 study participants ≥ 16 years met the case definition, yielding an adjusted annual incidence rate of 0.46 (95% CI 0.37-0.51) episodes per person-year. This extrapolates to 807 000 (95% CI 672 000-962 000) cases of acute gastroenteritis in Hesse each year for children ≤ 15 years of age and 2 225 000 (95% CI 1 880 000-2 625 000) cases in individuals ≥ 16 years. On multivariate analysis, among individuals aged ≤ 15 years with an acute gastroenteritis, factors associated with seeking medical care included age, vomiting ≥ 3 times in 24 h, fever, and duration of illness. Among cases ≥ 16 years, duration of illness was associated with seeking medical care. Of those seeking medical care, 15% provided a stool sample. Acute gastrointestinal illness appears to pose a significant burden in the Hessian population. Cases of acute gastrointestinal illness ascertained through laboratory-based public health surveillance likely differ systematically from unreported cases. Further research into the pathogen-specific burden is needed to better target intervention strategies.Das Gesundheitswesen 02/2011; 73(2):78-84. DOI:10.1055/s-0030-1270492 · 0.62 Impact Factor
Das Gesundheitswesen 12/2004; 66(12):779-782. DOI:10.1055/s-2004-813822 · 0.62 Impact Factor
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ABSTRACT: In Germany, surveillance for infectious disease outbreaks is integrated into an electronic surveillance system. For 2007, the national surveillance database contains case-based information on 201,224 norovirus cases, three-quarters of which are linked to outbreaks. We evaluated the data quality of the national database in reflecting nosocomial norovirus outbreak (NNO) data available in 19 Hessian local public health authorities (LPHAs) and the influence of differences between LPHA's follow-up procedures for laboratory notifications of Norovirus positive stool samples on outbreak underascertainment. Data on NNO beginning in 2007 and notified to the 19 LPHAs were extracted from the national database, investigated regarding internal validity and compared to data collected from LPHAs for a study on NNO control. LPHAs were questioned whether they routinely contacted all persons for whom a laboratory diagnosis of norovirus infection was notified. The number of outbreaks per 1,000 hospital beds and the number of cases within NNOs for acute care and rehabilitation hospitals were compared between counties with and without complete follow-up. The national database contained information on 155 NNOs, including 3,115 cases. Cases were missed in the national database in 58 (37%) of the outbreaks. Information on hospitalisation was incorrect for an estimated 47% of NNO cases. Information on county of infection was incorrect for 24% (199/820) of cases being forwarded between LPHAs for data entry. Reported NNO incidence and number of NNO cases in acute care hospitals was higher in counties with complete follow-up (incidence-rate ratio (IRR) 2.7, 95% CI 1.4-5.7, p-value 0.002 and IRR 2.1, 95% CI 1.9-2.4, p-value 0.001, respectively). Many NNOs are not notified by hospitals and differences in LPHA procedures have an impact on the number of outbreaks captured in the surveillance system. Forwarding of case-by-case data on Norovirus outbreak cases from the local to the state and national level should not be required.PLoS ONE 03/2011; 6(3):e17341. DOI:10.1371/journal.pone.0017341 · 3.53 Impact Factor