Andrea Ammon

Publications of Andrea Ammon

• SurvNet electronic surveillance system for infectious disease outbreaks, Germany.

  Authors: Gérard Krause, Doris Altmann, Daniel Faensen, Klaudia Porten, Justus Benzler, Thomas Pfoch, Andrea Ammon, Michael H Kramer, Hermann Claus

  Emerging infectious diseases. 11/2007; 13(10):1548-55.

  In 2001, the Robert Koch Institute (RKI) implemented a new electronic surveillance system (SurvNet) for infectious disease outbreaks in Germany. SurvNet has captured 30,578 outbreak reports inIn 2001, the Robert Koch Institute (RKI) implemented a new electronic surveillance system (SurvNet) for infectious disease outbreaks in Germany. SurvNet has captured 30,578 outbreak reports in 2001-2005. The size of the outbreaks ranged from 2 to 527 cases. For outbreaks reported in 2002-2005, the median duration from notification of the first case to the local health department until receipt of the outbreak report at RKI was 7 days. Median outbreak duration ranged from 1 day (caused by Campylobacter) up to 73 days (caused by Mycobacterium tuberculosis). The most common settings among the 10,008 entries for 9,946 outbreaks in 2004 and 2005 were households (5,262; 53%), nursing homes (1,218; 12%), and hospitals (1,248; 12%). SurvNet may be a useful tool for other outbreak surveillance systems because it minimizes the workload of local health departments and captures outbreaks even when causative pathogens have not yet been identified.

• Successful termination of a furunculosis outbreak due to lukS-lukF-positive, methicillin-susceptible Staphylococcus aureus in a German village by stringent decolonization, 2002-2005.

  Authors: Miriam Wiese-Posselt, Dagmar Heuck, Andreas Draeger, Martin Mielke, Wolfgang Witte, Andrea Ammon, Osamah Hamouda

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 07/2007; 44(11):e88-95.

  BACKGROUND: Skin infections due to Staphylococcus aureus have recently become a public concern, mainly because of emerging resistance against widely used antibiotics and specific virulenceBACKGROUND: Skin infections due to Staphylococcus aureus have recently become a public concern, mainly because of emerging resistance against widely used antibiotics and specific virulence determinants. Strains harboring the lukS-lukF gene (which codes for Panton-Valentine leukocidin) are frequently associated with severe furunculosis. Generally applicable strategies for the control of community outbreaks of furunculosis have not been defined. METHODS: We report the investigation and successful termination of an outbreak of furunculosis due to lukS-lukF-positive S. aureus in a German village (n=144). Nasal swab specimens were obtained from village residents. A retrospective cohort study was conducted. Nasally colonized persons, persons who had current furuncles or who had experienced relapsing furuncles since 2002, and their family members underwent stringent decolonization measures using mupirocin nasal ointment and disinfecting wash solution. Multiple nasal swab specimens were obtained to monitor the long-term outcome of decolonization measures. RESULTS: From January 1998 through December 2004, 42 cases and 59 relapses of furunculosis were identified by active case finding. Of 140 participants tested, 51 (36%) were found to be nasally colonized with S. aureus. In 9 participants, the strain was positive for lukS-lukF. No methicillin resistance was detected. Risk of furunculosis was associated with contact with case patients (relative risk, 6.8; 95% confidence interval, 3.2-14.3) and nasal colonization with a lukS-lukF-positive strain of S. aureus (relative risk, 3.6; 95% confidence interval, 2.3-5.9). Passive surveillance implemented in January 2005 did not detect any case of lukS-lukF-positive, S. aureus-associated furuncles in this village. CONCLUSION: This report describes a successful strategy for terminating the transmission of epidemic strains of S. aureus among a nonhospitalized population.

• Shiga toxin-producing Escherichia coli infection in Germany: different risk factors for different age groups.

  Authors: Dirk Werber, Susanne C Behnke, Angelika Fruth, Roswitha Merle, Susanne Menzler, Sabine Glaser, Lothar Kreienbrock, Rita Prager, Helmut Tschäpe, Peter Roggentin, Jochen Bockemühl, Andrea Ammon

  American journal of epidemiology. 02/2007; 165(4):425-34.

  The authors conducted a matched case-control study in Germany to identify risk factors for sporadic illness associated with Shiga toxin-producing Escherichia coli (STEC) infection, regardless ofThe authors conducted a matched case-control study in Germany to identify risk factors for sporadic illness associated with Shiga toxin-producing Escherichia coli (STEC) infection, regardless of serogroup. From April 2001 through March 2003, cases were prospectively enrolled through a laboratory-based sentinel surveillance system located in 14 of the 16 German federal states. One control was identified per case, matched by age and region. Conditional logistic regression was used in the analysis, which was conducted separately for three age groups (<3 years, 3-9 years, and > or =10 years). The median age of the 202 enrolled cases was 2.5 years (range, 3 months-89 years). Hemolytic uremic syndrome developed in five patients. Non-O157 strains accounted for 85% of the isolated STEC. In children under 3 years of age, having touched a ruminant had the highest odds of disease, and raw milk was the only food identified as a risk factor. In contrast, in persons aged 10 years or older, only food items (i.e., lamb meat, raw spreadable sausages) were significantly associated with illness. In this study, risk factors were age-specific. Direct transmission through food played a lesser role in children under 3 years of age, the population at greatest risk of both acquiring STEC infection and developing hemolytic uremic syndrome.

• Influenza vaccination coverage in adults belonging to defined target groups, Germany, 2003/2004.

  Authors: Miriam Wiese-Posselt, Katrin Leitmeyer, Osamah Hamouda, Nikolaus Bocter, Iris Zöllner, Walter Haas, Andrea Ammon

  Vaccine. 04/2006; 24(14):2560-6.

  In 2003, a nationwide cross-sectional study was conducted to assess the current influenza vaccination coverage of the adult population of Germany, especially in persons belonging to defined targetIn 2003, a nationwide cross-sectional study was conducted to assess the current influenza vaccination coverage of the adult population of Germany, especially in persons belonging to defined target groups. Of 666 surveyed persons, 190 (adjusted 24%) had received influenza vaccination and 419 participants belonged to at least one target group. Of those, 28% (95% confidence interval (CI) 22-35%) in former West Germany and 45% (95% CI 38-52%) in former East Germany had received influenza vaccination. The offer for vaccination by a physician was associated with a high likelihood for vaccination (odds ratio (OR) 19.0; 95% CI 8.9-40.6). Another important factor influencing vaccination uptake was having received influenza vaccination in prior seasons (OR 7.1; 95% CI 3.8-13.2). Vaccination coverage in the adult population of Germany remains unsatisfactory. Physicians have an important role and should be targeted for campaigns to offer the vaccination more frequently in particular to persons belonging to target groups.

• Salmonella agona outbreak from contaminated aniseed, Germany.

  Authors: Judith Koch, Annette Schrauder, Katharina Alpers, Dirk Werber, Christina Frank, Rita Prager, Wolfgang Rabsch, Susanne Broll, Fabian Feil, Peter Roggentin, Jochen Bockemühl, Helmut Tschäpe, Andrea Ammon, Klaus Stark

  Emerging infectious diseases. 08/2005; 11(7):1124-7.

  A nationwide outbreak of Salmonella Agona caused by aniseed-containing herbal tea occurred from October 2002 through July 2003 among infants in Germany. Consumers should adhere strictly to brewingA nationwide outbreak of Salmonella Agona caused by aniseed-containing herbal tea occurred from October 2002 through July 2003 among infants in Germany. Consumers should adhere strictly to brewing instructions, although in exceptional cases this precaution may not be protective, particularly when preparing tea for vulnerable age groups.

• International outbreak of Salmonella Oranienburg due to German chocolate.

  Authors: Dirk Werber, Johannes Dreesman, Fabian Feil, Ulrich van Treeck, Gerhard Fell, Steen Ethelberg, Anja M Hauri, Peter Roggentin, Rita Prager, Ian S T Fisher, Susanne C Behnke, Edda Bartelt, Ekkehard Weise, Andrea Ellis, Anja Siitonen, Yvonne Andersson, Helmut Tschäpe, Michael H Kramer, Andrea Ammon

  BMC infectious diseases. 03/2005; 5(1):7.

  BACKGROUND: This report describes a large international chocolate-associated Salmonella outbreak originating from Germany. METHODS: We conducted epidemiologic investigations including a case-controlBACKGROUND: This report describes a large international chocolate-associated Salmonella outbreak originating from Germany. METHODS: We conducted epidemiologic investigations including a case-control study, and food safety investigations. Salmonella (S.) Oranienburg isolates were subtyped by the use of pulsed-field gel electrophoresis (PFGE). RESULTS: From 1 October 2001 through 24 March 2002, an estimated excess of 439 S. Oranienburg notifications was registered in Germany. Simultaneously, an increase in S. Oranienburg infections was noted in other European countries in the Enter-net surveillance network. In a multistate matched case-control study in Germany, daily consumption of chocolate (matched odds ratio [MOR]: 4.8; 95% confidence interval [CI]: 1.3-26.5), having shopped at a large chain of discount grocery stores (MOR: 4.2; CI: 1.2-23.0), and consumption of chocolate purchased there (MOR: 5.0; CI: 1.1-47.0) were associated with illness. Subsequently, two brands from the same company, one exclusively produced for that chain, tested positive for S. Oranienburg. In two other European countries and in Canada chocolate from company A was ascertained that also contained S. Oranienburg. Isolates from humans and from chocolates had indistinguishable PFGE profiles. No source or point of contamination was identified. Epidemiological identification of chocolate as a vehicle of infections required two months, and was facilitated by proxy measures. CONCLUSIONS: Despite the use of improved production technologies, the chocolate industry continues to carry a small risk of manufacturing Salmonella-containing products. Particularly in diffuse outbreak-settings, clear associations with surrogates of exposure should suffice to trigger public health action. Networks such as Enter-net have become invaluable for facilitating rapid and appropriate management of international outbreaks.

• Cases of rabies in Germany following organ transplantation.

  Authors: Wiebke Hellenbrand, Christiane Meyer, Gernot Rasch, Ines Steffens, Andrea Ammon

  Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 02/2005; 10(2):E050224.6.

• A nationwide outbreak of Salmonella Bovismorbificans PT24, Germany, December 2004-March 2005.

  Authors: Andreas Gilsdorf, Andreas Jansen, Katharina Alpers, Helga Dieckmann, Ulrich van Treeck, Anja M Hauri, Gerhard Fell, Martina Littmann, Peter Rautenberg, Rita Prager, Wolfgang Rabsch, Peter Roggentin, Andreas Schroeter, Angelika Miko, Edda Bartelt, Juliane Braunig, Andrea Ammon

  Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 02/2005; 10(3):E050324.1.

• Risk factors for alveolar echinococcosis in humans.

  Authors: Petra Kern, Andrea Ammon, Martina Kron, Gabriele Sinn, Silvia Sander, Lyle R Petersen, Wilhelm Gaus, Peter Kern

  Emerging infectious diseases. 01/2005; 10(12):2088-93.

  We conducted a case-control study to investigate risk factors for acquiring autochthonous alveolar echinococcosis in Germany. Forty cases and 120 controls matched by age and residence wereWe conducted a case-control study to investigate risk factors for acquiring autochthonous alveolar echinococcosis in Germany. Forty cases and 120 controls matched by age and residence were interviewed. Patients were more likely than controls to have owned dogs that killed game (odds ratio [OR] = 18.0), lived in a farmhouse (OR = 6.4), owned dogs that roamed outdoors unattended (OR = 6.1), collected wood (OR = 4.7), been farmers (OR = 4.7), chewed grass (OR = 4.4), lived in a dwelling close to fields (OR = 3.0), gone into forests for vocational reasons (OR = 2.8), grown leaf or root vegetables (OR = 2.5), owned cats that roamed outdoors unattended (OR = 2.3), and eaten unwashed strawberries (OR = 2.2). Sixty-five percent of cases were attributable to farming. Measures that prevent accidental swallowing of possibly contaminated material during farming or adequate deworming of pet animals might reduce the risk for alveolar echinococcosis.

• Sequence-based typing of flaB is a more stable screening tool than typing of flaA for monitoring of Campylobacter populations.

  Authors: Alexander Mellmann, Jan Mosters, Edda Bartelt, Peter Roggentin, Andrea Ammon, Alexander W Friedrich, Helge Karch, Dag Harmsen

  Journal of clinical microbiology. 11/2004; 42(10):4840-2.

  Different typing schemes for Campylobacter spp. were evaluated with 70 outbreak and sporadic isolates. The discriminatory indexes were 0.944 (by pulsed-field gel electrophoresis), 0.920 (byDifferent typing schemes for Campylobacter spp. were evaluated with 70 outbreak and sporadic isolates. The discriminatory indexes were 0.944 (by pulsed-field gel electrophoresis), 0.920 (by genotyping of the flagellin A gene), 0.902 (by genotyping of flaB), and 0.886 (by multilocus sequence typing). Cross-classification gave 94.77 or 95.82% (PFGE-flaA or PFGE-flaB) concordance. flaA was overdiscriminatory in three cases, most probably due to intragenomic recombination.

• SARS transmission and commercial aircraft.

  Authors: J Gabrielle Breugelmans, Phillip Zucs, Klaudia Porten, Susanne Broll, Matthias Niedrig, Andrea Ammon, Gérard Krause

  Emerging infectious diseases. 09/2004; 10(8):1502-3.

• Increase in imported dengue, Germany, 2001-2002.

  Authors: Christina Frank, Irene Schöneberg, Gérard Krause, Hermann Claus, Andrea Ammon, Klaus Stark

  Emerging infectious diseases. 06/2004; 10(5):903-6.

  Dengue fever is a reportable disease in Germany. Surveillance data from 2001 and 2002 were analyzed and compared to travel patterns. Imported dengue fever increased strongly in this time. MostDengue fever is a reportable disease in Germany. Surveillance data from 2001 and 2002 were analyzed and compared to travel patterns. Imported dengue fever increased strongly in this time. Most infections were acquired in Southeast Asia, specifically Thailand. The 2002 epidemic in Brazil was also reflected in these data.

• European survey on Campylobacter surveillance and diagnosis 2001.

  Authors: J Takkinen, Andrea Ammon, O Robstad, T Breuer

  Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 12/2003; 8(11):207-13.

  Two surveys have been conducted on behalf of the Campylobacter Working Group with the aim of assessing the feasibility of a European network on human Campylobacter infections. The first survey,Two surveys have been conducted on behalf of the Campylobacter Working Group with the aim of assessing the feasibility of a European network on human Campylobacter infections. The first survey, conducted in 18 countries, collected information about diagnostic methods used for surveillance purpose while the second one, conducted among 10 European countries, gathered data on diagnostic methods and procedures in primary laboratories. Seventeen of the 18 countries had a surveillance system for Campylobacter infections and 13 a national reference laboratory. The case definition used for the surveillance in all these countries included laboratory confirmation. No commonly applicable subtyping methods were applied. Concerning primary laboratories dealing with Campylobacter infections, only a few of them reported directly to the national level, and antimicrobial susceptibility testing was performed by about half of the laboratories. These surveys indicated that a basic infrastructure for a wide European Campylobacter surveillance exists.

• Cross-sectional study on influenza vaccination, Germany, 1999-2000.

  Authors: Sybille Rehmet, Andrea Ammon, Günter Pfaff, Nikolaus Bocter, Lyle R Petersen

  Emerging infectious diseases. 12/2002; 8(12):1442-7.

  To assess influenza vaccination coverage in Germany, we conducted a nationwide telephone survey in November 1999 in adults (>18 yrs) using random-digit dialing. Overall, 23% of 1,190 surveyTo assess influenza vaccination coverage in Germany, we conducted a nationwide telephone survey in November 1999 in adults (>18 yrs) using random-digit dialing. Overall, 23% of 1,190 survey participants reported having been vaccinated (adjusted 18%) with 16% (adjusted 15%) in former West Germany versus 35% (adjusted 32%) in former East Germany. Immunization rates for vaccination target groups were lower in West Germany (21%) than in East Germany (40%). Seven percent of health-care workers were immunized. Previous influenza vaccination, positive attitudes towards immunization, and having a family physician increased the rate of vaccination; fear of adverse effects lowered the rate. Family physicians performed 93% of the vaccinations, which suggests their key role in improving low vaccination coverage in Germany. The fact that >71% (850/1,190) of participants belonged to at least one of the vaccination target groups recommended by the German Standing Commission on Immunization emphasizes the need to focus the definition of target groups.

• A multistate outbreak of Shiga toxin-producing Escherichia coli O26:H11 infections in Germany, detected by molecular subtyping surveillance.

  Authors: Dirk Werber, Angelika Fruth, Almut Liesegang, Martina Littmann, Udo Buchholz, Rita Prager, Helge Karch, Thomas Breuer, Helmut Tschäpe, Andrea Ammon

  The Journal of infectious diseases. 09/2002; 186(3):419-22.

  In the spring of 2000, a cluster of indistinguishable Shiga toxin-producing Escherichia coli (STEC) O26:H11 was identified in Germany by molecular subtyping surveillance. An investigation wasIn the spring of 2000, a cluster of indistinguishable Shiga toxin-producing Escherichia coli (STEC) O26:H11 was identified in Germany by molecular subtyping surveillance. An investigation was prompted to identify a common source of exposure. A case subject was defined as a person having a polymerase chain reaction-confirmed STEC O26 infection between March and April 2000, irrespective of clinical signs, and whose isolate was indistinguishable from the index strain by use of pulsed-field gel electrophoresis. Eleven case subjects were found in 5 institutions that were supplied by 4 kitchens located in 3 states. The median age was 2 years (range, 2-31 years). No bloody diarrhea was reported, and 5 persons remained asymptomatic. Comparison of invoices revealed a certain type of beef ("Seemerrolle") as possible source of infection. This is, to our knowledge, the first multistate outbreak associated with a non-O157 STEC detected by laboratory-based surveillance. Molecular subtyping was pivotal, as disease occurrence was sporadic or family-related.

• Escherichia coli harboring Shiga toxin 2 gene variants: frequency and association with clinical symptoms.

  Authors: Alexander W Friedrich, Martina Bielaszewska, Wen-Lan Zhang, Matthias Pulz, Thorsten Kuczius, Andrea Ammon, Helge Karch

  The Journal of infectious diseases. 01/2002; 185(1):74-84.

  Shiga toxin (Stx)-producing Escherichia coli (STEC) from patients with hemolytic-uremic syndrome (HUS), patients with diarrhea without HUS, or asymptomatic subjects were genotyped to assessShiga toxin (Stx)-producing Escherichia coli (STEC) from patients with hemolytic-uremic syndrome (HUS), patients with diarrhea without HUS, or asymptomatic subjects were genotyped to assess associations between stx2 variants and clinical manifestations of infection. Neither stx2d nor stx2e was found in 268 STEC isolates from patients with HUS. Of 262 STEC isolates from patients with diarrhea, stx(2d) was found in 41 (15.6%; P<.000001), and stx2e was found in 12 (4.6%; P=.0004). The stx2c genotype frequency was similar among isolates from patients with HUS (3.7%) and diarrhea (5.0%). The frequencies of stx2c, stx2d, and stx2e among 96 STEC isolates from asymptomatic subjects were comparable to those among isolates from patients with diarrhea. None of the 626 STEC isolates contained stx2f. All stx2d-positive or stx2e-positive STEC isolates were eae negative and originated from subjects older than those with STEC isolates with stx2c. stx2c-positive STEC isolates can cause HUS, but the presence of stx2d or stx2e may predict a milder disease with a minimal risk of HUS.

• Development of a research netwrok for emerging foodborne pathogens in Germany.

  Authors: D Werber, Andrea Ammon

  Euro surveillance : bulletin europeen sur les maladies transmissibles = European communicable disease bulletin. 12/2000; 5(11):120-123.

  A network of epidemiologists, microbiologists, veterinarians, and clinicians is being developed in Germany to support local and state health departments and veterinary authorities in their researchA network of epidemiologists, microbiologists, veterinarians, and clinicians is being developed in Germany to support local and state health departments and veterinary authorities in their research and epidemiological investigations on emerging foodborne

• Two outbreaks of trichinellosis in the state of Northrhine-Westfalia, Germany, 1998.

  Authors: S Rehmet, G Sinn, O Robstad, H David, D Lesser, K Noeckler, G Scherholz, D Erkrath, D Pechmann, Lyle R Petersen [......] J Laumen, U Nogay, M Dixius, J Eichenberg, F Dinse, D Stegemann, W Lotz, D Franke, P Hag, Andrea Ammon

  Euro surveillance : bulletin europeen sur les maladies transmissibles = European communicable disease bulletin. 08/1999; 4(7):78-81.

  Illness or death from trichinellosis is statutorily notifiable in Germany. Between nought and ten cases were reported each year from 1987 to 1997. From November 1998 to January 1999, however, 52Illness or death from trichinellosis is statutorily notifiable in Germany. Between nought and ten cases were reported each year from 1987 to 1997. From November 1998 to January 1999, however, 52 cases of trichinellosis were identified by the public health

• Increase in Imported Dengue, Germany, 2001–2002

  Authors: Christina Frank, Irene Schöneberg, Gérard Krause, Hermann Claus, Andrea Ammon, Klaus Stark

  Dengue fever is a reportable disease in Germany. Surveillance data from 2001 and 2002 were analyzed and compared to travel patterns. Imported dengue fever increased strongly in this time. MostDengue fever is a reportable disease in Germany. Surveillance data from 2001 and 2002 were analyzed and compared to travel patterns. Imported dengue fever increased strongly in this time. Most infections were acquired in Southeast Asia, specifically Thailand. The 2002 epidemic in Brazil was also reflected in these data.

• SurvNet@RKI - A multistate electronic reporting system for communicable diseases

  Authors: Daniel Faensen, Hermann Claus, Justus Benzler, Andrea Ammon, Thomas Pfoch, T Breuer, Gérard Krause

  In 2001 Germany implemented a new electronic reporting system for surveillance of notifiable infectious diseases (SurvNet@RKI). The system is currently being used in all 431 local health departmentsIn 2001 Germany implemented a new electronic reporting system for surveillance of notifiable infectious diseases (SurvNet@RKI). The system is currently being used in all 431 local health departments (LHD), the 16 state health departments (SHD) and the Robert Koch-Institut (RKI), the national agency for infectious disease epidemiology. The SurvNet@RKI software is written in MS Access 97 and Visual Basic and it supports MS Access as well as MS SQL Server database management systems as a back-end. The database is designed as a distributed, dynamic database for 73 reporting categories with more than 600 fields and about 7000 predefined entry values. An integrated version management system documents deletion, undeletion, completion and correction of cases at any time and entry level and allows reproduction of previously conducted queries. Integrated algorithms and help functions support data quality and the application of case definitions. RKI makes the system available to all LHDs and SHDs free of charge. RKI receives an average of 300,000 case reports and 6240 outbreak reports per year through this system. A public web-based query interface, SurvStat@RKI, assures extensive and timely publication of the data. During the 5 years that SurvNet@RKI has been running in all LHDs and SHDs in Germany it has coped well with a complex federal structure which makes this system particularly attractive to multinational surveillance networks. The system is currently being migrated to Microsoft C#/.NET and transport formats in XML. Based on our experiences, we provide recommendations for the design and implementation of national or international electronic surveillance systems.