Robert Koch Institut
  • Berlin, Germany
Recent publications
Digital technologies can help support the health of migrants and refugees and facilitate research on their health issues. However, ethical concerns include security and confidentiality of information; informed consent; how to engage migrants in designing, implementing and researching digital tools; inequitable access to mobile devices and the internet; and access to health services for early intervention and follow-up. Digital technical solutions do not necessarily overcome problems that are political, social, or economic. There are major deficits with regard to (1) reliable data on the health needs of migrants and mobile populations and on how they can use digital tools to support their health; (2) evidence on effectiveness of solutions; and (3) a broad framework to guide future work. This article provides a wide socio-technical perspective, as a framework for analysis and developing coherent agendas across global-to-local spaces, with particular attention to the European region.
Background Physical activity (PA) is a cornerstone in maintaining a healthy lifestyle as well as in the prevention and rehabilitation of non-communicable diseases (NCD). First analysis of PA showed lower activity rates in adults with NCD compared to the general population. To improve health monitoring and to address World Health Organization (WHO) recommendations to systematically identify and track efforts to reduce inequalities in PA participation, trend analysis of PA in adults with NCD was performed for the period 2014/15 to 2019/20 for Germany. Furthermore, motivational readiness for PA behavior change was analysed based on the transtheoretical model (TTM). Methods Based on two population-based cross-sectional health surveys (GEDA 2014/15-EHIS and GEDA 2019/20-EHIS) for Germany (N = 46,724), the prevalence of meeting WHO PA guidelines was analysed for adults with certain NCD compared to the general population. PA was assessed by self-report via the European Health Interview Survey– Physical Activity Questionnaire (EHIS-PAQ). Trend analyses and logistic regression models were performed to calculate disease specific Odds Ratios (OR) for fulfilment of PA recommendations. Motivational readiness for PA was assessed with the stages of change according to the TTM with data of GEDA 2014/15-EHIS. Results Reporting any NCD is associated with lower fulfilment of health-enhancing aerobic PA in both surveys for almost all NCD, with lowest levels among adults reporting stroke, type 2 diabetes mellitus, chronic obstructive pulmonary disease, obesity and coronary heart disease. Sufficient muscle-strengthening was higher in adults with musculoskeletal diseases like osteoarthritis, lower back pain and neck pain compared to adults without these diseases. The prevalence of meeting WHO PA recommendations among adults with NCD remains at a low level. Sufficient health-enhancing aerobic PA tend to decrease in adults with NCD from 2014/15 to 2019/20, while sufficient muscle-strengthening increased in the same period. Motivational readiness for PA is lower for most adults with NCD, compared to the general adult population. Conclusion Lower rates of WHO PA recommendation fulfilment is recognized for most NCD groups compared to the population without NCD for both surveys, but the proportion of adults with NCD who meet the WHO PA recommendations differ widely between NCD groups. A positive trend from 2014/15 to 2019/20 can only be seen for adults with osteoarthritis. Based on our findings the implementation of PA promotion particular with regards to motivational readiness and disease specific PA measures is strongly recommended to improve prevention and ambulatory health care for adults with NCD.
Zusammenfassung Die Urethritis ist ein häufiges, überwiegend durch sexuell übertragene Erreger wie Chlamydia trachomatis , Neisseria gonorrhoeae oder Mycoplasma genitalium verursachtes Krankheitsbild. Alleine aufgrund klinischer Merkmale ist die Unterscheidung der Erreger und der Ausschluss von Koinfektionen nicht sicher möglich. In der praktischen Versorgungssituation wird jedoch oftmals, noch vor dem Erregernachweis, eine empirische antibiotische Therapie durchgeführt. Ziel dieser evidenzbasierten S3‐Leitline ist die Förderung einer rationalen Syndrom‐orientierten Herangehensweise an das klinische Management männlicher Jugendlicher und Erwachsener mit Symptomen einer Urethritis. Neben Empfehlungen für Diagnostik, Klassifikation und Therapie beinhaltet die Leitlinie Empfehlungen zur Indikationsstellung für die empirische antibiotische Behandlung der penilen Urethritis. Neu gegenüber vorbestehenden, erregerspezifischen Leitlinien ist unter anderem das Flowchart für das Syndrom‐orientierte praktische Management. Bei Indikation zur empirischen Behandlung und Verdacht auf eine gonorrhoische Urethritis soll Ceftriaxon angewandt werden. Zusätzlich sollte, aufgrund des Risikos für eine Koinfektion mit Chlamydia trachomatis , Doxycyclin verordnet werden, es sei denn, eine Wiedervorstellung zur Behandlung möglicher Koinfektionen ist gesichert. Bei Verdachtsdiagnose einer nichtgonorrhoischen Urethritis soll die empirische Therapie mit Doxycyclin erfolgen. Azithromycin ist zur empirischen Behandlung der gonorrhoischen und nichtgonorrhoischen penilen Urethritis nur einzusetzen, wenn Kontraindikationen gegenüber Doxycyclin bestehen. Detaillierte Empfehlungen zur Differenzialdiagnostik, erregerspezifischen Behandlungen, spezifischen Situationen und zur Beratung und Nachsorge finden sich in der Leitlinie.
HIV testing and pre-exposure prophylaxis (PrEP) are recommended in Germany for individuals at increased HIV risk. However, data on HIV testing, PrEP use, and PrEP knowledge among trans and non-binary people are limited. We analysed data from the ‘Sexuelle Gesundheit in trans und nicht-binären Communitys’ (TASG) study, a participatory study on HIV/STI and sexual health among trans and non-binary people in Germany. The study was designed, promoted, and analysed with active involvement of community members. Participants were invited to complete an anonymous online survey between 1 March and 1 July 2022. The outcomes included HIV testing within the last 5 years, PrEP use, and PrEP-specific knowledge. Predictors for HIV testing were identified using a bootstrap stepwise selection procedure. Among 2468 HIV-negative participants with information on potential HIV risks, 21.5% had potential needs for HIV testing and PrEP. Of these, only 44.3% (208/470, missing: 60) reported testing for HIV within the last 5 years. Older participants, those living in larger cities, and those with higher education levels were more likely to have tested for HIV. Additionally, only 8.3% (38/459, missing: 71) reported ever using PrEP. Among 451 participants with potential PrEP needs (missing: 79), only 57.4% knew at least one of three key PrEP-related facts at the time of the survey. Our findings highlight substantial gaps in HIV testing and prevention among trans and non-binary individuals in Germany with potential needs for these services. Reducing barriers to testing and prevention is essential to enable broader access to these critical services.
To date, no drugs are approved for BK polyomavirus (BKPyV) reactivation, a major cause of nephropathy after kidney transplantation. Recently, tumor necrosis factor‐α (TNF‐α) blockade has been proposed as a promising therapy, however, the effect of TNF‐α on the clinically most common archetype (ww) BKPyV remained unclear. Assays in primary renal proximal tubule epithelial cells (RPTEC) allowed efficient replication only of BKPyV strains with rearranged (rr) non‐coding control regions (NCCR), which may develop at later disease stages, but not of ww‐BKPyV. Here, we optimized culture conditions allowing robust replication of patient‐derived ww‐BKPyV, while efficiently preserving their ww‐NCCR. TNF‐α promoted rr‐BKPyV replication, while the T H 1 cytokine IFN‐γ suppressed it, also in the presence of TNF‐α. Surprisingly, TNF‐α alone was sufficient to suppress all ww‐BKPyV strains tested. Comprehensive analysis using siRNAs, and chimeric or mutated BKPyV‐strains revealed that the response to TNF‐α depends on the NCCR type, and that the NF‐κB p65 pathway but not the conserved NF‐κB binding site is essential for the TNF‐α‐induced enhancement of rr‐BKPyV replication. Our data suggest that in immunosuppressed patients with archetype‐dominated infections, TNF‐α blockade could interfere with natural TNF‐α‐mediated anti‐BKPyviral control, and this could be detrimental when IFN‐γ‐driven T H 1 responses are impaired. Ongoing inflammation, however, could lead to the selection of rearrangements responding to NCCR‐activating pathways downstream of NF‐κB p65 signaling, that may overcome the initial TNF‐α‐mediated suppression. Our findings also highlight the importance of using clinically relevant BKPyV isolates for drug testing and discovery, for which this new assay paves the way.
Today, MALDI-ToF MS is an established technique to characterize and identify pathogenic bacteria. The technique is increasingly applied by clinical microbiological laboratories that use commercially available complete solutions, including spectra databases covering clinically relevant bacteria. Such databases are validated for clinical, or research applications, but are often less comprehensive concerning highly pathogenic bacteria (HPB). To improve MALDI-ToF MS diagnostics of HPB we initiated a program to develop protocols for reliable and MALDI-compatible microbial inactivation and to acquire mass spectra thereof many years ago. As a result of this project, databases covering HPB, closely related bacteria, and bacteria of clinical relevance have been made publicly available on platforms such as ZENODO. This publication in detail describes the most recent version of this database. The dataset contains a total of 11,055 spectra from altogether 1,601 microbial strains and 264 species and is primarily intended to improve the diagnosis of HPB. We hope that our MALDI-ToF MS data may also be a valuable resource for developing machine learning-based bacterial identification and classification methods.
Metaproteomics enables the large‐scale characterization of microbial community proteins, offering crucial insights into their taxonomic composition, functional activities, and interactions within their environments. By directly analyzing proteins, metaproteomics offers insights into community phenotypes and the roles individual members play in diverse ecosystems. Although database‐dependent search engines are commonly used for peptide identification, they rely on pre‐existing protein databases, which can be limiting for complex, poorly characterized microbiomes. De novo sequencing presents a promising alternative, which derives peptide sequences directly from mass spectra without requiring a database. Over time, this approach has evolved from manual annotation to advanced graph‐based, tag‐based, and deep learning‐based methods, significantly improving the accuracy of peptide identification. This Viewpoint explores the evolution, advantages, limitations, and future opportunities of de novo sequencing in metaproteomics. We highlight recent technological advancements that have improved its potential for detecting unsequenced species and for providing deeper functional insights into microbial communities.
Background Antimicrobial resistance is a global threat to public health, with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VREfm) being major contributors. Despite their clinical impact, comprehensive assessments of changes of the burden of bloodstream infections in terms of Disability-Adjusted Life Years (DALYs) and attributable deaths over time are lacking, particularly in Germany. Methods We used data from the Antimicrobial Resistance Surveillance system, which covered about 30% of German hospitals. Bloodstream infections were defined by a VREfm or MRSA-positive blood culture. We estimated incidences as a first step to further use these rates to calculate DALYs and attributable deaths using the Burden of Communicable Disease in Europe toolkit. The analysis included stratification by age, sex and region. Results From 2017 to 2023, 6262 MRSA and 5442 VREfm blood culture-positive isolates were identified. The incidence of MRSA bloodstream infections decreased from 4.0 to 2.1 per 100,000 population, with estimated DALYs decreasing from 14.6 to 8.6 per 100,000 and attributable deaths from 591 to 316. Conversely, VREfm-BSI incidence doubled from 1.7 to a peak of 3.0 (2021) before declining back to 1.7 per 100,000 in 2023, with estimated DALYs increasing from 8.9 to 16.5 and then decreasing to 8.5 per 100,000 and attributable deaths increasing from 317 to 327. Men and people over 60 years had the highest burden, with noticeable regional differences. Conclusion MRSA and VREfm bloodstream infections followed different trends in the past and now present a comparable burden in Germany. Both pathogens pose a significant threat, particularly to hospitalised older aged men. Our findings highlight the need for targeted prevention and continued surveillance of MRSA and VREfm to reduce infections and their impact.
Zoonoses are infectious diseases transmitted from animals to humans. Bats have been suggested to harbour more zoonotic viruses than any other mammalian order¹. Infections in bats are largely asymptomatic2,3, indicating limited tissue-damaging inflammation and immunopathology. To investigate the genomic basis of disease resistance, the Bat1K project generated reference-quality genomes of ten bat species, including potential viral reservoirs. Here we describe a systematic analysis covering 115 mammalian genomes that revealed that signatures of selection in immune genes are more prevalent in bats than in other mammalian orders. We found an excess of immune gene adaptations in the ancestral chiropteran branch and in many descending bat lineages, highlighting viral entry and detection factors, and regulators of antiviral and inflammatory responses. ISG15, which is an antiviral gene contributing to hyperinflammation during COVID-19 (refs. 4,5), exhibits key residue changes in rhinolophid and hipposiderid bats. Cellular infection experiments show species-specific antiviral differences and an essential role of protein conjugation in antiviral function of bat ISG15, separate from its role in secretion and inflammation in humans. Furthermore, in contrast to humans, ISG15 in most rhinolophid and hipposiderid bats has strong anti-SARS-CoV-2 activity. Our work reveals molecular mechanisms that contribute to viral tolerance and disease resistance in bats.
Since the onset of the pandemic, many SARS-CoV-2 variants have emerged, exhibiting substantial evolution in the virus’ spike protein¹, the main target of neutralizing antibodies². A plausible hypothesis proposes that the virus evolves to evade antibody-mediated neutralization (vaccine- or infection-induced) to maximize its ability to infect an immunologically experienced population1,3. Because viral infection induces neutralizing antibodies, viral evolution may thus navigate on a dynamic immune landscape that is shaped by local infection history. Here we developed a comprehensive mechanistic model, incorporating deep mutational scanning data4,5, antibody pharmacokinetics and regional genomic surveillance data, to predict the variant-specific relative number of susceptible individuals over time. We show that this quantity precisely matched historical variant dynamics, predicted future variant dynamics and explained global differences in variant dynamics. Our work strongly suggests that the ongoing pandemic continues to shape variant-specific population immunity, which determines a variant’s ability to transmit, thus defining variant fitness. The model can be applied to any region by utilizing local genomic surveillance data, allows contextualizing risk assessment of variants and provides information for vaccine design.
Hintergrund: Public Health-Maßnahmen sollen oft den Menschen gesundheitsförderliche Verhaltensweisen erleichtern, z.B. indem die sozialen und materiellen Lebensbedingungen dafür verändert werden. Die Weltgesundheitsorganisation (WHO) hat mit dem Konzept der „Behavioural and Cultural Insights“ (BCI, deutsch etwa „verhaltens- und sozialwissenschaftliche Erkenntnisse“) einen Ansatz etabliert, der darauf abzielt, gesundheitsbezogene Verhaltensweisen besser zu verstehen und entsprechende Public Health-Interventionen gezielter entwickeln zu können. Im Zentrum steht dabei die systematische Erfassung individueller wie auch z.B. kultureller, sozialer und umgebungsbezogener Barrieren und Förderfaktoren von Gesundheitsverhalten. Ziel: Der BCI-Ansatz soll helfen, präventive Maßnahmen stärker evidenzbasiert und bedarfsgerecht zu planen. Dazu werden einige Grundzüge von BCI skizziert, die berücksichtigt werden sollten, um das Konzept in ein zeitgemäßes „New Public Health“-Verständnis zu integrieren; dazu gehört, gesellschaftliche und individuelle Einflussfaktoren auf Gesundheit und Krankheitsentstehung und sozial bedingte gesundheitliche Ungleichheit zu beachten. Inhalt: Im Artikel erfolgt zunächst eine Abgrenzung des BCI-Konzepts vom verhaltensökonomischen Ansatz (z.B. Nudging). Zur Illustration des Potenzials von BCI für Bevölkerungsgesundheit und Chancengleichheit wird herausgearbeitet, das auf BCI basierende Maßnahmen (a) Verhalten und Verhältnisse im Blick haben, (b) auf gesundheitliche Chancengleichheit abzielen, (c) partizipativ entwickelt und implementiert werden, und (d) in ihrer Logik dem sog. Public Health Action Cycle folgen. Dazu müssen Einflussfaktoren auf menschliches Verhalten systematisch erfasst werden. Verhaltens- und sozialwissenschaftliche Erkenntnisse müssen zudem die Eigenschaften komplexer Interventionen berücksichtigen und auf lokale Gegebenheiten und die kulturelle Vielfalt bestimmter Bevölkerungsgruppen zugeschnitten werden. Schlussfolgerung: Der BCI-Ansatz hat viele Übereinstimmungen mit anderen Ansätzen qualitätsgesicherter und bedarfsorientierter Prävention. Der Fokus auf systematische Erfassung von Barrieren und Förderfaktoren bietet bei der Planung von Public Health-Maßnahmen einen wichtigen Mehrwert. Forschung zu verhaltens- und sozialwissenschaftlichen Erkenntnissen und ihre Nutzung in der Prävention sollten in Deutschland ausgebaut werden. Background: Public health intervention are often intended to make it easier for people to adopt health-related behaviours, e.g. by changing the social environment and material living conditions. With the concept of "Behavioral and Cultural Insights" (BCI), the World Health Organization (WHO) has established an approach that aims at better understanding health-related behaviours, in order to be able to develop corresponding public health interventions in a more targeted manner. The focus is on the empirical identification of individual as well as cultural, social and environmental barriers and facilitators of health behaviour. Aim: The BCI approach can be used to plan preventive measures in a more evidence-based and needs-oriented manner. To this end, the article outlines some basic features of BCI which should be taken into account in order to integrate the concept into a contemporary understanding of "new public health". This includes taking into account social and individual factors influencing health as well as social inequalities in health. Content: First, the article distinguishes the BCI concept from the approach of behavioural economics (e.g. nudging). To illustrate its potential for population health and health equity, the article then explains that BCI-based measures (a) focus on both behaviour and environment, (b) aim at health equity, (c) are developed and implemented in a participatory manner, and (d) follow the logic of the well-established Public Health Action Cycle. For BCI, it is key to systematically identify and analyse the factors influencing human behaviour in everyday life. BCI based interventions must also consider the characteristics of complex interventions and be tailored to local conditions and the cultural diversity of specific population groups. Conclusion: The BCI approach has many similarities with other approaches of quality-assured and needs-oriented prevention. The focus on a systematic identification of barriers and facilitators offers an important added value in the planning of public health measures. Research into BCI and their use in prevention should be expanded in Germany.
Background Carbapenem-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) are among WHO’s priority pathogens with antimicrobial resistance (AMR). Studies suggest potential impacts of the COVID-19-pandemic on AMR. We described changes in AMR incidence and epidemiology in Germany during the COVID-19-pandemic. Methods We used two independent datasets, statutory surveillance and laboratory-based Antibiotic Resistance Surveillance (ARS). We included statutory notifications of infections/colonisations of carbapenem-resistant Acinetobacter spp., Klebsiella pneumoniae, Escherichia coli (CRA/CRKP/CREC) and invasive MRSA. Using Poisson/negative binomial regression and assuming continued pre-pandemic (2015/2017–2020) trends, we projected hypothetical notifications as if the pandemic had not occurred. We quantified annual changes during the pandemic period (2020–2022) by comparing to observed notifications. Additional models considered inpatient reductions, seasonality, infections only, or resistant isolates from ARS. Results CRA notified cases were reduced by -30% (95%CI -39%|-20%) in 2020, -23% (-36%|-8%) in 2021, but + 32% (+ 6%|+64%) higher in 2022 relative to hypothetical pre-pandemic projections. Changes were − 35%/-31%/+6% for CRKP, -40%/-61%/-48% for CREC and − 33%/-25%/-20% for MRSA. Statutory-models accounting for fewer inpatients, seasonality and infections only showed similar trends, as did ARS-models for resistant isolates and infections. International mobility for CRA, CRKP and CREC decreased in 2020–2021, then increased in 2022. Conclusions We observed significant reductions of AMR notifications and infections during 2020–2021, also when accounting for fewer inpatients. We conclude a genuine reduction of AMR spread occurred during the pandemic. Factors like fewer hospitalisations and reduced international mobility contributed. Rising international mobility may partly explain increases for CRA, CRKP and CREC in 2022. A solid understanding of AMR trends improves infection prevention and control.
In 2024, circulating vaccine-derived poliovirus type 2 (cVDPV2) was detected in wastewater samples in Finland, Germany, Poland, Spain and the United Kingdom (UK). All strains were genetically linked, but sequence analysis showed high genetic diversity among the strains identified within individual wastewater sites and countries and an unexpected high genetic proximity among isolates from different countries. Taken together these results, with sequential samples having tested positive in various sites, a broader geographic distribution beyond positive sampling sites must be considered.
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534 members
Michael Laue
  • Center for Biological Threats and Special Pathogens
Hans Georg Butschalowsky
  • Department of Epidemiology and Health Monitoring
Astrid Lewin
  • Mycology/Parasitology/Intracellular Pathogens
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Address
Berlin, Germany
Head of institution
Prof. Dr. Lothar H. Wieler