Lena Fiebig

Tuberculosis (TB) caused by Mycobacterium tuberculosis kills over one million people yearly. TB diagnosis and treatment are complicated, and hence innovative diagnostic and treatment adherence monitoring tools are important. In this chapter, the application of innovative model of TB detection, linkage to care, and monitoring the adherence to treatm...

Background: Evaluating the completeness of tuberculosis (TB) notification data is important for monitoring of TB surveillance systems. We conducted an inventory study to calculate TB underreporting in Germany in 2013-2017. Methods: Acquisition of two pseudonymized case-based data sources (national TB notification data and antibiotic resistance s...

Finding and treating all tuberculosis (TB) patients is crucial for ending TB. We investigated whether rapid diagnostic turnaround time (TAT) and patient tracking could increase TB treatment initiation in Maputo, Mozambique. Among 3329 TB patients newly diagnosed by the University Eduardo Mondlane-Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling...

Introduction: Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment. Resistance to INH may increase the likelihood of negative treatment outcome. Aim: We aimed to determine the impact of INH mono-resistance on TB treatment outcome in the European Union/European Economic Area and to identify risk factors for unsuccessful outcome in ca...

Abstract Background The implementation of an integrated molecular surveillance (IMS) of tuberculosis (TB) is of high priority for TB control. IMS is defined as the systematic inclusion of molecular typing results in the national TB surveillance system. Although not standardized, an IMS of TB is already implemented in several low TB incidence countr...

Background Molecular typing and whole genome sequencing (WGS) information is used for (inter-) national outbreak investigations. To assist the implementation of these techniques for tuberculosis (TB) surveillance and outbreak investigations at European level there is a need for inter-country collaboration and standardization. This demands more info...

Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment and resistance to INH may increase the likelihood of negative treatment outcomes. We aimed to determine the impact of INH mono-resistance on TB treatment outcomes in the European Union/European Economic Area (EU/EEA) and identify factors associated with unsuccessful treatment of p...

Background Germany has a low tuberculosis (TB) incidence. A relevant and increasing proportion of TB cases is diagnosed among asylum seekers upon screening.Aim:We aimed to assess whether cases identified by screening asylum seekers had equally successful and completely reported treatment outcomes as cases diagnosed by passive case finding and conta...

Background: The risk of tuberculosis outbreaks among people fleeing hardship for refuge in Europe is heightened. We describe the cross-border European response to an outbreak of multidrug-resistant tuberculosis among patients from the Horn of Africa and Sudan. Methods: On April 29 and May 30, 2016, the Swiss and German National Mycobacterial Ref...

BACKGROUND The risk of tuberculosis outbreaks among people fleeing hardship for refuge in Europe is heightened. We describe the cross-border European response to an outbreak of multidrug-resistant tuberculosis among patients from the Horn of Africa and Sudan. METHODS On April 29 and May 30, 2016, the Swiss and German National Mycobacterial Referenc...

An integrated molecular surveillance for tuberculosis (TB) improves the understanding of ongoing TB transmission by combining molecular typing and epidemiological data. However, the implementation of an integrated molecular surveillance for TB is complex and requires thoughtful consideration of feasibility, demand, public health benefits and legal...

Survey to local public health offices (German). Fragebogen zum Typisierungsprojekt der Tuberkulose-Kulturen in Baden-Württemberg 2008–2010. (DOC)

Survey to local public health offices (English). Survey on the project for the molecular typing of tuberculosis cultures in Baden-Württemberg from 2008 to 2010. (DOC)

Migration patterns into and within Europe have changed over the last decade. In 2015, European Union (EU) countries received over 1.2 million asylum requests, more than double the number registered in the previous year. This review compares the published literature on policies for tuberculosis (TB) and latent tuberculous infection (LTBI) screening...

In July 2013, a passenger died of infectious extensively drug-resistant tuberculosis (XDR-TB) on board of an aircraft after a 3-hour flight from Turkey to Germany. Initial information indicated the patient had moved about the aircraft coughing blood. We thus aimed to contact and inform all persons exposed within the aircraft and to test them for ne...

WHO recently recommended the use of a shorter multidrug-resistant TB (MDR-TB) regimen under programmatic conditions. We assessed eligibility for this regimen in a cohort of 737 adult patients with MDR-TB from Latvia, Lithuania, Estonia and Bucharest city recruited in 2007 and 2009. Only 4.2% of the patients were eligible for this regimen. Ethambuto...

Molecular surveillance of multidrug-resistant tuberculosis (MDR-TB) using 24-loci MIRU-VNTR in the European Union suggests the occurrence of international transmission. In early 2014, Austria detected a molecular MDR-TB cluster of five isolates. Links to Romania and Germany prompted the three countries to investigate possible cross-border MDR-TB tr...

Background The ongoing West African Ebola epidemic began in December 2013 in Guinea, probably from a single zoonotic introduction. As a result of ineffective initial control efforts, an Ebola outbreak of unprecedented scale emerged. As of 4 May 2015, it had resulted in more than 19,000 probable and confirmed Ebola cases, mainly in Guinea (3,529), L...

Additional methods and results. (DOCX)

Long version of the case investigation form used in Sierra Leone and Liberia. (PDF)

Short version of the case investigation form used in Sierra Leone. (PDF)

Short version of the case investigation form used in Guinea. (PDF)

(DOCX)

Long version of the case investigation form used in Guinea. (PDF)

Short version of the case investigation form used in Liberia. (PDF)

Background: The quality of care for patients with TB in Eastern Europe has improved significantly; nevertheless drug resistance rates remain high. We analysed survival in a cohort of patients with multidrug-resistant and extensively drug-resistant (MDR-/XDR-) TB from Latvia, Lithuania, Estonia and Bucharest city. Methods: Consecutive adult new a...

In 2014, Ebola virus disease (EVD) in West Africa was first reported during March in 3 southeastern prefectures in Guinea; from there, the disease rapidly spread across West Africa. We describe the epidemiology of EVD cases reported in Guinea's capital, Conakry, and 4 surrounding prefectures (Coyah, Dubreka, Forecariah, and Kindia), encompassing a...

Monitoring the treatment outcome (TO) of tuberculosis (TB) is essential to evaluate the effectiveness of the intervention and to identify potential barriers for TB control. The global target is to reach a treatment success rate (TSR) of at least 85%. We aimed to assess the TB TO in the European Union and European Economic Area (EU/EEA) between 2002...

In Western Europe, migrants constitute an important risk group for tuberculosis, but little is known about successive generations of migrants. We aimed to characterize migration among tuberculosis cases in Berlin and to estimate annual rates of tuberculosis in two subsequent migrant generations. We hypothesized that second generation migrants born...

In addition to malaria and HIV/AIDS, tuberculosis (TB) is one of the world's most important infectious diseases. Also in Germany tuberculosis still remains a relevant public health problem that needs special attention. This article provides an overview of the tuberculosis epidemiology in Germany with emphasis on drug resistance and population group...

Migration is an important factor impacting on infectious disease epidemiology. The timely identification of groups at risk and prevention needs resulting from migration is indispensable to adequately design and implement public health measures. It remains to be assessed to which extent surveillance data for notifiable diseases can directly generate...

OBJECTIVE: To assess bacteriological confirmation of pulmonary tuberculosis (TB) in children using nucleic acid amplification tests (NAAT) and culture of gastric aspirates in Germany.DESIGN: We analysed 2002–2010 TB notification data to determine the use of gastric aspirates, NAAT and culture performance, including test agreement among pulmonary TB...

Laboratory confirmation of paediatric tuberculosis (TB) is frequently lacking. We reviewed the range of routine laboratory tests and their performance in different biological samples used to diagnose active TB in children. A questionnaire-based survey was conducted among the European Reference Laboratory Network for TB followed by collection of rou...

Tuberculosis (TB) still presents a leading cause of morbidity and mortality among people living with HIV/AIDS (PLWHA), including those on antiretroviral therapy. In this study, we aimed to determine the long-term incidence density rate (IDR) of TB and risk factors among PLWHA in relation to combination antiretroviral therapy (cART)-status. Data of...

Background Tuberculosis remains one of the most important infectious diseases worldwide. For 2011 the World Health Organization estimated that there were 8.7 million new cases of tuberculosis and 1.4 million deaths from tuberculosis. Objectives This article gives an overview on the current tuberculosis (TB) situation worldwide, in Europe as well as...

Eine Laborbestatigung der Tuberkulose ist bei Kindern aufgrund der pauzibazillaren Erkrankung eine Herausforderung. Die Auswahl geeigneter Probenmaterialien und diagnostischer Tests ist daher besonders wichtig. Ziel dieser Studie war es, Ergebnisse von Nukleinsaureamplifikationstechniken (NAT) und Kultur aus Magensaftproben bei Kindern (< 15 Jahren...

Tuberculosis (TB) surveillance commonly focuses on pulmonary (PTB) where the main organ affected is the lung. This might lead to underestimate extrapulmonary TB (EPTB) forms, where in addition to the lung other sites are affected by TB. In Germany, TB notification data provide the main site and the secondary site of disease. To gain an overview of...

Background In 2007, the ‘Berlin Declaration on Tuberculosis’ (BD) was signed by the Ministers of the WHO European Region Member States (MS) to address the re-emerging threat of tuberculosis (TB) by fully implementing the Stop TB strategy. WHO Euro developed a Monitoring and Evaluation (M&E) Framework using programmatic and epidemiological indicator...

Tuberculosis (TB) and HIV comorbidity is a major challenge in TB prevention and control but difficult to assess in Germany as in other countries, where data confidentiality precludes notifying the HIV status of TB patients. We aimed to estimate the HIV-prevalence in TB patients in Germany, 2002-2009, and to characterize the HIV/TB patients demograp...

We conducted a nationwide hospital-based prospective study in Germany of influenza A(H1N1)pdm09 cases among children <15 years of age admitted to pediatric intensive care units and related deaths during the 2009-10 pandemic and the 2010-11 postpandemic influenza seasons. We identified 156 eligible patients: 112 in 2009-10 and 44 in 2010-11. Althoug...

The threat of avian influenza (AI) viruses to humans in Europe in 2005 prompted the Robert Koch Institute to establish a routine monitoring instrument condensing information on all human AI cases worldwide reported from the World Health Organization (WHO) and other sources into a line list for further analysis. The 235 confirmed AI cases captured f...

Pets, often used as companionship and for psychological support in the therapy of nursing home residents, have been implicated as reservoirs for antibiotic-resistant bacteria. We investigated the importance of pets as reservoirs of multidrug-resistant (MDR) staphylococci in nursing homes. We assessed the carriage of MDR staphylococci in pets and in...

Background: Pathogenesis of COPD is complex and remains poorly understood. EUROSCOP (European Respiratory Society Study on Chronic Obstructive Pulmonary Disease) showed that 18% of their COPD participants were atopic (Watson, L. et al. ERJ 2006; 28:311-8). We investigated whether atopy affects symptoms and lung function in these COPD patients. Me...

In a hospital-based observational study in Germany, we investigated children admitted to pediatric intensive care units and deaths caused by confirmed pandemic (H1N1) 2009 to identify risk factors and outcomes in critically ill children. Ninety-three children were eligible for our study, including 9 with hospital-acquired infections. Seventy-five p...

Background: The spread of infectious disease is determined by biological factors, e.g. the duration of the infectious period, and social factors, e.g. the arrangement of potentially contagious contacts. Repetitiveness and clustering of contacts are known to be relevant factors influencing the transmission of droplet or contact transmitted diseases....

The passive surveillance of highly pathogenic avian influenza (HPAI) in domestic poultry is based essentially on the reporting of suspicious clinical cases by the poultry keepers to the veterinary services. As little was known about HPAI disease awareness among Swiss poultry keepers, a cross-sectional study was conducted among poultry keepers in Sw...

Ongoing economic losses by and exposure of humans to highly pathogenic avian influenza (HPAI) in poultry flocks across Asia and parts of Africa and Europe motivate also outbreak-free countries such as Switzerland to invest in preparedness planning. Country-specific population data on between-farm contacts are required to anticipate probable pattern...

The spread of infectious disease is determined by biological factors, e.g. the duration of the infectious period, and social factors, e.g. the arrangement of potentially contagious contacts. Repetitiveness and clustering of contacts are known to be relevant factors influencing the transmission of droplet or contact transmitted diseases. However, we...

Algorithms. Provides a description of the key algorithms used for this paper following the ISO 5807-1985 standard.

Epidemic curves. This document provides exemplary epidemic curves for selected parameter settings.

Contour plots & tables. Additional contour plots for the differences in peak size and the differences in the simulation time till the peak is reached are given. In addition, data tables of means and standard deviations are provided for many analyses presented in this paper.

Reproduction numbers. This document shows how equation 1 can be derived.

Die Ergebnisse der Influenza-Überwachung der Saison 2009/10 basieren auf den Daten des Sentinelsystems der Arbeitsgemeinschaft Influenza (AGI) des Robert Koch-Instituts (RKI) zum Auftreten akuter Atemwegserkrankungen in primärversorgenden Praxen. Die Ergebnisse fußen auch auf Informationen über die virologische Analyse der Influenzaviren von Patien...