der Saisonbericht 2013 ist da
(but I get an error, when downloading it)
----------OK, I have it now, RKI kindly sent it to me by email)
108 Seiten, 8.3MB
...
Inhaltsverzeichnis
1 Zusammenfassung 7
2 Einleitung 13
2.1 Ziel der Influenzasurveillance 13
2.2 Geschichte der AGI 14
2.3 Einbindung in internationale Netzwerke 14
3 Begriffs- und methodische Erläuterungen 17
4 Datenquellen und erhobene Daten 21
4.1 Syndromische Überwachung akuter respiratorischer Erkrankungen 21
4.2 Virologische Surveillance innerhalb des Sentinels der AGI 23
4.2.1 Daten des NRZ 23
4.2.2 Daten aus patientennaher virologischer Diagnostik 25
4.3 Daten der kooperierenden Landeslabors 25
4.4 Von den Gesundheitsämtern übermittelte Daten nach IfSG 25
5 Influenza-Überwachung in der Saison 2013/14 im Vergleich mit früheren Saisons 29
5.1 Ergebnisse der Surveillance (übermittelte Fälle gemäß IfSG) 29
5.2 Ergebnisse der Sentinel-Surveillance 30
5.2.1 Analyse der Konsultationsinzidenz und der Influenza-assoziierten Exzess-Konsultationen
nach Altersgruppen 35
5.2.2 Influenza-assoziierte Arbeitsunfähigkeit/Pflegebedürftigkeit nach Altersgruppen 38
5.2.3 Influenza-assoziierte Krankenhauseinweisungen nach Altersgruppen 39
5.3 Influenza-assoziierte Todesfallschätzungen 41
5.4 Internationale Situation in der Saison 2013/14 43
6 Weiterführende virologische Ergebnisse 45
6.1 Isolierte Viren 45
6.2 Antigene Charakterisierung der Influenzaviren 49
6.2.1 Influenza A(H1N1)pdm09-Viren 49
6.2.2 Influenza A(H3N2)-Viren 50
6.2.3 Influenza B-Viren 50
6.3 Molekulare Charakterisierung der Influenzaviren 51
6.3.1 Molekulare Analyse von Influenza A(H1N1)pdm09-Viren 51
6.3.2 Molekulare Analyse von Influenza A(H3N2)-Viren 51
6.3.3 Molekulare Analyse von Influenza B-Viren 51
6.4 Untersuchungen zur antiviralen Resistenz 58
7 Weitere Studien und Projekte des RKI zu Influenza 61
7.1 GrippeWeb – syndromische Surveillance akuter Atemwegserkrankungen auf Bevölkerungsebene 61
7.2 SEEDARE: Ergebnisse zur fallbasierten Auswertung von akuten respiratorischen Erkrankungen 65
7.2.1 Verteilung der Diagnosen für ARE 65
7.2.2 Patienten mit ICD-10-Codes für Grippe 66
7.2.3 Arbeitsunfähigkeit von Patienten mit einem ICD-10-Code für ARE 68
7.2.4 Krankenhauseinweisung von Patienten mit einem ICD-10-Code für ARE 70
7.3 Mortalitätssurveillance 73
7.3.1 Hintergrund 73
7.3.2 Mortalitätssurveillance in Berlin 73
7.4 Erfahrungen mit dem Management von Influenza-Ausbrüchen in Alten- und Pflegeheimen 74
7.4.1 Methoden 74
7.4.2 Ergebnisse 75
7.4.3 Diskussion 78
8 Influenza-Impfung 81
8.1 Zusammensetzung des Impfstoffs 81
8.2 Wirksamkeit der Impfung gegen saisonale Influenza ( Impfeffektivität) 81
8.3 Impfempfehlung für saisonale Influenza in der Saison 2014/15 83
8.4 Influenza-Impfverhalten schwangerer Frauen 84
9 Influenza als Zoonose 87
9.1 Aviäre Influenza 87
9.1.1 Influenzavirusinfektionen von Wildvögeln und Hausgeflügel 87
9.1.2 Aviäre Influenzavirusinfektionen des Menschen 89
9.2 Porcine Influenza 91
9.2.1 Influenza bei Schweinen 91
9.2.2 Humane Fälle mit Schweine influenzavirus-Infektion 92
10 Literaturhinweise 95
11 Danksagung 99
12 Anhang 102
---------------------------------------------------------------------
contents
1 Summary 7
2 Introduction 13
2.1 Purpose of Influenza Surveillance 13
2.2 History of AGI 14
2.3 Integration into international networks 14
3 definitions and methodological notes 17
4 Data sources and data collected 21
4.1 syndromic surveillance of acute respiratory diseases 21
4.2 Virological Surveillance within the Sentinels of AGI 23
4.2.1 Data of NRZ 23
4.2.2 Data from near-patient virological diagnostics 25
4.3 Data from the cooperating country laboratories 25
4.4 Information provided by the public health authorities according to data IfSG 25
5 Influenza Surveillance in the 2013-14 season compared with previous seasons 29
5.1 Results of Surveillance (submitted cases according IfSG) 29
5.2 Results of sentinel surveillance 30
5.2.1 Analysis of the consultation and incidence of influenza-associated excess consultations
by age group 35
5.2.2 Influenza-associated disability / long-term care by age group 38
5.2.3 Influenza-associated hospitalizations by age group 39
5.3 influenza-associated death estimates 41
5.4 The international situation in the season 2013/14 43
6 Further virological results 45
6.1 Isolated virus 45
6.2 antigens characterization of influenza viruses 49
6.2.1 Influenza A (H1N1) viruses pdm09 49
6.2.2 Influenza A (H3N2) viruses 50
6.2.3 Influenza B virus 50
6.3 Molecular characterization of influenza viruses 51
6.3.1 Molecular analysis of influenza A (H1N1) viruses pdm09 51
6.3.2 Molecular analysis of influenza A (H3N2) viruses 51
6.3.3 Molecular analysis of influenza B viruses 51
6.4 Studies on antiviral resistance 58
7 Further studies and projects of the RKI to influenza 61
7.1 GrippeWeb - syndromic surveillance of acute respiratory disease at the population level 61
SEEDARE 7.2: Results for case-based evaluation of acute respiratory diseases 65
7.2.1 Distribution of diagnoses for ARE 65
7.2.2 Patients with ICD-10 codes for influenza 66
7.2.3 disability of patients with an ICD-10 code for ARE 68
7.2.4 hospitalization of patients with an ICD-10 code for ARE 70
7.3 Mortality Surveillance 73
7.3.1 Background 73
7.3.2 Mortality Surveillance in Berlin 73
7.4 Experience with the management of influenza outbreaks in nursing homes 74
7.4.1 Methods 74
7.4.2 Results 75
7.4.3 Discussion 78
8 Influenza Vaccination 81
8.1 Composition of vaccine 81
8.2 Effectiveness of vaccination against seasonal influenza (vaccine effectivity) 81
8.3 recommendation for vaccination for seasonal influenza in the season 2014/15 83
8.4 influenza vaccination behavior of pregnant women 84
9 influenza as a zoonosis 87
9.1 Avian Influenza 87
9.1.1 influenza virus infections in wild birds and poultry 87
9.1.2 Avian influenza virus infections in humans 89
9.2 Porcine Influenza 91
9.2.1 Influenza in pigs 91
9.2.2 Human cases of swine influenza virus infection 92
10 Literature 95
11 Acknowledgements 99
12 Appendix 102
-----------------------------------------------------------
Executive Summary
Results of the influenza surveillance of the Robert
Koch Institute are primarily based on the ana-
lysis of: (1) reports of primary care physicians
about patients with acute respiratory illnesses;
(2) data from laboratory tests of respiratory sam-
ples taken from patients with influenza-like ill-
ness; (3) virological data from state laboratories
of Baden-Wuerttemberg, Bavaria, Mecklenburg-
Western Pomerania, Saxonia, Saxony-Anhalt and
Thuringia; and (4) mandatory reporting of labo-
ratory confirmed influenza submitted by county
health departments via state health departments
to RKI; and (5) data from the internet platform
»GrippeWeb« based on syndromic reporting from
the general population about acute respiratory ill-
nesses.
The influenza wave of the season 2013/14 be-
gan relatively late in calendar week (CW) 8/2014
and ended in CW 14/2014. Among samples of
the sentinel first cases of influenza were laborato-
ry confirmed in CW 48/2013. Although laborato-
ry confirmed influenza occurred in the subsequent
weeks, the proportion of positive samples (positiv-
ity rate) rose above 20 % not before CW 8/2014.
The activity of acute respiratory disease had sur-
passed the epidemic threshold in week 5, but in
this season this first increase was caused mainly
by other respiratory viruses than influenza. The
expansion of the virological virus panel investigat-
ed in the sentinel (Influenza, RSV, Adeno-, Rhino-
and hMP-Viruses) contributed significantly to the
assessment of the influenza situation. Thus, the
influenza season begun in CW 08/2014, reaching
a peak in CW 10/2014 and ended in week 14/2014.
The number of estimated excess consultations dur-
ing the influenza epidemic (influenza-associated
consultations) was 780,000 (95 % confidence in-
terval (CI), 510,000–1,010,000). The estimated
number of influenza-associated sick certificates
(or certified need for care of patients, e.g. children,
who do not need a sick certificate for leave of ab-
sence) was 430,000 (95 % CI 260,000–600,000)
and the estimated number of influenza-associated
hospitalizations was 3100 (95 % CI 1700–4500).
The estimates for all three indicators showed only
one-tenth of the estimates for the severe 2012/13
season and placed the 2013/14 season at the low
end of the scale in comparison to the last thirteen
seasons.
The National Reference Center for Influen-
za (NIC) identified influenza A(H3N2) with 61 %
as the dominating virus subtype in the sentinel,
followed by A(H1N1)pdm09 with 30 % and B
with 9 %.
Genetic and antigenic characterization of cir-
culating viruses in Germany supported the recom-
mendation of WHO regarding the current vaccine
strains. Investigations on neuraminidase resis-
tance were also performed by the NIC and results
are described in detail in this report.
Within the more specific chapters results are
presented from the internet platform GrippeWeb
that was well able to trace the epidemic influenza
wave. Similarly, data from the SEEDARE project us-
ing case-based, ICD-coded information is analysed
in detail and presented in a specific chapter. To es-
timate the overall burden of influenza one would
also use influenza-associated deaths. Timely esti-
mation of influenza associated deaths is presented
from the federal state of Berlin in this report. Risk
groups for severe outcomes are considered in two
chapters: local health authorities participated in a
study regarding influenza outbreak management
in nursing homes for the elderly and pregnant
women were asked about factors influencing their
decision to get the influenza vaccine. The effective-
ness of the influenza vaccine was analyzed using
data from the virological sentinel surveillance and
results are presented.
For the influenza season 2014/15 the World
Health Organization (WHO) did not change its
recommendation of the vaccine for the Northern
hemisphere:
▶ Influenza A(H1N1) component: an A/Califor-
nia/7/2009 (H1N1)-like virus;
▶ Influenza A(H3N2) component: an A/Te-
xas/50/2012 (H3N2)-like virus;
▶ Influenza B component: a B/Massachusetts/2
/2012-like virus from the Yamagata lineage.
This report cites also the recommendations from
the German Standing Committee on Vaccination
(STIKO).
Lastly, in a chapter on zoonotic influenza the
present situation on avian and porcine influenza is
described, including the occurrence of human ill-
ness with avian A(H7N9) in China in spring 2013
and the re-occurrence in a second wave 2014.
--------------------------------------------------------------
(but I get an error, when downloading it)
----------OK, I have it now, RKI kindly sent it to me by email)
108 Seiten, 8.3MB
...
Inhaltsverzeichnis
1 Zusammenfassung 7
2 Einleitung 13
2.1 Ziel der Influenzasurveillance 13
2.2 Geschichte der AGI 14
2.3 Einbindung in internationale Netzwerke 14
3 Begriffs- und methodische Erläuterungen 17
4 Datenquellen und erhobene Daten 21
4.1 Syndromische Überwachung akuter respiratorischer Erkrankungen 21
4.2 Virologische Surveillance innerhalb des Sentinels der AGI 23
4.2.1 Daten des NRZ 23
4.2.2 Daten aus patientennaher virologischer Diagnostik 25
4.3 Daten der kooperierenden Landeslabors 25
4.4 Von den Gesundheitsämtern übermittelte Daten nach IfSG 25
5 Influenza-Überwachung in der Saison 2013/14 im Vergleich mit früheren Saisons 29
5.1 Ergebnisse der Surveillance (übermittelte Fälle gemäß IfSG) 29
5.2 Ergebnisse der Sentinel-Surveillance 30
5.2.1 Analyse der Konsultationsinzidenz und der Influenza-assoziierten Exzess-Konsultationen
nach Altersgruppen 35
5.2.2 Influenza-assoziierte Arbeitsunfähigkeit/Pflegebedürftigkeit nach Altersgruppen 38
5.2.3 Influenza-assoziierte Krankenhauseinweisungen nach Altersgruppen 39
5.3 Influenza-assoziierte Todesfallschätzungen 41
5.4 Internationale Situation in der Saison 2013/14 43
6 Weiterführende virologische Ergebnisse 45
6.1 Isolierte Viren 45
6.2 Antigene Charakterisierung der Influenzaviren 49
6.2.1 Influenza A(H1N1)pdm09-Viren 49
6.2.2 Influenza A(H3N2)-Viren 50
6.2.3 Influenza B-Viren 50
6.3 Molekulare Charakterisierung der Influenzaviren 51
6.3.1 Molekulare Analyse von Influenza A(H1N1)pdm09-Viren 51
6.3.2 Molekulare Analyse von Influenza A(H3N2)-Viren 51
6.3.3 Molekulare Analyse von Influenza B-Viren 51
6.4 Untersuchungen zur antiviralen Resistenz 58
7 Weitere Studien und Projekte des RKI zu Influenza 61
7.1 GrippeWeb – syndromische Surveillance akuter Atemwegserkrankungen auf Bevölkerungsebene 61
7.2 SEEDARE: Ergebnisse zur fallbasierten Auswertung von akuten respiratorischen Erkrankungen 65
7.2.1 Verteilung der Diagnosen für ARE 65
7.2.2 Patienten mit ICD-10-Codes für Grippe 66
7.2.3 Arbeitsunfähigkeit von Patienten mit einem ICD-10-Code für ARE 68
7.2.4 Krankenhauseinweisung von Patienten mit einem ICD-10-Code für ARE 70
7.3 Mortalitätssurveillance 73
7.3.1 Hintergrund 73
7.3.2 Mortalitätssurveillance in Berlin 73
7.4 Erfahrungen mit dem Management von Influenza-Ausbrüchen in Alten- und Pflegeheimen 74
7.4.1 Methoden 74
7.4.2 Ergebnisse 75
7.4.3 Diskussion 78
8 Influenza-Impfung 81
8.1 Zusammensetzung des Impfstoffs 81
8.2 Wirksamkeit der Impfung gegen saisonale Influenza ( Impfeffektivität) 81
8.3 Impfempfehlung für saisonale Influenza in der Saison 2014/15 83
8.4 Influenza-Impfverhalten schwangerer Frauen 84
9 Influenza als Zoonose 87
9.1 Aviäre Influenza 87
9.1.1 Influenzavirusinfektionen von Wildvögeln und Hausgeflügel 87
9.1.2 Aviäre Influenzavirusinfektionen des Menschen 89
9.2 Porcine Influenza 91
9.2.1 Influenza bei Schweinen 91
9.2.2 Humane Fälle mit Schweine influenzavirus-Infektion 92
10 Literaturhinweise 95
11 Danksagung 99
12 Anhang 102
---------------------------------------------------------------------
contents
1 Summary 7
2 Introduction 13
2.1 Purpose of Influenza Surveillance 13
2.2 History of AGI 14
2.3 Integration into international networks 14
3 definitions and methodological notes 17
4 Data sources and data collected 21
4.1 syndromic surveillance of acute respiratory diseases 21
4.2 Virological Surveillance within the Sentinels of AGI 23
4.2.1 Data of NRZ 23
4.2.2 Data from near-patient virological diagnostics 25
4.3 Data from the cooperating country laboratories 25
4.4 Information provided by the public health authorities according to data IfSG 25
5 Influenza Surveillance in the 2013-14 season compared with previous seasons 29
5.1 Results of Surveillance (submitted cases according IfSG) 29
5.2 Results of sentinel surveillance 30
5.2.1 Analysis of the consultation and incidence of influenza-associated excess consultations
by age group 35
5.2.2 Influenza-associated disability / long-term care by age group 38
5.2.3 Influenza-associated hospitalizations by age group 39
5.3 influenza-associated death estimates 41
5.4 The international situation in the season 2013/14 43
6 Further virological results 45
6.1 Isolated virus 45
6.2 antigens characterization of influenza viruses 49
6.2.1 Influenza A (H1N1) viruses pdm09 49
6.2.2 Influenza A (H3N2) viruses 50
6.2.3 Influenza B virus 50
6.3 Molecular characterization of influenza viruses 51
6.3.1 Molecular analysis of influenza A (H1N1) viruses pdm09 51
6.3.2 Molecular analysis of influenza A (H3N2) viruses 51
6.3.3 Molecular analysis of influenza B viruses 51
6.4 Studies on antiviral resistance 58
7 Further studies and projects of the RKI to influenza 61
7.1 GrippeWeb - syndromic surveillance of acute respiratory disease at the population level 61
SEEDARE 7.2: Results for case-based evaluation of acute respiratory diseases 65
7.2.1 Distribution of diagnoses for ARE 65
7.2.2 Patients with ICD-10 codes for influenza 66
7.2.3 disability of patients with an ICD-10 code for ARE 68
7.2.4 hospitalization of patients with an ICD-10 code for ARE 70
7.3 Mortality Surveillance 73
7.3.1 Background 73
7.3.2 Mortality Surveillance in Berlin 73
7.4 Experience with the management of influenza outbreaks in nursing homes 74
7.4.1 Methods 74
7.4.2 Results 75
7.4.3 Discussion 78
8 Influenza Vaccination 81
8.1 Composition of vaccine 81
8.2 Effectiveness of vaccination against seasonal influenza (vaccine effectivity) 81
8.3 recommendation for vaccination for seasonal influenza in the season 2014/15 83
8.4 influenza vaccination behavior of pregnant women 84
9 influenza as a zoonosis 87
9.1 Avian Influenza 87
9.1.1 influenza virus infections in wild birds and poultry 87
9.1.2 Avian influenza virus infections in humans 89
9.2 Porcine Influenza 91
9.2.1 Influenza in pigs 91
9.2.2 Human cases of swine influenza virus infection 92
10 Literature 95
11 Acknowledgements 99
12 Appendix 102
-----------------------------------------------------------
Executive Summary
Results of the influenza surveillance of the Robert
Koch Institute are primarily based on the ana-
lysis of: (1) reports of primary care physicians
about patients with acute respiratory illnesses;
(2) data from laboratory tests of respiratory sam-
ples taken from patients with influenza-like ill-
ness; (3) virological data from state laboratories
of Baden-Wuerttemberg, Bavaria, Mecklenburg-
Western Pomerania, Saxonia, Saxony-Anhalt and
Thuringia; and (4) mandatory reporting of labo-
ratory confirmed influenza submitted by county
health departments via state health departments
to RKI; and (5) data from the internet platform
»GrippeWeb« based on syndromic reporting from
the general population about acute respiratory ill-
nesses.
The influenza wave of the season 2013/14 be-
gan relatively late in calendar week (CW) 8/2014
and ended in CW 14/2014. Among samples of
the sentinel first cases of influenza were laborato-
ry confirmed in CW 48/2013. Although laborato-
ry confirmed influenza occurred in the subsequent
weeks, the proportion of positive samples (positiv-
ity rate) rose above 20 % not before CW 8/2014.
The activity of acute respiratory disease had sur-
passed the epidemic threshold in week 5, but in
this season this first increase was caused mainly
by other respiratory viruses than influenza. The
expansion of the virological virus panel investigat-
ed in the sentinel (Influenza, RSV, Adeno-, Rhino-
and hMP-Viruses) contributed significantly to the
assessment of the influenza situation. Thus, the
influenza season begun in CW 08/2014, reaching
a peak in CW 10/2014 and ended in week 14/2014.
The number of estimated excess consultations dur-
ing the influenza epidemic (influenza-associated
consultations) was 780,000 (95 % confidence in-
terval (CI), 510,000–1,010,000). The estimated
number of influenza-associated sick certificates
(or certified need for care of patients, e.g. children,
who do not need a sick certificate for leave of ab-
sence) was 430,000 (95 % CI 260,000–600,000)
and the estimated number of influenza-associated
hospitalizations was 3100 (95 % CI 1700–4500).
The estimates for all three indicators showed only
one-tenth of the estimates for the severe 2012/13
season and placed the 2013/14 season at the low
end of the scale in comparison to the last thirteen
seasons.
The National Reference Center for Influen-
za (NIC) identified influenza A(H3N2) with 61 %
as the dominating virus subtype in the sentinel,
followed by A(H1N1)pdm09 with 30 % and B
with 9 %.
Genetic and antigenic characterization of cir-
culating viruses in Germany supported the recom-
mendation of WHO regarding the current vaccine
strains. Investigations on neuraminidase resis-
tance were also performed by the NIC and results
are described in detail in this report.
Within the more specific chapters results are
presented from the internet platform GrippeWeb
that was well able to trace the epidemic influenza
wave. Similarly, data from the SEEDARE project us-
ing case-based, ICD-coded information is analysed
in detail and presented in a specific chapter. To es-
timate the overall burden of influenza one would
also use influenza-associated deaths. Timely esti-
mation of influenza associated deaths is presented
from the federal state of Berlin in this report. Risk
groups for severe outcomes are considered in two
chapters: local health authorities participated in a
study regarding influenza outbreak management
in nursing homes for the elderly and pregnant
women were asked about factors influencing their
decision to get the influenza vaccine. The effective-
ness of the influenza vaccine was analyzed using
data from the virological sentinel surveillance and
results are presented.
For the influenza season 2014/15 the World
Health Organization (WHO) did not change its
recommendation of the vaccine for the Northern
hemisphere:
▶ Influenza A(H1N1) component: an A/Califor-
nia/7/2009 (H1N1)-like virus;
▶ Influenza A(H3N2) component: an A/Te-
xas/50/2012 (H3N2)-like virus;
▶ Influenza B component: a B/Massachusetts/2
/2012-like virus from the Yamagata lineage.
This report cites also the recommendations from
the German Standing Committee on Vaccination
(STIKO).
Lastly, in a chapter on zoonotic influenza the
present situation on avian and porcine influenza is
described, including the occurrence of human ill-
ness with avian A(H7N9) in China in spring 2013
and the re-occurrence in a second wave 2014.
--------------------------------------------------------------