Kristin Tolksdorf

Zeitliche Trends in der Inzidenz und Sterblichkeit respiratorischerKrankheiten von hoher Public-Health-Relevanz in Deutschland

Erkrankungen der Atemwege und der Lunge sind weltweit wichtige Ursachen von Krankheitslast und Sterblichkeit. In Deutschland haben neben akuten respiratorischen Erkrankungen (ARE) vor allem chronische Lungenerkrankungen – darunter Lungenkrebs, chronisch obstruktive Lungenerkrankung (COPD) und Asthma bronchi ale – hohe gesellschaftliche und wirtschaftliche Bedeutung. ARE-Neuerkrankungsraten unterscheiden sich deutlich nach Alter, Jahreszeit und Jahr. Sie werden als wöchentliche Konsultationsinzidenz über ausgewählte Einrichtungen der ambulanten und stationären Versorgung erfasst. Zwischen 2009 und 2016 liegen die Neuerkrankungsraten im ambulanten sowie im stationären Bereich (für schwere Krankheitsverläufe, SARI) bei Kleinkindern mit Werten von bis zu 9,4 % bzw. 0,2 % am höchsten. Auch die ARE-Sterblichkeit unterliegt saisonalen und jähr lichen Schwankungen. Sie wird mit jährlich mehr als 17.000 Todesfällen über die amtliche Todesursachenstatistik nur unzureichend erfasst, da häufig ein vorbestehendes chronisches Grundleiden anstelle der akuten Infektion als zum Tode führende Ursache kodiert wird. Zusätzlich sind daher Einschätzungen der ARE-Übersterblichkeit im Zusammenhang mit Grippewellen notwendig. Bei Lungenkrebs, COPD und Asthma ist insbesondere die langfristige zeitliche Entwicklung des Neuerkrankungsund Sterbegeschehens von gesundheitspolitischem Interesse. Daten der amtlichen Todesursachenstatistik von 1998 bis 2015 zeigen, dass Sterberaten für Lungenkrebs und COPD bei Männern im Mittel um 1,8 % bzw. 1,1 % pro Jahr sanken, während sie bei Frauen um 2,5 % bzw. 2,3 % anstiegen. Dennoch starben im Jahre 2015 immer noch mehr Männer als Frauen an Lungenkrebs (29.378 vs. 15.881) bzw. COPD (17.300 vs. 13.773). Sterberaten für Asthma bronchiale sind im gleichen Zeitraum pro Jahr um durchschnittlich 8,3 % bei Frauen und 11,2 % bei Männern gesunken und dabei zuletzt auf 659 Todesfälle bei Frauen und 393 bei Männern zurückgegangen. Neuerkrankungsraten für Lungenkrebs bewegen sich ab 1998 auf fast gleichem Niveau wie die Sterberaten. Für COPD und Asthma sind keine entsprechenden Daten verfügbar. Ausbau und Verstetigung von koordinierten Surveillance-Aktivitäten zu respiratorischen Krankheiten im Rahmen internationaler Aktionspläne zur Krankheitsprävention sind notwendig. RESPIRATORISCHE ERKRANKUNGEN · LUNGENERKRANKUNGEN · INZIDENZ · MORTALITÄT · SURVEILLANCE Journal of Health Monitoring Zeitliche Trends in der Inzidenz und Sterblichkeit respiratorischer Krankheiten von hoher Public-Health-Relevanz in Deutschland

Laboratory investigations of vaccinated patients with varicella

BACKGROUND Accompanying varicella vaccination in children in Germany recommended with one (2004) and two (2009) doses, sentinel surveillance of varicella with a sample (n∼900) of private physicians was established in 2005. Physicians reported monthly aggregated data on all varicella cases and case-based on vaccinated patients, of whom skin lesion samples were laboratory investigated to identify varicella-zoster virus (VZV). We analyzed the impact of vaccination frequency on the number of cases and on laboratory results within the sentinel. METHODS Swabs were obtained with a Teflon tip and sent together with a case-based questionnaire to the reference laboratory. VZV wild-type and vaccine-type was identified by polymerase chain-reaction (PCR) and pyrosequencing methods. Case-based data and laboratory results were analyzed descriptively. RESULTS From April 2005 to March 2014, of all monthly reported cases (n=111,456) 4789 were vaccinated and eligible for further analysis. No differences were found between laboratory investigated and not investigated cases (1017 vs. 3772) except that the proportion of cases vaccinated twice was higher in lab-cases (29.4% vs. 16.1%). PCR remained negative in 69.6% (197/283) of breakthrough-cases vaccinated twice, in comparison to 22.7% (147/649) breakthrough-cases vaccinated once. VZV was confirmed in 500 (81) patients with breakthrough varicella after one (two) vaccination(s); identification of VZV wild-type, vaccine-type, or no further differentiation was possible in 485 (72), 5 (6), and 10 (3) cases, respectively. CONCLUSION Varicella breakthrough disease is rare in Germany and suspected clinical cases require laboratory confirmation. The lower confirmation rate of VZV after two vaccine doses suggests a better protection compared to one dose.

Trends in herpes zoster epidemiology in Germany based on primary care sentinel surveillance data, 2005–2016

ABSTRACT Herpes zoster (HZ) is caused by reactivation of the varicella-zoster-virus (VZV). Childhood varicella vaccination, as recommended in Germany in 2004, may reduce the risk of HZ in vaccinated children but also virus circulation and thus the booster possibility of latent infected persons. In this context we analyzed age-specific trends in HZ epidemiology in Germany using data on HZ-associated outpatient consultations in participating sentinel sites and HZ-associated cases in all hospitals since 2005. We analyzed two separate time periods that differed in sentinel management and data integrity. For the period 2005–2010, we found a decrease in HZ-associated outpatient consultations in 1- to 4-year-olds (IRR = 0.72, 95%CI 0.63-0.81, p<0.001). For the period 2013–2016, we observed a decrease in HZ-associated outpatient consultations in 10- to 14-year-olds (IRR = 0.85, 95%CI 0.78-0.93, p<0.01). Moreover, we detected an increase in the age groups 20 years and older except for the group 30–39 years. HZ-associated hospitalizations showed similar trends for the second time period (here 2012–2015). The decrease in HZ-associated outpatient consultations and hospitalizations in children started and continued over cohorts eligible for varicella vaccination and could be a result of their reduced HZ-risk. Whether the observed steady increasing HZ incidences for adults are associated with the varicella vaccination in children remains unclear and could not be investigated with our data.

Infektionskrankheiten und ihre Codierung

ZusammenfassungDie Revision der Internationalen statistischen Klassifikation der Krankheiten und verwandter Gesundheitsprobleme (International Classification of Diseases – ICD) geht mit grundlegenden Änderungen der Morbiditäts- und Mortalitätsstatistik einher, die auch den Bereich der Infektionskrankheiten betreffen. Die Zuordnung der einzelnen Infektionskrankheiten zu den Kapiteln in der aktuellen ICD-10 erfolgt aufgrund unterschiedlicher Konzepte, teilweise nach auslösendem Agens, nach betroffenem Organsystem oder nach Lebensperiode. Besondere Herausforderungen der Klassifizierung der Infektionskrankheiten bestehen u. a. darin, dass regelmäßig ein Anpassungsbedarf durch neu auftretende Erreger entstehen kann. Außerdem reichen die Angaben hinsichtlich Umfang und Tiefe in der ICD-10 teilweise nicht aus, um epidemiologische Auswertungen der Daten durchzuführen.Die ICD ermöglicht den weltweiten Vergleich von Statistiken zu Infektionskrankheiten. Zunehmend wird die ICD jedoch auch für die Erhebung von Surveillance- und Forschungsdaten eingesetzt, z. B. im Rahmen des Meldewesens (Identifizierung von Meldetatbeständen), aber auch in der syndromischen Surveillance akuter Atemwegsinfektionen und für den Aufbau neuer Surveillance-Systeme sowie der Evaluation der Datenqualität durch Abgleich mit Sekundärdaten.Die Chancen der ICD-11 liegen vor allem darin, dass Infektionskrankheiten eindeutiger codiert werden können und ihre Codierung mehr relevante Informationen für die epidemiologische Bewertung enthält. Durch die hohe Komplexität können jedoch Verzerrungen in den Daten entstehen, die die Fortschreibung der Morbiditäts- und Mortalitätsstatistiken erschweren.AbstractThe revision of the International Classification of Diseases (ICD) could change morbidity and mortality statistics significantly, which also affects the area of infectious diseases. Infectious diseases are classified according to their etiology, affected body system or the life period during which the episode occurs. Specific challenges arise from emerging pathogens and the respective necessary adaptation. For epidemiologic analysis ICD-10 does not always offer enough additional information.ICD provides the basis for international comparison of infectious disease morbidity and mortality statistics, but it is also used to collect data for surveillance and research purposes, e. g. the notification system for infectious diseases, syndromic surveillance systems and the evaluation of data quality by using secondary data sources.ICD-11 offers the chance to better represent epidemiological concepts of infectious diseases by adding more relevant information as affected body system or manifestation. Due to the complexity of coding, ensuring continuity of morbidity and mortality statistics could be challenging.The revision of the International Classification of Diseases (ICD) could change morbidity and mortality statistics significantly, which also affects the area of infectious diseases. Infectious diseases are classified according to their etiology, affected body system or the life period during which the episode occurs. Specific challenges arise from emerging pathogens and the respective necessary adaptation. For epidemiologic analysis ICD-10 does not always offer enough additional information.ICD provides the basis for international comparison of infectious disease morbidity and mortality statistics, but it is also used to collect data for surveillance and research purposes, e. g. the notification system for infectious diseases, syndromic surveillance systems and the evaluation of data quality by using secondary data sources.ICD-11 offers the chance to better represent epidemiological concepts of infectious diseases by adding more relevant information as affected body system or manifestation. Due to the complexity of coding, ensuring continuity of morbidity and mortality statistics could be challenging.

Time trends in incidence and mortality of respiratory diseases ofhigh public health relevance in Germany

Respiratory diseases are major causes of disease burden and mortality throughout the world. In Germany, alongside acute respiratory infections (ARI), chronic lung diseases – including lung cancer, chronic obstructive pulmonary disease (COPD), and asthma – are of particular socioeconomic importance. ARI incidence rates differ significantly according to age, season and year. They are recorded as weekly consultation rates as reported by selected outpatient and inpatient care facilities. Between 2009 and 2016, the highest incidence rates of severe acute respiratory infection (SARI) were recorded among young children in outpatient (9.4%) and inpatient (0.2%) care. Mortality rates for ARI are also subject to seasonal and annual fluctuations. However, the official statistics on causes of death, which lead to estimates of more than 17,000 annual deaths, provide an inadequate measure of death rates because chronic underlying illnesses are often recorded as the cause of death rather than a more recently acquired acute infection. Therefore, the excess mortality caused by ARI needs to be assessed in the context of influenza outbreaks. Regarding lung cancer, COPD and asthma, the long-term time trends in disease incidence and mortality rates are of particular interest from a health policy perspective. Analyses of data from the official statistics on causes of death for the years 1998 through 2015 show that mortality rates for lung cancer and COPD decreased on average by 1.8% and 1.1% per year respectively, among men, whereas among women they increased by 2.5% (lung cancer) and 2.3% (COPD) annually. Nevertheless, more men than women died of lung cancer or COPD in 2015 in Germany: 29,378 men and 15,881 women died from lung cancer, and 17,300 men and 13,773 women died from COPD. During the same period, the asthma mortality rates decreased on average by 8.3% annually among women and by 11.2% annually among men, and the absolute number of deaths came down to 659 among women and 393 among men. Lung cancer incidence rates have been at similar levels as lung cancer death rates since 1998. No such data are available on time trends in COPD or asthma incidence rates. Coordinated surveillance of respiratory diseases needs to be expanded within the framework of international action plans for disease prevention. RESPIRATORY DISEASES · LUNG DISEASES · INCIDENCE · MORTALITY · SURVEILLANCE Journal of Health Monitoring · 2017 2(3) DOI 10.17886/RKI-GBE-2017-061 Robert Koch Institute, Berlin Authors: Henriette Steppuhn*, Silke Buda*, Antje Wienecke*, Klaus Kraywinkel, Kristin Tolksdorf, Jörg Haberland, Detlef Laußmann, Christa Scheidt-Nave *contributed equally