Hesse State Health Office

Dillenburg, Germany

Hesse State Health Office

Dillenburg, Germany
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Diercke M.,Governmental Institute of Public Health of Lower Saxony | Diercke M.,Robert Koch Institute RKI | Kirchner M.,Governmental Institute of Public Health of Lower Saxony | Claussen K.,Governmental Institute of Public Health of Lower Saxony | And 5 more authors.
Epidemiology and Infection | Year: 2014

SUMMARY We investigated a cluster of shiga toxin-producing Escherichia coli (STEC) O104:H4 infections after a family party during a large STEC O104:H4 outbreak in Germany. To identify the vehicle we conducted a retrospective cohort study. Stool samples of party guests, and food and environmental samples from the catering company were tested for STEC. We defined cases as party guests with gastrointestinal symptoms and laboratory-confirmed STEC infection. We found 23 cases among 71 guests. By multivariable analysis consumption of salmon [odds ratio (OR) 15, 95% confidence interval (CI) 2·3-97], herb cream (OR 6·5, 95% CI 1·3-33) and bean salad (OR 6·1, 95% CI 1·4-26) were associated with STEC infection. STEC O104:H4 was detected in samples of bell pepper and salmon. The food handler developed STEC infection. Our results point towards transmission via several food items contaminated by a food handler. We recommend regular education of food handlers emphasizing their role in transmitting infectious diseases. © Cambridge University Press 2013.


Fullerton K.E.,Centers for Disease Control and Prevention | Kirk M.D.,Australian National University | Mahon B.E.,Centers for Disease Control and Prevention | Angulo F.J.,Centers for Disease Control and Prevention | And 6 more authors.
Foodborne Pathogens and Disease | Year: 2012

Epidemiologists have used case-control studies to investigate enteric disease outbreaks for many decades. Increasingly, case-control studies are also used to investigate risk factors for sporadic (not outbreak-associated) disease. While the same basic approach is used, there are important differences between outbreak and sporadic disease settings that need to be considered in the design and implementation of the case-control study for sporadic disease. Through the International Collaboration on Enteric Disease "Burden of Illness" Studies (the International Collaboration), we reviewed 79 case-control studies of sporadic enteric infections caused by nine pathogens that were conducted in 22 countries and published from 1990 through to 2009. We highlight important methodological and study design issues (including case definition, control selection, and exposure assessment) and discuss how approaches to the study of sporadic enteric disease have changed over the last 20 years (e.g., making use of more sensitive case definitions, databases of controls, and computer-assisted interviewing). As our understanding of sporadic enteric infections grows, methods and topics for case-control studies are expected to continue to evolve; for example, advances in understanding of the role of immunity can be used to improve control selection, the apparent protective effects of certain foods can be further explored, and case-control studies can be used to provide population-based measures of the burden of disease. © Copyright 2012, Mary Ann Liebert, Inc. 2012.


Arvand M.,Division for Applied Infection Control and Hospital Hygiene | Ruscher C.,Division for Applied Infection Control and Hospital Hygiene | Bettge-Weller G.,Hesse State Health Office | Goltz M.,Regional Health Office | Pfeifer Y.,Robert Koch Institute
Journal of Hospital Infection | Year: 2017

Background: Rehabilitation clinics may vary widely in terms of type of care provided, duration of hospital stay, and case severity. Few data are available on prevalence of Clostridium difficile or extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) colonization in rehabilitation clinics in Germany. Aim: This study investigated the frequency of intestinal colonization by these pathogens among patients in rehabilitation clinics of different specialization. Methods: In the scope of a point prevalence study, faecal samples and demographic and clinical data were collected in five rehabilitation clinics. Samples were screened for C. difficile and ESBL-E by culture. Isolates were characterized by polymerase chain reaction for C. difficile toxins A and B, for β-lactamase genes, and by molecular typing including pulsed-field gel electrophoresis and PCR-based ribotyping. Findings: Of 305 patients screened, 11.1% were colonized by toxigenic C. difficile and 7.5% by ESBL-E. Colonization rates differed markedly between facilities, ranging from 1.6% to 26.3% for C. difficile and from zero to 23.7% for ESBL-E. Prevalence of colonization by C. difficile and ESBL-E was higher in neurological rehabilitation clinics than in clinics with other specialties (P <. 0.001). Molecular typing revealed six patients from one neurological rehabilitation clinic harbouring a unique C. difficile strain (ribotype 017). CTX-M-15 was the most prevalent ESBL type. We detected several indistinguishable pairs of ESBL-E isolates within some facilities. Conclusion: Significant differences were found in the prevalence of C. difficile and ESBL-E between rehabilitation clinics. Facilities providing specialized medical care for critically ill patients had higher prevalence rates. These results may help to delineate the requirements for infection prevention and control in rehabilitation clinics. © 2017 The Healthcare Infection Society.


Mazick A.,Statens Serum Institute | Gergonne B.,The National Board of Health and Welfare | Nielsen J.,Statens Serum Institute | Wuillaume F.,Scientific Institute of Public Health | And 13 more authors.
Eurosurveillance | Year: 2012

In February and March 2012, excess deaths among the elderly have been observed in 12 European countries that carry out weekly monitoring of all-cause mortality. These preliminary data indicate that the impact of influenza in Europe differs from the recent pandemic and post-pandemic seasons. The current excess mortality among the elderly may be related to the return of influenza A(H3N2) virus, potentially with added effects of a cold snap. ©2007-2011. All rights reserved.


Uphoff H.,Hesse State Health Office | Hedrich B.,Public Health Authority | Strotmann I.,Public Health Authority | Arvand M.,Hesse State Health Office | And 2 more authors.
Journal of Public Health (Germany) | Year: 2014

Aim: During a large outbreak of Shiga toxin-producing Escherichia coli (STEC) O104:H4 in Germany 2011 caused by Fenugreek sprouts, 56 cases of haemolytic uraemic syndrome (HUS) and 124 cases of STEC were notified in Hesse. Almost 50% of these cases were linked to six clusters. Timely identification of vehicles was warranted to halt the outbreak. Subject and methods: A retrospective cohort study was conducted. The description of this cluster investigation exemplarily addresses short-comings and obstacles to the prompt identification of outbreak sources. Results: The only uncooked food item which could explain all cases was a salad containing radish sprouts. A second cluster probably related to the consumption of radish sprouts was discovered, raising the count to 4 HUS and 3 STEC-cases for both clusters. The backtracking of the radish sprouts shortly after the source farm had been publicly mentioned, as probably implicated in the outbreak, provided an early support of this hypothesis. Conclusion: In contrast to the Fenugreek sprouts mentioned with other clusters, Radish sprouts were identified as the most probable source of the two clusters, indicating cross contamination at production. This investigation revealed several hitherto known but still not sufficiently addressed deficits such as a need for earlier mobilization of additional laboratory capacities, better documentation and sharing of information, better use of modern communication systems and data sources, clear responsibilities, early indication if support is needed, structured and intensified retrieval of possible common exposures, more resources to follow all traces at short notice. © Springer-Verlag 2013.


Hauri A.M.,Hesse State Health Office | Westbrock H.-J.,Hesse State Health Office | Claus H.,Robert Koch Institute | Geis S.,Hesse State Health Office | And 4 more authors.
PLoS ONE | Year: 2011

Background: In Germany, surveillance for infectious disease outbreaks is integrated into an electronic surveillance system. For 2007, the national surveillance database contains case-based information on 201,224 norovirus cases, three-quarters of which are linked to outbreaks. We evaluated the data quality of the national database in reflecting nosocomial norovirus outbreak (NNO) data available in 19 Hessian local public health authorities (LPHAs) and the influence of differences between LPHA's follow-up procedures for laboratory notifications of Norovirus positive stool samples on outbreak underascertainment. Methods: Data on NNO beginning in 2007 and notified to the 19 LPHAs were extracted from the national database, investigated regarding internal validity and compared to data collected from LPHAs for a study on NNO control. LPHAs were questioned whether they routinely contacted all persons for whom a laboratory diagnosis of norovirus infection was notified. The number of outbreaks per 1,000 hospital beds and the number of cases within NNOs for acute care and rehabilitation hospitals were compared between counties with and without complete follow-up. Results: The national database contained information on 155 NNOs, including 3,115 cases. Cases were missed in the national database in 58 (37%) of the outbreaks. Information on hospitalisation was incorrect for an estimated 47% of NNO cases. Information on county of infection was incorrect for 24% (199/820) of cases being forwarded between LPHAs for data entry. Reported NNO incidence and number of NNO cases in acute care hospitals was higher in counties with complete follow-up (incidence-rate ratio (IRR) 2.7, 95% CI 1.4-5.7, p-value 0.002 and IRR 2.1, 95% CI 1.9-2.4, p-value 0.001, respectively). Conclusions: Many NNOs are not notified by hospitals and differences in LPHA procedures have an impact on the number of outbreaks captured in the surveillance system. Forwarding of case-by-case data on Norovirus outbreak cases from the local to the state and national level should not be required. © 2011 Hauri et al.


Hauri A.M.,Hesse State Health Office | Gotsch U.,Public Health Authority | Strotmann I.,Public Health Authority | Krahn J.,Public Health Authority | And 4 more authors.
Eurosurveillance | Year: 2011

During the recent outbreak of Shiga toxin-producing Escherichia coli (STEC) O104:H4 in Germany most cases notified in the State of Hesse (6 million inhabitants) were linked to satellite clusters or had travelled to the outbreak area in northern Germany. Intensified surveillance was introduced to rapidly identify cases not linked to known clusters or cases and thus to obtain timely information on possible further contaminated vehicles distributed in Hesse, as well to describe the risk of secondary transmission among known cases. As of 21 July 2011, 56 cases of haemolytic uraemic syndrome (HUS) including two fatal cases, and 124 cases of STEC gastroenteritis meeting the national case definitions have been reported in Hesse. Among the 55 HUS and 81 STEC gastroenteritis cases that met the definition for the ongoing outbreak, one HUS case and eight STEC gastroenteritis cases may have acquired their infection through secondary transmission. They include six possible transmissions within the family, two possible nosocomial and one possible laboratory transmission. Our results do not suggest an increased transmissibility of the outbreak strain compared to what is already known about E. coli O157 and other STEC serotypes.


Hauri A.M.,Hesse State Health Office | Hofstetter I.,Public Health Authority Darmstadt Dieburg | Seibold E.,National Reference Laboratory for Tularemia | Kaysser P.,National Reference Laboratory for Tularemia | And 4 more authors.
Emerging Infectious Diseases | Year: 2010

In November 2005, an outbreak of tularemia occurred among 39 participants in a hare hunt in Hesse, Germany. Previously reported tularemia outbreaks in Germany dated back to the 1950s. We conducted a retrospective cohort study among participants and investigated the environment to identify risk factors for infection. Ten participants had serologic evidence of acute Francisella tularensis infection; 1 other participant died before laboratory confirmation was obtained. Presence within 5 meters of the place where disemboweled hares were rinsed with a water hose was the risk factor most strongly associated with infection (risk ratio 22.1; 95% confidence interval 13.2-154.3). Swabs taken at the game chamber and water samples were PCR negative for F. tularensis. Eleven of 14 hare parts showed low-level concentrations of F. tularensis, compatible with cross-contamination. More than half of case-patients may have acquired infection through inhalation of aerosolized droplets containing F. tularensis generated during rinsing of infected hares.


Fitzenberger J.,Hesse State Health Office
Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin | Year: 2010

Campylobacter infection is the most common cause of bacterial gastroenteritis worldwide. This study examines the association between campylobacteriosis incidence and degree of urbanicity in Hesse, Germany, by age and Campylobacter species. During a one-year period (July 2005-June 2006), Hessian local health authorities provided information on municipality of residence for 3,315 campylobacteriosis cases. We calculated age- and Campylobacter species-specific incidences for six levels of urbanicity, as defined by population density and accessibility of centres. For children under five years old, living in inner rural areas (incidence rate ratio (IRR): 2.9; 95% confidence interval (CI): 1.9 to 4.4) and for children aged 5-14 years living in inner rural (IRR: 2.1; 95% CI: 1.3 to 3.1) or intermediate areas (inner intermediate area IRR: 1.8; 95% CI: 1.2 to 2.7; outer intermediate area IRR: 2.1; 95% CI: 1.3 to 3.3) was associated with a statistically significantly higher campylobacteriosis risk (reference category: inner urban area). Calculations by Campylobacter species showed a higher risk of gastroenteritis due to C. coli for inhabitants (all ages) of non-urban areas. This study suggests that differences in risk factors by age, Campylobacter species and degree of urbanicity do exist. For children contact with animals or the environment may be responsible for a substantial proportion of sporadic Campylobacter infections.


PubMed | Hesse State Health Office
Type: Journal Article | Journal: European journal of microbiology & immunology | Year: 2013

The quality of water from dental units is of considerable importance since patients and dental staff are regularly exposed to water and aerosols generated from the dental unit. This study analyzed the microbial quality of water obtained for periodical monitoring from 56 dental units in different dental practices in Hesse. Contamination by Legionella spp., Pseudomonas aeruginosa, and increased total colony counts were detected in 27.8%, 3.5%, and 17% of samples. Legionella pneumophila serogroup 1 accounted for 28% of Legionella isolates. The Legionella concentration was >100 cfu/100 ml in 84% of contaminated samples. Samples collected from an instrument channel were more frequently contaminated by Legionella than those from cup filler (41.7% vs. 18.6%, p = 0.02). After release of these results, decontamination measures were performed in units that had revealed unsatisfactory results. The outcome of the intervention was followed-up by microbiological analysis. At follow-up, 65.2% and 72.7% of waterlines that had previously been contaminated by Legionella or had shown increased total colony counts were free of contamination. Our results show a high rate of contamination of water from dental units in dental practices in Hesse. They highlight the risk of exposure for patients and personnel and the need for effective strategies to reduce microbial contamination.

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