Contamination during production of heater-cooler units by Mycobacterium chimaera potential cause for invasive cardiovascular infections: results of an outbreak investigation in Germany, April 2015 to February 2016
Haller S.,Robert Koch Institute RKI
Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin | Year: 2016
Invasive infections with Mycobacterium chimaera were reported in patients with previous open chest surgery and exposure to contaminated heater-cooler units (HCUs). We present results of the surveillance of clinical cases and of contaminated HCUs as well as environmental investigations in Germany up until February 2016. Clinical infections occurred in five male German cases over 50 years of age (range 53-80). Cases had been exposed to HCUs from one single manufacturer during open chest surgery up to five years prior to onset of symptoms. During environmental investigations, M. chimaera was detected in samples from used HCUs from three different countries and samples from new HCUs as well as in the environment at the manufacturing site of one manufacturer in Germany. Our investigation suggests that at least some of the M. chimaera infections may have been caused by contamination of HCUs at manufacturing site. We recommend that until sustainable measures for safe use of HCUs in operation theatres are implemented, users continue to adhere to instructions for use of HCUs and Field Safety Notices issued by the manufacturer, implement local monitoring for bacterial contamination and continuously check the websites of national and European authorities for current recommendations for the safe operation of HCUs.
Fasel D.,University of Basel |
Mellmann A.,University of Munster |
Cernela N.,University of Zürich |
Hachler H.,University of Zürich |
And 7 more authors.
Journal of Clinical Microbiology | Year: 2014
We report on a 65-year-old male patient with a Shiga toxin-producing Escherichia coli O51:H49 gastrointestinal infection and sepsis associated with hemolytic uremic syndrome (HUS) with a fatal outcome. The strains isolated harbored stx2e and eae, a very unusual and new virulence profile for an HUS-associated enterohemorrhagic E. coli. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
Delere Y.,Robert Koch Institute RKI |
Bohmer M.M.,Robert Koch Institute RKI |
Bohmer M.M.,Robert Koch Institute |
Walter D.,Robert Koch Institute RKI |
Wichmann O.,Robert Koch Institute RKI
Human Vaccines and Immunotherapeutics | Year: 2013
Objective: Routine immunization of adolescent girls aged 12-17 y against human papillomavirus (HPV) was recommended in Germany in March 2007. We aimed to assess HPV-vaccine uptake and knowledge about post-vaccination cervical cancer screening and condom use in women aged 18-20 years, three years after adoption of HPV-vaccination into the routine vaccination schedule. Results: Overall 2,001 females participated in our study. Of these, 49% reported receipt of a complete three-dose course of HPV-vaccines; 11% received 1 or 2 doses. Living in East Germany, high educational status, and interest in healthrelated issues were independently associated with HPV-vaccination. Misconceptions among survey-participants were rare: Only 8% believed that HPV-vaccination would obviate the need for cervical screening and 1% that condom use would be dispensible after vaccination. Methods: In 2010, a nationwide cross-sectional telephone-survey was performed among randomly-selected women aged 18-20 years living in Germany. Telephone interviews were conducted by a large professional market research institute as part of a daily omnibus survey. Conclusion: HPV-vaccination coverage is low in Germany. The results indicate that there is an urgent need for the implementation of a coordinated adolescent vaccination program to facilitate access to vaccination, including balanced information tailored to this age group. Otherwise, the HPV-vaccination effort will fall short of reaching its maximum public health benefit. © 2013 Landes Bioscience.
Cnops L.,Institute of Tropical Medicine |
Domingo C.,Robert Koch Institute RKI |
Van den Bossche D.,Institute of Tropical Medicine |
Vekens E.,Medisch Labo Medina |
And 2 more authors.
Journal of Clinical Virology | Year: 2014
We report a dengue virus (DENV) co-infection in a Belgian traveler after a three-weeks holiday to Thailand. The patient recovered well without any complication. The infection was diagnosed by NS1 antigen testing and the concurrent presence of serotype DENV1 and DENV2 was demonstrated by reverse transcriptase polymerase chain reaction (RT-PCR) in acute phase serum sampled three days after symptoms onset. The predominant DENV1 serotype was identified as genotype I, lineage Asia-3 by sequencing. To our knowledge, this is the first time that a dengue co-infection is reported in a European traveler. The co-infection accounts for 1.0% of the total number of RT-PCR-positive samples (n=105) diagnosed in the reference laboratory of Belgium between 2008 and 2013. We expect that the number of reports on acute co-infections will increase in the coming years considering the increasing number of regions that are progressively becoming hyperendemic, especially in Southeast Asia. © 2014 Elsevier B.V.
Schielke A.,Robert Koch Institute RKI |
Rosner B.M.,Robert Koch Institute RKI |
Stark K.,Robert Koch Institute RKI
BMC Infectious Diseases | Year: 2014
Background: Campylobacteriosis caused by Campylobacter spp. is the most common notifiable bacterial gastrointestinal disease in Germany and a major problem in many other European countries as well. In contrast to other infectious diseases, e.g., salmonellosis, the annual number of notified campylobacteriosis cases has increased in Germany and other European countries from 2001-2010. Methods: National surveillance data from 2001 through 2010 were the basis of a detailed description of the epidemiological pattern of Campylobacter infections in Germany. Special focus was placed on geographical distribution and time trends of Campylobacter infections as well as the identification of risk groups. Results: In total, 588,308 cases of campylobacteriosis were recorded during the observed time period. The mean annual incidence increased from 67 cases/100,000 population in 2001 to 80/100,000 population in 2010. Almost 92% of the notified Campylobacter infections were acquired in Germany. A seasonal distribution was observed with a large peak in the summer months and a small peak in January. Incidence was highest in children ≤4 years and young adults 20-29 years of age. Especially young children living in rural regions in Germany seemed to be at high risk of Campylobacter infection. Conclusions: Campylobacter is the leading cause of bacterial gastroenteritis in Germany, and has been of rising public health concern. There is a need for enhanced prevention of Campylobacter infections and the data presented here may contribute to better target prevention measures with focus on identified risk groups such as children and young adults. © 2014 Schielke et al.; licensee BioMed Central Ltd.
Mall S.,NRW Institute of Health and Work |
Buchholz U.,Robert Koch Institute RKI |
Tibussek D.,Heinrich Heine University Düsseldorf |
Jurke A.,NRW Institute of Health and Work |
And 4 more authors.
Pediatric Infectious Disease Journal | Year: 2011
Background: Benign acute childhood myositis (BACM) is a rare syndrome associated with various viral infections. Bilateral calve pain may lead to inability to walk. During winter 2007/2008, we investigated a nationwide outbreak of influenza-associated BACM (IA-BACM) to identify etiologic (sub)type, describe the course of disease, and explore how well the syndrome is known among physicians. Methods: We performed retrospective and prospective case finding in all German federal states. Physicians returned patient-based questionnaires containing information about sex, age, disease progression, patient-management, and number of BACM cases treated previously. We compared IA-BACM cases with influenza cases from the German virologic sentinel surveillance system for influenza. Results: We investigated 219 children with IA-BACM. They coincided with the curve of influenza B of the German virologic sentinel surveillance system for influenza. Median age was 7 years, 74% (160/216) of cases were male, median time between the onset of fever and onset of BACM-symptoms was 3 days lasting for a median of 4 days. Almost half of the affected children had presented at hospitals. One case with beginning renal impairment occurred, but the patient recovered completely. Most reporting physicians had not seen BACM-patients previously. Multivariable analysis showed IA-BACM's strong association with influenza B, male sex, and age between 6 and 9 years. Conclusions: Influenza B caused a large BACM outbreak in Germany. Onset of BACM symptoms followed shortly after the onset of influenza symptoms. The course of this disease was almost exclusively mild and self-limiting. Diagnosis of this rare but distinct clinical entity by the alert physician can spare the patient potentially unneeded invasive testing and hospital admission. © 2011 Lippincott Williams & Wilkins.
Alexandrov T.,University of Bremen |
Alexandrov T.,Steinbeis Innovation Center |
Lasch P.,Robert Koch Institute RKI
Analytical Chemistry | Year: 2013
Over the past decade, confocal Raman microspectroscopic (CRM) imaging has matured into a useful analytical tool to obtain spatially resolved chemical information on the molecular composition of biological samples and has found its way into histopathology, cytology, and microbiology. A CRM imaging data set is a hyperspectral image in which Raman intensities are represented as a function of three coordinates: a spectral coordinate λ encoding the wavelength and two spatial coordinates x and y. Understanding CRM imaging data is challenging because of its complexity, size, and moderate signal-to-noise ratio. Spatial segmentation of CRM imaging data is a way to reveal regions of interest and is traditionally performed using nonsupervised clustering which relies on spectral domain-only information with the main drawback being the high sensitivity to noise. We present a new pipeline for spatial segmentation of CRM imaging data which combines preprocessing in the spectral and spatial domains with k-means clustering. Its core is the preprocessing routine in the spatial domain, edge-preserving denoising (EPD), which exploits the spatial relationships between Raman intensities acquired at neighboring pixels. Additionally, we propose to use both spatial correlation to identify Raman spectral features colocalized with defined spatial regions and confidence maps to assess the quality of spatial segmentation. For CRM data acquired from midsagittal Syrian hamster (Mesocricetus auratus) brain cryosections, we show how our pipeline benefits from the complex spatial-spectral relationships inherent in the CRM imaging data. EPD significantly improves the quality of spatial segmentation that allows us to extract the underlying structural and compositional information contained in the Raman microspectra. © 2013 American Chemical Society.
Lasch P.,Robert Koch Institute RKI
Chemometrics and Intelligent Laboratory Systems | Year: 2012
Recent years have seen substantial progress toward the application of infrared (IR) and Raman spectroscopy as useful analytical tools in biomedical research. Vibrational spectroscopy, and (in particular) microspectroscopy, have been successfully applied to biomedical samples ranging from intact microorganisms, eukaryotic cells, body fluids, and tissues. The progress in the field was driven not only by technical developments but also by the effective implementation of modern concepts of spectral analysis.Pre-processing has been identified as an indispensable part of spectral data analysis. It involves, among others, outlier rejection, normalization, filtering, detrending, transformation, folding and feature selection. Goals of spectral pre-processing include better interpretability of the spectra, higher robustness and improved accuracy of subsequent quantitative or classification analysis. The aim of this review article is to explore the concepts and techniques of a variety of individual pre-processing methods and to discuss the applicability of different pre-processing techniques in the context of practical applications of biomedical IR or Raman spectroscopy. It is hoped that this article not only represents a useful guideline for beginners in the field of biomedical applications of vibrational spectroscopy, but serves also as a source of reference for more experienced spectroscopists. © 2012 Elsevier B.V.
Stark K.,Robert Koch Institute RKI |
Schoneberg I.,Robert Koch Institute RKI
Eurosurveillance | Year: 2012
A significant increase of malaria cases imported to Germany from Pakistan was observed in 2012. As of 14 November, Pakistan was the country of infection in 32 out of 434 malaria cases in 2012, compared to zero to eight annual malaria cases (out of over 500 cases) in previous years. Physicians and public health authorities should consider malaria in febrile patients returning or migrating from Pakistan. © 2007-2011. All rights reserved.
Karo B.,Robert Koch Institute RKI |
Hauer B.,Robert Koch Institute RKI |
Hollo V.,Centers for Disease Control and Prevention |
Van der Werf M.J.,Centers for Disease Control and Prevention |
And 2 more authors.
Eurosurveillance | Year: 2015
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 and 2011, and to identify factors associated with unsuccessful treatment. Only 18 countries reported information on TO for the whole observation period accounting for 250,854 new culture-confirmed pulmonary TB cases. The 85% target of TSR was not reached in any year between 2002 and 2011 and was on average 78%. The TSR for multidrug-resistant (MDR)-TB cases at 24-month follow-up was 49%. In the multivariable regression model, unsuccessful treatment was significantly associated with increasing age (odds ratio (OR) = 1.02 per a one-year increase, 95% confidence interval (CI): 1.02-1.02), MDR-TB (OR = 8.7, 95% CI: 5.09-14.97), male sex (OR = 1.40, 95% CI: 1.28-1.52), and foreign origin (OR = 1.32, 95% CI: 1.03-1.70). The data highlight that special efforts are required for patients with MDR-TB and the elderly aged ≥65 years, who have particularly low TSR. To allow for valid monitoring at EU level all countries should aim to report TO for all TB cases. © 2015, European Centre for Disease Prevention and Control (ECDC). All rights reserved.