Transmission of SARS-CoV-2 in children aged 0 to 19 years in childcare facilities and schools after their reopening in May 2020, Baden-Württemberg, Germany.

We investigated data from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected 0-19 year olds, who attended schools/childcare facilities, to assess their role in SARS-CoV-2 transmission after these establishments' reopening in May 2020 in Baden-Württemberg, Germany. Child-to-child transmission in schools/childcare facilities appeared very uncommon. We anticipate that, with face mask use and frequent ventilation of rooms, transmission rates in schools/childcare facilities would remain low in the next term, even if classes' group sizes were increased.

A cluster of two human cases of tick-borne encephalitis (TBE) transmitted by unpasteurised goat milk and cheese in Germany, May 2016.

In May 2016, two cases of tick-borne encephalitis (TBE) were confirmed by serology (positive IgM and IgG antibodies against TBE virus (TBEV) in serum), with a possible link to raw milk and cheese from a goat farm in a region in Baden-Württemberg, Germany not previously known as TBE-endemic. The outbreak investigation identified 32 consumers of goat dairy products (29 consumers, one farm employee, two owners) of whom none had IgM antibodies against TBEV 3-8 weeks after consumption. Of the 27 notified TBE cases in the State, none reported consumption of raw goat milk or cheese from the suspected farm. Five of 22 cheese samples from 18 different batches were RT-qPCR-positive for TBEV -genome, and two of the five samples were confirmed by virus isolation, indicating viability of TBEV in the cheese. Nine of the 45 goats had neutralising TBEV antibodies, two of them with a high titre indicating recent infection. One of 412 Ixodes ricinus was RT-qPCR-positive, and sequencing of the E gene from nucleic acid extracted from the tick confirmed TBEV. Phylogenetic analyses of tick and cheese isolates showed 100% amino acid homology in the E gene and a close relation to TBEV strains from Switzerland and Austria.

[Interdisciplinary management of a large Legionella outbreak in Germany]. / Interdisziplinäres Management eines länderübergreifenden Legionellenausbruchs.

Between December 2009 and the end of January 2010, the largest hitherto known outbreak of Legionella in Germany took place in the cities of Ulm and Neu-Ulm. Of a total of 64 patients involved, 60 patients had to be hospitalized, and 5 patients died from the infection. This event was caused by a wet cooling tower of a large air conditioning system in the city center of Ulm. The search for the source of the Legionella emission was extremely difficult, since these plants are neither notifiable nor subject to authorization in Germany. We report about the search for the source and the measures to control the outbreak. We also discuss communication and coordination during these investigations. Regulatory measures as proposed by the World Health Organization (WHO) and the European Network for Legionellosis (EWGLI) and already implemented in numerous other European countries would be desirable to prevent such outbreaks in the future.

Steep rise in notified hantavirus infections in Germany, April 2010.

From January to April 2010, 396 hantavirus infections were notified in Germany, a considerable increase compared with previous years (mean: 83 for January-April 2004-2009) including the record-setting year, 2007 (n=232 January-April). Most patients are residents of known Puumala virus endemic areas in southern Germany. The recent increase in notified hantavirus infections is probably due to an increased population density of the main animal reservoir, the bank vole (Myodes glareolus).

Prolonged hospital and community-based listeriosis outbreak caused by ready-to-eat scalded sausages.

Listeria monocytogenes is a foodborne bacterial pathogen. Immunocompromised patients are at higher risk of developing invasive listeriosis with high fatality rates. After notification of two patients with Listeria that had stayed in the same hospital (hospital A) before the onset of infection, we began an investigation to ascertain the extent of the outbreak, identify its source and prevent further infections. We conducted active case finding by contacting hospital A, reviewing medical records and retrospectively investigating listeriosis notifications from the German surveillance system (SurvNet). The kitchen (hospital A) and its meat supplier (company X) were inspected and environmental and food samples were taken for microbiological testing. All isolates of L. monocytogenes, together with patient and food-related isolates from Baden-Württemberg 2006 to 2008, were characterised by pulsed-field gel electrophoresis (PFGE). Altogether, 16 cases of listeriosis were identified. Serotype 4b with the indistinguishable PFGE patterns (AscI 17a/ApaI 10) was detected from nine patients, five environmental and three ready-to-eat scalded sausage samples from company X, and two food samples from hospital A. All 11 patient cases linked to hospital A were immunosuppressed and were regularly served food during their hospital stay. Ten of these patients received corticosteroids and proton pump inhibitors (PPIs). Five cases were fatal. Our investigations indicate that ready-to-eat scalded sausages from company X caused this outbreak of listeriosis. Hospital food suppliers should guarantee the absence of L. monocytogenes in ready-to-eat meat products, controlled through optimised quality assurance.

Survey and case-control study during epidemics of Puumala virus infection.

In Baden-Wuerttemberg, a federal state in south-west Germany, a large outbreak of 1089 laboratory-confirmed human Puumala virus (PUUV) infections occurred in 2007. We conducted a survey to describe the disease burden and a case-control study to identify risk factors for acquiring PUUV. Case-patients were interviewed about clinical outcome and both case-patients and randomly recruited controls were interviewed about exposure. We calculated matched odds ratios (mOR) using a conditional logistic regression model. Multivariable analysis of 191 matched case-control pairs showed that case-patients were more likely than controls to have seen small rodents/their droppings (mOR 1.9, 95% CI 1.2-3.0), cleaned utility rooms (mOR 1.8, 95% CI 1.0-3.4) and visited forest shelters (mOR 3.9, 95% CI 1.1-14.3). Two thirds of case-patients required hospitalization. During PUUV epidemics rodent control measures and use of protective equipment should be considered in utility rooms and shelters.

Tularemia in Germany: the tip of the iceberg?

Tularemia is a rare, notifiable zoonosis in Germany. Since November 2004, several lines of evidence including outbreaks in humans or animals and confirmed infections in indigenous hare and rodent populations have indicated a re-emergence of tularemia in different German federal states. Unfortunately, reliable basic information on the seroprevalence in different geographical regions, permitting the identification of risk factors, does not exist. Combining a sensitive screening assay with a highly specific confirmative immunoblot test, we performed a serological investigation on 2416 sera from a population-based, cross-sectional health survey of the city population of Leutkirch, Baden-Wuerttemberg. A total of 56 sera gave positive results indicating a seroprevalence of 2.32%. Thus, the seroprevalence is tenfold higher than that previously reported in a nationwide study in 2004. Francisella tularensis can cause a wide variety of clinical syndromes including severe, sometimes fatal disease. Missing epidemiological data on its spatial and temporal distribution in an endemic country complicate an appropriate risk assessment necessary for public health authorities to be prepared for an adequate outbreak management. This is of special concern regarding the extraordinary potential of F. tularensis as an agent of bioterrorism. Our investigation performed in a presumed low-risk area demonstrated that tularemia might be seriously underestimated in Germany and probably in other central European countries as well.

Emergence of hantavirus in South Germany: rodents, climate and human infections.

Human hantavirus (serotype Puumala) infections are prevalent throughout Europe. The bank vole is the main reservoir of the Puumala virus (PUUV). Between 2001 and 2006, the annual incidences in Germany ranged from 0.1 to 0.5 per 100,000 inhabitants. About half of the cases were reported from the state of Baden-Württemberg (BW) in southwest Germany. In 2007, 1,089 PUUV infections were reported from BW. This reflects an incidence of 10.1:100,000, which is more than 11 times higher than the mean incidence of the previous 6 years. Spatial analysis highlights incidences up to 90:100,000 in the most affected district. The winter season 2006/2007 showed an all time high in reported mean temperature. The previous summer and autumn led to a beech mast year, resulting in favourable feed conditions for bank voles in the winter season 2006/2007. The causes of the observed increase in PUUV infections in 2007 cannot be restricted to known cycles in the bank vole population. Favourable feed conditions, a mild winter and an early onset of spring may have influenced bank vole population size as well as human exposure to infectious rodent excretions. Further epidemiologic studies are necessary to better understand the interaction between environmental factors, occurrence of Puumala virus in bank voles and the risk for human disease.

Serological and epidemiological analysis of an outbreak of gastroenteritis among military recruits in Germany caused by Cryptosporidium parvum.

BACKGROUND: Cryptosporidium spp. cause enteritic disease worldwide. Besides those patients with an impaired immune system, the general population is also at risk. PATIENTS AND METHODS: Stool samples from participants of a military field exercise were tested for enteritic pathogens and sera were analyzed for Cryptosporidium-antibodies. All participants received a questionnaire for assessing possible risk factors. RESULTS: After a 5-day field training, 201 of a total of 450 soldiers (45%) developed acute gastroenteritis. Immediate microbiological analysis ruled out enteropathogenic bacteria and viruses as the cause of the disease. Only after hospitalization of one of the patients diagnostic procedures were expanded to the identification of parasites and Cryptosporidium parvum was identified. In addition, 14 fecal samples of 217 specimens were subsequently identified in a Cryptosporidium antigen ELISA. A serological analysis of 214 sera revealed 72% positive for specific IgG antibodies compared with 17% of a control group of soldiers who had not participated in the field training (relative risk 3.38; 95% CI 2.39-4.77; p < 0.001). Analysis of specific IgM levels was less conclusive. Epidemiological analysis of questionnaires correlated drinking of tap water, or consumption of various meals with gastroenteritis. However, the source of contamination could not be identified. CONCLUSION: Cryptosporidium spp. can cause acute enteritis even in healthy, young adults as demonstrated by this outbreak. Using serological methods, the extent of the outbreak could be estimated in a retrospective analysis.

First evidence of Babesia gibsoni (Asian genotype) in dogs in Western Europe.

Canine babesiosis in Europe is generally caused by Babesia canis canis and Babesia canis rossi. Here we describe the first two autochthonous cases of Babesia gibsoni (Asian genotype) infection in Germany. Two American pit bull terriers showed clinical and hematologic signs consistent with babesiosis. Polymerase chain reaction (PCR) analysis of the 18S rDNA of blood samples revealed 486 bp fragments. The sequences were 100% identical to each other and 100% identical to Babesia gibsoni (Asian genotype). These results represent the first genetic evidence of Babesia gibsoni (Asian genotype) parasites in dogs in Western Europe.

An outbreak of Salmonella München in Germany associated with raw pork meat.

In summer 2001, an outbreak of Salmonella München occurred in Germany. We conducted descriptive epidemiology and hypothesis-generating interviews among case patients, two retrospective cohort studies, and a case-control study of suboutbreaks. We performed pulsed-field gel electrophoresis (PFGE) from selected patient isolates and a limited trace-back investigation for analytical purposes. Four states were consecutively affected: Saxonia (SX), Brandenburg (BB), Berlin (BE), and Baden-Württemberg (BW). Although hypothesis-generating interviews failed to identify a plausible food item, descriptive data and investigations of the suboutbreaks suggested pork meat as a probable source in three states (SX, BB, and BE) but not in BW. The PFGE profiles from isolates of case patients in the first three states were indistinguishable but differed from PFGE profiles of case patients in BW. Trace-back investigation suggested that contamination of pork meat occurred early in the rearing-production chain. This outbreak demonstrates how contamination early in the production process that can yield different end products may complicate multistate outbreaks. Investigation of suboutbreaks and use of the trace-back method as investigational tools may be useful adjuncts in solving the problem of multistate outbreaks.