[Assessment of available and currently applied typing methods of zoonotic pathogens using the example of Shiga toxin-producing and enterohemorrhagic Escherichia coli (STEC/EHEC)].

Introduction: In order to improve patient care and to increase food safety within the framework of One Health, the project "Integrated Genomic Surveillance of Zoonotic Agents (IGS-Zoo)" aims to develop concepts for a genomic surveillance of Shiga toxin(Stx)-producing and enterohemorrhagic Escherichia coli (STEC/EHEC) in Germany.

Methods: An online survey was conducted to assess the currently available and applied STEC/EHEC typing methods in the federal laboratories of veterinary regulation, food control, and public health service.

Results: Twenty-six questionnaires from 33 participants were evaluated with regard to STEC/EHEC.

Novel insights into pivotal risk factors for rectal carriage of extended-spectrum-β-lactamase-producing enterobacterales within the general population in Lower Saxony, Germany.

Aims: To estimate the prevalence of extended-spectrum-β-lactamase (ESBL)-producing enterobacterales (ESBL-E) carriage in the general population of Lower Saxony, Germany, and to identify risk factors for being colonized.

Methods And Results: Participants were recruited through local press and information events. Detection of ESBL-E by culture was conducted using ESBL-selective chromagar plates containing third-generation cephalosporins.

Shiga toxin-producing Escherichia coli O103:H2 outbreak in Germany after school trip to Austria due to raw cow milk, 2017 - The important role of international collaboration for outbreak investigations.

Following a school ski-trip to Austria from 10 to 18/02/2017, nine of 25 participants of the group from Lower Saxony (Germany) developed gastroenteritis. The students and teachers (17-41 years) shared meals in a hotel. Active case finding revealed further cases among German school groups from North Rhine-Westphalia and Schleswig-Holstein, staying at the same hotel in February 2017.

Cross-border comparison of the Dutch and German guidelines on multidrug-resistant Gram-negative microorganisms.

Background: In all European countries, hospital-acquired infections caused by Gram-negative multidrug-resistant microorganisms (GN-MDRO) are a major health threat, as these pathogens cannot be adequately treated anymore, or the start of effective antibiotic treatment is delayed. The efforts to limit the selection and spread of GN-MDRO remains a problem in cross-border healthcare, as the national guidelines on hygiene standards applicable for patients colonized or infected with GN-MDRO in hospitals are not harmonized between European countries.

Methods: In order to point out the similarities and differences in the national guidelines of Germany and The Netherlands regarding GN-MDRO, guidelines were compared and an expert workshop was organized by the INTERREG IVa project EurSafety Health-net.

Sporadic salmonellosis in Lower Saxony, Germany, 2011-2013: raw ground pork consumption is associated with Salmonella Typhimurium infections and foreign travel with Salmonella Enteritidis infections.

To investigate risk factors for sporadic salmonellosis, for each notified case four randomly selected population controls matched for age, sex and geographical region were interviewed via self-administered questionnaire. Conditional logistic regression analysis of 285 matched pairs revealed significant associations for raw ground pork consumption [odds ratio (OR) 6·0, 95% confidence interval (CI) 1·8-20·1], taking antacids (OR 5·8, 95% CI 1·4-24·5), eating meat outside the home (OR 5·7, 95% CI 2·2-14·6) and daily changing or cleaning of dishcloth (OR 2·1, 95% CI 1·2-3·9). Animal contact and ice cream consumption were negatively associated with salmonellosis (OR 0·5, 95% CI 0·2-1 and OR 0·3, 95% CI 0·1-0·6, respectively).

Risk factors associated with sporadic salmonellosis in children: a case-control study in Lower Saxony, Germany, 2008-2011.

We conducted a case-control study based on 884 laboratory-confirmed sporadic Salmonella cases reported to the German infectious disease notification system. For controls, we recruited 510 rotavirus cases via the same system. Univariable and multivariable logistic regression analyses were performed separately for children aged 0-3 years and 4-14 years.

[The EHEC O104:H4 outbreak in Germany 2011 - lessons learned?!].

The EHEC O104:H4 outbreak 2011 in Germany provided numerous insights into the recognition and control of such epidemic situations. Food-borne outbreaks and their related dynamics may lead to a critical burden of disease and an eventual capacity overload of the medical care system. Possible difficulties in the microbiological diagnostics of new or significantly altered infectious agents may result in a delayed detection of the outbreak as well as the launching of interventional measures.

Duration of fecal shedding of Shiga toxin-producing Escherichia coli O104:H4 in patients infected during the 2011 outbreak in Germany: a multicenter study.

Background: In May-July 2011, Germany experienced a large food-borne outbreak of Shiga toxin 2-producing Escherichia coli (STEC O104:H4) with 3842 cases, including 855 cases with hemolytic uremic syndrome (HUS) and 53 deaths.

Methods: A multicenter study was initiated in 5 university hospitals to determine pathogen shedding duration. Diagnostics comprised culture on selective media, toxin enzyme-linked immunosorbent assay, and polymerase chain reaction.

Epidemiological analysis of a cluster within the outbreak of Shiga toxin-producing Escherichia coli serotype O104:H4 in Northern Germany, 2011.

In May 2011 one of the worldwide largest outbreaks of haemolytic uraemic syndrome (HUS) and bloody diarrhoea caused by Shiga toxin-producing Escherichia coli (STEC) serotype O104:H4 occurred in Germany. One of the most affected federal states was Lower Saxony. We present the investigation of a cluster of STEC and HUS cases within this outbreak by means of a retrospective cohort study.

Subtype specific risk factor analyses for sporadic human salmonellosis: a case-case comparison in Lower Saxony, Germany.

With the intention to deepen the knowledge of the vertical transmission of particular subtypes of Salmonella enterica from "the stable to the table" a case1-case2 analysis in Lower Saxony, Germany, was conducted. The data collection was based on standardised telephone interviews with 1741 Salmonella case persons. Single-factor-analyses revealed statistically significant associations between S.

Risk factors associated with sporadic salmonellosis in adults: a case-control study.

In order to identify and assess recent risk factors for sporadic human infections with Salmonella enterica, we conducted a case-control study in Lower Saxony, Germany. The data collection was based on standardized telephone interviews with 1017 cases and 346 controls aged >14 years. Odds ratios were calculated in single-factor and multi-factor analyses for Salmonella cases and two different control groups, i.

MRSA-ST398 in livestock farmers and neighbouring residents in a rural area in Germany.

Prevalence of and risk factors associated with MRSA-ST398 carriage in 1872 (response 70%) farmers and neighbouring residents in a pig- and poultry-dense area in Germany were investigated using a cross-sectional study and self-sampling nasal swabs. In the population, 1% without occupational livestock contact and 24% with occupational livestock contact tested positive for MRSA-ST398. The group without occupational livestock contact was 3·8 times [95% confidence interval (CI) 1·5-9·3] more likely to be colonized if a household member had livestock contact and 3·2 times (95% CI 1·4-7·4) more likely if they regularly made private farm visits (e.

[Antimicrobial resistance monitoring in Lower Saxony (ARMIN): first trends for MRSA, ESBL-producing Escherichia coli and VRE from 2006 to 2010].

Antimicrobial resistance is one of the most important health topics of the past few years. To identify regional trends of antimicrobial resistance in inpatient and outpatient care, the Governmental Institute of Public Health of Lower Saxony (Germany) launched the sentinel system ARMIN (Antimicrobial Resistance Monitoring in Lower Saxony). Currently 9 laboratories participate as sentinel sites and contribute single case data of their microbiological results.

Communicable diseases prioritized for surveillance and epidemiological research: results of a standardized prioritization procedure in Germany, 2011.

Introduction: To establish strategic priorities for the German national public health institute (RKI) and guide the institute's mid-term strategic decisions, we prioritized infectious pathogens in accordance with their importance for national surveillance and epidemiological research.

Methods: We used the Delphi process with internal (RKI) and external experts and a metric-consensus approach to score pathogens according to ten three-tiered criteria. Additional experts were invited to weight each criterion, leading to the calculation of a median weight by which each score was multiplied.

[Comparison of the tuberculin skin test with the interferon-gamma test in the framework of a surroundings investigation in a prison].

After the occurrence of a multidrug-resistant tuberculosis in a prison of Lower Saxony (Germany), 223 contact persons (178 inmates, 45 staff members) were identified. To detect latent tuberculosis infections, all contact persons were tested with the tuberculin skin test (TST) and the interferon-gamma release assay (IGRA). An additional standardised questionnaire on anamnestic information and risk factors was completed by the participants.

[Protracted nosocomial outbreak of Salmonella Enteritidis LT 8/7].

Introduction: In spring 2007a cluster of nosocomial salmonellosis cases, culture confirmed for SALMONELLA Enteritidis lysotype (LT) 8/7, occurred in a Wolfsburg hospital. An outbreak investigation was initiated to determine the epidemiology of the outbreak and to identify and control the possible sources.

Methods: A multidisciplinary outbreak team was formed including members from hospital hygiene and local, state and national health and veterinarian authorities.

New immuno-PCR assay for detection of low concentrations of shiga toxin 2 and its variants.

Shiga toxin (Stx)-producing Escherichia coli (STEC) strains secrete toxins that are major virulence factors and diagnostic targets, but some STEC strains secrete Stx in amounts that cannot be detected using conventional cell cytotoxicity or immunological assays. Therefore, there is an urgent need for more-sensitive Stx detection methods. We describe the development of an assay that can detect low concentrations of Stx2 and its variants.

[Regionally increased incidence of notified cryptosporidiosis cases due to different laboratory methods].

Introduction: In Lower Saxony, during 2001 to 2005, 744 cases of cryptosporidiosis were reported according to the Protection against Infection Act to the Governmental Institute of Public Health of Lower Saxony. The yearly incidence rate of 1.9 notified cases per 100,000 population exceeded the German mean incidence rate of 1.

[Surveillance of acute respiratory illnesses (ARI) in Lower Saxony: first experience from the years 2005-2006].

In the context of influenza pandemic preparedness planning, a surveillance system for influenza and other acute respiratory illnesses was implemented in Lower Saxony at the beginning of the influenza season 2004/2005 and coordinated by the Governmental Institute of Public Health of Lower Saxony. This surveillance system represents an addition to already existing national monitoring systems. The goal of this surveillance system is to have available prompt information on the beginning, course and end of the influenza season and to recognise the spectrum of pathogens and identify outbreaks of other viral acute respiratory illnesses (ARI).

[Surveillance of infectious foodborne diseases after enactment of the German Protection against Infection Act in 2001. Potentials and requirements].

The epidemiology of infectious foodborne diseases has changed. Outbreaks more frequently occur geographically dispersed or protractedly over longer periods of time, and they often appear as a scatter of seemingly sporadic cases. This hampers and delays the identification of their epidemiological link.

[The epidemiology of human enterohemorrhagic Escherichia coli infections in Lower Saxony].

Background: In the German federal state Lower Saxony, data on infections with enterohemorrhagic Escherichia coli (EHEC) and hemolytic uremic syndrome (HUS) are collected systematically since 1997 based on reports by physicians and laboratories. Initially the data were collected by means of a specific established surveillance system, since 2001 they are collected as part of the new infectious disease law.

Results: From 1997 to 2003, in Lower Saxony 880 EHEC-infections and 112 HUS-cases, 6 of whom died, were notified.

Comparison of a shiga toxin enzyme-linked immunosorbent assay and two types of PCR for detection of shiga toxin-producing Escherichia coli in human stool specimens.

Shiga toxin (Stx)-producing Escherichia coli (STEC) is a major cause of sporadic cases of disease as well as serious outbreaks worldwide. The spectrum of illnesses includes mild nonbloody diarrhea, hemorrhagic colitis, and hemolytic-uremic syndrome. STEC produces one or more Stxs, which are subdivided into two major classes, Stx1 and Stx2.

Escherichia coli harboring Shiga toxin 2 gene variants: frequency and association with clinical symptoms.

Shiga toxin (Stx)-producing Escherichia coli (STEC) from patients with hemolytic-uremic syndrome (HUS), patients with diarrhea without HUS, or asymptomatic subjects were genotyped to assess associations between stx2 variants and clinical manifestations of infection. Neither stx2d nor stx2e was found in 268 STEC isolates from patients with HUS. Of 262 STEC isolates from patients with diarrhea, stx(2d) was found in 41 (15.

[Surveillance of gastroenteritic infections in lower Saxony: results and experiences from a regional public-health project over six years].

In Lower Saxony, a regional public health project on a pathogen-specific surveillance of Enteritis infectiosa was carried out from 1994 to 2000. In a separate reporting procedure thirteen health departments transmitted data on the specific pathogen collected from laboratory reports for a joint analysis. The results were distributed among the participants, providing them with information on the situation and trends in their districts and in addition giving them the possibility to compare their data with those of other districts.