Doctors advising against measles vaccination and doctors not giving any advice proved to be important risk factors for childhood undervaccination against measles. Future strategies to increase measles vaccination rates in Germany should focus more on family doctors.
In 2000, the new German infectious disease control act replaced aggregate with individual case reporting. The process was facilitated by the simultaneous introduction of electronic data transfer within the public health system. Reporting laboratories have not been electronically connected to this network. A survey by means of a postal questionnaire was conducted in 2003 among 537 German medical microbiology laboratories to explore their reporting habits, preference for electronic reporting formats, and relevant software equipment. Almost 90% of the respondents indicated a reporting delay of no more than 24 hours and 45% were still manually filling in paper forms for reporting purposes. The introduction of electronic reporting formats was favoured by 74% of the laboratories although 33% were not using any microbiology-specific software and the remaining 67% listed 62 different products. Pilot projects with selected software manufacturers might help to pave the way for the implementation of a standardised electronic infectious disease reporting format in Germany.
In February 2003, a three-fold increase of notified Salmonella Agona infections was observed in Germany. Two-thirds of the cases were infants below one year. An investigation was started to determine the outbreak's extent, risk factors and source. Cases were identified through the notification system and reference laboratories. Parents of cases were interviewed by a standardised questionnaire (eg, on food exposures). A case-control study was conducted, defining cases as children aged <14 months with acute S. Agona infection from October 2002 to July 2003. Four age-matched controls per case were randomly selected from population registries. Food control authorities and laboratories were contacted to identify food contaminated with S. Agona. All human and food isolates were subtyped by phagetyping and pulsed-field gel electrophoresis. Overall, 40 geographically dispersed cases were identified; 31 cases and 130 controls were included in the case-control study. Of the cases, 68% had consumed tea products containing aniseed compared to 7% of the controls (OR 28, 95% CI 10-78). In logistic regression, this risk factor was confirmed (adjusted OR 31, 95% CI 10-95), whereas breast-feeding was protective (OR 0.2, 95% CI 0.1-0.7). In 33% of the cases (controls 15%) tea had not always been prepared with boiling water. Of 568 samples of herbal teas and aniseed of different companies 6% were positive for S. Agona. Subtyping of human, tea and aniseed isolates revealed identical strain patterns. There is strong epidemiologic and microbiologic evidence that contaminated aniseed in herbal tea was the vehicle for the outbreak. As surveillance only captures a proportion of cases the true number of affected infants is likely to be higher. Affected tea products were recalled and consumers were advised to only use boiling water for tea preparation. A discussion about increased safety measures in herbal tea production has started among producers.
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