ZusammenfassungAm 27.01.2020 wurde in Deutschland der erste Fall mit einer SARS-CoV-2-Infektion diagnostiziert. Für die Beschreibung des Pandemieverlaufs im Jahr 2020 wurden 4 epidemiologisch verschiedene Phasen betrachtet und Daten aus dem Meldesystem gemäß Infektionsschutzgesetz (IfSG) sowie hospitalisierte COVID-19-Fälle mit schwerer akuter respiratorischer Infektion aus der Krankenhaus-Surveillance eingeschlossen.Phase 0 umfasst den Zeitraum von Kalenderwoche (KW) 5/2020 bis 9/2020, in dem vor allem sporadische Fälle <60 Jahre und regional begrenzte Ausbrüche beobachtet wurden. Insgesamt wurden 167 Fälle übermittelt, die vorwiegend mild verliefen. Dem schloss sich in Phase 1 (KW 10/2020 bis 20/2020) die erste COVID-19-Welle mit 175.013 Fällen im gesamten Bundesgebiet an. Hier wurden vermehrt Ausbrüche in Krankenhäusern, Alten- und Pflegeheimen sowie ein zunehmender Anteil an älteren und schwer erkrankten Personen verzeichnet. In Phase 2, dem „Sommerplateau“ mit eher milden Verläufen (KW 21/2020 bis 39/2020), wurden viele reiseassoziierte COVID-19-Fälle im Alter von 15–59 Jahren und einzelne größere, überregionale Ausbrüche in Betrieben beobachtet. Unter den 111.790 Fällen wurden schwere Verläufe seltener beobachtet als in Phase 1. Phase 3 (KW 40/2020 bis 8/2021) war gekennzeichnet durch die zweite COVID-19-Welle in Deutschland, die sich zum Jahresende 2020 auf dem Höhepunkt befand. Mit 2.158.013 übermittelten COVID-19-Fällen und insgesamt deutlich mehr schweren Fällen in allen Altersgruppen verlief die zweite Welle schwerer als die erste Welle. Unabhängig von den 4 Phasen waren v. a. Ältere und auch Männer stärker von einem schweren Krankheitsverlauf betroffen.

BackgroundSyndromic surveillance of severe acute respiratory infections (SARI) is important to assess seriousness of disease as recommended by WHO for influenza. In 2015 the Robert Koch Institute (RKI) started to collaborate with a private hospital network to develop a SARI surveillance system using case-based data on ICD-10 codes. This first-time description of the system shows its application to the analysis of five influenza seasons.MethodsSince week 40/2015, weekly updated anonymized data on discharged patients overall and on patients with respiratory illness including ICD-10 codes of primary and secondary diagnoses are transferred from the network data center to RKI. Retrospective datasets were also provided. Our descriptive analysis is based on data of 47 sentinel hospitals collected between weeks 1/2012 to 20/2016. We applied three different SARI case definitions (CD) based on ICD-10 codes for discharge diagnoses of respiratory tract infections (J09 - J22): basic CD (BCD), using only primary diagnoses; sensitive CD (SCD), using primary and secondary diagnoses; timely CD (TCD), using only primary diagnoses of patients hospitalized up to one week. We compared the CD with regard to severity, age distribution and timeliness and with results from the national primary care sentinel system.ResultsThe 47 sentinel hospitals covered 3.6% of patients discharged from all German hospitals in 2013. The SCD comprised 2.2 times patients as the BCD, and 3.6 times as many as the TCD. Time course of SARI cases corresponded well to results from primary care surveillance and influenza virus circulation. The patients fulfilling the TCD had been completely reported after 3 weeks, which was fastest among the CD. The proportion of SARI cases among patients was highest in the youngest age group of below 5-year-olds. However, the age group 60 years and above contributed most SARI cases. This was irrespective of the CD used.ConclusionsIn general, available data and the implemented reporting system are appropriate to provide timely and reliable information on SARI in inpatients in Germany. Our ICD-10-based approach proved to be useful for fulfilling requirements for SARI surveillance. The exploratory approach gave valuable insights in data structure and emphasized the advantages of different CD.

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Information on severity of coronavirus disease (COVID-19) (transmissibility, disease seriousness, impact) is crucial for preparation of healthcare sectors. We present a simple approach to assess disease seriousness, creating a reference cohort of pneumonia patients from sentinel hospitals. First comparisons exposed a higher rate of COVID-19 patients requiring ventilation. There were more case fatalities among COVID-19 patients without comorbidities than in the reference cohort. Hospitals should prepare for high utilisation of ventilation and intensive care resources.

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Herpes zoster (HZ) is caused by reactivation of the varicella-zoster-virus (VZV). Childhood varicella vaccination, as recommended in Germany in 2004, may reduce the risk of HZ in vaccinated children but also virus circulation and thus the booster possibility of latent infected persons. In this context we analyzed age-specific trends in HZ epidemiology in Germany using data on HZ-associated outpatient consultations in participating sentinel sites and HZ-associated cases in all hospitals since 2005. We analyzed two separate time periods that differed in sentinel management and data integrity. For the period 2005–2010, we found a decrease in HZ-associated outpatient consultations in 1- to 4-year-olds (IRR = 0.72, 95%CI 0.63-0.81, p<0.001). For the period 2013–2016, we observed a decrease in HZ-associated outpatient consultations in 10- to 14-year-olds (IRR = 0.85, 95%CI 0.78-0.93, p<0.01). Moreover, we detected an increase in the age groups 20 years and older except for the group 30–39 years. HZ-associated hospitalizations showed similar trends for the second time period (here 2012–2015). The decrease in HZ-associated outpatient consultations and hospitalizations in children started and continued over cohorts eligible for varicella vaccination and could be a result of their reduced HZ-risk. Whether the observed steady increasing HZ incidences for adults are associated with the varicella vaccination in children remains unclear and could not be investigated with our data.