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Article ; Online: Application of the screening method for estimating COVID-19 vaccine effectiveness using routine surveillance data: Germany's experience during the COVID-19 pandemic, July 2021 to March 2023.

Perumal, Nita / Schönfeld, Viktoria / Wichmann, Ole

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin

2024 Volume 29, Issue 8

Abstract: The screening method represents a simple, quick, and practical tool for estimating vaccine effectiveness (VE) using routine disease surveillance and vaccine coverage data, even if these data cannot be linked. In Germany, where notification data, ... ...

Abstract	The screening method represents a simple, quick, and practical tool for estimating vaccine effectiveness (VE) using routine disease surveillance and vaccine coverage data, even if these data cannot be linked. In Germany, where notification data, laboratory testing data, and vaccine coverage data cannot be linked due to strict data protection requirements, the screening method was used to assess COVID-19 VE continuously between July 2021 and March 2023. During this period, when Delta and Omicron variants circulated, VE estimates were produced in real-time for different age groups and clinical outcomes. Here we describe the country's overall positive experience using the screening method, including its strengths and limitations, and provide practical guidance regarding a few issues, such as case definition stringency, testing behaviour, and data stratification, that require careful consideration during data analysis and the interpretation of the results.
MeSH term(s)	Humans ; COVID-19 Vaccines ; COVID-19/epidemiology ; COVID-19/prevention & control ; Pandemics/prevention & control ; Vaccine Efficacy ; SARS-CoV-2 ; Germany/epidemiology
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2024-02-23
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	1338803-4
ISSN	1560-7917 ; 1025-496X
ISSN (online)	1560-7917
ISSN	1025-496X
DOI	10.2807/1560-7917.ES.2023.29.8.2300329
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Article ; Online: Impact of COVID-19 immunisation on COVID-19 incidence, hospitalisations, and deaths by age group in Germany from December 2020 to October 2021.

Perumal, Nita / Steffen, Annika / Ullrich, Alexander / Siedler, Anette

Vaccine

2022 Volume 40, Issue 21, Page(s) 2910–2914

Abstract: Background: Utilising national surveillance data, we investigated the impact of the COVID-19 immunisation campaign on COVID-19 morbidity and mortality between December/2020 and October/2021 in Germany.: Methods: We compared patterns in immunisation ... ...

Abstract	Background: Utilising national surveillance data, we investigated the impact of the COVID-19 immunisation campaign on COVID-19 morbidity and mortality between December/2020 and October/2021 in Germany. Methods: We compared patterns in immunisation coverage, incidence, hospitalisations, and deaths among 12-17, 18-59, and 60+ year-olds and examined these patterns within the context of anti-pandemic measures. Results: COVID-19 incidence increased in all age groups following the end of lockdown restrictions in March/2021, but as Germany experienced successive peaks in incidence, age groups with higher immunisation coverage experienced successively smaller peaks. Notwithstanding corresponding increases during periods of higher incidence, among those aged 60+ years, COVID-19 related hospitalisations and deaths declined considerably as immunisation coverage increased, despite circulation of virus variants known to cause more severe illness. Conclusion: Although ecological in nature, this study allows us to demonstrate clear patterns of decline in COVID-19 morbidity and mortality in Germany during the course of the immunisation campaign.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; Communicable Disease Control ; Germany/epidemiology ; Hospitalization ; Humans ; Immunization ; Incidence
Language	English
Publishing date	2022-04-08
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2022.04.002
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Article: Impact of COVID-19 immunisation on COVID-19 incidence, hospitalisations, and deaths by age group in Germany from December 2020 to October 2021

Perumal, Nita / Steffen, Annika / Ullrich, Alexander / Siedler, Anette

Vaccine. 2022 May 09, v. 40, no. 21

2022

Abstract: Utilising national surveillance data, we investigated the impact of the COVID-19 immunisation campaign on COVID-19 morbidity and mortality between December/2020 and October/2021 in Germany. We compared patterns in immunisation coverage, incidence, ... ...

Abstract	Utilising national surveillance data, we investigated the impact of the COVID-19 immunisation campaign on COVID-19 morbidity and mortality between December/2020 and October/2021 in Germany. We compared patterns in immunisation coverage, incidence, hospitalisations, and deaths among 12–17, 18–59, and 60+ year-olds and examined these patterns within the context of anti-pandemic measures. COVID-19 incidence increased in all age groups following the end of lockdown restrictions in March/2021, but as Germany experienced successive peaks in incidence, age groups with higher immunisation coverage experienced successively smaller peaks. Notwithstanding corresponding increases during periods of higher incidence, among those aged 60+ years, COVID-19 related hospitalisations and deaths declined considerably as immunisation coverage increased, despite circulation of virus variants known to cause more severe illness. Although ecological in nature, this study allows us to demonstrate clear patterns of decline in COVID-19 morbidity and mortality in Germany during the course of the immunisation campaign.
Keywords	COVID-19 infection ; disease severity ; immunization ; monitoring ; morbidity ; mortality ; vaccines ; viruses ; Germany
Language	English
Dates of publication	2022-0509
Size	p. 2910-2914.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2022.04.002
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Article ; Online: Inventory study on completeness of tuberculosis case notifications in Poland in 2018.

Domaszewska, Teresa / Korzeniewska-Kosela, Maria / Hauer, Barbara / Perumal, Nita / Wesolowski, Stefan / Haas, Walter / Kroeger, Stefan

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin

2024 Volume 29, Issue 1

Abstract: BackgroundEvaluating tuberculosis (TB) notification completeness is important for monitoring TB surveillance systems, while estimating the TB disease burden is crucial for control strategies.AimWe conducted an inventory study to assess TB reporting ... ...

Abstract	BackgroundEvaluating tuberculosis (TB) notification completeness is important for monitoring TB surveillance systems, while estimating the TB disease burden is crucial for control strategies.AimWe conducted an inventory study to assess TB reporting completeness in Poland in 2018.MethodsUsing a double-pronged inventory approach, we compared notifications of culture-positive TB cases in the National TB Register to records of diagnostic laboratories. We calculated under-reporting both with observed and capture-recapture (CRC)-estimated case numbers. We further compared the notifications by region (i.e. voivodship), sex, and age to aggregated data from hospitalised TB patients, which provided an independent estimate of reporting completeness.ResultsIn 2018, 4,075 culture-positive TB cases were notified in Poland, with 3,789 linked to laboratory records. Laboratories reported further 534 TB patients, of whom 456 were linked to notifications from 2017 or 2019. Thus, 78 (534 - 456) cases were missing in the National TB Register, yielding an observed TB under-reporting of 1.9% (78/(4,075 + 78) × 100). CRC-modelled total number of cases in 2018 was 4,176, corresponding to 2.4% ((4,176 - 4,075)/4,176 × 100) under-reporting. Based on aggregated hospitalisation data from 13 of 16 total voivodeships, under-reporting was 5.1% (3,482/(3,670 - 3,482) × 100), similar in both sexes but varying between voivodeships and age groups.ConclusionsOur results suggest that the surveillance system captures ≥ 90% of estimated TB cases in Poland; thus, the notification rate is a good proxy for the diagnosed TB incidence in Poland. Reporting delays causing discrepancies between data sources could be improved by the planned change from a paper-based to a digital reporting system.
MeSH term(s)	Male ; Female ; Humans ; Poland/epidemiology ; Tuberculosis/diagnosis ; Tuberculosis/epidemiology ; Incidence ; Hospitalization ; Cost of Illness ; Disease Notification
Language	English
Publishing date	2024-01-05
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	1338803-4
ISSN	1560-7917 ; 1025-496X
ISSN (online)	1560-7917
ISSN	1025-496X
DOI	10.2807/1560-7917.ES.2024.29.1.2300081
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Article ; Online: International tuberculosis contact-tracing notifications in Germany: analysis of national data from 2010 to 2018 and implications for efficiency.

Glasauer, Saskia / Kröger, Stefan / Haas, Walter / Perumal, Nita

BMC infectious diseases

2020 Volume 20, Issue 1, Page(s) 267

Abstract: Background: International contact-tracing (CT) following exposure during long-distance air travel is resource-intensive, whereas evidence for risk of tuberculosis (TB) transmission during international travel is weak. In this study, we systematically ... ...

Abstract	Background: International contact-tracing (CT) following exposure during long-distance air travel is resource-intensive, whereas evidence for risk of tuberculosis (TB) transmission during international travel is weak. In this study, we systematically analyzed the information from international requests for CT received at the national level in Germany in order to evaluate the continued utility of the current approach and to identify areas for improvement. Methods: An anonymized archive of international CT notifications received by the Robert Koch Institute between 2010 and 2018 was searched for key parameters for data collection. A total of 31 parameters, such as characteristics of TB patients and their identified contacts, were extracted from each CT notification and collated into a dataset. Descriptive data analysis and trend analyses were performed to identify key characteristics of CT notifications, patients, and contacts over the years. Results: 192 CT notifications, each corresponding to a single TB index case, were included in the study, increasing from 12 in 2010 to 41 in 2018. The majority of notifications (N = 130, 67.7%) concerned international air travel, followed by private contact (N = 39, 20.3%) and work exposure (N = 16, 8.3%). 159 (82.8%) patients had sputum smear results available, of which 147 (92.5%) were positive. Of 119 (62.0%) patients with drug susceptibility testing results, most (N = 92, 77.3%) had pan-sensitive TB, followed by 15 (12.6%) with multi-drug resistant TB. 115 (59.9%) patients had information on infectiousness, of whom 99 (86.1%) were considered infectious during the exposure period. 7 (5.3%) patients travelled on long-distance flights despite a prior diagnosis of active TB. Of the 771 contact persons, 34 (4.4%) could not be reached for CT measures due to lack of contact information. Conclusion: The high variability in completeness of information contained within the international CT requests emphasizes the need for international standards for reporting of CT information. With the large proportion of TB patients reported to have travelled while being infectious in our study, we feel that raising awareness among patients and health professionals to detect TB early and prevent international long-distance travel during the infectious disease phase should be a cornerstone strategy to safeguard against possible transmission during international travel.
MeSH term(s)	Adult ; Air Travel/statistics & numerical data ; Antitubercular Agents/pharmacology ; Contact Tracing/methods ; Contact Tracing/statistics & numerical data ; Female ; Germany/epidemiology ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Mycobacterium tuberculosis/drug effects ; Sputum/microbiology ; Travel-Related Illness ; Tuberculosis/epidemiology ; Tuberculosis/microbiology ; Tuberculosis, Multidrug-Resistant/epidemiology ; Tuberculosis, Multidrug-Resistant/microbiology
Chemical Substances	Antitubercular Agents
Language	English
Publishing date	2020-04-06
Publishing country	England
Document type	Journal Article
ISSN	1471-2334
ISSN (online)	1471-2334
DOI	10.1186/s12879-020-04982-z
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Article ; Online: Effekte der COVID-19-Impfung auf Inzidenz und Todesfälle in der älteren Bevölkerung in Deutschland

Perumal, Nita / Steffen, Annika / Ullrich, Alexander / Siedler, Annette

erste Ergebnisse einer ökologischen Analyse

2021

Abstract: Alle in Deutschland verabreichten Impfungen gegen COVID-19 müssen gemäß der Coronavirus-Impfverordnung an das RKI gemeldet werden, welches dafür speziell eine Datenbank für das "Digitale Impfquotenmonitoring" (DIM) aufgebaut hat. Die im Epidemiologischen ...

Abstract	Alle in Deutschland verabreichten Impfungen gegen COVID-19 müssen gemäß der Coronavirus-Impfverordnung an das RKI gemeldet werden, welches dafür speziell eine Datenbank für das "Digitale Impfquotenmonitoring" (DIM) aufgebaut hat. Die im Epidemiologischen Bulletin 19/2021 veröffentlichte Studie untersucht den Effekt der COVID-19-Impfung auf die Inzidenz und Mortalität in der älteren Bevölkerung Deutschlands anhand von Daten aus den 10 Bundesländern, die täglich einzelfallbezogene, pseudonymisierte Impfdaten direkt über das DIM-System meldeten. Zielgruppe der Analyse waren Personen ab einem Alter von 80 Jahren, die aufgrund des besonders hohen Risikos für einen schweren Verlauf oder den Tod an COVID-19 prioritär geimpft wurden.
Keywords	COVID-19 ; Schutzimpfung ; DIM ; Impfquoten ; Meldedaten ; 610 Medizin und Gesundheit ; ddc:610
Language	German
Publishing date	2021-05-12
Publisher	Robert Koch-Institut
Publishing country	de
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Ein historisches Signal für den Kampf gegen Tuberkulose – Deutschland muss das Momentum nutzen

Perumal, Nita / Hauer, Barbara

2019

Abstract: Auf der internationalen Agenda steht Tuberkulose weit oben und war im Herbst 2018 erstmals Thema in der Generalversammlung der Vereinten Nationen. Dort wurde eine historische politische Deklaration verabschiedet mit dem Ziel, den weltweiten Kampf für die ...

Abstract	Auf der internationalen Agenda steht Tuberkulose weit oben und war im Herbst 2018 erstmals Thema in der Generalversammlung der Vereinten Nationen. Dort wurde eine historische politische Deklaration verabschiedet mit dem Ziel, den weltweiten Kampf für die Elimination einer der ältesten Krankheiten der Menschheit zu beschleunigen. Eine niedrige TB-Inzidenz sowie ein gut funktionierendes Sozial- und Gesundheitssystem versetzen Deutschland in diesem globalen Unterfangen zwar in eine gute Ausgangslage. Die Zahl der Tuberkulose-Erkrankungen in Deutschland war 2018 jedoch ähnlich hoch wie 2017, berichtet das RKI im Epidemiologischen Bulletin 11/12 2019. Ein jährlicher Rückgang um 10 Prozent wäre aber erforderlich, um das Ziel der WHO zu erreichen, Tuberkulose bis 2050 zu eliminieren. Daher sind in der Tuberkulosekontrolle auch in Deutschland zusätzliche Anstrengungen notwendig. Von zentraler Bedeutung sind leistungsfähige Gesundheitsämter, um im Umfeld eines Tuberkulosepatienten infizierte oder bereits erkrankte Personen zu identifizieren und eine Verbreitung der Tuberkulose zu verhindern. Bei Symptomen wie länger bestehendem Husten, Nachtschweiß, Fieber und Gewichtsabnahme sollte immer auch an Tuberkulose gedacht werden. Bedeutsam sind auch eine frühzeitige Resistenztestung und eine resistenzgerechte Behandlung. Auch die molekulare Surveillance ist ein wichtiger Beitrag zur Elimination der Tuberkulose und sollte landesweit etabliert werden. Peer Reviewed
Keywords	Tuberkulose ; 610 Medizin und Gesundheit ; ddc:610
Language	German
Publishing date	2019-03-14
Publisher	Robert Koch-Institut
Publishing country	de
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Tuberkulose bleibt eine Herausforderung – auch für Deutschland

Hauer, Barbara / Perumal, Nita

2018

Abstract: Dem Robert Koch-Institut wurden nach vorläufigen Daten für 2017 insgesamt 5.486 Tuberkulose-Fälle übermittelt, nach 5.949 im Jahr 2016 und 5.834 in 2015 (Datenstand 1.3.2018). Die aktuelle Situation und Herausforderungen, national wie international, ... ...

Abstract	Dem Robert Koch-Institut wurden nach vorläufigen Daten für 2017 insgesamt 5.486 Tuberkulose-Fälle übermittelt, nach 5.949 im Jahr 2016 und 5.834 in 2015 (Datenstand 1.3.2018). Die aktuelle Situation und Herausforderungen, national wie international, sind Schwerpunktthema in der Ausgabe 11/12 2018 des Epidemiologischen Bulletins.
Keywords	610 Medizin ; ddc:610
Language	German
Publishing date	2018-03-15
Publisher	Robert Koch-Institut, Infektionsepidemiologie
Publishing country	de
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evaluation der COVID-19-Impfung nach breiter Anwendung – ein Zwischenfazit für Deutschland im Juli 2022.

Siedler, Anette / Schönfeld, Viktoria / Peine, Caroline / Perumal, Nita / Friedsam, Amelie / Stoliaroff-Pépin, Anna / Harder, Thomas

Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz

2022 Volume 65, Issue 12, Page(s) 1272–1280

Abstract: Vaccines against COVID-19 have been available in Germany since December 2020. At the Robert Koch Institute (RKI), the Immunization Unit is responsible for monitoring vaccination coverage and assessment of vaccine effectiveness. This article provides an ... ...

Title translation	Evaluation of the COVID-19 vaccination after broad implementation-an interim conclusion for Germany in July 2022.
Abstract	Vaccines against COVID-19 have been available in Germany since December 2020. At the Robert Koch Institute (RKI), the Immunization Unit is responsible for monitoring vaccination coverage and assessment of vaccine effectiveness. This article provides an overview of the respective reporting structures, vaccination databases, and epidemiological studies established by the Immunization Unit during the COVID-19 pandemic. We describe the COVID-19 Digital Vaccination Coverage Monitoring (DIM), which provides daily updates on vaccination coverage by age group. We next describe how, based on the DIM data and COVID-19 case data, the assessment of vaccine effectiveness against different clinical endpoints (hospitalization, intensive care, death) is performed. While this method is used for a preliminary estimate of vaccine efficacy, population-based nonrandomized studies are able to provide more precise and detailed estimates under "real-world" conditions. In this context, we describe the hospital-based case-control study COViK, which is being conducted in collaboration with the Paul Ehrlich Institute (PEI). We discuss strengths and limitations of the abovementioned structures and tools. Finally, we provide an outlook on future challenges that may arise during the ongoing pandemic and during the transition phase into an endemic situation.
Language	German
Publishing date	2022-11-10
Publishing country	Germany
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	1461973-8
ISSN	1437-1588 ; 1436-9990
ISSN (online)	1437-1588
ISSN	1436-9990
DOI	10.1007/s00103-022-03618-8
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Article ; Online: Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries - a model-based cost-effectiveness analysis.

Marx, Florian M / Hauer, Barbara / Menzies, Nicolas A / Haas, Walter / Perumal, Nita

BMC public health

2021 Volume 21, Issue 1, Page(s) 2172

Abstract: Background: Enhancing tuberculosis (TB) prevention and care in a post-COVID-19-pandemic phase will be essential to ensure progress towards global TB elimination. In low-burden countries, asylum seekers constitute an important high-risk group. TB ... ...

Abstract	Background: Enhancing tuberculosis (TB) prevention and care in a post-COVID-19-pandemic phase will be essential to ensure progress towards global TB elimination. In low-burden countries, asylum seekers constitute an important high-risk group. TB frequently arises post-immigration due to the reactivation of latent TB infection (LTBI). Upon-entry screening for LTBI and TB preventive treatment (TPT) are considered worthwhile if targeted to asylum seekers from high-incidence countries who usually present with higher rates of LTBI. However, there is insufficient knowledge about optimal incidence thresholds above which introduction could be cost-effective. We aimed to estimate, among asylum seekers in Germany, the health impact and costs of upon-entry LTBI screening/TPT introduced at different thresholds of country-of-origin TB incidence. Methods: We sampled hypothetical cohorts of 30-45 thousand asylum seekers aged 15 to 34 years expected to arrive in Germany in 2022 from cohorts of first-time applicants observed in 2017-2019. We modelled LTBI prevalence as a function of country-of-origin TB incidence fitted to data from observational studies. We then used a probabilistic decision-analytic model to estimate health-system costs and quality-adjusted life years (QALYs) under interferon gamma release assay (IGRA)-based screening for LTBI and rifampicin-based TPT (daily, 4 months). Incremental cost-effectiveness ratios (ICERs) were calculated for scenarios of introducing LTBI screening/TPT at different incidence thresholds. Results: We estimated that among 15- to 34-year-old asylum seekers arriving in Germany in 2022, 17.5% (95% uncertainty interval: 14.2-21.6%) will be latently infected. Introducing LTBI screening/TPT above 250 per 100,000 country-of-origin TB incidence would gain 7.3 (2.7-14.8) QALYs at a cost of €51,000 (€18,000-€114,100) per QALY. Lowering the threshold to ≥200 would cost an incremental €53,300 (€19,100-€122,500) per additional QALY gained relative to the ≥250 threshold scenario; ICERs for the ≥150 and ≥ 100 thresholds were €55,900 (€20,200-€128,200) and €62,000 (€23,200-€142,000), respectively, using the next higher threshold as a reference, and considerably higher at thresholds below 100. Conclusions: LTBI screening and TPT among 15- to 34-year-old asylum seekers arriving in Germany could produce health benefits at reasonable additional cost (with respect to international benchmarks) if introduced at incidence thresholds ≥100. Empirical trials are needed to investigate the feasibility and effectiveness of this approach.
MeSH term(s)	Adolescent ; Adult ; COVID-19 ; Cost-Benefit Analysis ; Humans ; Incidence ; Latent Tuberculosis/diagnosis ; Latent Tuberculosis/drug therapy ; Latent Tuberculosis/epidemiology ; Mass Screening ; Refugees ; SARS-CoV-2 ; Tuberculin Test ; Young Adult
Language	English
Publishing date	2021-11-26
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-021-12142-4
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