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Country Presentation Germany

Country Presentation Germany. Walter H. Haas Department for Infectious Disease Epidemiology Robert Koch Institute, Berlin. Germany. Population: 82 Million (235/km 2 ) Federal Republic with 16 States 450 Counties (pop.: 35 000 - 1.7 Million) 1 local health department per county

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Country Presentation Germany

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  1. Country PresentationGermany Walter H. Haas Department for Infectious Disease Epidemiology Robert Koch Institute, Berlin

  2. Germany • Population: 82 Million (235/km2) • Federal Republic with 16 States • 450 Counties (pop.: 35 000 - 1.7 Million) • 1 local health department per county • Mainly private health care providers • Health servicesreimbursed by health security system

  3. Legal background of ID surveillance • Case-based surveillance introduced by the Communicable Diseases Law Reform Act (IfSG) in 2001 • Cases have to fulfil a case definition for transmission to the state and country level • Development of case definitions and reporting tools by the Robert Koch Institute

  4. TB case definition • Symptoms compatible with tuberculosis AND decision to treat with combination therapy (with OR without epidemiological link) • Laboratory confirmation by culture ORsmear microscopy AND positive nucleic acid amplification test of the same specimen

  5. Reporting and transmission flow dcwerc fferc dfkfafkm ewfdc wdc djföoijfgp dde dsadgrg FJGOJG sdfdgrertg ^sgtbwetrn 2 ^sddgf g SADaS dsdd casdADSD feiteite eccas FFDOKG werotit FGPGdwr2 fgd dfkasürirjt dgoijpjjgijj dsfoj ^spoewe dfsdgfg dfgdg jdgiaergjgrpog ogipgug goipqre gtijpgo revqekfs efwifeherhgfer erpgjpjt ^ffgvwgbw ^safertbnewrt 1 Mo Lab Clinician 2 Tu 3 We Report 4 Th 5 Fr Local Health Authority 6 Sa 7 So 8 Mo 9 Tu State Health Authority 10 We Week 1 11 Th 12 Fr 13 Sa 14 So 15 Mo Robert Koch Institute 16 Tu 17 We Week 2 18 Th 19 Fr 20 Sa 21 So 22 Mo 23 Tu Epidemiological Bulletin 24 We Week 3 25 Th 26 Fr 27 Sa 28 So

  6. Nationwide case-based data since 2001 (IfSG)

  7. Nationwide case-based data since 2001 cont‘d (IfSG)

  8. months Follow-up of TB cases

  9. TB mortality in Germany since 1750

  10. TB morbidity in Germany 1938-1990

  11. TB incidence 1993-2002 n

  12. Number of cases 2001 and 2002

  13. TB incidence 2002 by gender andage group (n=7676)

  14. TB incidence 2002 by citizenship and age group (n=7539)

  15. Site of disease 2002 (n=7335)

  16. Smear+ pulmonary tuberculosisby age group (n=1959)

  17. TB drug resistance (n=4489)

  18. Case detection rates/100,0001996-1998 Study of the German Central Committee against TB (DZK) and local health authorities on the epidemiology of tuberculosis in Germany 1996 - 2000

  19. Treatment outcome of culture+ pulmonary tuberculosis, DZK-Study 1997-2000 M. Forßbohm, 2002

  20. Cure or treatment completed 2001 (n=5094) WHO

  21. Remaining analytical problems • Denominator to assess sensitivity of case detection and TB screening • Estimation of TB prevalence based on nationwide incidence data • Analysis of contact tracing efficacy • Measuring TB incidence in high risk groups (e.g. HIV+, prisons)

  22. Summary • Incidence of tuberculosis decreasing on average by 1 per 100.000 per year • Stagnation of case number 2001-2002 • Nationwide case-based reporting since 2001 • International compatible case definition • Information includes results of susceptibility testing and treatment outcome • Outcome data available for 75% of cases 2001 • Treatment completed or cured in 81,1%

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