Introduction
Disease | Introduction of routine childhood vaccination recommendation | Current childhood immunisation schedule | Current adult immunisation schedule | Mandatory reporting since |
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Measles | FRG: 1974; GDR: 1966 (voluntary), 1970 (mandatory) | 11–14 months and 15–23 months (catch-up until 17 years) | One-time vaccination for all adults born after 1970 who are of unclear vaccination status, are unvaccinated, or have received only one vaccination in childhood | 2001 |
Mumps | FRG: 1976; GDR: 1977 (voluntary) | 11–14 months and 15–23 months (catch-up until 17 years) | No routine immunisation | 2013 |
Pertussis | FRG: 1969/1991a; GDR: 1964 (mandatory) | 2–4 months and 11–14 months (catch-up until 4 years); booster 5-6 and 9-17 years | The next due tetanus and diphtheria vaccination as a one-time tetanus, diphtheria and pertussis combination vaccination | 2013 |
Varicella | 2004 | 11–14 months and 15–23 months (catch-up until 17 years) | No routine immunisation | 2013 |
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Passive surveillance mainly refers to national notification systems based on mandatory case reporting. This means that health care providers (e.g. physicians and hospitals) and laboratories are required by law to routinely report the occurrence of certain infectious diseases to public health officials. Passive surveillance is the most common method for collecting data on vaccine-preventable diseases. It captures the entire population and requires relatively few resources, but completeness of reporting is highly dependent on the compliance of health facilities. Moreover, diagnostic accuracy can differ among health care providers, particularly since case definition criteria of notification systems often include not only laboratory-confirmed cases but also clinically diagnosed cases.
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Active surveillance involves a proactive search for cases by health authorities through contacting health care providers on a regular basis. This data collection procedure can provide a more complete picture of disease frequency, but it is usually more costly than passive surveillance. That is why active surveillance is often limited to outbreaks or other short-term investigations.
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Sentinel surveillance, which may comprise elements of both active and passive surveillance approaches, relies on a limited number of carefully selected reporting sites. Selection criteria may include representativeness, geographic area, and practical considerations related to feasibility and reporting quality (e.g. willingness to participate, well-qualified staff, and adequate technical resources). Sentinel surveillance requires fewer resources than population-based surveillance and can provide high-quality data. The main shortcoming of this approach is that the generalisability of the findings may be limited.
Methods
Literature search
Inclusion and exclusion criteria
Data extraction
Surveillance data
Results
Literature review
Publication | Methods (study type, data source, population, and time frame) | Outcome measures | Results |
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Measles | |||
Arenz et al. (2009) | Analysis of surveillance data; paediatric hospital-based surveillance data (ESPED); hospitalised children and adolescents <16 years (detailed questionnaire-based information was obtained for 96 children); 2006 | Children hospitalised for measles | 115 children (42 % were <2 years) |
Median length of hospital stay | 6 days | ||
Complications | Pneumonia: 54 %; otitis media: 11 %; seizures: 7 % | ||
Measles-related deaths | 2 children died of measles (with encephalitis) | ||
Carabin et al. (2003) | Multi-country cost study; country-specific incidence and cost data; direct costs include physicians’ visits, prescription medication, hospitalisation, and long-term care for sequelae; general population in Germany; 2001 | Average annual costs (2001 values) of caring for measles per capita in Germany from a health care provider perspective | Approximately EUR 0.02 per capita |
Gillesberg Lassen et al. (2014) | Outbreak report; notification data and clinical data collected through interviews with case-patients; community members, students of an anthroposophic school, and family members and friends of the students in Berlin; April–July 2011 | Cases of measles | 73 cases (27 % of all case-patients and 38 % of community case-patients were ≥20 years) |
Hospitalisation | 15 % | ||
Hegasy et al. (2012) | Outbreak report; notification data and contact tracing activities; non-Roma inhabitants and Roma community members living in Hamburg; December 2008–June 2009 | Cases of measles | 216 cases (69 % were confirmed by laboratory analyses); a local Roma community comprised more than 50 % of the notified cases |
Mankertz et al. (2011) | Study on spread of the D4-Hamburg strain; results of laboratory samples; general population in Germany; 2008–2010 | Cases of measles | 216 cases in Hamburg; 72 cases in Lower Saxony; 48 cases in Munich; several cases occurred in Roma community members and asylum seekers |
Hospitalisation | 40 % of patients (due to pneumonia or otitis media) | ||
Mette et al. (2011) | Claims data analysis and comparison with surveillance data; ASHIP billing data and notification data; 15.4 million people covered by statutory health insurance living in North Rhine-Westphalia; 2006–2007 | Confirmed measles diagnoses (ASHIP data) | 2534 diagnoses (87 % of billed measles diagnoses occurred in children <10 years) |
Reported cases of measles (notification data) | 2014 cases (40 % of measles cases were reported for children <10 years) | ||
Ratio of confirmed measles diagnoses and reported cases of measles | 1.26: 1 (underreporting) | ||
Muscat et al. (2009) | Multi-country analysis of surveillance data; data of national mandatory notification systems; general population in Germany; 2006–2007 | Cases of measles | 2307 cases in 2006; 571 cases in 2007 |
Incidence per 100,000 inhabitants | 2.8 per 100,000 in 2006; 0.7 per 100,000 in 2007 | ||
Measles-related deaths | 2 fatal cases in children (caused by encephalitis) | ||
Muscat et al. (2014) | Multi-country analysis of surveillance data; data submitted by national surveillance institutions to the WHO Regional Office for Europe; general population in Germany; 2012–2013 | Cases of measles | 167 cases in 2012; 1773 cases in 2013 |
Incidence per million inhabitants per year | 2 per million in 2012; 21.4 per million in 2013 | ||
Plass et al. (2014) | Burden of disease study; DALY estimates are based on a model of the natural history of disease using notification data; general population in Germany; 2005–2007 | Average loss of DALYs per year | 740 DALYs (93 % was due to acute symptomatic infections and 7 % was due to long-term sequelae) |
Average loss of DALYs per case | 0.26 DALYs | ||
Roggendorf et al. (2012) | Outbreak report; surveillance data of a community health centre; 1st outbreak: children attending a free progressive school in Essen and their contacts; 2nd outbreak: children and adults in a low socio-economic setting and with migration background in Essen; March–July 2010 | Cases of measles | 1st outbreak: 75 cases; 2nd outbreak: 11 cases |
Hospitalisation | 15 % | ||
Siedler et al. (2006) | Outbreak report; surveillance data of the mandatory reporting system and data collected through interviews of the local health authorities with physicians and family members; general population in Hesse and Bavaria; January–May 2005 (Hesse) and March–July 2005 (Bavaria) | Cases of measles (without sporadic cases) | Hesse: 223 cases; Bavaria: 279 cases; 74 % in school aged children |
Incidence per 100,000 inhabitants | Hesse: 14 per 100,000; Bavaria: 12 per 100,000 | ||
Hospitalisation in patients ≥20 years | Outbreak in Hesse: 34 % | ||
Measles-related deaths | Outbreak in Hesse: 1 case | ||
Siedler et al. (2013a) | Analysis of surveillance data; sentinel data collected by 1488 paediatric and primary care practices; patients of practices participating in the sentinel system; 2001–2010 | Cases of measles | 3100 cases (2495 cases in children <10 years) |
Complications | 15 % (mostly otitis media and pneumonia) | ||
Takla et al. (2014) | Claims data analysis and comparison with surveillance data; ASHIP billing data and mandatory notification data; 68 % (2007) and 79 % (2008–2011) of the total population living in Germany (ASHIP data); 2007–2011 | Cases of measles (notification data) | 4440 cases |
Annual incidence per million population (notification data) | Total: 10.8 per million (range 6.9–19.6 per year); northern Germany: 8.7; western Germany: 7.2; eastern Germany: 5.5; southern Germany: 20.3 | ||
Annual incidence per million residents with statutory health insurance (ASHIP data) | 27.5 per million; incidence based on ASHIP data was up to 4.8-fold higher than incidence based on notified cases | ||
Tischer et al. (2001) | Analysis of surveillance data; sentinel data and notification data; general population in Germany; October 1999–March 2001 | Cases of measles (sentinel data) | 1291 cases |
Complications (sentinel data) | 24 % | ||
Hospitalisation (sentinel data) | 2.2 % | ||
Incidence per 100,000 inhabitants | 38.9 per 100,000 (sentinel data); <0.5–5.7 per 100,000 (notification data of the first quarter of 2001) | ||
Tischer et al. (2002) | Analysis of surveillance data; sentinel data collected by 1271 paediatric and primary care practices; general population in Germany; October 1999–September 2001 | Cases of measles | 1720 cases |
Incidence per 100,000 inhabitants | 20 per 100,000 (range <1–56 per 100,000, depending on the federal state) | ||
Complications | 16 % (mostly otitis media and pneumonia) | ||
Hospitalisation | 2.4 % | ||
Wadl et al. (2011) | Outbreak report; surveillance data and data collected through questionnaires; general population in four Bavarian counties (including attendees of an anthroposophic school in Austria); March–July 2008 | Cases of measles | 217 cases |
Incidence per 100,000 population | 32 per 100,000 | ||
Hospitalisation | 11 % | ||
Complications | 18 % | ||
Wichmann et al. (2007) | Retrospective cohort study on the initial phase of an outbreak; data collected through questionnaires; 1098 students aged 10–21 years of a public day school in Duisburg; January–May 2006 | Cases of measles | 53 cases |
Hospitalisation | 4 % | ||
Complications | Otitis media: 4 cases; pneumonia: 1 case; encephalitis: 1 case | ||
Wichmann et al. (2009) | Study on outbreak-related morbidity and costs; surveillance data and data collected through questionnaires/interviews (face-to-face or by telephone); health care provider costs (including physician consultations, laboratory tests, antibiotic treatment, and hospitalisation) are calculated using DRGs, the outpatient fee schedule and medication prices; general population in Duisburg; 2006 | Cases of measles | 614 cases in Duisburg |
Hospitalisation | 15 % | ||
Antibiotic treatment | 32 % | ||
Complications | Otitis media: 19 %; pneumonia: 7 %; encephalitis: 0.6 % | ||
Measles-related deaths | 2 fatal cases in children (caused by encephalitis) | ||
School days missed | 2854 days | ||
Work days lost | 301 days | ||
Average costs (2006 values) | EUR 373 per measles patient; EUR 1877 per hospitalised patient | ||
Mumps | |||
Otto et al. (2010) | Outbreak report; laboratory samples and clinical data; adolescents and young adults in Bavaria; July–October 2010 | Laboratory-confirmed infections | 115 laboratory-confirmed mumps infections (median age: 24.5 years, predominantly male patients) |
Complications | 1 case of meningitis and 21 cases of orchitis | ||
Takla et al. (2013) | Claims data analysis and comparison with surveillance data; ASHIP billing data and notification data; statutory health-insured population and general population in the eastern and western federal states of Germany; 2007–2011 | Countrywide mean annual incidence per 100,000 people covered by statutory health insurance | 10.3 per 100,000 (range 9.3–11.8); incidence was significantly higher in western than in eastern federal states; comparison of notification data with ASHIP data indicated severe underreporting of incidence estimates based on notification data |
Complications | Orchitis: 6.2 % of male cases; meningitis: 0.4 %; pancreatitis: 0.3 %; encephalitis: 0.2 %; proportion of complications in cases ≥15 years was significantly higher than in cases <15 years | ||
Pertussis | |||
Hellenbrand et al. (2009) | Analysis of surveillance data; surveillance data (notification and sentinel data) and hospital discharge statistics; general population in Germany; 2000–2007 | Incidence per 100,000 inhabitants in eastern federal states (notification data) | 20.5 per 100,000 in 2000; 39.3 per 100,000 in 2007 |
Incidence in adults per 100,000 inhabitants | 160–169 per 100,000 in 2002–2004 | ||
Hospitalisation in eastern federal states (surveillance data) | 1.9–4.9 % in 2002–2007 (depending on the federal state) | ||
Hospitalisation (cases per 100,000 population, hospital discharge statistics) | 1.7 per 100,000 in eastern federal states in 2007; 1.5 per 100,000 in western federal states in 2005; most cases occurred in children <1 year | ||
Juretzko et al. (2001) | Analysis of surveillance data; paediatric hospital-based surveillance data (ESPED) and clinical data collected through questionnaires; children <16 years; 1997–1998 | Standardised incidence of pertussis requiring hospitalisation per 100,000 person-years | 2.70 per 100,000; 2.36 per 100,000 in western federal states; 4.50 per 100,000 in eastern federal states |
Mean length of hospital stay | 14.9 days | ||
Complications in hospitalised children | All: 44 % (60 % occurred in children <6 months); pneumonia: 28.1 %; apnea: 20.6 %; seizures: 2.5 %; encephalopathy: 2.1 % | ||
Pertussis-related deaths in hospitalised children | 0.3 % | ||
Liese et al. (2003) | Prospective long-term surveillance study; follow-up data of a population-based case–control efficacy study; 11,087 children (3–8 years) of the original study population and all other children of the same age group presenting in the participating paediatric practices; 8.3 % were not vaccinated against pertussis; May 1997–March 1999 | Cases of pertussis | 180 cases; 64 % were caused by B pertussis infections and 36 % were caused by B parapertussis infections |
Incidence per 1000 person-years |
B pertussis infections: 4.8 per 1000; B parapertussis infections: 2.8 per 1000 | ||
Riffelmann et al. (2006) | Prospective incidence and cost study; laboratory samples, clinical and resource consumption data collected through questionnaires; direct costs include physician consultations, laboratory tests, and medication; indirect costs are based on the number of work days lost and a cost of EUR 114.30 per day; 971 primary care patients having cough for ≥7 days in two German cities (Krefeld and Rostock); economic analysis is based on 45 cases of pertussis; 2001–2004 | Proportion of patients with pertussis | 10 % |
Incidence per 100,000 inhabitants | 165 per 100,000 | ||
Pertussis patients with antibiotic prescription | 53 % | ||
Average direct costs (2004 values) per case | EUR 120 | ||
Average indirect costs (2004 values) per case in employed patients | EUR 2443 | ||
Sin et al. (2009) | Outbreak report; active case finding by the local health authorities and a retrospective cohort study performed in 4 affected schools (questionnaires); mostly children and adolescents attending schools in Ludwigslust district, Mecklenburg-Western Pomerania; 2005–2006 | Cases of pertussis | 104 cases |
Attack rate | 1.9–32.0 % (depending on the time since last vaccine dose); results suggest that vaccine-induced immunity begins to wane approximately 5 years after completion of the primary series | ||
Stojanov et al. (2000) | Prospective surveillance study; data of a case–control efficacy study; 11,016 children <2 years presenting with cough ≤7 days at 63 paediatric practices in Germany; March 1993–May 1995 | Proportion of patients with pertussis | 6.6 % |
Hospitalisation | 4.5 % | ||
Complications in hospitalised pertussis patients | All: 48 %; bradycardia: 21 %; apnea: 12 %; conjunctivitis: 12 %; pneumonia: 6 %; otitis media: 6 % | ||
Mean length of hospital stay | 8 days | ||
Varicella | |||
Banz et al. (2004) | Cost study; cost estimates are based on a decision-analytic model using survey data (Wagenpfeil et al. 2004); direct costs include physician consultations, medication, and hospitalisation; transfer payments are based on parental work days lost; indirect costs are based on the number of work days lost and a cost of EUR 150 per day; general population in Germany; 1999 prices (pre-vaccination era) | Annual third-party payer costs (1999 values of direct costs and transfer payments to parents caring for their sick children) | EUR 78 million (direct medical costs: 43 %) |
Annual societal costs (1999 values of direct and indirect costs) | EUR 187.5 million (direct medical costs: 18 %) | ||
Grote et al. (2007) | Analysis of surveillance data; paediatric hospital-based surveillance data (ESPED); paediatric population up to the age of 17 years; 2003–2004 (pre-vaccination era) | Cases of varicella-associated deaths | 10 cases (none was vaccinated against varicella) |
Annual mortality rate (cases per million children) | 0.4 per million | ||
Liese et al. (2008) | Analysis of surveillance data; nationwide paediatric hospital-based surveillance data (ESPED), practice sentinel network and hospital diagnosis data in one federal state (North Rhine-Westphalia); children ≤16 years; 2003–2004 (pre-vaccination era) | Hospitalised varicella cases (ESPED data) | 918 cases (with a median age of 3.3 years) |
Annual incidence of varicella-related hospitalisations (cases per 100,000 children) | 3.25 per 100,000 (ESPED data); 14.1 per 100,000 (capture–recapture methodology for two sources); 19.7 per 100,000 (hospital diagnosis data) | ||
Median length of hospital stay | 5 days | ||
Complications in hospitalised cases | All: 79.6 %; neurological: 25.4 %; skin: 23.2 %; gastrointestinal tract: 15 %; lower respiratory tract: 11.8 %; severe systemic bacterial infections: 4.4 % | ||
Cases of varicella-associated deaths | 10 cases | ||
Siedler and Arndt (2010) | Analysis of surveillance data; sentinel data collected by paediatricians and general practitioners; general population in Germany; April 2005–March 2009 (vaccination era) | Cases of varicella and trend analysis | 83,181 cases; sentinel data showed a reduction of 55 % of varicella cases in all ages over time |
Siedler et al. (2013b) | Analysis of surveillance data; sentinel data, notification data, and hospital diagnosis statistics; general population in Germany; 2005–2012 (vaccination era) | Trend analysis of varicella-related morbidity | Significant decline of varicella incidence, complications, and hospitalisations over time |
Siedler and Dettmann (2014) | Analysis of hospitalisation data; national hospital discharge statistics; general population in Germany; 1995–2012 (pre-vaccination era and vaccination era) | Trend analysis of varicella hospitalisation incidence | No particular trend until 2003, hospitalisation incidence peaked in 2004 (time of vaccine recommendation), and decreased thereafter; hospitalisation incidence per 100,000 was significantly lower in the vaccination period (1.86) than in the pre-vaccination period (3.30) |
Spackova et al. (2010) | Analysis of surveillance data; sentinel data collected by paediatricians and general practitioners; general population in Germany; April 2005–March 2009 (vaccination era) | Cases of varicella and trend analysis | 83,075 cases; the total number of varicella cases decreased over time with increasing vaccine uptake |
Complications | All: 0,34 %; bacterial superinfection: 0.13 %; otitis media: 0.06 %; neurological: 0.03 % | ||
Hospitalisation in varicella patients with complications | 25 % | ||
Streng et al. (2013) | Analysis of surveillance and survey data; data of the Bavarian Varicella Surveillance Project (BaVariPro) based on parent surveys (vaccination coverage), paediatric practice surveillance, and paediatric hospital database queries; children <17 years in Munich; October 2006–September 2011 (vaccination era) | Cases of varicella and trend analysis | 16,054 cases; the mean number of cases decreased by 67 % during the five seasons |
Incidence per 1000 children (based on the number of reported cases) | 26 per 1000 in the first season and 6 per 1000 in the fifth season | ||
Complications in practice patients | 0.8 % (mostly skin complications and otitis media) | ||
Complications in hospitalised patients | Central nervous system: 22.5 %; skin: 15.7 %; lower respiratory tract: 9 % | ||
Median length of hospital stay | 3 days | ||
Hospitalisation incidence (cases per 100,000 children) and trend analysis | 8.2 per 100,000; hospitalisation incidence decreased by 43 % between 2005 and 2009 | ||
Wagenpfeil et al. (2004) | Retrospective epidemiological and resource consumption study; clinical data were obtained from medical files through telephone interviews with physicians; 1334 unvaccinated varicella patients of a representative and German-wide sample of paediatric and primary care practices; 1999 (pre-vaccination era) | Complications | All: 5.7 %; bacterial superinfection: 2.5 % (≤12 years), 1.9 % (>12 years); neurological: 0.2 % (≤12 years); pneumonia or bronchitis: 1.9 % (≤12 years), 1.9 % (>12 years); otitis media: 1.1 % (≤12 years) |
Hospitalisation period per diagnosed varicella case | 0.1 inpatient days | ||
Work days lost per diagnosed varicella case | 1.3 days | ||
Ziebold et al. (2001) | Analysis of surveillance data; paediatric hospital-based surveillance data (ESPED) and clinical data collected through questionnaires; hospitalised children ≤16 years; 1997 (pre-vaccination era) | Hospitalised varicella cases | 119 |
Complications in hospitalised varicella cases | Neurological: 62.3 %; infectious: 35.2 % |