@article{StrengGroteLiese2011,
  author    = {Streng, Andrea and Grote, Veit and Liese, Johannes G.},
  title     = {Severe influenza cases in paediatric intensive care units in Germany during the pre-pandemic seasons 2005 to 2008},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-69120},
  year      = {2011},
  abstract  = {Background: Data on complications in children with seasonal influenza virus infection are limited. We initiated a nation-wide three-year surveillance of children who were admitted to a paediatric intensive care unit (PICU) with severe seasonal influenza. Methods: From October 2005 to July 2008, active surveillance was performed using an established reporting system for rare diseases (ESPED) including all paediatric hospitals in Germany. Cases to be reported were hospitalized children < 17 years of age with laboratory-confirmed influenza treated in a PICU or dying in hospital. Results: Twenty severe influenza-associated cases were reported from 14 PICUs during three pre-pandemic influenza seasons (2005-2008). The median age of the patients (12 males/8 females) was 7.5 years (range 0.1-15 years). None had received vaccination against influenza. In 14 (70\%) patients, the infection had been caused by influenza A and in five (25\%) by influenza B; in one child (5\%) the influenza type was not reported. Patients spent a median of 19 (IQR 12-38) days in the hospital and a median of 11 days (IQR 6-18 days) in the PICU; 10 (50\%) needed mechanical ventilation. Most frequent diagnoses were influenza-associated pneumonia (60\%), bronchitis / bronchiolitis (30\%), encephalitis / encephalopathy (25\%), secondary bacterial pneumonia (25\%), and ARDS (25\%). Eleven (55\%) children had chronic underlying medical conditions, including 8 (40\%) with chronic pulmonary diseases. Two influenza A- associated deaths were reported: i) an 8-year old boy with pneumococcal encephalopathy following influenza infection died from cerebral edema, ii) a 14-year-old boy with asthma bronchiale, cardiac malformation and Addison's disease died from cardiac and respiratory failure. For nine (45\%) patients, possibly permanent sequelae were reported (3 neurological, 3 pulmonary, 3 other sequelae). Conclusions: Influenza-associated pneumonia and secondary bacterial infections are relevant complications of seasonal influenza in Germany. The incidence of severe influenza cases in PICUs was relatively low. This may be either due to the weak to moderate seasonal influenza activity during the years 2005 to 2008 or due to underdiagnosis of influenza by physicians. Fifty \% of the observed severe cases might have been prevented by following the recommendations for vaccination of risk groups in Germany.},
  subject      = {Deutschland},
  language  = {en}
}
@article{StrengGroteCarretal.2013,
  author    = {Streng, Andrea and Grote, Veit and Carr, David and Hagemann, Christine and Liese, Johannes G.},
  title     = {Varicella routine vaccination and the effects on varicella epidemiology - results from the Bavarian Varicella Surveillance Project (BaVariPro), 2006-2011},
  series = {BMC Infectious Diseases},
  journal   = {BMC Infectious Diseases},
  doi       = {10.1186/1471-2334-13-303},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-96297},
  year      = {2013},
  abstract  = {Background In 2004, routine varicella vaccination was recommended in Germany for children 11-14 months of age with one dose, and since 2009, with a second dose at 15-23 months of age. The effects on varicella epidemiology were investigated. Methods Data on varicella vaccinations, cases and complications were collected from annual parent surveys (2006-2011), monthly paediatric practice surveillance (Oct 2006 - Sep 2011; five varicella seasons) and paediatric hospital databases (2005-2009) in the area of Munich (about 238,000 paediatric inhabitants); annual incidences of cases and hospitalisations were estimated. Results Varicella vaccination coverage (1st dose) in children 18-36 months of age increased in two steps (38\%, 51\%, 53\%, 53\%, 66\% and 68\%); second-dose coverage reached 59\% in the 2011 survey. A monthly mean of 82 (62\%) practices participated; they applied a total of 50,059 first-dose and 40,541 second-dose varicella vaccinations, with preferential use of combined MMR-varicella vaccine after recommendation of two doses, and reported a total of 16,054 varicella cases <17 years of age. The mean number of cases decreased by 67\% in two steps, from 6.6 (95\%CI 6.1-7.0) per 1,000 patient contacts in season 2006/07 to 4.2 (95\%CI 3.9-4.6) in 2007/08 and 4.0 (95\%CI 3.6-4.3) in 2008/09, and further to 2.3 (95\%CI 2.0-2.6) in 2009/10 and 2.2 (95\%CI 1.9-2.5) in 2010/11. The decrease occurred in all paediatric age groups, indicating herd protection effects. Incidence of varicella was estimated as 78/1,000 children <17 years of age in 2006/07, and 19/1,000 in 2010/11. Vaccinated cases increased from 0.3 (95\%0.2-0.3) per 1,000 patient contacts in 2006/07 to 0.4 (95\%CI 0.3-0.5) until 2008/09 and decreased to 0.2 (95\%CI 0.2-0.3) until 2010/11. The practices treated a total of 134 complicated cases, mainly with skin complications. The paediatric hospitals recorded a total of 178 varicella patients, including 40 (22.5\%) with neurological complications and one (0.6\%) fatality due to varicella pneumonia. Incidence of hospitalisations decreased from 7.6 per 100,000 children <17 years of age in 2005 to 4.3 in 2009, and from 21.0 to 4.7 in children <5 years of age. Conclusions Overall, the results show increasing acceptance and a strong impact of the varicella vaccination program, even with still suboptimal vaccination coverage.},
  language  = {en}
}