Schweiger B, Buda S
Fachgebiet Influenza und respiratorische Infektionen, Robert Koch-Institut, Nordufer 20, 13353, Berlin, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013 Jan;56(1):28-37. doi: 10.1007/s00103-012-1580-6.
For many years, the Working Group on Influenza (AGI) has been the most important influenza surveillance system in Germany. An average sample of the population is covered by both syndromic and virological surveillance, which provides timely data regarding the onset and course of the influenza wave as well as its burden of disease. However, smaller influenza outbreaks cannot be detected by the AGI sentinel system. This is achieved by the information reported by the mandatory notification system (Protection Against Infection Act, IfSG), which serves as the second pillar of the national influenza surveillance. Approaches to recognize such outbreaks are based either on reported influenza virus detection and subsequent investigations by local health authorities or by notification of an accumulation of respiratory diseases or nosocomial infections and subsequent laboratory investigations. In this context, virological diagnostics plays an essential role. This has been true particularly for the early phase of the 2009 pandemic, but generally timely diagnostics is essential for the identification of outbreaks. Regarding potential future outbreaks, it is also important to keep an eye on animal influenza viruses that have repeatedly infected humans. This mainly concerns avian influenza viruses of the subtypes H5, H7, and H9 as well as porcine influenza viruses for which a specific PCR has been established at the National Influenza Reference Centre. An increased incidence of respiratory infections, both during and outside the season, should always encourage virological laboratory diagnostics to be performed as a prerequisite of further extensive investigations and an optimal outbreak management.
多年来,流感工作组(AGI)一直是德国最重要的流感监测系统。症状监测和病毒学监测涵盖了普通人群的平均样本,可提供有关流感流行的起始、过程及其疾病负担的及时数据。然而,AGI哨点系统无法检测到规模较小的流感暴发。这要通过强制报告系统(《感染防护法》,IfSG)所报告的信息来实现,该系统是国家流感监测的第二大支柱。识别此类暴发的方法要么基于所报告的流感病毒检测结果以及当地卫生当局随后进行的调查,要么基于呼吸道疾病或医院感染聚集情况的报告以及随后的实验室调查。在这种情况下,病毒学诊断起着至关重要的作用。这在2009年大流行的早期阶段尤其如此,但一般而言,及时诊断对于识别暴发至关重要。对于未来可能出现的暴发,密切关注反复感染人类的动物流感病毒也很重要。这主要涉及H5、H7和H9亚型禽流感病毒以及猪流感病毒,国家流感参考中心已针对这些病毒建立了特异性PCR检测方法。在流感季节期间及之外,呼吸道感染发病率的增加都应始终促使进行病毒学实验室诊断,这是进一步广泛调查和优化暴发管理的前提条件。