Robert Koch Institute

Men-who-have-sex-with-men (MSM), as well as transgender and non-binary individuals, continue to face a disproportionate burden of stigma, mental health challenges, HIV, and other sexually transmitted infections. To address their needs, public health planners require reliable and comparable data. Monitoring behaviours in these populations also supports the evaluation of health policies. The European-MSM-Internet-Survey (EMIS-2024) builds on our international surveys conducted in 2010 and 2017, expanding its scope to include explicitly transgender women and non-binary people. It provides much-needed data for planning interventions, promoting health, and harmonising behavioural surveillance. A key strength of EMIS-2024 is the use of a shared sampling frame and a core questionnaire across all participating countries. This approach allows meaningful cross-national comparisons, unlike many national surveys with varying methods. The three core consortium partners (Deutsche Aidshilfe, Robert Koch Institute and Maastricht University) led the revision of the EMIS-2017 questionnaire. Over 60 partners from 40 countries played a key role in the survey’s success, providing high-quality translations in 35 languages and actively promoting the survey. National partners ensured the survey’s visibility, credibility, and relevance once dating app advertisements or invitations appeared. The survey ran online during the first half of 2024. Overall, 165,380 responses were received, of which 50,330 qualified for the analytic sample. EMIS-2024 demonstrates that large-scale, multi-country sexual health surveys are feasible with public funding. A harmonised questionnaire, shared sampling strategy, and meaningful community involvement were key to generating robust, comparable data across Europe.

Background/Objectives: Nosocomial outbreaks of viral respiratory infections strain healthcare systems and endanger patients and healthcare workers (HCWs). We describe two large nosocomial outbreaks with the SARS-CoV-2 Alpha variant, during its initial emergence in Germany, to assess transmission dynamics, effectiveness of control measures, and challenges in managing highly transmissible respiratory viruses. Methods: Confirmed cases were inpatients, HCWs, or their contacts testing SARS-CoV-2-positive since 1 January 2021 (Hospital A [HA])) or 21 January 2021 (Hospital B [HB])) with N501Y and delH69/V70 spike gene mutations. We conducted case interviews, reviewed medical records and shift schedules, and performed sequencing, genome reconstruction, and phylogenetic analysis. We describe cases, transmission chains, and control measures. Results: HA reported 18 patient cases, 20 HCW cases, and 33 community cases (N = 71). HB reported 48 patient cases, 43 HCW cases (13 in a COVID-19 ward), and 27 community cases (N = 118). In-hospital transmission occurred patient-to-patient, HCW-to-patient, patient-to-HCW, and HCW-to-HCW. HA halted admissions immediately after the initial cases; HB implemented measures gradually. Regular testing detected pre-symptomatic (HA = 6; HB = 18) and asymptomatic cases (HA = 3; HB = 13). Testing of agency staff was incomplete. The suspected primary case was an HCW in HA and a patient in HB who required resuscitation shortly after admission. Conclusions: Early COVID-19 outbreaks offer valuable lessons for managing emerging nosocomial outbreaks of highly transmissible respiratory viruses. Our findings provide empirical evidence for effective interventions, including rapid response, testing, HCW protection, and rigorous contact tracing in high-risk emergency situations. Managing agency staff remains a major challenge.

Intimate partner violence (IPV) is a significant barrier to HIV prevention service utilization, yet little is known about its impact on pre-exposure prophylaxis (PrEP) adherence among gay, bisexual, and other men who have sex with men (GBMSM). This study examines the association between IPV victimization and PrEP adherence using data from an online survey of 937 current PrEP users in Ukraine, conducted in early 2022, a few days before Russia's invasion. Participants reported on six types of IPV experienced in the past six months, physical, sexual, emotional, and financial abuse as well as partners' monitoring and controlling behaviors. Further, they self-reported their PrEP adherence and were asked to describe the reasons for missing PrEP medications through an open-ended question. Nearly 40% of respondents experienced at least one form of IPV, with sexual and emotional IPV being most common. Only 35.4% reported excellent or very good adherence to PrEP medication. Self-reported reasons for missed doses included COVID-19 restrictions, changes in sexual behavior, use of alternative HIV prevention methods, and health or psychological factors. In multivariable models adjusting for sociodemographic and behavioral factors, sexual IPV, monitoring, and controlling IPV were associated with higher PrEP adherence. The positive association may suggest that IPV survivors increase their PrEP adherence as a protective strategy against HIV infection. These findings highlight the importance of integrating trauma-informed IPV screening and support within PrEP programs and adopting flexible service models to sustain adherence, especially during social and political crises. Future longitudinal research should explore mechanisms linking IPV and PrEP adherence and develop structural interventions to better support this vulnerable population.

Submaximale Parameter wie Laktatschwellen ermöglichen eine präzise und sichere Einschätzung der Ausdauerleistungsfähigkeit und unterstützen die gezielte Trainingssteuerung. Ziel dieser Arbeit ist es, Referenzwerte für die Leistungsfähigkeit an der Laktatschwelle 2 beim Radfahren sowie Grenzwerte zur Identifikation eines erhöhten kardiometabolischen Risikos am 10. Perzentil bei 14- bis 17-jährigen Jugendlichen in Deutschland zu erstellen. Die Leistungsdiagnostik erfolgte auf kalibrierten Fahrradergometern nach WHO-Protokoll mit stufenweiser Belastungssteigerung. Die Laktatschwelle 2 wurde mittels Kapillarblut bestimmt, der Test bei Erschöpfung oder Abbruchkriterium beendet. Die Referenzwerte wurden mittels GAMLSS berechnet. Es wurden 1.714 Jugendliche (869 Jungen, 845 Mädchen, 14–17 Jahre) untersucht. Die relative Leistung an der Laktatschwelle 2 nimmt mit dem Alter ab (Jungen: –0,033 W/kg/Jahr; Mädchen: –0,013 W/kg/Jahr), ist aber bei Jungen höher (Mittelwert: 1,70 vs. 1,42 W/kg; 10. Perzentil: 1,21 W/kg vs. 1,03 W/kg). Die absolute Leistung bleibt von 14 bis 17 Jahren stabil (Jungen: 110,7–113,2 W; Mädchen: 84,5–84,6 W); das 10. Perzentil liegt bei durchschnittlich 80,55 W (Jungen) bzw. 63,09 W (Mädchen). Da die Ergebnisse einen altersabhängigen Rückgang sowie Geschlechtsunterschiede in der relativen Leistung an der Laktatschwelle 2 zwischen 14 und 17 Jahren belegen, sind alters- und geschlechtsspezifische Referenzwerte für eine valide Beurteilung der individuellen Ausdauerleistungsfähigkeit und des kardiometabolischen Risikos im Jugendalter unerlässlich. Querschnittsstudie. Submaximal parameters such as lactate thresholds allow for a precise and safe assessment of cardiorespiratory fitness and support targeted training management. The aim of this study was to establish reference values for cycling performance at the lactate threshold 2 and cut-off values to identify increased cardiometabolic risk in 14- to 17-year-old adolescents in Germany. Performance diagnostics were conducted on calibrated cycle ergometers following the WHO protocol with incremental workload increases. Lactate threshold 2 was assessed via capillary blood samples, and the test was terminated upon exhaustion or reaching a termination criterion. Reference values were calculated using GAMLSS. A total of 1714 adolescents (869 boys, 845 girls, aged 14–17 years) were analyzed. Relative power at the lactate threshold 2 decreases with age (boys: –0.033 W/kg/year; girls: –0.013 W/kg/year), but is higher in boys (mean: 1.70 vs. 1.42 W/kg; 10th percentile: 1.21 W/kg vs. 1.03 W/kg). Absolute power remains stable from age 14 to 17 (boys: 110.7–113.2 W; girls: 84.5–84.6 W); the 10th percentile is on average 80.55 W (boys) and 63.09 W (girls). Since the results demonstrate an age-dependent decline in the relative lactate threshold 2 between 14 and 17 years, age- and sex-specific reference values are essential for a valid assessment of individual endurance capacity during adolescence. Cross sectional study.

National privacy laws diverge between the European Union and United States, hindering transatlantic health data exchange and slowing AI-driven medical innovation. In response, the German Ministry of Health launched the pre-competitive Data for Health initiative, leading to the BRIDGE Pilot Study (2023-2025), a researcher-led effort to address this regulatory and legal gap. Using a mixed-methods approach, including structured surveys (n = 56 expert responses), ranking of steps via relative importance indexing, and 4 Delphi meetings, experts co-developed a practical framework composed of 30 steps in 3 consecutive phases for legally compliant and technically interoperable EU-US health data collaboration. The framework emphasizes early data protection assessments, secure transfer protocols, and iterative governance checks. The final consensus framework provides a stepwise guide to navigate regulatory and legal complexities and operationalize cross-border research. Ongoing input from researchers and stakeholders will help ensure the framework remains adaptable and provides a clear, scalable foundation for cross-border health data exchange.

Zusammenfassung Das Zertifizierungssystem „Zertifiziertes Gefäßzentrum“, das seit 2003 eine externe Überprüfung der Struktur‑, Prozess- und Ergebnisqualität anbietet, besitzt heute eine hohe Akzeptanz und Außenwirkung. Ziel der Arbeit ist eine Darstellung der Entwicklung des interdisziplinären Zertifizierungssystems in den Anfangsjahren und der Anpassungen im Verlauf und nun im Besonderen in Hinblick auf die Krankenhausreform in Deutschland. Derzeit sind 117 Zentren zertifiziert, und es wurden auch Zentren in Österreich, der Schweiz und Luxemburg erfolgreich begutachtet. Neben einer Verbesserung der Struktur- und Prozessqualität konnten wissenschaftliche Arbeiten aus der Versorgungsforschung nachweisen, dass die Ergebnisqualität der Versorgung von Patienten mit Bauchaortenaneurysmen, mit peripherer arterieller Verschlusserkrankung oder einer Carotisstenose durch die Zertifizierung signifikant verbessert werden konnten. Das Zertifizierungssystem wurde weiterentwickelt und durch die Digitalisierung des Antragswesens beschleunigt. Weiterhin wurde ein Gefäßzentrumssignet entwickelt, um die Außenwirkung des Zertifikates klarer darzustellen. Man bemühte sich, eine Zentrumsvergütung über die Gemeinsamer Bundesausschuss (G‑BA)-Zentrumsregelung zu erreichen. Eine Kooperation mit der Weissen Liste führte zu einer verbesserten Außendarstellung und als eines der wenigen Zertifizierungssysteme zu einer Erstaufnahme in den Bundes-Klinik-Atlas. Die Überprüfung des Zertifizierungssystems im Rahmen der Krankenhausreform durch das Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIG) führte zu einer Weiterentwicklung der Zertifizierungskriterien mit Erstellung und Veröffentlichung eines Statuts und der Evidenzbasis des Zertifikates. Diese Optimierungen und der zu erwartende Strukturwandel im Rahmen der Krankenhausreform mit Fokus auf eine Zentralisierung werden zu einer weiteren positiven Entwicklung des Zertifizierungssystems und der Marke „Zertifiziertes Gefäßzentrum“ führen.

Tularemia is a zoonotic infection caused by Francisella tularensis. Human cases in Germany are emerging and are usually associated with hare or tick exposure. Transmission via squirrel bites has only been reported once before in Germany. We describe a 23-year-old woman who developed tularemia 11 days after being bitten by an injured red squirrel (Sciurus vulgaris) in southern Germany. Initial symptoms included headache, chills and fatigue, followed by painful right axillary lymphadenopathy without fever. Empirical ciprofloxacin (500 mg twice daily) was initiated on day 10 post-bite. Francisellatularensis serology was negative at presentation but seroconversion was documented 19 days later, confirming the diagnosis. The patient recovered fully after a 10-day course of ciprofloxacin. This case underscores the need to consider tularemia after rodent bites in endemic areas, including squirrel bites, and highlights the favourable clinical course following early fluoroquinolone therapy.

Abstract Disparities in formal bioinformatics training exacerbate the global skills gap, impeding the democratized application of advanced genomic technologies. To bridge this divide, we introduce a scalable, hybrid training framework designed to rapidly accelerate regional bioinformatics capacity. We exemplify this approach through the Eastern European Bioinformatics and Genomics (EEBG) workshop series — a cross-disciplinary initiative that pairs international faculty with local institutions to deliver modular, hands-on curricula. Functioning as a structured knowledge-transfer pipeline, the series has catalyzed a sustainable educational ecosystem, evidenced by the establishment of multiple independent summer schools across the region. The assessment of the 2025 EEBG workshop in Kraków, Poland, validates the model’s viability; participant metrics confirm high efficacy in skill acquisition (mean satisfaction: 4.4/5.0) and community building. Crucially, the hybrid delivery mode dismantled geographic barriers, serving as a vital mechanism for maintaining scientific continuity for researchers facing displacement and crisis. Synthesizing these outcomes, we define the core features of a replicable blueprint for scientific readiness in resource-constrained environments. We conclude by presenting a strategic roadmap — organized around infrastructure standardization, governance sustainability, and geographical expansion — for adapting this regional proof-of-concept into a global export-ready model, offering a critical path toward ensuring universal access to genomic innovation.