Vivantes Klinikum

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.

On 15 October 2025, the revised S3 guideline on schizophrenia (living) was published and transferred to the MAGICapp evidence ecosystem and will be updated annually in the future. This narrative review summarizes essential innovations and explains their development. New and revised recommendations and MAGICapp background information were extracted and summarized. The guideline is now fully integrated into MAGICapp and annually updated. Key changes include adowngrading of the recommendation for antipsychotic monotherapy, asubstantial expansion of guidance on adverse effect monitoring and management and astrengthened emphasis on evidence-based psychotherapeutic interventions, such as metacognitive training and systemic therapy. Additionally, 4 new recommendations (digital/technology-assisted interventions, mindfulness-based procedures, acceptance and commitment therapy [ACT], trauma-focussed therapy for post-traumatic stress disorder [PTSD]) were implemented and 12 were removed. All chapters were comprehensively revised.

Zusammenfassung Psychische Erkrankungen gehen für die Betroffenen und ihre Angehörigen mit erheblichen Belastungen und für die Gesellschaft mit besonders hohen Kosten einher. Früherkennung und Frühintervention haben das Potential, die Krankheitsverläufe und die soziale Inklusion der Betroffenen substanziell zu verbessern und die gesellschaftlichen Kosten dramatisch zu reduzieren

ABSTRACTRecently, cases of human infection with rat hepatitis E virus (ratHEV, Rocahepevirus ratti) have been reported worldwide. Due to the significant genetic differences between ratHEV and human HEV genotypes 1–4 (Paslahepevirus balayani), current HEV diagnostic assays are unable to detect ratHEV. The aim was to establish and validate a laboratory‐developed ratHEV RT‐qPCR assay for use with human plasma and stool samples on a fully automated, high‐throughput platform. Published primers and probes were optimized for use on cobas 5800/6800/8800 systems using European Union In Vitro Diagnostics Regulation (IVDR)‐grade reagents, including an RNA full‐process inhibition control. Analytical sensitivity (21 repeats), linear range (five repeats) and precision (three repeats over 3 days) were evaluated using viral particles from cell culture (MN450851.1). The inclusivity was verified using DNA oligonucleotides and known positive samples (rat liver and human serum). The limits of detection were 98.9 copies/ml in plasma and 60.3 copies/ml in stool, and the assay showed excellent linearity over at least 5 log (r2: 0.991 in plasma and 0.9989 in stool) and high precision (< 0.62 ct). The assay reliably detected different ratHEV C1 subgenotypes, returning positive results for all 11 rat liver samples and one known ratHEV RNA‐positive human plasma sample, while no false positives were detected in the broad cross‐reactivity set (n = 41). In the pilot ratHEV surveillance cohort, 1.1% of plasma samples (n = 1999) were positive for HEV RNA, but none were positive for ratHEV RNA. Our new, fully automated, lab‐developed ratHEV assay can be used in compliance with the IVDR for routine human diagnostics. Further studies are needed to determine the clinical relevance in different human cohorts.

All data generated or analysed during this study are included in this published article.