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Challenges in Infection Epidemiology: On the Underreporting of Norovirus Gastroenteritis Cases in Germany

1
Research Centre for Occupational and Social Medicine (FFAS), 79098 Freiburg, Germany
2
Institute of Earth and Environmental Sciences, University of Freiburg, 79104 Freiburg, Germany
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(1), 314; https://doi.org/10.3390/ijerph17010314
Received: 8 November 2019 / Revised: 5 December 2019 / Accepted: 28 December 2019 / Published: 2 January 2020
(This article belongs to the Section Public Health Statistics and Risk Assessment)
It is commonly accepted that the number of officially reported incidences of norovirus (NoV) according to the German Protection against Infection Act (Infektionsschutzgesetz) does not reflect the ‘true’ incidence of NoV in Germany. This study aims to reveal the reasons for the underreporting of NoV cases by comparing secondary data. Methods: NoV incidence (cases per 100,000 reference persons) in the age group 18–65 was derived from register data of four different sources in the German public health system (2011–2015): Statutory health insurance in the federal state of Lower Saxony (AOK; in- and outpatient cases), the Research Institute of Ambulatory Health Care in Germany (ZI; outpatient cases), the German Federal Statistical Office (inpatient cases; DESTATIS), and the Robert Koch Institute (RKI SurvStat; health reporting data). Results: the incidence derived from the AOK in Lower Saxony varied between 49 and 66 NoV cases per 100,000 persons and was thus lower than at the federal level. Incidences of all inpatient and outpatient data were lower than the incidence according to the RKI in the last 2–3 years of the observation period. Conclusions: the disagreement between NoV incidences calculated from secondary inpatient and outpatient data and the respective numbers published by the RKI can be regarded as an indication that not all NoV cases were reported to public health authorities. This might be due to missed cases during the notification procedure or misclassification of gastroenteritis cases by general practitioners. Considering the limitations associated with analyzing secondary data, the appropriateness of these assumptions should be verified in future studies. View Full-Text
Keywords: norovirus gastroenteritis; notifiable disease; epidemiology; secondary data; public health; underreporting norovirus gastroenteritis; notifiable disease; epidemiology; secondary data; public health; underreporting
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MDPI and ACS Style

Hofmann, F.M.; Olawumi, E.; Michaelis, M.; Hofmann, F.; Stößel, U. Challenges in Infection Epidemiology: On the Underreporting of Norovirus Gastroenteritis Cases in Germany. Int. J. Environ. Res. Public Health 2020, 17, 314. https://doi.org/10.3390/ijerph17010314

AMA Style

Hofmann FM, Olawumi E, Michaelis M, Hofmann F, Stößel U. Challenges in Infection Epidemiology: On the Underreporting of Norovirus Gastroenteritis Cases in Germany. International Journal of Environmental Research and Public Health. 2020; 17(1):314. https://doi.org/10.3390/ijerph17010314

Chicago/Turabian Style

Hofmann, Felix M., Edward Olawumi, Martina Michaelis, Friedrich Hofmann, and Ulrich Stößel. 2020. "Challenges in Infection Epidemiology: On the Underreporting of Norovirus Gastroenteritis Cases in Germany" International Journal of Environmental Research and Public Health 17, no. 1: 314. https://doi.org/10.3390/ijerph17010314

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