Norovirus and Campylobacter were among the most commonly reported notifiable diseases in Germany this past year, according to the Robert Koch Institute (RKI).

In 2018, a total of 67,872 Campylobacter infections were recorded, which was 2 percent lower than the year before. The data come from the country’s infectious disease epidemiology annual report.

Campylobacter was the second most frequent notifiable diarrheal disease reported to RKI after norovirus. When information was given on probable country of infection, Germany was at the top but Spain, Italy, France, Morocco, Indonesia and Thailand were mentioned.

In 2018 there were 77,583 norovirus gastroenteritis infections reported to RKI, which is 6 percent more than in 2017. Many of them were not foodborne and were linked to hospitals, nursing homes, childcare facilities and private households. The highest age-specific incidences were among children younger than 2 years old and the age group older than 79.

E. coli increase

For Shiga toxin-producing E. coli (STEC) infection the rise in cases could be because of an increase in the number of samples submitted for testing, according to the report.

In 2018, there were 2,226 cases of enterohemorrhagic E. coli (EHEC), also known as STEC, reported. This is an increase of 10 percent compared to the 2,024 infections in 2017. Incidence was much higher in children younger than five years of age. Two deaths were reported, a man and woman aged 74 and 82 years.

When probable infection country was named, Germany was listed most often followed by Turkey, Egypt, Spain, Italy and Morocco.

There was a significant increase in cases where the O antigen was not typeable and in serogroup E. coli O26. Serogroups O128, O103 and O111 more than doubled from 2016 to 2017, but the increase has not continued. Newly represented among the 10 most frequent serogroups is O8. When an O group could be assigned, O91, O103 and O157 were the top three.

A total of 68 cases of hemolytic uremic syndrome (HUS) were reported, well below the 97 from the previous year, which included an outbreak. Incidence was significantly higher in children younger than the age of five than in other age groups. Females were more impacted than males.

As in the previous year, E. coli serogroups O157 and O26 were given the most followed by O111 and O145. An HUS-related death was reported in a one-year-old child with evidence of E. coli O157. When probable country of infection was listed, Germany was named the most, followed by Turkey, Kosovo, Croatia and Egypt and then United Kingdom, Romania and Northeast Africa.

Slowdown for Salmonella and Listeria

In 2018, 13,529 salmonellosis infections were recorded. It was the second most notifiable bacterial gastrointestinal disease after Campylobacter. The number of illnesses fell by 5.2 percent compared to 2017 but was still higher than in 2016. As in previous years, the highest age-specific incidences were in children younger than five years old.

When data on serovar was known, S. Enteritidis and S. Typhimurium were the most often recorded by far from S. Infantis, S. Derby and S. Kentucky. Compared to the previous year, the number of S. Enteritidis and S. Typhimurium decreased.

Most infections were in Germany but others were distributed to typical holiday destinations such as Egypt, Turkey, Thailand and Spain. Fourteen deaths were related to salmonellosis versus 20 in 2017. Eight men and six women between 42 and 92 died. In 10 deaths a serovar was named; S. Enteritidis six times, S. Typhimurium three times and S. Agona once.

In 2018, 701 Listeria infections were recorded compared to 769 in the previous year. Among the 20 cases involving pregnancy, two had a stillbirth, five had a premature birth and three miscarried. A total of 32 deaths were noted in which listeriosis was reported as cause of death compared to 31 in 2017.

Non-pregnancy-associated, invasive listeriosis affected 272 women and 385 men with incidence increasing significantly with age.

Hepatitis A and E

Most of the vaccine-preventable diseases, such as hepatitis A, occurred in unvaccinated individuals, although effective vaccination is available.

A total of 1,043 cases of hepatitis A were reported, 191 less than in the previous year and the second highest number since 2009. There was a rise in September to November which reflects the delayed incubation period of up to 50 days from increased travel and bigger risk of infection in summer and autumn months.

Germany was mentioned most often as the likely country of infection followed by Morocco, Egypt, Spain, Romania, Italy, India, Turkey, Pakistan, Greece and Afghanistan. Men were more likely to be affected than women with the age group 25 to 29 years old the most impacted. Six deaths were reported in three women and three men aged 50 to 93 years old.

The increasing trend in the number of reported hepatitis E cases, which has been observed over the past several years, continued in 2018. The increase can possibly be attributed to increased awareness among physicians and an increase in samples submitted for testing.

In 2018, 3,996 cases of hepatitis E were reported to the RKI compared to 2,951 in the previous year representing an increase of 15 percent. Eight outbreaks involving 17 people were reported.


Nine cases of foodborne botulism were required in Germany compared to three in 2017. Botulism is a rare but life-threatening condition caused by toxins produced by Clostridium botulinum bacteria
Illnesses occurred in three women between 23 and 74 years old, five men from 32 to 79 years old, and an 8-year-old girl. One death was reported in a 79-year-old male.

Homemade beans and ham and self-caught fish were linked to illness. Botulinum neurotoxin serotype A was detected in the beans and the couple that had eaten them. In the ham, botulinum neurotoxin serotype B was found. For a roach fish case, Clostridium botulinum with the ability to produce botulinum neurotoxin serotype E was detected in the patient but not in the fish.

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