gms | German Medical Science

Background: To provide estimates of the communicable diseases burden in Europe, the ECDC initiated the BCoDE project in 2009. The methodology developed is currently piloted in four European countries (Estonia, Germany, Italy and the Netherlands). The main objective of the pilot study is to test and improve the feasibility of the methodology by first assessing disease burden of four selected pathogens.

Methods: The BCoDE consortium used a refined methodology based on the Global Burden of Disease approach developed by the World Health Organisation to estimate the disease burden of measles, influenza, hepatitis B and salmonellosis in Germany. A pathogen-based approach was developed to account for long-term sequelae resulting from an initial infection. Outcome-trees with pathogen-specific health-states and transition probabilities were generated based on semi-systematic literature reviews and expert opinions. Disability Adjusted Life Years (DALY) were estimated using input data collected from publicly accessible data sources provided by national health authorities (e.g. notification data from SurvStat). Multiplication factors were used to account for under-estimation. Uncertainty of multiplication factors and transition probabilities was assessed by sensitivity analysis using @Risk probability distributions.

Results: For the study period of 2005-2007, annual averages of 882 DALYs for measles, 34,690 DALYs for influenza, 6,839 DALYs for hepatitis B and 3,575 DALYs for salmonellosis were calculated for the German population. DALY rates per 100,000 were 0.99 for measles, 39.79 for influenza, 8.18 for hepatitis B and 4.34 for salmonellosis. For measles and influenza the acute burden accounted for 97.4% and 94.5% and the sequelae burden for 2.6% and 5.5% of the total burden, respectively. For hepatitis B and salmonellosis, the acute burden accounted for 2.6% and 35.0% and the sequelae burden for 97.4% and 65.0% of the total burden, respectively. Stratified by sex, male disease burden for measles, influenza, hepatitis B and salmonellosis was 1.03, 43.09, 8.04 and 4.29 DALY/100,000, respectively. The female burden of measles, influenza, hepatitis B and salmonellosis accounted for 0.95, 41.19, 8.30 and 4.39 DALY/100,000, respectively.

Conclusion: The preliminary results indicate that the BCoDE methodology allows for comprehensively estimating the impact of infectious pathogens on population health in Germany. For hepatitis B and salmonellosis, the approach highlights the impact of long-term sequelae from infectious pathogens with 97.4% and 65.0% of the total DALY burden. These estimates still exclude the burden of prevalent hepatitis B infection acquired elsewhere. Refinement of methodology is currently under way, and will provide improved results accentuating infectious diseases and their specific characteristics.