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Confirmed cases or probable cases ???
On July 20, 2009, Robert Koch Institute (RKI) reported on the latest update of confirmed cases in Germany and published the following statement:
?In addition comes that by the technical rearrangement also those cases are disclosed [in the left column of the tally named ?confirmed?] , with which even no laboratory diagnosis was accomplished, which had however had contact to other laboratory-confirmed patients.?
(?Hinzu kommt, dass durch die technische Umstellung auch F?lle neu ausgewiesen werden, bei denen selbst keine Labordiagnose durchgef?hrt wurde, die aber Kontakt zu anderen laborbest?tigten Erkrankten hatten.?)
But both due to RKI?s case definition and ECDC?s case definition of a ?confirmed case?, any case could NOT be a ?confirmed case? without a positive specific laboratory test (proven by real-time RT-PCR or viral culture).
So, some of the RKI cases which were named as ?confirmed cases? aren?t ?confirmed? yet but should correctly be named as ?probable cases? !?
ECDC case definition of novel influenza virus A (H1N1)
EN L 110/58 Official Journal of the European Union 1.5.2009
COMMISSION DECISION of 30 April 2009 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council (notified under document number C(2009) 3517)
?NOVEL INFLUENZA VIRUS A(H1N1) (THE SO-CALLED SWINE INFLUENZA VIRUS A(H1N1) AND MEXICAN INFLUENZA VIRUS) ( 1 )
B. Probable case [ECDC]
Any person meeting the clinical AND epidemiological criteria AND with a laboratory result showing positive influenza A infection of an unsubtypable type.
C. Confirmed case [ECDC]
Any person meeting the laboratory criteria for confirmation.
[RKI-] Falldefinition f?r Neue Influenza (A/H1N1)
RKI case definition of novel influenza virus A (H1N1)
Probable case
Any person meeting the laboratory criteria for confirmation by a laboratory, that was not approved by the NRZ (national reference center) (?)
Any person meeting the clinical AND epidemiological criteria of category B or E.
Category E: direct contact to a probable or confirmed case or to a fatal case of novel Influenza A (H1N1)
Category E: working in a laboratory, in which samples [swabs] are tested for novel influenza A (H1N1)
Wahrscheinlicher Fall
Person mit labordiagnostischem Nachweis der neuen Influenza A/H1N1 in einem Labor, das nicht vom NRZ f?r Influenza speziell benannt wurde*,
Person mit labordiagnostischem Nachweis von Influenza A und einem negativen labordiagnostischen Ergebnis f?r die saisonalen Influenzasubtypen A/H1 und A/H3,
Person mit erf?lltem klinischem Bild mit einer epidemiologischen Exposition der Kategorie B oder E.
(B) ►direkter Kontakt mit einem wahrscheinlichen oder best?tigten Fall oder Todesfall durch Neue Influenza (A/H1N1)
(E) Laborexposition Arbeit in einem Labor, in dem Proben auf neue Influenzaviren (A/H1N1) getestet werden.
Confirmed case
Any person meeting the laboratory criteria for confirmation by NRZ (national reference center) or by a NRZ approved laboratory.
Best?tigter Fall
Person mit labordiagnostischem Nachweis von neuer Influenza (A/H1N1) durch das NRZ f?r Influenza oder einem vom NRZ f?r Influenza speziell benannten Labor.
On July 20, 2009, Robert Koch Institute (RKI) reported on the latest update of confirmed cases in Germany and published the following statement:
?In addition comes that by the technical rearrangement also those cases are disclosed [in the left column of the tally named ?confirmed?] , with which even no laboratory diagnosis was accomplished, which had however had contact to other laboratory-confirmed patients.?
(?Hinzu kommt, dass durch die technische Umstellung auch F?lle neu ausgewiesen werden, bei denen selbst keine Labordiagnose durchgef?hrt wurde, die aber Kontakt zu anderen laborbest?tigten Erkrankten hatten.?)
But both due to RKI?s case definition and ECDC?s case definition of a ?confirmed case?, any case could NOT be a ?confirmed case? without a positive specific laboratory test (proven by real-time RT-PCR or viral culture).
So, some of the RKI cases which were named as ?confirmed cases? aren?t ?confirmed? yet but should correctly be named as ?probable cases? !?
ECDC case definition of novel influenza virus A (H1N1)
EN L 110/58 Official Journal of the European Union 1.5.2009
COMMISSION DECISION of 30 April 2009 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council (notified under document number C(2009) 3517)
?NOVEL INFLUENZA VIRUS A(H1N1) (THE SO-CALLED SWINE INFLUENZA VIRUS A(H1N1) AND MEXICAN INFLUENZA VIRUS) ( 1 )
B. Probable case [ECDC]
Any person meeting the clinical AND epidemiological criteria AND with a laboratory result showing positive influenza A infection of an unsubtypable type.
C. Confirmed case [ECDC]
Any person meeting the laboratory criteria for confirmation.
[RKI-] Falldefinition f?r Neue Influenza (A/H1N1)
RKI case definition of novel influenza virus A (H1N1)
Probable case
Any person meeting the laboratory criteria for confirmation by a laboratory, that was not approved by the NRZ (national reference center) (?)
Any person meeting the clinical AND epidemiological criteria of category B or E.
Category E: direct contact to a probable or confirmed case or to a fatal case of novel Influenza A (H1N1)
Category E: working in a laboratory, in which samples [swabs] are tested for novel influenza A (H1N1)
Wahrscheinlicher Fall
Person mit labordiagnostischem Nachweis der neuen Influenza A/H1N1 in einem Labor, das nicht vom NRZ f?r Influenza speziell benannt wurde*,
Person mit labordiagnostischem Nachweis von Influenza A und einem negativen labordiagnostischen Ergebnis f?r die saisonalen Influenzasubtypen A/H1 und A/H3,
Person mit erf?lltem klinischem Bild mit einer epidemiologischen Exposition der Kategorie B oder E.
(B) ►direkter Kontakt mit einem wahrscheinlichen oder best?tigten Fall oder Todesfall durch Neue Influenza (A/H1N1)
(E) Laborexposition Arbeit in einem Labor, in dem Proben auf neue Influenzaviren (A/H1N1) getestet werden.
Confirmed case
Any person meeting the laboratory criteria for confirmation by NRZ (national reference center) or by a NRZ approved laboratory.
Best?tigter Fall
Person mit labordiagnostischem Nachweis von neuer Influenza (A/H1N1) durch das NRZ f?r Influenza oder einem vom NRZ f?r Influenza speziell benannten Labor.