Introduction: Following the COVID-19 pandemic, a retrospective evaluation of the measures is still pending in Germany. This article will attempt to draw constructive and critical lessons from this pandemic for the actions of the public health authorities (PHA) in similar situations in the future. Results: First, the legal and professional basis of the public health authorities in Germany to deal with a pandemic is presented. However, the analysis of the work of the PHA during the pandemic shows that the health authorities imposed extensive restrictions on freedom due to political and administrative law requirements without implementing the pandemic plan, the technical evidence and the principles of administrative law. The lessons of history were also ignored. Discussion: The non-compliance with professional und legal requirements may be explained by mass phenomena that occurred during the pandemic. Simplified messages and narratives led to uncertainty and fear, blurring individual boundaries in favor of collective reactions. Within a very short time in spring 2020, a collective threat scenario had gripped the whole of society-including the public health services. Combating the virus became the only goal, which supposedly unconditionally required maximum measures and restrictions on freedom and did not sufficiently take into account the considerable consequences for society as a whole. The question arises as to how, even in times of a pandemic, evidence and experience can continue to guide decisions instead of threat scenarios, as was possible in Sweden. There, the Swedish pandemic plan was implemented in accordance with the principle of proportionality. Conclusion: With our contribution to the discussion, we would like to encourage the PHA to take up this discussion and reappraisal-in responsibility for itself, for society and, in particular, for the people whose freedoms have been significantly restricted.

Background: The German Society for Arthroplasty (AE) recommends a single dose of 2,000 mg amoxicillin as an antibiotic prophylaxis to prevent periprosthetic joint infections (PJI) in patients with total hip or knee arthroplasty (THA, TKA) who undergo invasive dental procedures (DP). We searched for evidence to support this recommendation. Materials and methods: We conducted a Medline query and made additional searches based on the literature found in the Medline database. We looked for relevant recommendations on antibiotic prophylaxis (AP) in other countries, as well as for standardized reviews and other studies published after the last reviews on the question of antibiotic prophylaxis for joint implant recipients in connection with dental treatment. Results: In twelve countries, no current guideline recommends general antibiotic prophylaxis for dental procedures, seven guidelines suggest that antibiotic prophylaxis should be considered in patients with risk factors, and five guidelines recommend that antibiotic prophylaxis be considered in conjunction with specific dental procedures that have an increased risk. Three reviews (2012, 2017 and 2020) mostly comprised of low-quality studies, all agreed that there is no direct evidence to indicate AP prior to dental procedures in patients with total joint arthroplasty (TJA). Six new retrospective studies from four countries on three continents, which included a total of more than 200,000 patients with TJA, confirmed the results of earlier studies: PJIs are rare and not significantly associated with DPs, and AP does not significantly reduce the (already low) risk. This applies not only to primary but also to revision TKA. Furthermore, a recent study comprising 61,124 patients with TJA or cardiac conditions who received AP for DP found that 62 (0.1%) experienced serious adverse drug events. Discussion: Even though most studies were conducted retrospectively and are based on insurance data and not on the analysis of individual medical records, it should be noted that there is still no robust evidence showing that dental procedures increase the risk of PJI, nor that AP has a risk-reducing effect both for primary THA and TKA as well as for revision TKA. Therefore, it is suggested that the AE should revise its recommendation, announced in 2022, in order to avoid the risks of unnecessary AP.

INTRODUCTION:Numerous studies have examined mortality during the SARS-CoV-2 pandemic in Germany and worldwide. In Germany, excess mortality was highest in 2022 compared to the other pandemic years. In a small-scale analysis in Frankfurt am Main, Germany, the excess mortality 2022 was associated with an influenza wave at the end of the year. The aim of this study was to investigate this for the whole of Germany. METHODS:We used publicly available data for the number of deaths, for the population data and for notifications of SARS-CoV-2 and influenza. Standardized mortality ratios (SMR) were estimated for Germany for the years 2020-2023, for seven SARS-CoV-2 waves and for the influenza wave at the end of 2022. Expected numbers of deaths were estimated by two methods: in the first, average mortality in the pre-pandemic years 2016-2019 was used; in the latter, an exponential extrapolation was used to consider the increase in life expectancy. RESULTS:Relative excess mortality was highest in 2022 (SMR = 1.069 (95% confidence interval: 1.066-1.071) by method 1, SMR = 1.094 (1.092-1.096) by method 2). During the influenza wave from calendar week 47 / 2022 to calendar week 1 / 2023, the SMR was higher than that of any SARS-CoV-2 wave: SMR = 1.252 (95% CI: 1.246-1.258) by method 1, and SMR = 1.374 (95% CI: 1.367-1.380) by method 2. Among all waves considered, the mean number of excess deaths per week was highest during the influenza wave by both methods (5,043, and 6,812, respectively). Age-stratified analyses showed that the excess mortality during the influenza wave at the end of 2022 was highest in individuals aged 70 years and older. DISCUSSION:During an influenza wave at the end of 2022, excess mortality was higher than in any SARS-CoV-2 wave in 2020-2022 in Germany. Because this study is based on all‑cause mortality and population‑level surveillance indicators, it cannot establish causation or quantify the proportion of excess deaths directly attributable to influenza infection.

Introduction:Mortality during the SARS-CoV-2 pandemic was studied in many countries. The results were strongly influenced by the chosen calculation method, the adjustment to the ageing of the population and the reference periods used. Smaller-scale studies sometimes showed considerable differences within countries, but it is unclear whether the differences within a country were due to the fact that the studies were small (sampling error) or whether they were true differences. In an earlier small-scale study in Frankfurt, we examined mortality during the first two years of the pandemic. Our aim was to continue this analysis until the end of 2023, for the first time taking into account other factors influencing mortality such as influenza and heat. Method:We obtained population data for Frankfurt am Main for 2016-2023 from the Municipal Office of Statistics, City of Frankfurt/Main, mortality data from 2016 to 2023 from the Hessian State Office for Health and Care, data on SARS-CoV-2 and influenza notifications from the homepage of the Robert Koch-Institute and weather data from the homepage of the German Meteorological Office. For calculating standardized mortality ratios (SMR= observed number of deaths divided by the expected number of deaths), we multiplied the mean mortality rate for 5 age groups from 2016-2019 with the total numer of residents in those age groups in the further years or periods, and finally added the numbers of expected deaths per age group. Results:The update of the assessment of mortality adjusted for age and population trend in the years 2020-2023 in Frankfurt am Main shows an excess mortality (SMR 1.029; 95% CI 1.004-1.054, +185 excess deaths) in 2022, followed by a negative excess mortality in 2023 (SMR 0.972; 95% CI 0.948-0.996). In the years 2020 and 2021 however, no increase in excess mortality had been found (2020: SMR 0.976; 95% CI 0.951-1.001; 2021: 0.998; 95% CI 0,973-1.023). In the second wave of the SARS CoV-2 pandemic with the Wuhan type (fall 2020), a significantly increased mortality was found (SMR 1.106; 95% CI 1.066-1.147, +274 deaths), as well as during the first four waves overall (Wuhan, Alpha and Delta type) (SMR 1.023; 95 CI 1.001-1.045), whereas no increased mortality occurred during the further waves with the Omikron variant in 2022 (SMR 0.988; 95% CI 0.963-1.014). The increased mortality in 2022 was associated with an influenza wave in the last 6 weeks of the year, which had led to a strong increase in mortality (SMR 1.250; 95% CI 1.170-1.330). Discussion:During the SARS-CoV-2 pandemic, significant excess mortality occurred in Frankfurt am Main only in the second wave at the end of 2020 before vaccination was introduced; in all other waves, no significant excess mortality was recorded. Overall, there was a non-significant negative excess mortality in Frankfurt am Main in 2020 and 2021 and a significant negative excess mortality in 2023. In 2022, however, a significant excess mortality was observed, which could not be attributed to SARS-CoV-2 but to a short, intense wave of influenza in the last 6 weeks at the end of that year, which had also led to a significant increase in mortality throughout Germany. This influenza wave was associated with an excess mortality rate in Frankfurt am Main, which was higher than in any wave of the SARS-CoV-2 pandemic in Frankfurt am Main. The number of excess deaths during that influenza waves was larger than the excess deaths during all SARS-CoV-2 waves altogether. This remarkable fact should be taken into account when dealing with the evaluation of the pandemic, a process which is increasingly beeing called for in many ways in Germany but is still pending.

During the COVID-19 pandemic, residents of care homes for the elderly were at a particularly high risk of contracting the virus and dying from it. Strict protective measures were therefore taken, including bans on visits. However, the negative effects of these contact-restricting measures on the mental and physical health, quality of life, right to self-determination and ultimately the dignity of the residents soon became apparent and the question was raised as to whether isolation (confinement disease) was even more harmful to health than the disease itself. Statements on infection control measures in care facilities, studies with the views of those affected (residents, relatives, employees in care facilities) and interviews with residents of care facilities as well as reviews on adverse effects of the protective measures were researched. The search included both so-called "gray literature" and publications from PubMed. The residents suffered greatly from isolation and from the fact that decisions were made about them without consulting them. They complained about the loss of their autonomy and felt that their dignity was violated. The reviews showed that the residents generally experienced loneliness, anxiety, sadness and depression more frequently, and in some cases also physical deterioration. In future, care must be taken to achieve a good balance from a legal and health perspective between protection against infection and protection of the mental and physical health, well-being and quality of life of residents, respect for autonomy, the right to self-determination and the dignity of residents. This requires a broad social discussion in which not only experts from the fields of infectiology but also from the fields of geriatrics, nursing, public health, ethics and law, but in particular also those affected themselves or their representatives, their relatives, are heard and their arguments taken into account.

Hitzeperioden führen zu erhöhter Morbidität und Mortalität. Es soll untersucht werden, ob ein Trend der Rettungsdiensteinsätze an Hitzetagen mit Tagesmaximaltemperaturen (Tmax)≥32°C von 2014 bis 2024 erkennbar ist, ob die Zahl der Rettungseinsätze bereits bei geringeren Temperaturen (Tmax≥30°C oder≥28°C) steigt und ob eine Expositions-Wirkungs-Kurve für den Zusammenhang zwischen Tagesmaximaltemperaturen und der Zahl der Rettungseinsätze erkennbar ist. Es wurden alle 250.507 Rettungsdiensteinsätze von Juni bis August 2014–2024 in Frankfurt am Main und Wetterdaten des Deutschen Wetterdienstes (DWD) der Messstelle Frankfurt genutzt. Pro Jahr wurden die Einsätze an Hitzetagen mit denen an Nicht-Hitzetagen verglichen (Differenz und Ratio). Mit den Wertepaaren (Jahr, zusätzliche Zahl der Rettungseinsätze an Hitzetagen mit Tmax≥32°C) wurde für die Jahre 2014 bis 2024 ein lineares Regressionsmodell angepasst und die Änderung der zusätzlichen Zahl der Einsätze pro Jahr geschätzt. Weitere Analysen erfolgten für Tmax≥30°C und≥28°C. Für die Expositions-Wirkungs-Kurve wurde die relative Änderung der Zahl der Einsätze über alle Jahre nach Tmax in 2°C-Schritten, mit Tmax<18°C als Referenz, berechnet. Diese Analysen wurden für alle Patienten sowie für Altersgruppen bis 59 Jahre, 60–79 Jahre und ab 80 Jahre durchgeführt. Zwischen 2014 und 2024 nahmen die zusätzlichen Rettungsdiensteinsätze an Hitzetagen mit Tmax≥32°C deutlich ab von+25 (2014) auf − 6,6 (2024) (− 2,9 pro Jahr; 95% KI − 3,5 – − 2,4). Insgesamt wurden im gesamten Zeitraum 2014 – 2024 an Tagen mit Tmax≥32°C 6,2% (Ratio=1,062 (95% KI: 1,050–1,075)) mehr Rettungsdiensteinsätze erforderlich als an Tagen ohne diese Definition. Der zusätzliche Bedarf war vergleichbar an Tagen mit Tmax≥30°C (+6,3%; Ratio=1,063 (95% KI: 1,053–1,073)), resp.≥28°C (+6,1%; Ratio=1,061 (95% KI: 1,052–1,069)). Die größte Zunahme zeigte sich bei Patienten<60 Jahren. Die „Expositions-Wirkungs-Kurve“ zeigte eine lineare Zunahme um 27% bei unter 60-Jährigen und 16% bei über 80-Jährigen, wobei bei den über-80-Jährigen bereits ab Tmax von 28°C – 30°C ein Plateau erreicht wird. Der abnehmende zusätzliche Bedarf an Rettungsdiensteinsätzen bei Tmax≥32°C könnte auf eine Anpassung der Bevölkerung hinweisen. Die Zahl der Rettungseinsätze steigt bereits an Tagen mit geringeren Tagesmaximaltemperaturen. Da Menschen<60 Jahren besonders betroffen sind, sollten die Präventionsmaßnahmen auch auf jüngere, berufstätige Personen ausgeweitet werden.

Background Periods of heat lead to increased mortality and morbidity. The aim of the present study was to investigate whether a trend of rescue deployments on heat days (Tmax >= 32 degrees C) from 2014 to 2024 is recognizable, whether morbidity already increases at lower temperatures (Tmax >= 30 degrees C or >= 28 degrees C) and whether an exposure-response curve is recognizable - for all patients and separately for different age groups.Methods All 250,507 deployments from June to August 2014-2024 in Frankfurt am Main and weather data from the German meteorological Service at the Frankfurt weather station were used for the study. For each year, the deployments on heat days were compared with those on non-heat days (difference and ratio). Using the pairs of values (year, additional number of rescue missions on heat days with Tmax >= 32 degrees C), a linear regression model was adapted for the years 2014 to 2024 and the trend in the additional number of missions per year was estimated. Additional analyses were carried out for Tmax >= 30 degrees C and >= 28 degrees C. For the calculation of the exposure-response curve, the exposures over all years were calculated according to daily Tmax in 2 degrees C steps, with Tmax<18 degrees C as reference. These analyses were carried out for all patients and for age groups up to 59 years, 60-79 years and 80 years and older.Results Between 2014 and 2024, the additional deployments on heat days with Tmax >= 32 degrees C decreased significantly from+25 in 2014 to - 6.6 in 2024 (- 2.9; 95% CI - 3.5 - - 2.4). Overall, 6.2% (ratio=1.062 (95% CI: 1.050-1.075)) more deployments were required on heat days with Tmax >= 32 degrees C than on days without this definition, comparable to days with Tmax >= 30 degrees C (+6.3%; ratio=1.063 (95% CI: 1.053-1.073)), or >= 28 degrees C (+6.1%; ratio=1.061 (95% CI: 1.052-1.069)). The largest increase was seen in patients under 60 years of age, The dose-response curve showed a linear increase of 27% in those under 60 and 16% in those over 80, with the latter reaching a plateau at Tmax 28 degrees C and above.Conclusion The decreasing additional need for deployments at Tmax >= 32 degrees C could indicate an adaptation of the population, but requires further investigation. Morbidity already increases on days with lower Tmax. As people <= 60 y are particularly affected, prevention measures should be strengthened and extended to younger, working people.

Hintergrund: Im Sommer 2023 wurde in Deutschland eine namentliche Meldepflicht für Respiratory Syncytial Virus (RSV) eingeführt. Als Ziele wurden angegeben: 1) Verbesserung der Datengrundlage (zur Verhütung der Überlastung des Gesundheitssystems), 2) Durchführung zielgerichteter und frühzeitiger Ermittlung und Maßnahmen der Gesundheitsämter vor Ort zur Verhinderung der Weiterverbreitung und 3) Beurteilung der Impfstoffe nach der zu erwartenden Zulassung einer RSV-Impfung [1].

Eine der zentralen Aufgaben der Gesundheitsämter ist der Infektionsschutz in der Bevölkerung. Hierzu werden im Infektionsschutzgesetz (IfSG) Aufgaben und Ziele sowie die rechtlichen Möglichkeiten der Umsetzung von Schutzmaßnahmen festgelegt, einschließlich der möglichen Einschränkung von Grundrechten, wo dies zum Schutz der Bevölkerung erforderlich ist. In diesem Beitrag sollen zunächst die Regelungen des Infektionsschutzgesetzes zur Hygiene in medizinischen und in Gemeinschaftseinrichtungen und die damit verbundenen Aufgaben der Gesundheitsämter vorgestellt werden. Im Anschluss werden beispielhaft das Vorgehen und die Erfahrungen aus dem Gesundheitsamt Frankfurt am Main bei der Beratung und Kontrolle dieser Einrichtungen vorgestellt und diskutiert.

Background:The major heatwave in Europe in August 2003 resulted in 70,000 excess deaths. In Frankfurt am Main, a city with 767,000 inhabitants in the south-west of Germany, around 200 more people died in August 2003 than expected. Soon afterwards, the city introduced adaptation measures to prevent heat-related health problems and subsequently established further mitigation measures to limit climate change. Frankfurt is rated as being one of the cities in Germany to have implemented the best climate adaptation and mitigation measures. This study addressed the following questions: is there already a downward trend in mortality from heat and can this be attributed to the measures taken?Materials and methods:The age-standardized mortality rate (ASR) was calculated for the months of June to August and for calendar weeks 23 to 34 of the individual years on the basis of population data and deaths of the inhabitants of Frankfurt am Main for the years 2000 to 2023. This was related to the meteorological data from the Frankfurt measuring station of the German National Meteorological Service. For four different heat exposure indicators (heat days, days in heat weeks, days in heatwaves and days with heat warnings), the incidence rate (death cases per 1 million person days) (IR) was calculated for days with and without exposure, and the incidence rate difference and the incidence rate ratio (IRR) were estimated to compare days with vs days without exposure.Results:Over the years, the mean daily temperatures tended to increase, and the standardized mortality rate decreased. An increase in ASR was observed during heatwaves up to 2015, but no longer in the later ones. In the summer of 2003, the incidence rate was 16.0 (95% confidence interval (CI) 12.2-19.9) per 1 million person days greater on heat days than on days not classified as heat days, and the corresponding incidence rate ratio was 1.64 (95% CI 1.48-1.82). Although the weather data for the summers of 2018 and 2022 were comparable with the record-breaking heat summer of 2003, the incidence rate differences (2018: 3.8, 95% CI 0.9-6.7; 2022: 2.3, 95% CI -0.3-4.9) and the IRR (2018: 1.20, 95% CI 1.05-1.37; 2022: 1.12, 95% CI 0.99-1.26) were considerably lower. Similar results were also obtained when comparing mortality in heat weeks and heatwaves as well as on days with heat warnings.Discussion:In summary, our study in Frankfurt am Main not only showed a decrease in heat-related mortality in the population as a whole over the years, but also a decrease in excess mortality during various heat periods (day, week, wave, warning), especially in comparison with the years with very high heat stress and drought (2003, 2018 and 2022). However, whether this development represents success of the intensive prevention measures that have been implemented in the city for years or merely describes a general trend cannot be answered with certainty by the present study. To answer this question, a comparative study should be carried out in various municipalities in the Rhine-Main region with different levels of intensity in dealing with the heat problem.

Eine der zentralen Aufgaben der Gesundheitsämter ist der Infektionsschutz in der Bevölkerung. Hierzu werden im Infektionsschutzgesetz Aufgaben und Ziele sowie die rechtlichen Möglichkeiten der Umsetzung von Schutzmaßnahmen festgelegt, einschließlich der möglichen Einschränkung von Grundrechten, wo dies zum Schutz der Bevölkerung erforderlich ist. Im folgenden Beitrag sollen zunächst die Regelungen des Infektionsschutzgesetzes zum Meldewesen und die damit verbundenen Aufgaben der Gesundheitsämter vorgestellt werden. Im Anhang werden anhand verschiedener Beispiele die Herausforderungen, Möglichkeiten und Grenzen der Meldepflichten vorgestellt und ein Ausblick auf mögliche neue Entwicklung gegeben.

Introduction:In Germany, hospitals, rehabilitation facilities and outpatient surgery facilities are required by law to perform antibiotic-consumption surveillance. Established IT programs are available for recording the defined daily doses. These do not exist for long-term care facilities (LTCFs). Antibiotic stewardship is also recommended for LTCFs. In view of the lack of IT solutions for consumption surveillance, this study investigated whether point prevalence studies could be a suitable basis for a data-based antibiotic stewardship program in LTCFs.Method:In May 2023, 18 elderly-care facilities in Berlin, Germany, participated in a point prevalence survey on antibiotic consumption according to the established HALT (healthcare-associated infections in long-term care facilities) method. The number of residents present and their risk factors (including the use of catheters and antibiotic therapy) were recorded. The results were compared with comparable data from previous surveys in LTCFs in Berlin, Germany as well as with the HALT data for Europe as a whole and for Germany.Results:On the day of the survey, 2040 residents were present, 7.7% of whom bore a urinary catheter and 0.5% a vascular catheter. 0.2% of the residents had a port access, 0.4% a dialysis catheter and one resident (0.05%) a tracheostoma. Twenty-seven (1.3%) residents were receiving an antibiotic on the day of the survey. Of these, 29.6% had a urinary tract catheter. 63.0% of the antibiotics were given for a urinary tract infection, 14.8% for a respiratory tract infection and 11.1% for a wound/soft tissue infection. The overall prevalence of antibiotics was in the range of previous surveys from Germany (1.2-2.4%) and significantly lower than in the Europe-wide HALT survey overall (4.3-4.5%).Discussion:The survey showed low use of antibiotics in the LTCFs in comparison with Europe-wide surveys. The time required was less than 2 hours for a 100-bed facility. Until appropriate IT programs to determine the defined daily doses are also available for LTCFs, such easy-to-perform and standardized point-prevalence surveys - if repeated several times a year - can be a suitable method for recording the use of antibiotics in nursing homes for the elderly.

Background: In summer 2023, mandatory reporting of respiratory syncytial virus (RSV) by name was introduced in Germany. The stated objectives were: 1. to improve the database to prevent overburdening of the healthcare system, 2. to implement targeted, early investigation and action by local health authorities to prevent further spread, and 3. to assess vaccines after the expected approval of RSV vaccination. Methods: These objectives are examined against the background of data from mandatory reporting of RSV in the German federal state of Saxony, which has been required since 2002, and the data from the ARE (acute respiratory diseases) survey in Germany, considering 1. the basic legal requirements and options of the Infection Protection Act, 2. the requirements of the EU Commission for the collection of data on infectious diseases and the recommendations by experts of the European Centre for Disease Prevention and Control (ECDC), 3. the options for individual or general preventive measures by the health authorities and 4. previous experience with the evaluation options of the reported data (especially regarding the effectiveness of vaccinations). Results and discussion: An extrapolation of the previously reported data from Saxony to the whole of Germany shows that over 100,000 reports per year must be expected (more than the reports of both rota and noroviruses together). Neither the requirements of the EU Commission nor the views of an expert group of the ECDC recommend mandatory RSV reporting. Mandatory reporting by name is also not appropriate from a legal perspective. A sentinel, which is also better suited to assessing vaccinations, would be more appropriate to avoid unnecessarily overburdening the health authorities. In addition, initial experience with wastewater sentinels for RSV has shown that they may be used to record local and regional RSV infections - albeit without information on the severity of the disease and thus the burden on the healthcare system. Against this background, mandatory reporting of RSV does not appear to be appropriate. Instead, the existing sentinels should be continued and further expanded, possibly supplemented by RSV wastewater monitoring.

Introduction:Nursing-home residents are among the highest risk group in the SARS-CoV-2 pandemic. At the onset of the SARS-CoV-2 pandemic, the majority of all deaths from or with SARS-CoV-2 occurred in long-term care facilities (LTCFs), so that maximum protective measures were mandated for these facilities. This study analyzed the impact of the new virus variants and the vaccination campaign on disease severity and mortality among nursing home residents and staff through 2022 as a basis for determining which protective measures remain necessary and appropriate. Methods:In five homes in Frankfurt am Main, Germany, with a total capacity for 705 residents, all cases occurring in the facility among residents and staff were recorded and documented (date of birth and diagnosis, hospitalization and death, vaccination status) and were descriptively analyzed with SPSS. Results:By 31st August 2022, 496 residents tested positive for SARS-CoV-2, 93 in 2020, 136 in 2021, and 267 in 2022; 14 residents presented with a second SARS-CoV-2 infection in 2022, having previously experienced an infection in 2020 or 2021. The percentage of hospitalizations decreased from 24.7% (2020) and 17.6% (2021) to 7.5% (2022), and the percentage of deaths decreased from 20.4% and 19.1% to 1.5%. In 2021, 61.8% of those infected were vaccinated (at least 2x); in 2022, 86.2% of residents had been vaccinated twice, 84% of whom had already had a booster vaccination. Hospitalization and death rates were significantly higher among the unvaccinated than the vaccinated throughout all years (unvaccinated 21.5% and 18.0%; vaccinated 9.8% and 5.5%; KW test p=0.000). However, this difference was no longer significant under the prevalence of the Omicron variant in 2022 (unvaccinated 8.3% and 0%; p=0.561; vaccinated 7.4% and 1.7%; p=0.604). From 2020 to 2022, 400 employees were documented as infected, with 25 having second infections in 2022. Only one employee showed a second infection in 2021 following the first in 2020. Three employees were hospitalized; no deaths occurred. Discussion and conclusion:Severe COVID-19 courses occurred with the Wuhan Wild type in 2020, with a high death rate among nursing-home residents. In contrast, during the waves in 2022 with the relatively mildly pathogenic Omicron variant, many infections but few severe courses and deaths were observed among the now mostly vaccinated and boostered nursing-home residents. Given the high immunity of the population and the low pathogenicity of the circulating virus - even in nursing-home residents - protective measures in nursing homes that restrict people's right to self-determination and quality of life no longer seem justified. Instead, the general hygiene rules and the recommendations of the KRINKO (German Commission for Hospital Hygiene and Infection Prevention) on infection prevention should be followed, and the recommendations of the STIKO (German Standing Commission on Vaccination) on vaccination not only against SARS-CoV-2 but also against influenza and pneumococci should be observed.

Aims: Excess mortality during the SARS-CoV-2 pandemic has been studied in many countries. Accounting for population aging has important implications for excess mortality estimates. We show the importance of adjustment for age trends in a small-scale mortality analysis as well as the importance of analysing different pandemic phases for mortality in an urban population.Methods: Population data for Frankfurt/Main for 2016-2021 were obtained from the Municipal Office of Statistics, City of Frankfurt/Main. Mortality data from 2016 to 2021 were provided by the Hessian State Authority. For standardized mortality ratios (SMR=observed number of deaths divided by the expected number of deaths), the expected number of deaths was calculated in two ways: For SMRcrude, the mean mortality rate from the years 2016-2019 was multiplied by the total number of residents in 2020 and 2021 separately. For SMRadjusted, this procedure was performed separately for five age groups, and the numbers of ex-pected deaths per age group were added.Results: SMRcrudewas 1.006 (95% CI: 0.980-1.031) in 2020, and 1.047 (95% CI: 1.021-1.073) in 2021. SMRadjusted was 0.976 (95% CI: 0.951-1.001) in 2020 and 0.998 (95% CI: 0.973-1.023) in 2021. Excess mortality was observed during pandemic wave 2, but not during pandemic waves 1 and 3.Conclusion: Taking the aging of the population into account, no excess mortality was observed in Frankfurt/Main in 2020 and 2021. Without adjusting for population aging trends in Frankfurt/Main, mortality would have been greatly overestimated.

Many publications dealt with the monitoring of heat-related mortality. Fewer analyses referred to indicators of heat-related morbidity. The aim of this work was to describe the heat-related morbidity using rescue service data from the city of Frankfurt/Main, Germany for the time period 2014-2022, with regard to the questions: 1) How do rescue service deployments develop over the years? Is there a trend identifiable towards a decrease in deployments over the years, e.g. as an effect of either (physiological) adaptation of the population or of the measures for prevention of heat-related morbidity? 2) Which heat parameters (days with a heat warning, heat days, heat weeks, heat waves) are most strongly associated with heat-related morbidity in terms of rescue service deployments and might therefore be additionally used as an easily communicable and understandable heat-warning indicator? Rescue service data were provided by the interdisciplinary medical supply compass system "IVENA" and adjusted for population development including age development. The effect of various indicators for heat exposure, such as days with a heat warning from the German meteorological service based on the scientific concept of "perceived heat", heat days, heat wave days and heat week days on different endpoints for heat morbidity (deployments in total as well as for heat associated diagnoses) was calculated using both difference-based (difference +/- 95% CI) and ratio-based (ratio +/- 95% CI) effect estimators. Rescue services deployments in summer months increased overall from 2014 to 2022 in all age groups over the years (2698 to 3517/100.000 population). However, there was a significant decrease in 2020, which could be explained by the special situation of the COVID-19 pandemic, probably caused by the absence of tourists and commuters from the city. In addition, no data are available on the actual implementation of the measures by the population. Therefore, an effect of the measures taken to prevent heat-associated morbidity in Frankfurt am Main could not be directly demonstrated, and our first question cannot be answered on the basis of these data. Almost all heat definitions used for exposure (day with a heat warning, heat day, heat wave day, heat week day) showed significant effects on heat-associated diagnoses in every year. When analysing the effect on all de-ployments, the effect was in part strongly dependent on individual years: Heat wave days and heat week days even showed negative effects in some years. The definition heat day led to a significant increase in rescue service deployments in all single years between 2014 and 2022 (ratio 2014-2022 1.09 (95CI 1.07-1.11); with a range of 1.05 (95CI 1.01-1.09) in 2020 and 1.14 (95CI 1.08-1.21) in 2014), this was not the case for days with a heat warning (ratio 2014-2022 1.04 (95CI1.02-1.05); with a range of 1.01 (95CI 0.97-1.05) in 2017 and 1.16 (95CI 1.10-1.23). Thus being not inferior to the heat warning day, the "heat day" defined as >= 32 degrees C maximum temperature, easily obtainable from the weather forecast, can be recommended for the activities of the public health authorities (warning, surveillance etc.) regarding heat health action planning.