Niedersächsisches Landesgesundheitsamt (NLGA) - EPIET

acknowledged by EPIET
Roesebeckstrasse 4-6
DE-30449 Hannover

Contact person

Elke Mertens
Tel. +49 511 4505 303
Fax. +49 511 4505 4298

Description of the institute

The Public Health Agency of Lower Saxony (Niedersächsisches Landesgesundheitsamt, NLGA) is the competent state authority responsible for the prevention, detection and control of emerging health hazards as well as for health reporting within Lower Saxony. It collaborates with other institutions of the public health system and coordinates measures in incidents affecting more than one district. There is also a close cooperation with the state food safety authority regarding outbreaks of zoonotic diseases, antibiotic resistance and teaching.

The NLGA provides scientific information on health protection for the government, the ministry of health, the local public health departments (LPHD) and other public health actors (e. g. health professionals) in Lower Saxony.

Further tasks are to collect, to analyse and to interpret epidemiological data and to conduct laboratory investigations. These tasks include the identification and examination of disease clusters as well as management of the notification system and communication with other institutions of the public health service on national and local level.

The tasks and activities include:

  • Surveillance of notifiable infectious diseases both collected through routine reporting and dedicated epidemiological surveys, e. g. running active and passive surveillance systems on
    • influenza and acute respiratory diseases
    • meningitis and encephalitis
    • tick borne encephalitis
    • measles and rubella
    • haemolytic uremic syndrome
  • Conducting laboratory investigations (including biosafety level 3 laboratory (BSL3) and Next Generation Sequencing (NGS)) for surveillance and research projects
  • Conducting studies, e. g. on tuberculosis in asylum seekers and antibiotic resistant pathogens in peasant populations, vaccine effectiveness
  • Outbreak investigations, particularly for STEC, Salmonellosis and other zoonotic diseases as well as for hospital associated infections
  • Developing guidelines, e. g. on outbreak management
  • Teaching: the NLGA offers advanced training courses on various topics to public health officers, hygiene specialists in hospitals (nurses and physicians), nursing home employees and medical students. In addition the NLGA is involved in the organisation of two yearly scientific conferences, one on public health and one on hospital and environmental hygiene.
  • Communication: a weekly bulletin is provided to LPHD on current topics of infectious diseases and study results are published in national and international scientific journals.

Particular strengths are:

  • highly motivated, multi-professional team
  • strong national and international network
  • instant access to subject experts in
    • epidemiology
    • statistics
    • microbiology (including BSL3laboratory and NGS)
    • geography
  • EPIET graduate on site
  • interface position between local and national public health actors: the fellow will be acquainted with different perspectives of the German public health system
  • central location in Germany and Europe
  • Hochdeutsch (modern standard German) is spoken throughout the whole area

The NLGA comprises four departments:

  • Dep. 1: Administration (e.g. internal organization, personnel management, budget, education and professional training, and health communication/internet).
  • Dep. 2: Communicable Diseases (e.g. virology, clinical bacteriology, health protection, hospital hygiene, infectious disease epidemiology, surveillance).
  • Dep. 3: Environmental Health (e.g. environmental medicine, -hygiene and epidemiology of non-communicable diseases).
  • Dep. 4: Special tasks of Public Health Authority (e.g. health reporting and Trust authority of the Register for cancer in Lower Saxony (EKN)”

Further fields of activity as quality management, the Centre for Health and Infectious Disease Hazards (ZGI) and public relations are primary administrated by the president of the NLGA.

Number of employees: 180

The EPIET fellow will be based in the Microbiology & Infectious Disease Unit. The institute is 10 minutes away from downtown Hannover (520 000 inhabitants), the capital of Lower Saxony (2nd largest federal state of Germany, 8 Mio inhabitants). Hannover is a green city with an excellent but budget-friendly infrastructure and a wide range of culture and leisure facilities. Thanks to the central location in Germany, the airport and the express train station, major German and European cities as well as popular destinations are within easy reach (travel time to Berlin: 100 Minutes).

Training opportunities

The EPIET fellow will be involved in the routine infectious disease surveillance and encouraged to participate in specific surveillance projects as well as outbreak investigations. They will have the opportunity to attend practical lab-trainings in the onsite laboratories and to practise health communication and teaching.

We offer project outlines for epidemiological studies but also invite the fellow to contribute own ideas. NLGA fellows can draw on the experience of the excellent EPIET/FETP infrastructure at the Robert Koch Institute (RKI), Berlin, including weekly academic sessions (telephone conferencing) and quarterly meetings held at RKI.

The NLGA provides best conditions to fulfill the EPIET requirements and to acquire a sound expertise in infectious disease epidemiology. Short-term international assignments are supported. 

Like all EPIET and PAE fellows in German, the NLGA fellow has the opportunity to enrol in the Master of Science in Applied Epidemiology (MSAE) programme (120 ECTS points) which is organised by RKI and Charité University, the medical university of Berlin.

Training supervision

Primary supervision is provided by Elke Mertens and Johannes Dreesman. Elke Mertens is a German FETP fellow who graduated from EPIET and the MSAE programme in 2011. Johannes Dreesman is the head of the department and, besides being and expert in statistics, he draws from many years of experience in infectious disease epidemiology.

Other supervisors depend on the projects chosen. Currently there are six infectious diseases epidemiologists, four microbiologists, one WGS-Expert, two statisticians and two geographers at the department, all happy to support the EPIET fellow.

Language requirements

Good English skills and working knowledge of German (and the willingness to improve) are recommended to communicate with municipal partners. Language classes can be organised easily.

Training history

Number of EPIET fellows trained at institute: Two (2014, 2018)

Number of PAE fellow trained at institute: Four (2008, 2010, 2012, and 2016)

Number of EPIET alumni working at institute: None

Number of PAE alumni working at institute: One

Annex: Project Proposals 2018

Surveillance projects

Developing a surveillance system for rural music festivals

Training field: Implement/complement a surveillance system, sampling methods


Lower Saxony is an area state with a young and very active music scene. Several music festivals with increasing numbers of participants are organised on a yearly basis in rural areas.

Timely and effective infectious disease surveillance is crucial to ensure appropriate medical care for patients and to interrupt transmission chains.

In this project, the fellow will develop the surveillance system in cooperation with the local public health department (LPHD) of Cuxhaven for the “Deichbrand” festival (50.000 participants in 2017).

Aims and objectives

  • Develop a surveillance system for rural music festivals 2018/19
  • Run, evaluate and review the system 2019/20


  • LPHD of Cuxhaven, head of infection control department (EPIET alumna)


Evaluation of cluster test data and spatial representation of results

Training field: Implement/complement a surveillance system


NLGA collects infectious disease notification data from the population of Lower-Saxony which accounts for 8 Mio divided into 45 districts. Different statistical procedures are used at NLGA to identify clusters of notified cases in space and time, indicating outbreaks. Further methods might be established.

Aims and objectives

  • To evaluate the performance of the implemented cluster detection algorithm against other indicators like the electronic outbreak reports of the local health departments
  • To develop graphical representation of the outbreaks in maps (requires application of R-software)


  • Local public health departments


Control-survey in the general population as extension of gastrointestinal infection surveillance

Training field: Implement/complement a surveillance system, sampling methods


Monitoring of infectious diseases is a crucial task of public health bodies. The German infectious disease notification system provides data on the disease characteristics of notified cases and (suspected) vehicles/sources. For the selection and weighting of suspected risk factors, the comparison of the risk profiles of cases and non-cases is needed. These risk profiles should be stratified for age, gender and region, because dietary behaviour and daily activities can differ considerably in these categories.

As the notification system is lacking information on non-cases, an additional survey on risk factors of food-borne infections in the general population may fill this gap.

Aims and objectives

  • To compile a list of risk factors for food-borne gastro-enteric infections in the general population
  • To provide risk profiles stratified for age, gender and region


  • Population Register Centre


Research Projects

Influenza vaccination campaign for hospital staff: development and evaluation

Training fields: Conduct an epidemiological study, sampling methods, multivariable analysis, vaccinology


Vaccination of hospital staff is crucial to prevent influenza epidemics in hospitals, because in this setting, staff is the main vector of infectious diseases. Additionally, a sufficient immunization rate prevents staff shortage due to sick leaves during influenza seasons.

Aims and objectives

  • To develop an influenza vaccination campaign for hospital staff
  • To evaluate the effectiveness of the campaign


  • Hospital of maximum care level with 1500 beds


Influenza vaccination in nursing home care workers – Vaccination coverage of staff caring for the elderly, knowledge, attitude, and perception (KAP) and strategies for improving vaccination coverage

Training fields: Conduct an epidemiological study, sampling methods, multivariable analysis, vaccinology


Besides general infection control measures and vaccination of residents themselves, vaccination of nursing home care workers is one part of a multiple strategy to prevent infections in residents of nursing homes for the elderly. The immunisation of health care staff is particularly important for the prevention of influenza, because effectiveness of vaccination depends on the age and immune­competence and may be below 50% in particularly vulnerable groups of the elderly.

In many influenza seasons, several nursing homes in Lower Saxony and other Federal States reported outbreaks of influenza with high caseloads, serious infections and infection related deaths. While vaccination coverage in infected residents was high, only few health care staff was vaccinated.

These incidents highlight the need for action as improvement of staff vaccination status could serve as a protective shield for vulnerable residents for which vaccination effectiveness is limited.

Aims and objectives

  • Assessment of vaccination coverage of nursing home care workers
  • Assessment of knowledge, attitude, and perception (KAP) of nursing home care workers towards influenza vaccination
  • Identification of individual and institutional based factors influencing influenza vaccination status of nursing home care workers
  • Based on those factors, develop strategies together with stakeholders to improve vaccination coverage in nursing home care workers


  • Selected nursing homes for the elderly in Lower Saxony, staff
  • NLGA vaccination and hospital infection control experts


Estimating vaccine effectiveness of influence vaccination from routine laboratory surveillance data

Training field: conduct an epidemiological study / surveillance


NLGA runs a sentinel with about 40 paediatricians during the flu season. Paediatricians take swabs (up to 5 swabs/week each) from children with acute respiratory illness (ARI) and complete short questionnaires including information about vaccination status. Swabs are analysed for different viruses causing ARI (Adeno, Influenza, Metapneumo, Picorna- and Respiratory syncytial virus). Saxony-Anhalt, a neighbouring federal state, runs a similar sentinel.

Aims and objectives

  • Analyse the association between laboratory-confirmed influenza and vaccination status to derive estimates of vaccine effectiveness (Sub analyses can be performed for different virus strains, age groups or types of vaccine)


Governmental Institute of Public Health of Saxony-Anhalt


Establishment and evaluation of procedures and tools for event based surveillance

Training field: conduct an epidemiological study / surveillance


Indicator based surveillance denotes the use of standardised notification data for monitoring the occurrence of diseases while event based surveillance denotes the use of unstructured information like newspaper articles for this purpose. NLGA has access to such newspaper articles but does not use them systematically for surveillance purposes.

Aims and objectives

  • To develop and test a concept how the newspaper articles can be explored and used systematically for surveillance purposes
  • To combine the concept with the implemented indicator based surveillance
  • To implement and evaluate the combined system


Health risks posed by skin care treatment with garra rufa fish

Training field: conduct an epidemiological study


In fish spas, Garra rufa fish are used for skin exfoliation, mainly manicure and pedicure. The fish eat away dead skin cells. From the infectiological perspective the question arises, whether infectious diseases can be transmitted from one customer to another.

Aims and objectives

  • To investigate the number of fish spas in Lower Saxony and conduct a study with the customers, whether they have experienced health threats originating from the garra rufa treatment.


  • Lower Saxony State Office for Consumer Protection and Food Safety (LAVES)


Further projects

  • Knowledge, attitude, and perception (KAP) of general practitioners towards the prescription of oral antibiotics
  • Infectious disease surveillance during a local mud race (Steelman Hannover)
  • Evaluation of the NLGA ARI surveillance, conducted since 2004
  • Ideas from fellows are welcome