{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T12:35:37Z","timestamp":1779366937498,"version":"3.53.0"},"reference-count":17,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2020,10,13]],"date-time":"2020-10-13T00:00:00Z","timestamp":1602547200000},"content-version":"unspecified","delay-in-days":286,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2020]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:p>In early March 2020, a COVID-19-outbreak occurred in the district of Tirschenreuth, Germany. The outbreak was characterised by a rapid increase in case numbers and a comparatively high crude case fatality ratio (CFR; 11%). Until the beginning of May 2020, 1122 cases were reported in the district. To investigate the outbreak, we analysed surveillance and other data available at the district health department, including data on cases living in care facilities and public health measures applied. Furthermore, we compared the number of tests performed in Tirschenreuth and in Germany as a whole. We interviewed the first 110 cases in order to investigate potential exposures at the beginning of the outbreak. We found that returning ski-travellers from Austria and Italy and early undetected community transmission likely initiated the outbreak which was then accelerated by Bavarian beer festivities. Testing of mainly acute cases in the district of Tirschenreuth resulted in a higher rate of positive tests compared to the whole of Germany. Despite adjustment for age, the CFR continued to exceed the German mean which was due to spread to vulnerable populations. Strict public health measures likely contributed to control the outbreak by mid-April 2020.<\/jats:p>","DOI":"10.1017\/s0950268820002460","type":"journal-article","created":{"date-parts":[[2020,10,13]],"date-time":"2020-10-13T04:51:03Z","timestamp":1602564663000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":18,"title":["Mass gathering events and undetected transmission of SARS-CoV-2 in vulnerable populations leading to an outbreak with high case fatality ratio in the district of Tirschenreuth, Germany"],"prefix":"10.1017","volume":"148","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2820-5019","authenticated-orcid":false,"given":"M.","family":"Brandl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5531-5198","authenticated-orcid":false,"given":"R.","family":"Selb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Seidl-Pillmeier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Marosevic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U","family":"Buchholz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Rehmet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,10,13]]},"reference":[{"key":"S0950268820002460_ref7","unstructured":"7. WHO. Coronavirus disease 2019 (COVID-19): situation report-71. Published 31 March 2020. Accessed June 29, 2020. Available at https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200331-sitrep-71-covid-19.pdf?sfvrsn=4360e92b_8."},{"key":"S0950268820002460_ref10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2006100"},{"key":"S0950268820002460_ref6","unstructured":"6. RKI. Situation Report, 13 May 2020. Available at https:\/\/www.rki.de\/DE\/Content\/InfAZ\/N\/Neuartiges_Coronavirus\/Situationsberichte\/2020-05-13-en.pdf?__blob=publicationFile."},{"key":"S0950268820002460_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30314-5"},{"key":"S0950268820002460_ref15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.4683"},{"key":"S0950268820002460_ref2","unstructured":"2. WHO. Coronavirus disease 2019 (COVID-19): situation report-170. Published July 08, 2020. Accessed 9 July 2020. Available at https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200708-covid-19-sitrep-170.pdf?sfvrsn=bca86036_2."},{"key":"S0950268820002460_ref5","unstructured":"5. RKI. SARS-CoV-2 Steckbrief zur Coronavirus-Krankheit-2019 (COVID-19), version 26 June 2020, accessed 30 June 2020. Available at https:\/\/www.rki.de\/DE\/Content\/InfAZ\/N\/Neuartiges_Coronavirus\/Steckbrief.html;jsessionid=ADB4CC02985C25E597A8C98DA8AD762D.internet071#doc13776792bodyText4."},{"key":"S0950268820002460_ref17","unstructured":"17. WHO. Laboratory testing strategy recommendations for COVID-19. Available at https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/331509\/WHO-COVID-19-lab_testing-2020.1-eng.pdf [Version 21 March 2020, Accessed 22 June 2020]."},{"key":"S0950268820002460_ref4","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9020538"},{"key":"S0950268820002460_ref3","first-page":"10","article-title":"Sch\u00e4tzung der aktuellen Entwicklung der SARS-CoV-2-Epidemie in Deutschland \u2013 nowcasting","volume":"17","author":"an der Heiden","year":"2020","journal-title":"Epidemiologisches Bulletin"},{"key":"S0950268820002460_ref1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2001017"},{"key":"S0950268820002460_ref14","unstructured":"14. Schr\u00f6der, H (2020) Monitor: Gesundheitliche Beeintr\u00e4chtigungen \u2013 Vorerkrankungen mit erh\u00f6htem Risiko f\u00fcr schwere Verl\u00e4ufe von COVID-19. Verbreitung in der Bev\u00f6lkerung Deutschlands und seinen Regionen. Berlin. Available at https:\/\/www.wido.de\/fileadmin\/Dateien\/Dokumente\/News\/wido_dat_correct_paper_covid-19_2020.pdf."},{"key":"S0950268820002460_ref16","unstructured":"16. RKI. COVID-19-Verdacht: Ma\u00dfnahmen und Testkriterien \u2013 Orientierungshilfe f\u00fcr \u00c4rzte. Available at https:\/\/www.rki.de\/DE\/Content\/InfAZ\/N\/Neuartiges_Coronavirus\/Massnahmen_Verdachtsfall_Infografik_Tab.html [Version 12 May 2020, Accessed 22 June 2020]."},{"key":"S0950268820002460_ref11","first-page":"8","article-title":"Der erste Monat mit COVID-19-F\u00e4llen im Land-kreis Wittenberg, Sachsen-Anhalt","volume":"20","author":"Frank","year":"2020","journal-title":"Epidemiologisches Bulletin"},{"key":"S0950268820002460_ref8","unstructured":"8. RKI. Situation Report, 8 March 2020. Available at https:\/\/www.rki.de\/DE\/Content\/InfAZ\/N\/Neuartiges_Coronavirus\/Situationsberichte\/2020-03-08-en.pdf?__blob=publicationFile."},{"key":"S0950268820002460_ref12","unstructured":"12. RKI. Situation Report, 5 March 2020. Available at https:\/\/www.rki.de\/DE\/Content\/InfAZ\/N\/Neuartiges_Coronavirus\/Situationsberichte\/2020-03-05-en.pdf?__blob=publicationFile."},{"key":"S0950268820002460_ref9","unstructured":"9. RKI. Situation Report, 13 March 2020. Available at https:\/\/www.rki.de\/DE\/Content\/InfAZ\/N\/Neuartiges_Coronavirus\/Situationsberichte\/2020-03-13-en.pdf?__blob=publicationFile."}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268820002460","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T05:00:27Z","timestamp":1603774827000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268820002460\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020]]},"references-count":17,"alternative-id":["S0950268820002460"],"URL":"https:\/\/doi.org\/10.1017\/s0950268820002460","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2020. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e252"}}