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PubMed2007

Long-term cost-effectiveness of clopidogrel in patients with acute coronary syndrome without ST-segment elevation in Germany.

Patients with acute coronary syndrome without ST-segment elevation receiving clopidogrel in addition to acetylsalicylic acid (ASA) showed a 20% risk reduction in comparison to patients receiving ASA monotherapy (CURE trial). Economic models for assessing the impact on costs exist for several countries but not for Germany on a long-term basis. The objective of this model adaptation is to assess the long-term economic impact of clopidogrel taken in addition to ASA in Germany. A Markov model with six states [at risk, first year with stroke, following years with stroke, first year with new myocardial infarction (MI), following years with MI, and death] was adapted for Germany. Model outcome was life-years saved. Effects of 1-year treatment were calculated based on the CURE trial. Resource use for the different health states was based on published data, which included costs for drugs, outpatient care, hospitalization, rehabilitation and nursing. Risk data for MI and stroke were based on Swedish data and validated for the German adaptation. The model calculates lifetime costs and survival length. Costs were estimated from the payers' perspective. A series of one-way sensitivity analyses was conducted (follow-up costs, discount rates). The Markov analysis predicts a survival of 8.89years in the placebo treatment group and 9.02 years in the clopidogrel treatment group. The cumulated costs were euro 8,548 and euro 8,953, respectively. The incremental cost-effectiveness ratio (ICER) was euro 3,113 for each life-year saved. The model was robust regarding variations in key parameters in the sensitivity analysis, resulting in a range of ICER from euro 1,338 to euro 9,322. Our results are in line with the results for other healthcare systems. Adding clopidogrel to ASA for patients with acute coronary syndrome without ST-segment elevation generated an additional life-year saved at a comparably low value of euro 3,113. One-year treatment with clopidogrel is a cost-effective treatment option in patients with acute coronary syndrome from the perspective of a third-party payer in Germany.

Acute Coronary Syndrome↗
PubMed2005

Epidemiology of Streptococcus agalactiae colonization in Germany.

Streptococcus agalactiae can cause severe pneumonia, sepsis and meningitis in neonates and remains one of the most prevalent causes of invasive neonatal infections. Maternal transmission of S. agalactiae during delivery can be prevented by prenatal screening and peripartal antibiotic prophylaxis. Implementation of CDC guidelines for group B streptococci (GBS) disease prevention resulted in a significant decline of invasive neonatal S. agalactiae infections in the USA. Similar national guidelines were issued in 2000 for Germany. However, the epidemiology of S. agalactiae colonization in Germany has not been investigated for more than 15 years and the impact these guidelines will have is therefore unknown. To assess colonization rates in Germany, we cultured vaginal and rectal swabs for S. agalactiae from pregnant and non-pregnant adult patients in the region of Aachen and Munich. Swabs were cultivated in selective broth medium for 24h and subsequently plated on blood agar plates according to the CDC recommendations. Colonies negative for catalase and pyrrolidonyl aminopeptidase were further differentiated by the CAMP test and a DNA probe specific for S. agalactiae. Rectal or vaginal colonization of S. agalactiae was found in 34 (16%) of 210 pregnant patients and in 41 (16%) of 250 non-pregnant women. S. agalactiae was found only in rectal swabs in 4% of pregnant and non-pregnant patients. For further characterization of the strains capsular serotypes and major surface protein antigens were determined by Ouchterlony immunodiffusion and PCR. Among the 75 different patient isolates serotype III was the most prevalent with 21 (28%) isolates, followed by 16 (21%) isolates of serotype II, 13 (17%) isolates of serotype Ia, 12 (16%) of serotype V, 11 (15%) of serotype Ib and only 2 (3%) isolates of serotype IV. The vast majority of all strains harbored genes for the major surface protein antigens, the alpha-C-protein or alpha-C-protein like antigens like Alp2-4, epsilon and Rib. These data show that S. agalactiae colonization is common in Germany and strict adherence to the guidelines for the preventions of GBS disease will result in peripartal antibiotic prophylaxis in up to 20% of all deliveries.

Bacterial Capsules↗
PubMed2006

Seroprevalence of tick-borne and mosquito-borne arboviruses in European brown hares in Northern and Western Germany.

Tríbec virus (Kemerovo serogroup, genus Orbivirus), Eyach virus (genus Coltivirus), and Tahyna virus (California encephalitis serogroup, genus Bunyavirus) are arthropod-borne viruses known to occur in Germany. These viruses are also suspected to cause human disease. So far, no information is available on their geographical distribution in Germany and their natural transmission cycles. A total of 166 sera from European brown hares (Lepus europaeus) collected in seven districts of the Federal State of Schleswig-Holstein and in four districts of the Federal State of North Rhine-Westphalia was tested by plaque reduction neutralization test (PRNT) for antibodies against Tríbec virus, Eyach virus, Tahyna virus, and Central European encephalitis virus. One out of 22 sera (4.5%) collected in the district Nord-Friesland in Schleswig-Holstein was found positive (PRNT(90) 1:10) against Tríbec virus. Neither did sera from other regions of Schleswig-Holstein nor from hares from North Rhine-Westphalia react against any of the arboviruses tested. For the first time, antibodies against Tríbec virus could be found in a European brown hare in Germany. The negative serological results for Central European encephalitis virus are in line with the current knowledge of its natural distribution within Germany. The negative serological results for Tahyna virus or Eyach virus argue against an autochthonous circulation of these viruses in the regions tested.

Animals↗
PubMed2005

Influenza vaccination coverage in adults belonging to defined target groups, Germany, 2003/2004.

In 2003, a nationwide cross-sectional study was conducted to assess the current influenza vaccination coverage of the adult population of Germany, especially in persons belonging to defined target groups. Of 666 surveyed persons, 190 (adjusted 24%) had received influenza vaccination and 419 participants belonged to at least one target group. Of those, 28% (95% confidence interval (CI) 22-35%) in former West Germany and 45% (95% CI 38-52%) in former East Germany had received influenza vaccination. The offer for vaccination by a physician was associated with a high likelihood for vaccination (odds ratio (OR) 19.0; 95% CI 8.9-40.6). Another important factor influencing vaccination uptake was having received influenza vaccination in prior seasons (OR 7.1; 95% CI 3.8-13.2). Vaccination coverage in the adult population of Germany remains unsatisfactory. Physicians have an important role and should be targeted for campaigns to offer the vaccination more frequently in particular to persons belonging to target groups.

Adult↗
PubMed1994

Eosinophilia-myalgia syndrome in Germany: an epidemiologic review.

OBJECTIVE: To review the epidemiologic features of eosinophilia-myalgia syndrome (EMS) in Germany. DESIGN: We determined the incidence of EMS in Germany through May 1992 and analyzed the dose of L-tryptophan used, the duration of intake, and the concurrent medications. MATERIAL AND METHODS: All patients receiving L-tryptophan preparations in Germany were already under medical supervision before the onset of the disease; thus, information on patient history and other potential risk factors was readily available. Because of the drug status of L-tryptophan preparations, brands could be accurately traced back to suppliers of raw materials. Statistical differences in age and gender of patients, dose of L-tryptophan, eosinophil count, and skin involvement were sought between patients with and those without concurrent medications. RESULTS: On the basis of guidelines established by the Centers for Disease Control and Prevention, 105 patients fulfilled the criteria for EMS. No apparent correlation was found between the incidence of EMS and the dose of L-tryptophan or the duration of intake before onset of EMS. Assessment of the study group showed that 45% were taking various other medications, whereas 55% were taking L-tryptophan only. Analysis by type of pharmaceutical agent showed no preponderance of a specific concurrent drug (in particular, psychotropic drugs). Thus, concurrently used medications did not seem to be an important variable. All cases of EMS were associated with L-tryptophan from formulators that had used raw materials from the previously implicated source. CONCLUSION: This study supports the pathophysiologic role of a contaminant in L-tryptophan in the occurrence of cases of EMS in Germany.

Adult↗
PubMed2001

Mapping the geogenic radon potential in Germany.

Mapping the geogenic radon potential in Germany is a research project initiated by the German Federal Ministry for the Environment, Conservation and Reactor Safety. The project was aimed to develop a standard methodology for the estimation of a geogenic radon potential and to apply this method to map the region of Germany as an overview for planning purposes. The regionalisation results from a distance-weighted interpolation of the site-specific values of radon concentration in soil gas and in situ gas permeability of soils on a regular grid considering the corresponding geological units. The map of Germany in a scale of 1:2 million is based on the radon concentration in soil gas as an estimator of the geogenic radon potential assuming the 'worst case' of uniform highest permeability. The distribution is subdivided into categories of low (< 10 kBq/m3), medium (10-100 kBq/m3), increased (100-500 kBq/m3) and high (> 500 kBq/m3) radon concentration. High values occur especially in regions with granites and basement rocks of Paleozoic age, and are proven by measurements in 0.03% of the total area. Many of these regions are also known for their enhanced indoor values. The class with increased values takes a portion of 7.86% and likewise occurs mainly in regions with outcrops of folded and metamorphic basement, but also of some Meso- and Cenozoic sediments with increased uranium contents and/or higher emanation coefficients. For 67.3% of the country, the radon concentration is classified as 'medium', and an assignment to specific geological units cannot be made at the map scale considered. Low radon contents, where protective measures against radon are usually not considered, are found in the geologically rather homogeneous part of northern Germany with unconsolidated Cenozoic sediments, covering approximately 25% of the total country. It is of course not possible to predict the indoor radon concentration of single houses from these maps, because construction type and structural fabric of houses are essentially governing the extent to which subsoil radon potential affects the indoor concentration. Besides this, in places with site-specific geochemical, structural and soil-physical properties, local radon anomalies may occur which were not recorded in the course of the wide-meshed screening study.

Air Pollutants, Radioactive↗
PubMed2003

Smoking among adolescents in Muenster, Germany: increase in prevalence (1995-2000) and relation to tobacco advertising.

BACKGROUND: Understanding patterns and trends of smoking among youths is of major importance for the assessment of the burden of smoking in the society and efforts to decrease it. OBJECTIVE: The aims were to determine the prevalence and trends of smoking among adolescents in Muenster, Germany, and to assess its relation to youths' awareness of tobacco advertisement. DESIGN: Information on smoking habits was collected during two school-based surveys (1994/1995 and 1999/2000) of 12- to 15-year-old adolescents (3934 students in 1994/5 and 4028 students in 1999/2000) in Muenster, Germany. In addition, in 1994/1995 information about youths' awareness and appreciation of tobacco advertisement was collected. RESULTS: During the 5-year period, the prevalence of current smoking increased from 21.3 to 28.3%, and daily smoking increased from 10.0 to 14.2%. Among girls, daily smoking increased by 62% during this period. Almost all participants (94%) in 1994/1995 knew a tobacco brand, and appreciation of tobacco advertisement was strongly associated with the frequency of smoking. CONCLUSION: Smoking is increasing among adolescents in Germany especially among girls. These data are a cause of concern and call for efforts to reverse these trends, which should include a ban on tobacco advertisement in Germany.

Adolescent↗
PubMed2000

Violence and fear of violence in East and West Germany.

The purpose of this research was to assess the effect of major social changes in Germany since 1989 on mortality due to intentional injury. Mechanisms and types of fatal intentional injury in East and West Germany between 1970 and 1995 were determined from death certificates and compared with judicial data on violent crime convictions and recent public survey data on citizen fear of crime. The number of homicides among East German males increased between 1989 and 1991, and the homicide rate remains high when compared with West German males (although lower than that of American males). Homicide among German females is less common, presently about equally likely in East and West. Violent crime in general has become more frequent in Germany, and citizen fear of crime has increased markedly, especially in the East. Non-citizens are convicted for an increasing number of homicides and assaults. Rates of suicide were declining in East and West before reunification, and these rates have continued to decline. Social changes in Europe since 1989 have led to noticeable increases in violence and homicide in Germany, which in turn have reduced feelings of security among German citizens, especially in the East. Suicide rates have not been affected.

Adult↗
PubMed2003

Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000.

OBJECTIVES: In 1979, we conducted a representative study to determine the prevalence and incidence of urolithiasis in Germany. Significant progress in stone therapy and changes in nutritional and environmental factors since then consequently led to a second study in 2001 under the same conditions as in 1979. METHODS: A representative sample of 7500 persons from all over Germany was questioned on the occurrence of urinary stones during their lifetimes (prevalence) and on acute urolithiasis in 2000 (incidence). Additionally, data were collected on urinary stone therapy and metaphylaxis. The current data were then compared with those from 1979. RESULTS: Prevalence has risen from 4% to 4.7% from 1979 to 2001. 9.7% of the 50-64 year old males in 2000 had already had urinary stones (females: 5.9%). The current recurrence rate of urinary stones was estimated to be 42%. In the year 2000, the incidence of urolithiasis in Germany was found to be 1.47% (1979: 0.54%). Over 40% of the stones were passed spontaneously. CONCLUSION: There has been a marked increase in the prevalence and incidence of urolithiasis in Germany within the last 22 years. This probably results from improvements in clinical-diagnostic procedures, changes in nutritional and environmental factors and a general apathy towards metabolic clarification and metaphylaxis.

Adult↗
PubMed2000

Radiation therapy for benign diseases: patterns of care study in Germany.

BACKGROUND: Radiotherapy of benign diseases is controversial and rarely applied in Anglo-American countries, whereas in other parts of the world it is commonly practiced for several benign disorders. Similar to a European survey, a patterns of care study was conducted in Germany. METHOD: Using a mailed questionnaire, radiation equipment, treatment indication, number of patients, and treatment concepts were assessed in 1994, 1995, and 1996 in 134 of 152 German institutions (88%): 22 in East and 112 in West Germany; 30 in university hospitals and 104 in community hospitals. Average numbers of each institution and of all institutions were analyzed for frequencies and ratios between regions and among institutions. Radiation treatment concepts were analyzed. RESULTS: A mean of 2 (range 1-7) megavoltage and 1.4 (range 0-4) orthovoltage units were available per institution; 32 institutions (24%) had no orthovoltage equipment. A mean of 20,082 patients were treated annually: 456 (2%) for inflammatory diseases (221 hidradenitis, 78 local infection, 23 parotitis; 134 not specified) 12,600 (63%) for degenerative diseases (2711 peritendinitis humeroscapularis, 1555 epicondylitis humeri; 1382 plantar/dorsal heel spur; 2434 degenerative osteoarthritis; 4518 not specified); 927 (5%) for hyperproliferative diseases (146 Dupuytren's contracture, 382 keloids; 155 Peyronie's disease; 244 not specified); 1210 (6%) for functional disorders (853 Graves' orbitopathy; 357 not specified); and 4889 (24%) for other disorders (e.g., 3680 heterotopic ossification prophylaxis). In univariate analysis, there were geographic (West vs. East Germany) differences in using radiation therapy (RT) for inflammatory and degenerative disorders, and institutional differences (university versus community hospitals) in using RT for hyperproliferative and functional disorders (p < 0.05). The prescribed dose concepts were mostly in the low dose range, <10 Gy but varied widely and inconsistently within geographic regions and institutions. CONCLUSION: Radiation therapy is a well-accepted and frequently practiced treatment for several benign diseases in Germany; however, there are significant geographic and institutional differences. As the number of orthovoltage units decreases, an increasing patient load will demand more megavoltage units, which may compromise the cost-effectiveness of this treatment. Only 4% of all clinical institutions have been involved in controlled clinical trials. To maintain a high level of RT service to other disciplines, RT treatment guidelines, quality control, and continuing medical education are required.

Disease Management↗
PubMed1999

Perspectives of clinical epidemiology in Germany.

The aim of this article is to discuss the perspective of clinical epidemiology in Germany. The following statements are discussed: (1) There is some confusion about the definition of clinical epidemiology. (2) There is a latent and growing need for clinical epidemiology in Germany. (3) Clinical epidemiology is an interdisciplinary field and not simply clinical medicine, epidemiology, biometry, or medical informatics. (4) We must continue with the education of clinicians and nonclinical methodologists in clinical epidemiology to develop the field of clinical epidemiology in Germany, Biometry, medical informatics, and epidemiology will play an essential role for this purpose. (5) The German scientific community urgently needs clinicians and scientists with experience in methodological research to specialize in the methods of clinical epidemiology. (6) The starting point for the development of clinical epidemiology in Germany, clear deficits in the past notwithstanding, is promising. However, we will only be able to develop the field if the egoism of the different disciplines can be tamed.

Biometry↗
PubMed1992

Epidemiology and ecology of tick-borne encephalitis in the eastern part of Germany between 1960 and 1990 and studies on the dynamics of a natural focus of tick-borne encephalitis.

From 1960 to 1990, attempts to isolate TBE virus from ticks and small mammals were made and investigations to detect TBE antibody in small mammals, game and humans were performed in the five new federal Länder of Germany. The confirmed TBE cases for which the site of exposure could be determined were also registered. As a result of these epidemiological and ecological investigations, a map is presented showing the natural foci of TBE which are primarily located in the subatlantic and mountainous climatic regions. TBE was endemic in the area of investigation from 1960 to 1990 showing a morbidity of up to 0.7 per 100,000 inhabitants which decreased in recent years to 0.02 per 100,000 inhabitants. The natural foci of TBE virus in eastern Germany showed a high activity between 1960 and 1970. Since that time, there have hardly been any cases of human disease and TBE virus could no longer be detected, neither in ticks nor in small mammals. Taking the natural focus on the Island of Usedom as an example, attempts have been made to elucidate whether such foci have become extinct or whether they have persisted. From 1983 to 1989, a surveillance programme was performed to detect antibodies to TBE virus in small mammals and game and to attempt to culture virus from ticks and small mammals. The attempts to isolate virus from a total of 8200 ticks were negative. Attempts to isolate virus from the brains of small mammals were also negative. Antibody prevalence in 446 small mammals and 500 animals of game was ca. 1%. At one site, the sero-positive reactions converted from 0% (1983-1988) to 4.5% (1989) among small mammals population. The investigations performed on the Island of Usedom have shown that this natural focus has not disappeared but is in a state of endemic latency. Moreover, the seroconversion observed in the small mammals population shows that further surveillance of such foci is necessary. This becomes obvious by the sporadic occurrence of single TBE cases as well as by a low antibody prevalence of 1% in small mammals and game. The epidemiological situation in eastern Germany is thus completely different from that in western Germany where an average of 70-120 TBE cases per year are registered, occurring mainly in Bavaria and Baden-Württemberg.

Animals↗
PubMed2003

Changing patterns of skin melanoma mortality in West Germany from 1968 through 1999.

PURPOSE: Skin cancer incidence data from West Germany are available only for the territory of the Federal State of Saarland. We examined time trends in melanocytic and non-melanocytic skin cancer mortality for the territory of West Germany including a population of about 66 million people. METHODS: We analyzed the melanocytic and non-melanocytic skin cancer mortality data (1968-99) from West Germany including West Berlin. We calculated age-specific and age-standardized mortality rates and used Poisson regression to estimate underlying age, cohort, and period effect. RESULTS: The estimated percent annual increase of the skin melanoma mortality rate was 1.0% (95% CI, 0.7-1.3) among men and 0.5% (95% CI, 0.2-0.7) among women. This increase is mainly due to a rate increase in people aged 60 years or more. The skin melanoma mortality trend was best explained by age-, cohort-, and period effects. The risks increased in each successive birth cohort born between 1890 and roughly 1935. Thereafter, the risks declined through the most recent birth cohort born in 1975. CONCLUSIONS: Skin melanoma mortality in West Germany showed an increase from 1968 through 1999 in people aged 60 years or more. The favorable mortality decline by birth cohort in the most recent birth cohort is an important indicator of a likely decline in mortality over the coming years.

Adult↗
PubMed2004

Tick-borne encephalitis (TBE) in Germany--epidemiological data, development of risk areas and virus prevalence in field-collected ticks and in ticks removed from humans.

In Germany, 100-300 autochthonous clinical TBE cases have been recorded annually. There are high-risk areas in Bavaria and Baden-Wuerttemberg and ongoing low-risk areas in Hesse, Thuringia, and the Rhineland-Palatinate and single cases in Saxony. In order to be able to evaluate the epidemiological changes described here, it must be mentioned that a new definition of TBE risk areas was introduced on the district level in 1998 in Germany and in 2001 with the new Infection Protection Act (Infektionsschutzgesetz) which states that TBE is a notifiable disease. This led to the replacement of earlier surveillance systems and to many changes to data collection. In 1998 63 country and town districts were TBE risk areas, in 2001 79 and in 2002 86. There were new risk districts within Bavaria and Baden-Wuerttemberg and outside these regions in Thuringia, Hesse and the Rhineland-Palatinate. An interesting trend was observed in TBE epidemiology. The TBE incidence in Bavaria and Baden-Wuerttemberg has been stable on a high level for years; outside these areas it has steadily been climbing (Odenwald, Thuringia). On the basis of epidemiological data on TBE from the eastern part of Germany since 1960, it is obvious that major changes in virus activity in TBE risk areas also occurred in the past, the explanation of which has remained a matter for speculation. The epidemiological situation in the different risk areas for TBE in Germany was found to vary considerably, if one considers the surveillance data of the last 40 years. 1. Establishment of completely new low-risk areas. 2. Reactivation of formerly active areas with endemic latency. 3. High-risk areas with stable viral activity over long periods. 4. High-risk areas which have expanded and merged with low-risk areas. 5. High-risk areas which have developed into endemic areas or become inactive. High-risk TBE areas from 1960-1975 (i.e. Mecklenburg-Western Pomerania) have since completely disappeared. There were, at the same time, high-risk areas in Thuringia which had only become latent and have now obviously become active again. The Odenwald demonstrated growing virus activity in the 1990s. These changes in TBE activity in German risk areas over more than the last 40 years are presented schematically. This ongoing number of risk areas is certainly linked to the notification obligation and greater public awareness. Nevertheless, any effects of ecological and climatic changes on the natural foci cannot be ruled out nor can changes in human leisure behaviour. Local weather conditions also have a major effect on the TBE incidence. Warm and dry summers may cause low tick activities, rainy summers may lead to low exposure rates of human beings. Even changes in forms of agricultural production prompted by different political structures probably have an impact as do economic constraints which may lead to lower vaccination and higher exposure rates. Regular, systematic virus prevalence measurements from 1997 to 2002 in field-collected ticks in German high-risk areas do not indicate any risk increase nor do they suggest a downward trend. Studies on virus prevalence in questing versus partially engorged ticks indicate that we neither exactly know nor understand the real quantitative relations between the virus and the host. In a first study, virus prevalence in Ixodes ricinus removed from humans was examined. Humans which were exposed in some districts near Passau in Bavaria. In the autumn of 2001, virus prevalence of unengorged free-living nymphs (n = 820) in this area was 0.38 (0.08-1.1)% and of adults (n = 90) 1.17 (0.03-6.38)%. Surprisingly, virus prevalence in partially engorged ticks from the same area collected during the same period was significantly higher (nymphs, n = 86, 6.9% and adults, n = 129, 9.3%). Virus-positive partially engorged ticks were only found in districts known as risk areas. Nucleotide and deduced amino acid sequence data of the PCR products have confirmed the presence of virus prototype Neudoerfl only.

Animals↗
PubMed2002

Characterization of tick-borne encephalitis (TBE) foci in Germany and Latvia (1997-2000).

Knowledge concerning the prevalence of the tick-borne encephalitis virus (TBEV) in wild living tick populations is very important for understanding the epidemiology of the disease and for immuno prophylactic strategy. In Germany high and low risk areas of TBE exist. In the years 1997-2000, 533 autochthonous clinical TBE cases were recorded, in the high-risk areas of Bavaria and Baden-Wuerttemberg 140 and 363, and in the low risk areas in Hesse (Odenwald) and Rhineland-Palatinate 22 and 8, respectively. Corresponding to these case reports we have measured the virus prevalence in free living ticks in these four risk areas and compared these findings with the situation in high-risk areas in Latvia. In the years 1997-2000, 2,797 clinical TBE cases were recorded in Latvia. For the studies in Germany, a total of 17,398 Ixodesricinus ticks (14,860 nymphs and 2,538 adults) were collected by flagging and examined for TBEV, in Latvia the corresponding numbers were 525 I. ricinus ticks (350 adults and 175 nymphs) and 281 I. persulcatus ticks (adults only). Information concerning annual and seasonal differences of the TBEV prevalence in natural TBE foci is not available in Germany. This paper is a continuation of the study (Süss et al., 1999), starting in 1997. We investigated every year, in May and September, the virus prevalence in ticks in high risk areas of Bavaria (8 foci) and Baden-Wuerttemberg (5 foci). A total of 15,400 ticks (13,100 nymphs and 2,300 adults) were examined for TBEV. The ticks were tested for the presence of TBEV-RNA using a sensitive, nested-RT-PCR. The virus prevalence in the Bavarian foci of the whole tick population ranged from 0.3 to 2.0% during these four years, in adults between 1.2 and 5.3% and in nymphs between 0.1 and 1.4%. In the high-risk areas of Baden-Wuerttemberg, in the Black Forest, the estimated virus prevalence rates of investigated ticks varied from 0.2 to 3.4%, in adults from 0 to 4.8%, and in nymphs from 0.2 to 3.4%. Using the same methods, we have also tested the low risk areas in the Odenwald (840 nymphs, 160 adults) and in Rhineland-Palatinate (920 nymphs, 78 adults). Ticks were collected in those areas where most TBE cases were registered. The virus prevalence in the Odenwald was 0% in adults and 0.5% in nymphs, whereas in ticks from Rhineland-Palatinate we have not found any positive PCR signal. Sequence data of the PCR products have shown that all strains in Germany were closely related to the central European virus prototype Neudoerfl. In I. ricinus ticks, collected in Riga county, the following virus prevalence rates were found: in females 2.4%, in males 3.7%, and in all adults 3.0%, in nymphs 2.4% and in the I. ricinus tick population examined 2.8%. The virus prevalence in I. persulcatus, collected in the eastern parts of Latvia was 6% in females, 4% in males and 5% in all adults. All the PCR products were sequenced and a phylogenetic tree was constructed. Studies in natural foci of TBE in Latvia have shown that I. ricinus carried the central European virus subtype (prototype Neudoerfl) whereas in I. persulcatus two strains have been found, the central European virus subtype (prototype Neudoerfl) and the Siberian virus subtype (prototype Vasilchenko). Sequences of the Far Eastern subtype have not been detected yet.

Animals↗
PubMed1999

Dietary recommendations and prevailing food and nutrient intakes in Germany.

Dietary recommendations on nutrient intakes as published by the German Society of Nutrition are only met by a very small proportion of the adult population in East and in West Germany. Dietary data from the Nutrition Survey and Risk Factor Analysis Study in West Germany and from the National Health Survey in East Germany were used to identify differences in nutrient intakes and in food consumption patterns between subgroups of the study participants that were close to, or failed to meet the dietary guidelines. The subgroups were created by dividing subjects into quartiles on the basis of their daily intakes of total fat (%energy), saturated fatty acids (%energy), fibre (g/d) and the food group fruit and vegetables (g/d). Comparisons of the consumption patterns between subjects in the first and in the fourth quartile of intake of the nutrients under study were performed. Differences in food and nutrient intakes were seen among those more compliant and less compliant with the recommendations. The presented analysis provides first indications for future improvements of the existing food-based dietary guidelines in Germany.

Adolescent↗
PubMed2000

The economic burden of hepatitis B in Germany.

Despite the widespread distribution of Hepatitis B virus (HBV) infection and the ongoing controversy about HBV immunization, surprisingly few published studies examined in detail the economic impact of HBV infection in Europe. Therefore, we investigated a cohort of 180 patients throughout Germany to evaluate the economic burden of HBV-associated disease. In 58 patients with acute and 122 patients with chronic HBV infection, cost-consuming events including direct medical costs and work-loss costs were documented. The direct costs were DM 7702 (95% confidence interval (CI): 5473-9931) for each acute HBV infection and DM 4247 (CI: 1601-6893) per patient-year of chronic HBV infection, with marked differences between different stages of HBV disease. The derived overall costs (1997 price levels) per year were DM 10,018 (CI: 7613-12,421) and DM 4860 (CI: 2185-7536), respectively. Based on crude population-based estimates (30,000 acute and 420,000 chronic HBV cases), we calculated the total HBV-related costs in Germany to exceed DM 1200 millions in 1997 (CI: 924.2-1536.7), with the treatment of patients with chronic active HBV disease as the major cost determinant. Previously published data from Germany probably overestimated the financial impact of acute HBV infection. In summary, our results illustrate the ongoing economic importance of this potentially life-threatening, but preventable disease and support the call for more accurate HBV surveillance and control in Germany.

Adult↗
PubMed1999

Allergens in house-dust samples in Germany: results of an East-West German comparison.

The background of this study is the finding of several studies that the frequency of respiratory allergies was significantly higher in the former West Germany than the former East Germany. The present study investigated the levels of allergens of house-dust mite (Der p 1 and Der f 1), cat (Fel d 1), and cockroach (Bla g 2) in the household dust of 201 homes in Hamburg (West Germany) and 204 homes in Erfurt (East Germany), and examined the factors that affect these levels. The characteristics of homes were assessed by a questionnaire. The allergen levels were studied in dust from living rooms (LR), bedrooms (BR), and mattresses (MA). We detected in samples from Hamburg significantly higher allergen concentrations than in Erfurt: three times higher Der p 1, five times higher Der f 1, and three times higher Fel d 1. For Bla g 2, no comparison was possible because the concentrations were below the detection limit in 93% of the samples. Most of the differences could be explained by differences in housing and living characteristics between both cities. The mean ratio of Der p 1 levels in mattress dust between Hamburg and Erfurt decreased from 4.1 to 1.54 (NS) after adjustment for season, building material, age of the house, story of the dwelling, type of heating, age of carpet/mattress, presence of dogs, and indoor climate (temperature, humidity). The mean ratio of Der f 1 levels decreased from 6.9 to 2.78 (P<0.05) after adjustment for these factors. The mean ratio for Fel d 1 in mattress dust decreased fom 4.03 to 1.65 (P<0.05) after adjustment for season, building material, story of dwelling, size of dwelling, ventilation, cleaning routines, and pets. A similar reduction was seen for floor dust (LR plus BR). Our results indicate that the differences between the concentrations of mite and cat allergens found in Hamburg and Erfurt are explicable mainly, but not completely, by different building characteristics (age of houses, building material, story, and size of the dwelling) which affected the indoor climate, as well as by differences in other individual living habits (keeping of pets, age of carpets or mattresses, and cleaning routines).

Air Pollution, Indoor↗