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PubMed1995

Germany at the crossroads: national identity and the challenges of immigration.

"In Germany the discussion [of immigration] is taking place between two extreme positions, one that denies Germany is de facto an immigration country...and one that compares Germany with traditional immigration societies like the United States, Canada, or Australia. As will be demonstrated, both arguments are too simplistic.... To illustrate the importance of migration movements for Germany's national fabric, first an overview of the history of pre- and postwar migrations and refugee movements as well as their effects on the domestic situation in Germany are presented. Next, the origins of the contradictory nature of the current asylum, citizenship and naturalization regulations and the need to redefine Germany's legal framework, immigration policy, and national identity after unification are discussed."

Demography↗
PubMedDate not supplied

[Model calculation to explain the BSE-incidence in Germany].

The future development of BSE-incidence in Germany is investigated using a simple epidemiological model calculation. Starting point is the development of the incidence of confirmed suspect BSE-cases in Great Britain since 1988, the hitherto known mechanisms of transmission and the measures taken to decrease the risk of transmission as well as the development of the BSE-incidence in Germany obtained from active post mortem laboratory testing of all cattle older then 24 months. The risk of transmission is characterized by the reproduction ratio of the disease. There is a shift in time between the risk of BSE transmission and the BSE incidence caused by the incubation time of more than 4 years. The observed decrease of the incidence in Germany from 2001 to 2003 is not a consequence of the measures taken at the end of 2000 to contain the disease. It can rather be explained by an import of BSE contaminated products from countries with a high BSE incidence in the years 1995/96 being used in calf feeding in Germany. From the future course of the BSE-incidence in Germany after 2003 a quantification of the recycling rate of BSE-infected material within Germany before the end of 2000 will be possible by use of the proposed model if the active surveillance is continued.

Animals↗
PubMed1997

[The dimension of animal carcass disposal in Germany and Europe-- quantification and differentiation].

A survey is given concerning the amount and kind of raw-materials processed in the rendering-industry in Germany and the EU. In Germany about 2,550,000 Mg of material were processed yearly and in the EU about 12,131,000 Mg. The raw-materials were processed to about 800,000 Mg of products (meat/bone meals and fats) in Germany and about 3,259,000 Mg meat/bone meals as well as 1,345,000 Mg of animal fats in the EU every year. Main producers are France (22%), Germany (18%) and Italy (15%). The directive 90/667/EWG (133 degrees C, at least 20 min. at 3 bar pressure) is only consequently followed in Austria, Germany and The Netherlands, in all other EU countries a part of the raw-material is still processed at lower temperatures until now. The costs for rendering in the EU are between 65,-DM/Mg and 270,-DM/Mg. If all material should be burned in Germany the costs will be three times higher as with safe rendering.

Adipose Tissue↗
PubMed2000

Diet in residents of East and West Germany in 1991-1992 as ascertained by a retrospective food frequency questionnaire.

In this study, we compared dietary habits of residents in East (N = 76) and West Germany (N = 266) using results obtained in 1992-1993 from a retrospective semi-quantitative food frequency questionnaire referring to 1991-1992. Nutrient intakes were calculated based on the German Federal Food Code. Univariate and multivariate logistic regression was used to determine whether dietary intakes varied according to residence in East and West Germany. At the food level, East German subjects reported a higher consumption of bread, spreadable fat, and sausage, whereas West German participants reported a higher intake of fruit, vegetables, and pasta and rice. At the macronutrient level, energy intake did not differ significantly between groups, nor did the percent contribution of protein, carbohydrate, fat, and alcohol to total energy intake. East German participants had a lower total water and fibre intake, the latter significant only after adjustment for confounders. At the micro-nutrient level, East German participants had a higher intake of cobalamin, retinol and retinol-equivalents (but not of beta-carotene). There were no differences in the intake of vitamins C, D, and E between groups. Less salt and more potassium, calcium, magnesium and zinc were consumed by West than by East German subjects. Overall, both groups showed disadvantageous dietary patterns. The results are discussed in the context of an overview of other dietary surveys performed in the two parts of Germany before and after reunification. In general our results are consistent with other observations showing that dietary habits in East Germany rapidly approached those in West Germany after reunification, although some residual differences seemed to persist.

Adult↗
PubMed1993

Contraception in Germany: a review.

In this paper studies on current contraceptive use and attitudes toward various contraceptive methods in Germany are reviewed. Both the former West and East Germany are considered. On the basis of the existing studies it is difficult to have a clear impression of which methods are currently used in both countries and how contraceptive practice developed over time, due to methodological differences between studies. Nevertheless, it can be concluded that use of reliable contraceptive methods is widespread in both East and West Germany. In this respect East Germany differs considerably from other previously communistic countries. Attitudes were mainly assessed in West Germany, and with respect to oral contraceptives and IUDs great concern appeared to exist regarding the safety of both methods. As far as oral contraceptives are concerned, selective mass media attention toward possible side-effects of oral contraceptives may have contributed to this situation.

Adolescent↗
PubMed1996

[Autologous blood transfusion in the Federal Republic of Germany--results of a questionnaire in 1993. 2. The use of autologous transfusion in the old and new federation].

In 1993, we conducted a postal survey to assess the use of autologous blood transfusion (ABT) in the Federal Republic of Germany after reunification. The results of this survey have already been reported in a previous paper, but without differentiation between the "old" and "new" states (former West Germany and former German Democratic Republic, respectively). In the present study, the data of our 1993 survey were further analysed to see if there were differences in the use of ABT between the "old" and "new" states. METHODS. The study is based on data of a 1993 postal survey of German hospitals. Details concerning the performance of the survey have been reported in a previous paper. Briefly, questionnaires were mailed to the anaesthesia departments of 400 randomly selected hospitals in the "old" states and 284 hospitals in the "new" states of the Federal Republic of Germany. The questionnaires contained 36 questions related to general information on the hospital and the use of ABT; 305 completed questionnaires were returned from the "old" states and 197 from the "new" states, response rates of 76% and 69%, respectively. For the present investigation, the responses of the hospitals of the "old" and "new" states were analysed separately. Frequency distributions of categorical variables were analysed by the chi-square test. Because of multiple testing, statistical significance was attained only at the 0.05% level (P < or = 0.0005). RESULTS. There were no significant differences between the "old" and "new" states with respect to hospital size by number of beds, percentage of general and specialised hospitals, and percentage of operations requiring blood transfusion. In both the "old" and "new" states, 9% of the responding hospitals maintained a hospital-based transfusion service, while the other depended on regional blood banks. Preoperative autologous blood donation (PABD) was performed at least "rarely" in 85% and 71% (P = 0.0001), and "mostly" in 20% and 10% (P = 0.0014) of the hospitals in the "old" and "new" states, respectively. Uniformly, the principal uses of PABD were for orthopaedic and cardiac surgery. In 62% and 27% (P < 0.0001) of those hospitals that reported performing PABD, the autologous blood service was run by the anaesthesia department. Preoperative plasmapheresis was performed in 14% and 8% (P = 0.008), and isovolaemic haemodilution in 82% and 56% (P < 0.0001) of the hospitals in the "old" and "new" states, respectively. Automated autotransfusion devices (cell savers) were available in 38% and 19% (P < 0.0001) of the hospitals, respectively. Simple collection devices for perioperative blood salvage were used in 17% and 15% (P = 0.24) of the hospitals in the "old" and "new" states, respectively. CONCLUSION. We conclude that ABT is more widely used in the "old" than the "new" states of the Federal Republic of Germany. ABT is regarded as a desirable alternative to homologous blood transfusion, and in the interest of equal standards of medical care throughout the nation, the use of ABT should be further promoted, especially in the "new" states of the Federal Republic of Germany.

Blood Transfusion, Autologous↗
PubMed1999

Psychological distress and psychiatric disorders in primary health care patients in East and West Germany 1 year after the fall of the Berlin Wall.

BACKGROUND: The reunification of Germany confronted citizens in East and West Germany with many changes in their lives. These changes may be considered as critical life events. Especially for those in East Germany, life circumstances drastically changed, and individuals were increasingly required to adopt and develop coping capabilities. In addition to new opportunities and freedom, there was threatening uncertainty about the future. Theories of life events and stress postulate that threat events have an impact on human well-being. It was expected that there would be an increased rate of psychiatric morbidity after unification, especially in the eastern part of Germany. METHOD: An international study by the WHO on psychiatric disorders in general health care was carried out in 1990, 1 year after the opening of the Berlin Wall, in both parts of Berlin and in Mainz, West Germany. This allowed for a comparison of the prevalence rates of psychiatric disorders among general health care patients in the East and West, after the euphoria immediately following unification had subsided. RESULTS: The prevalence rates of current ICD-10 diagnoses and of subthreshold disorders in East Berlin were similar to the rates in West Berlin and Mainz. The recognition rate of psychiatric disorders by physicians did not differ in East Berlin as compared to West Berlin and Mainz. CONCLUSION: Contrary to the prediction expected from the literature on individual negative life events, major changes in life circumstances and stressful life events on a societal level within 1 year did not have a major impact on psychological function.

Adult↗
PubMed1997

The integration of two health systems: social stratification, work and health in East and West Germany.

This is an analysis of system integration, social stratification and work for health status and health care in East and West Germany. It is based on aggregate data and representative survey data of random samples of 2554 adults in both subsystems. Findings show that there were marked differences in life-expectancy prior to unification. The integration of the two systems, which occurred almost totally with regard to terms of West German health care organization, shows adjustment problems in the East for the public Health-Care-Funds and few if any for ambulatory care. The work situation has an impact on health, but there are no significant differences for East versus West. Social stratification variables show an influence on subjective health status for education (East) and for income, social status (West), while physician utilization (despite a preference of specialists by those with higher status) is not significantly determined by stratification variables in either East or West Germany. Beyond the central focus on work and stratification determinants a major finding pertains to a comparatively worse health situation for the aged and for women in what was the former East Germany. System models of Capitalism versus Socialism fit the results and recent history of the two systems to only a limited degree, as the West German corporate health system shows clear limits in following free market principles. The East German system, regardless of its centralized organization and move towards a socialist system, never fully abandoned the traditional model of German health care. Unlike the East German health system, that of West Germany, with its general expansion to 92% of the population, shows an increasing effect for social redistribution. The latter may be a reason why standard indicators of social stratification show less of an impact on health and health care than expected, while conditions at work clearly determine the health of people-the latter being the case in both the former East and West Germany.

Adult↗
PubMed2002

T(H)1/T(H)2 immune response profiles differ between atopic children in eastern and western Germany.

BACKGROUND: Lower prevalence rates for childhood respiratory allergies have been reported in eastern Germany than in western Germany. OBJECTIVE: Because allergic phenotypes are thought to be associated with an unbalanced T(H)1/T(H)2 T cell effector response, a cross-sectional investigation was carried out as part of the German ISAAC Phase II study to determine whether T(H)1/T(H)2 capacity might have developed in different directions during the separation between the 2 parts of the country. METHODS: In a community-based random sample of 9- to 11-year-old (n = 6399) and 5- to 7-year-old (n = 6202) children in eastern and western Germany, the prevalence of atopy was assessed. Heparinized blood samples were collected from a subgroup of children stratified according to the number of older siblings. T(H)1 and T(H)2 cytokine productivity was determined after stimulation with phorbol ester plus ionomycin. RESULTS: Individuals who grew up in eastern Germany had a marked bias toward T(H)0 responsiveness (>60%), regardless of whether they were atopic. In contrast, the children of western Germany, particularly when they were atopic, showed T(H)2 polarization. CONCLUSIONS: This is the first epidemiologic survey to demonstrate regional differences in the T(H)1/T(H)2 response pattern and their relation to atopic disease between regions.

Asthma↗
PubMed1997

Epidemiology of pollution-induced airway disease: urban/rural differences in East and West Germany.

The prevalence of asthma and allergic disorders was assessed in 9-11 year-old children in Leipzig and Halle in East Germany, as well as in Munich, West Germany. Both East German cities are heavily polluted due to private burning of coal and industrial emissions, while Munich has low smoke emissions but heavy road traffic. All fourth grade pupils in Munich were compared with those in Leipzig and Halle. Non-specific airway disease (bronchitis), cough, and autumn/winter nasal symptoms were most prevalent in Leipzig and Halle. Hay fever and skin test reactivity to aeroallergens were higher in West Germany compared with East Germany. Furthermore, the prevalence of asthma was also higher in the West German study area. Increased skin prick test reactivity in the West explained the increased prevalence of asthma. Longitudinal analysis showed increased respiratory symptoms on days with high mean levels of sulphur dioxide and oxides of nitrogen, as well as on days with a high peak level of 10 mu respirable particles (PM10) in East Germany. The effects of these pollutants were additive. Exposure to heavy road traffic in Munich was related to decreased pulmonary function and non-specific airway symptoms, but not to allergic sensitization and asthma.

Air Pollutants↗
PubMed2004

Drugs in palliative care: results from a representative survey in Germany.

The development of palliative medicine in inpatient units in Germany has been impressive in the last years. As a first step of quality assurance, a core documentation form was developed in 1996. In 2001, 55 of the 83 palliative inpatient units in Germany and one unit each in Switzerland and Austria participated in the third phase of the evaluation of the core documentation. A total of 1304 patients were documented consecutively in the 57 units for a period of up to three months. This study investigates the frequency of drugs used in palliative care units in Germany. During inpatient treatment, the most common drug classes were strong opioids (68% of the patients), nonopioids (59%), corticosteroids (32%), laxatives (31%), antiemetics (27%), gastric protection agents (24%), neuroleptics (19%), sedatives/anxiolytics (18%), antidepressants (16%) and diuretics (15%). These ten drug classes made up for 72% of all prescriptions in the palliative care units. The substances used most frequently were dipyrone (47% of the patients), morphine (42%), fentanyl (28%), dexamethasone (27%), metoclopramide (21%), sodium picosulfate (15%), haloperidol (13%), pantoprazole (11%), macrogol (11%), amtriptyline (11%), furosemide (10%), omeprazole (9%), lactulose (8%), rofecoxib (8%) and lorazepam (7%). The 15 most commonly used drugs accounted for 54% of the prescriptions in the palliative care units in Germany. Drug treatment was related to sex, age and functional status of the patients. Patients who died in a palliative care unit had received significantly more frequent doses of neuroleptics (P < 0.001), corticosteroids (P < 0.001), sedatives/anxiolytics (P < 0.001) and strong opioids (P < 0.001). This study is the first representative and systematic evaluation of drug treatment in palliative care units in a European country. Many of the 'top 15' drugs were drugs included in the list of essential drugs of the World Health Organisation though availability and cultural differences have an effect on the use of drugs, e.g., the high usage of dipyrone in Germany. Age and sex-related differences in drug therapy were seen, and more research is needed to recognize possible undertreatment of symptoms in subgroups of patients, e.g., treatment of depression in older or male patients.

Adult↗
PubMed1991

Parasitology in East Germany--roots, period of the G.D.R., future.

The paper starts with a historical reflection on the region and on famous scientific personalities which worked up parasitological problems on the territory of East Germany. Native scientists like J. L. Frisch, C. A. Rudolphi, R. Leuckart, A. C. Gerlach, R. Virchow, R. Koch, R. von Ostertag, W. Nöller, R. Wetzel made in fundamental contributions to the growth of knowledge in General and Special Parasitology. The parasitological institutions existing in East Germany are represented briefly. The parasitologists of East Germany, nearly 160,--biologists, physicians and veterinarians--among them more than 50 specialized parasitologists were associated in the Parasitological Society of the G.D.R. since 1961. A review is given of actual parasitological problems of agricultural and other domestic animals, fair game animals, of bees and freshwater fish as well as of the most important parasitoses of man frequent in East Germany, under the aspects of epidemiology, diagnosis and control. The rapid evolution of an intensive animal production under large scale management conditions required a permanent control of infestation with pathogenic protozoans, arthropods and helminths. Some selected results achieved in research and practice are represented. The epidemiological situation referring to parasitic zoonoses is favourable at present. Since 1970 a group of experts from East Germany working successfully in Mongolia on the systematic control of ectoparasites of farm animals together with Mongolian parasitologists. It is considered to be necessary to make an international agreement in parasitological research in future more than till now.

Germany↗
PubMed1993

Drug-prescription in the five new federal lands--a comparison with the prescription of the old federal lands of Germany.

In the present study, the consumption of several drugs on the territories of the former GDR and FRG was compared using 200,000 prescriptions and the defined daily doses (DDD). Furthermore, for the two parts of Germany, the 20 most frequently prescribed drugs were evaluated. Calcium antagonists and the beta-blockers prevailed in East Germany, while cardiac glycosides, vasodilators, reserpin-containing antihypertensives, bronchodilators (beta-adrenoceptor agonists), neuroleptics, tricyclic antidepressants, antacids, H2-receptor blockers, chondroprotectives were used 1.5 to 5 times more frequently in West Germany. Because in East Germany, a shortage of drugs was no longer observed in 1991, several other reasons for the "over-prescription" of drugs for the patients in West Germany must be mentioned.

Drug Prescriptions↗
PubMed1998

Contamination of human breast milk with organochlorine residues: a comparison between East and West Germany through sentinel practice networks.

STUDY OBJECTIVE: The aim of the study was to assess and compare the contamination of human breast milk with organochlorine residues through two sentinel practice networks in Lower Saxony, a state of former West Germany, and Saxony-Anhalt, a state of former East Germany. DESIGN: Eligible women were enrolled in this cross sectional study by a network of 51 paediatric practices in Lower Saxony and 44 in Saxony-Anhalt when bringing their babies for a regular screening examination four to six weeks after delivery. Sociodemographic, lifestyle, and exposure factors were determined by questionnaire. Milk samples were analysed for hexachlorocyclohexane (HCH), hexachlorbenzole (HCB), DDT, dieldrin, polychlorinated biphenyls (PCB), and heptachlorepoxid (HCE); half the samples were also analysed for dioxin. Analytic statistics were computed using multiple logistic regression. SETTING: The study was conducted in Lower Saxony, Germany, from July 1992 to June 1993, and in Saxony-Anhalt, Germany, from January to June 1995. PARTICIPANTS: 156 primiparous, breast-feeding women from Lower Saxony and 113 from Saxony-Anhalt were studied, who either were born and raised in former West or East Germany, respectively. MAIN RESULT: Mean age of mothers and children differed significantly between the two study groups. In Lower Saxony all but two milk samples were well below the tolerable concentrations established by the German Research Council (Deutsche Forschungsgemeinschaft (DFG)). In Saxony-Anhalt no participant had concentrations above those recommended by the DFG. After adjustment for age of mother and child, occupational and non-occupational pesticide contact, DDT and beta-HCH concentrations were significantly lower in Lower Saxony; HCE and dieldrin concentrations were lower in Saxony-Anhalt. No differences between the two states were found for PCB, HCB, gamma-HCH, and dioxin. CONCLUSIONS: Breast milk contamination levels in former East German Saxony-Anhalt exceeded the contamination in Lower Saxony only for DDT and beta-HCH.

Adult↗
PubMed1997

Pollution and the development of allergy: the East and West Germany story.

Allergic diseases are partly genetically determined, but environmental factors have a strong influence on the expression of allergic symptoms in genetically predisposed subjects. In particular, outdoor air pollution has received widespread attention as a potential manifestation factor. The unification of Germany provided a unique opportunity to study the impact of radically different environmental and social conditions on the development of allergies in two genetically homogeneous populations. A high car density and NO2 exposure were typical for many West German cities. Severe pollution due to heavy industrialization and private coal burning for heating purposes were the main sources of air pollution in East German cities. We assessed the prevalence of asthma and allergic disorders in 9-11 year old children in in East Germany (Leipzig and Halle) and in West Germany (Munich). All fourth grade pupils in Munich (n = 7,445) were compared with those in Leipzig and Halle 1991 (n = 3,105). Hay fever, skin test reactivity to common aeroallergens and asthma were considerably more prevalent in West Germany as compared to East Germany. When atopy was taken into account, there was no longer a significant difference in the prevalence of asthma between the two parts of the country.

Air Pollution↗
PubMed1996

[Current state of alimentary iodine deficiency in Germany].

Germany finds itself among the most iodine deficient countries of Europe. Voluntary use of iodized salt constitutes the only goiter prophylaxis. In the last few years, measures such as the opening up of European internal markets, abolition of lac pertaining to the alimentary iodine consumption. Random samples of urine collected from 5932 persons without thyroid ailment, distributed over 32 regions of Germany, were measured for iodine excretion. The median value of iodine excretion was 72.4 micrograms I/g creatinine. Children under 10 years (76.9) and persons over 70 years (80.7) showed a slightly higher iodine elimination than those between 11-70 years (71.9). No differences between the former East Germany and West Germany as well as North, South and middle regions of unified Germany were observed. 55% of the study population presented with iodine values between 50 and 100 micrograms, 19% with lower than 50 micrograms. Only 9% showed sufficient iodine state. The results expose the inadequacy of the voluntary measures to tackle the problem of alimentary iodine deficiency.

Adolescent↗
PubMed1999

[Radiotherapy of benign diseases: a pattern of care study in Germany].

BACKGROUND: Radiation therapy of benign diseases is controversially discussed and rarely applied in Anglo-American countries, while in other parts of the world, especially Central and East Europe, it is commonly practised for several benign disorders. Similar to the European Society of Therapeutic Radiology and Oncology survey, a patterns of care study was performed in Germany. METHOD: A questionnaire was mailed in 3 years (1994, 1995, 1996) to all radiation facilities in Germany, which assessed equipment, indications, number of patients and treatment concepts. A total of 134 (88%) institutions returned all requested data: 22 in East and 112 in West Germany; 30 in university and 104 in community/private hospitals. The average data of each institution and of all institutions were analyzed for frequencies and ratios between different regions and institutions. RESULTS: A mean of 2 (range 1 to 7) megavoltage (Linac/Cobalt 60) and 1.4 (range 0 to 4) orthovoltage units were available per institution; 32 (24%) institutions had no orthovoltage equipment. A mean of 20,082 patients were treated per year: 456 (2%) for inflammatory diseases (221 hidradenitis, 78 nail bed infection, 23 parotitis, 134 not specified), 12,600 (63%) for degenerative diseases (2,711 peritendinitis humeroscapularis, 1,555 epicondylitis humeri, 1,382 heel spur, 2,434 degenerative osteoarthritis, 4,518 not specified), 927 (5%) for hypertrophic diseases (146 Dupuytren's contracture, 382 keloids, 155 Peyronie's disease, 244 not specified), 1,210 (6%) for functional disorders (853 Graves' orbitopathy, 357 not specified), and 4,889 (24%) for other disorders (e.g. 3,680 heterotopic ossification prophylaxis). In univariate analysis, there were significant geographical (West vs East Germany) differences in the use of radiotherapy for inflammatory and degenerative disorders and institutional differences (university vs community/private hospitals) in the use of radiotherapy for hypertrophic 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 institution types. CONCLUSION: Radiotherapy is a well accepted and frequently practised treatment for several benign diseases in Germany, however, there are significant geographical and institutional differences. As the number of orthovoltage units decreases, an increasing patient load is in demand of more megavoltage units, which may compromise the cost-effectiveness of this treatment. Only 4% of all clinical institutions are involved in controlled clinical trials. To maintain a high level of radiotherapy service to other disciplines, radiotherapy treatment guidelines, quality control and continuing medical education are required.

Dose Fractionation, Radiation↗
PubMed2004

[Prevalence of hantavirus infections in Germany].

Hantaviruses belong to the group of "emerging" viruses. Pathogenic European hantaviruses can cause a human disease designated "hemorrhagic fever with renal syndrome" of varying severity. In general, diagnostics of hantavirus infections are based on immunofluorescence assays using virus-infected cells or enzyme immunoassays and Western blot tests using recombinant nucleocapsid proteins. For highly sensitive detection of hantavirus-specific antibodies in the enzyme immunoassay, a homologous hantavirus nucleocapsid protein is needed as a diagnostic antigen. Serological typing of hantavirus infections can be obtained by neutralization assays, which in certain cases require the use of late convalescent sera. The seroprevalence in the normal German population is about 1%. In professionally exposed risk groups, e. g., forest workers, a seroprevalence higher than that in the normal population was observed. Endemic regions for hantavirus infections are located mainly in Baden-Württemberg. In the years 2001-2003 an annual number of about 200 clinically apparent hantavirus infections were registered in Germany. Neutralization assays detected almost exclusively human infections caused by Puumala and Dobrava viruses, only very rarely by Tula virus. Until this day in Germany mainly mild to moderate courses of human hantavirus infections have been documented. Besides infections caused by "German" hantaviruses, up to 10% of the clinically apparent hantavirus infections registered annually in Germany are caused by infections imported from other countries, mainly from Europe. So far only very limited molecular genetic data about the circulating hantaviruses in Germany are available. Additional investigations are needed to get a more precise picture about the distribution of hantaviruses in Germany and to calculate the resulting risk for the human population.

Communicable Disease Control↗