[National immunization program initiatives-What are their contribution to the elimination of measles and rubella in Germany?] / Nationale Initiativen im Impfwesen ­ Was können sie zur Elimination der Masern und Röteln in Deutschland beitragen?

In Germany, vaccinations, like the entire health sector, are organized at the federal level. A common strategy is necessary for the implementation of national immunization goals, e. g., for the elimination of measles and rubella, as intended by the World Health Organization (WHO). Current and reliable data concerning the vaccination status of the population on one hand and regional differences on the other hand are prerequisites for the identification of specified fields of action.In this paper, the strengths and challenges of the national immunization program in Germany are described, establishing the current status of the elimination of measles and rubella as a reference. Important criteria for the fulfilment of this goal, e. g., the achievement and maintenance of a vaccination coverage of 95% with two doses of vaccines against these two diseases, were again not met in 2018. Therefore, national initiatives will contribute to closing the immunity gaps, such as: the National Immunization Conference as a platform for the continuous communication between the main players and for the development of new ideas and suggestions, the national immunization plan and the 2015-2020 national action plan for the elimination of measles and rubella, which contains the goals and the required activities, and the national immunization steering group for prioritization of the agenda items and recommendations for the measures required for their realization as well as coordination of the national activities.The first results described in this paper suggest that the taken course is promising, but further efforts by all players are urgently needed.

Sentinel health department project in Baden-Wuerttemberg (Germany)--a useful tool for monitoring children's health and environment.

In the Federal State of Baden-Wuerttemberg, Germany, an environmental health surveillance system has been established focusing on children aged 10 years. Four study regions (two larger cities, one small city, and one rural area) were designated in order to get information about the body burden of persistent chemicals (toxic metals and chlorinated compounds) in children and about lung function, frequency of respiratory diseases, and allergies. From 1992/1993 to 2002/2003, seven cross-sectional investigations were carried out, and more than 10,000 children took part in the study. DDE, HCB, PCB-138, PCB-153 and PCB-180 were measured in individual blood samples of about 400 children per year, whereas PCDD/PCDF and coplanar PCBs were determined in pooled blood samples. From 1993 to 2003, blood concentrations of these compounds decreased 2 to 4-fold. Concerning regional differences, slightly lower concentrations of DDE, PCBs and PCDD/PCDF could be seen in children from the municipal population of Mannheim compared to other regions. Breast feeding was associated with considerably higher concentrations of PCBs and most other chlorinated compounds. Static and dynamic lung function parameters showed no differences between the investigated areas. For prevalences of respiratory diseases and allergies, no time trend was observed except for pertussis, which showed a decrease in 2002/2003 probably due to an increase of vaccination rates. In addition, the prevalence of atopic sensitization against aero allergenes remained unchanged at about 35% during the observation period. In conclusion, this environmental health survey delivers objective data about spatial and temporal trends and provides information about possible sources of children's exposure to toxic compounds in the environment. Adaptations of the survey to new problems are discussed.

Indoor fungi levels in homes of children with and without allergy history.

A study was performed at the four sentinel health departments of Baden-Württemberg between November 1999 and March 2000 to investigate the indoor levels of fungi at the homes of school children (mean age 10 y) and to describe possible associations with allergy statuses. Three hundred and ninety-seven households of school children with (n = 199) and without (n = 198) allergic history were included in the study. The median of colony forming units (CFU/m3) of fungi, measured in the children's bedrooms' in indoor air, was 105 (range 5 to 15,000), in outdoor air 110 (range 10 to 1500). The median of viable mould spores (CFU/g dust) in floor dust was 28,500 (range 1500 to 1,235,000), in mattresses 16,250 (range 0 to 2,500,000). Neither climatological conditions, nor differences between urban and rural regions showed a systematic influence on fungi counts. There was no difference in concentrations and distribution of fungi species levels between children with and without allergic history. The sensitization rate against molds (IgE) was higher for children with allergic condition (9.2%) than in control children (4.4%), but there was no association with the fungi counts in the rooms. In conclusion, the study defined the mould levels in children's rooms, but did not find an association with allergic history of the children or their sensitization rate.