[Interdisciplinary management of a large Legionella outbreak in Germany]. / Interdisziplinäres Management eines länderübergreifenden Legionellenausbruchs.

Between December 2009 and the end of January 2010, the largest hitherto known outbreak of Legionella in Germany took place in the cities of Ulm and Neu-Ulm. Of a total of 64 patients involved, 60 patients had to be hospitalized, and 5 patients died from the infection. This event was caused by a wet cooling tower of a large air conditioning system in the city center of Ulm. The search for the source of the Legionella emission was extremely difficult, since these plants are neither notifiable nor subject to authorization in Germany. We report about the search for the source and the measures to control the outbreak. We also discuss communication and coordination during these investigations. Regulatory measures as proposed by the World Health Organization (WHO) and the European Network for Legionellosis (EWGLI) and already implemented in numerous other European countries would be desirable to prevent such outbreaks in the future.

Preliminary report: outbreak of Legionnaires disease in the cities of Ulm and Neu-Ulm in Germany, December 2009 - January 2010.

Currently an investigation is ongoing to explore and control an outbreak of Legionnaires disease, affecting 65 people as of 22 January 2010, in the cities of Ulm and Neu-Ulm, south-west Germany. A hitherto unidentified wet cooling system in these twin cities is considered as the most likely source of infection.

Prevalence and determinants of Helicobacter pylori infection in preschool children: a population-based study from Germany.

BACKGROUND: Helicobacter pylori is among the most common infections in humans and has been recognized as major cause of various gastroduodenal diseases. There is limited knowledge, however, on the prevalence and determinants of this infection in children. We addressed these issues in a population-based cross-sectional study in Southern Germany. METHODS: Study subjects were all preschool children in Ulm, a city in the South of Germany, who were screened for school fitness by physicians of the public health service in 1996. Infection status was determined by 13C-urea breath test. In addition, the parents of the children were asked to fill out a standardized questionnaire. RESULTS: In total, 945 out of the 1201 eligible preschool children participated in the study (response rate = 79%). The children were aged 5-8 years. The majority were of German nationality (72.6%). Overall, 127 children (13.4%) were infected with H. pylori. Nationality, place of residence in the first year of life and duration of living in Germany were strongly associated with H. pylori infection status. The prevalence varied from 4.8% (95% confidence interval [CI]: 3.3-6.8%) in children with German nationality who were born in Germany or had lived in Germany since their first year of life to 66.7% (95% CI: 29.9-92.5%) in the children with Turkish nationality who came to Germany after the first year of life. CONCLUSION: Our results showed a large variation in prevalence of H. pylori infection in children living in the same geographical area according to nationality. They indicate an association between living conditions in early childhood and H. pylori infection and indicate that H. pylori associated morbidity may evolve very differently in population subgroups living in the same area.

[Possibilities of epidemiologic studies within the scope of school entrance examinations exemplified by Ulm Helicobacter pylori studies]. / Möglichkeiten epidemiologischer Erhebungen im Rahmen von Einschulungsuntersuchungen am Beispiel der Ulmer Helicobacter pylori-Studien.

This paper illustrates the possibilities and the evidential value of epidemiologic studies in combination with the pre-school screening examinations, which in Germany are mandatory for all children who are to attend school for the first time. Aspects of study design and study conduct are discussed primarily. We used two studies conducted in the city of Ulm in 1996 and in 1997. The aim of these studies was to investigate the prevalence, determinants and effects of Helicobacter pylori infection among pre-school children and their parents. Study subjects were all pre-school children in Ulm, a city in the South of Germany, who were screened for school fitness by physicians of the Public Health Service in 1996 and 1997, respectively. Infection status was determined by 13C-urea breath test. In addition, the parents of the children were asked to fill out a standardized questionnaire. In the 1997 study, the infection status of the accompanying parents was also evaluated by 13C-urea breath test. We present some selected results from the study of 1996. In total 945 out of the 1201 eligible pre-school children participated in the study (response rate = 79%). Overall, 127 children (13.4%) were infected with Helicobacter pylori. The prevalence varied between 6.1% in the children with German nationality to 44.8% in children with Turkish nationality and 24.8% in children with other nationality. In addition, we identified further determinants and investigated effects of the infection. The results of these studies demonstrate that epidemiologic studies combined with the mandatory screening examinations in pre-school children may be an important and feasible way to gain knowledge. The participation of the Public Health Service is of special advantage and allows to collect health related data in a efficient way.

Helicobacter pylori among preschool children and their parents: evidence of parent-child transmission.

This study assessed the role of parental infection status in the transmission of Helicobacter pylori infection in a large population-based sample of preschool-aged children. The subjects, who lived in Ulm, Germany, and in two nearby communities, were screened for school fitness between January and July 1997. Their H. pylori infection status was determined by 13C-urea breath test. Of 1522 eligible children, 1221 (80.2%) participated in the study. Crude prevalence of H. pylori infection in children was 11.3% (95% confidence interval [CI], 9.5-13.3) and 36.4% in their parents (95% CI, 33.5-39.4). The crude odds ratio (OR) for H. pylori infection of children whose mothers were infected was 16.5 (95% CI, 8.9-30.8) and 7.9 after adjustment for potential confounders (95% CI, 4.0-15.7). The crude OR if the child's father was infected was 7.8 (95% CI, 2. 5-24.2) and 3.8 after adjustment for potential confounders (except maternal infection) (95% CI, 0.8-19.1). The results suggest that infected parents, especially infected mothers, may have a key role in transmission of H. pylori within families.