Human papillomavirus vaccination of girls in the German model region Saarland: Insurance data-based analysis and identification of starting points for improving vaccination rates.

In Germany, the incidence of cervical cancer, a disease caused by human papillomaviruses (HPV), is higher than in neighboring European countries. HPV vaccination has been recommended for girls since 2007. However, it continues to be significantly less well received than other childhood vaccines, so its potential for cancer prevention is not fully realized. To find new starting points for improving vaccination rates, we analyzed pseudonymized routine billing data from statutory health insurers in the PRÄZIS study (prevention of cervical carcinoma and its precursors in women in Saarland) in the federal state Saarland serving as a model region. We show that lowering the HPV vaccination age to 9 years led to more completed HPV vaccinations already in 2015. Since then, HPV vaccination rates and the proportion of 9- to 11-year-old girls among HPV-vaccinated females have steadily increased. However, HPV vaccination rates among 15-year-old girls in Saarland remained well below 50% in 2019. Pediatricians vaccinated the most girls overall, with a particularly high proportion at the recommended vaccination age of 9-14 years, while gynecologists provided more HPV catch-up vaccinations among 15-17-year-old girls, and general practitioners compensated for HPV vaccination in Saarland communities with fewer pediatricians or gynecologists. We also provide evidence for a significant association between attendance at the children´s medical check-ups "U11" or "J1" and HPV vaccination. In particular, participation in HPV vaccination is high on the day of U11. However, obstacles are that U11 is currently not financed by all statutory health insurers and there is a lack of invitation procedures for both U11 and J1, resulting in significantly lower participation rates than for the earlier U8 or U9 screenings, which are conducted exclusively with invitations and reminders. Based on our data, we propose to restructure U11 and J1 screening in Germany, with mandatory funding for U11 and organized invitations for HPV vaccination at U11 or J1 for both boys and girls.

German federal-state-wide seroprevalence study of 1st SARS-CoV-2 pandemic wave shows importance of long-term antibody test performance.

Background: Reliable data on the adult SARS-CoV-2 infection fatality rate in Germany are still scarce. We performed a federal state-wide cross-sectional seroprevalence study named SaarCoPS, that is representative for the adult population including elderly individuals and nursing home residents in the Saarland. Methods: Serum was collected from 2940 adults via stationary or mobile teams during the 1st pandemic wave steady state period. We selected an antibody test system with maximal specificity, also excluding seroreversion effects due to a high longitudinal test performance. For the calculations of infection and fatality rates, we accounted for the delays of seroconversion and death after infection. Results: Using a highly specific total antibody test detecting anti-SARS-CoV-2 responses over more than 180 days, we estimate an adult infection rate of 1.02% (95% CI: [0.64; 1.44]), an underreporting rate of 2.68-fold (95% CI: [1.68; 3.79]) and infection fatality rates of 2.09% (95% CI: (1.48; 3.32]) or 0.36% (95% CI: [0.25; 0.59]) in all adults including elderly individuals, or adults younger than 70 years, respectively. Conclusion: The study highlights the importance of study design and test performance for seroprevalence studies, particularly when seroprevalences are low. Our results provide a valuable baseline for evaluation of future pandemic dynamics and impact of public health measures on virus spread and human health in comparison to neighbouring countries such as Luxembourg or France.

Nitrate dynamics in springs and headwater streams with agricultural catchments in southwestern Germany.

The present study examined the dynamics of nitrate pollution in springs and headwater streams in agriculturally used watersheds. The objectives of the study were to record the pollution dynamics throughout the year as a function of different weather patterns and determine the correlation of these dynamics with the degree of agricultural use of the relevant catchments. Moreover, continuous measuring methods should be compared with regular manual sampling procedures. Seven springs with agricultural catchments and their headstreams were studied over 2 years, as well as a reference water body with a forested catchment. At two of the springs, continuous measurements were additionally performed using ion-selective electrodes. Two agrometeorological stations were installed to record the relevant weather parameters. Every water body with agriculturally used surroundings exhibited increased nitrate values. A significant correlation was found between the NO3- concentration and the proportion of arable land in the catchment. The nitrate concentration dynamics exhibited extreme weather-related and seasonal fluctuations. While nitrate maxima in autumn and winter correlated widely with the precipitation curve, heavy rainfall in spring and summer led only to short concentration peaks, followed by lower values, presumably caused by dilution effects. Between the spring and downstream measuring points, the nitrate loads increased by the same extent as the arable land area primarily responsible for their emission. No clear nitrate retention was observed between the springs and headstream measuring points. Grab sampling appeared to be sufficiently accurate to record nitrate concentrations when performed at monthly intervals over a two-year measurement period. However, continuous discharge measurements in parallel seemed necessary to determine the loads. The year of 2015 was characterized by a much drier summer and wetter winter, with universally higher nitrate pollution. If these conditions become more established as climate change progresses, increased nitrate pollution must be expected in future.

Pesticides in agricultural headwater streams in southwestern Germany and effects on macroinvertebrate populations.

Pesticides are a major burden for stream ecosystems in the central European cultivated landscape. The objective of the present study was to investigate the applicability of ecological indicator methods in relation to toxicity of pesticides under the specific hydro-morphological conditions in small water bodies. Thus, an association of toxicity evaluating methods with different ecological indicators was to be attempted. Based on three random samples taken within the 2016 vegetation period, 23 headwater areas in the Saarland were investigated to test for pesticides and their metabolites. The macroinvertebrate population was also surveyed in 16 of these streams. Evidence was found of 41 substances in total. Most dominant substances include atrazine, isoproturone, quinmerac and tebuconazol as well as metabolites of dimethenamid, chloridazon and metazachlor. At 9 of the 23 sampling points, over 10 plant protection products and metabolites were found. Only 17% of the water bodies investigated contained fewer than 5 substances. Around half of the bodies of water investigated show noticeably high concentrations of metabolites of plant protection products. Maximum concentrations exceeding environmental quality standards or the Health-oriented Guideline Values were measured for 13 substances at individual sampling points. Analysis of the biological data for only 4 of the water bodies investigated resulted in the Ecological Status Class (ESC) "good". All others fell short of the quality target, although they were classified as "good" or "very good" according to the Saprobic index. SPEARpesticides as a measurement of the sensitivity of the biocoenosis to pesticides shows their influence in a few water bodies. Likewise, high toxic unit values have also been calculated, indicating the presence of toxic substances at relevant concentrations. However, an actual correlation between SPEARpesticides and toxic unit could not be derived. Clearly in these very headwater streams other habitat-determining hydromorphological factors overlay the toxic impact of pesticides.