[Determination of vaccination quotas for pneumococcal conjugate vaccine in children on the basis of routine data of the statutory health insurance]. / Bestimmung von Impfquoten zur Pneumokokken-Konjugatimpfung bei Kindern anhand von GKV-Routinedaten.

The pneumococcal conjugate vaccine is recommended since July 2006 for all children up to 24 months by the Standing Committee on Vaccination (STIKO) in Germany. Immunisation includes 4 doses; a single dose should be administered at completed 2, 3, 4 months and 11-14 months of age. To analyse the immunization coverage, timeliness and completeness of vaccinations, a claims data analysis was conducted. The evaluation was based on routine claims data of a statutory health insurance covering the period from May 2008-September 2009. Overall, 81.2% (5 484/6 755) of all live births of mothers and fathers of the insurance received at least one vaccination dose. In 91.3% and 72.0% of these cases, the second and third dose was administered, respectively. A vaccination cycle of 4 doses was often not completed and the recommended time points for vaccination were not met in two-thirds of all children. Due to the limited and relatively short observation period, a conclusion about the rate of fully completed vaccination cycles was not possible.

Potential benefits from currently available three pneumococcal vaccines for children--population-based evaluation.

BACKGROUND: Currently there are 3 pneumococcal vaccines available in Germany. The aim of this study is to evaluate the potential of the three currently available pneumococcal vaccines to reduce the burden of invasive pneumococcal disease in children. SUBJECTS: Children younger than 16 years who have been hospitalized because of IPD between July 2007 and June 2009 in a German pediatric hospitals. METHOD: Surveillance of IPD in German pediatric hospitals and laboratories serving these hospitals. The case definition is isolation of Streptococcus pneumoniae from any normally sterile body site. The actual number of IPD cases is based on the capture recapture method combining information from both reporting systems. RESULTS: In the study period an estimated yearly number of 164 IPD cases occurred among children younger than 2 years compared to 144 and 116 cases among children aged 2-4 years and 5-15 years. Among children under 2 years of age, 69 cases were caused by serotypes covered by PCV10 compared to 103 cases potentially preventable by PCV13. Among children aged 2-4 years 94 IPD cases were caused by serotypes covered by PCV13 compared to 108 cases covered by PPV23. CONCLUSION: The newly available pneumococcal conjugate vaccines with better serotype coverage have the potential to further reduce IPD burden in Germany. The additional benefit of vaccination of children aged 2-4 years at high risk for pneumococcal infections with PPV23 is questionable.

[Epidemiologic challenges in rare diseases]. / Epidemiologische Herausforderungen bei seltenen Krankheiten.

Rare diseases, often called "orphan diseases", are a special challenge for epidemiologic research. Apart from the mere logistic effort for sample collection, there are considerable implications in statistical methodology. Usually one will not find enough cases of an orphan disease in a random sample from the population at risk. Furthermore, random error plays a more important role for decreasing probability of disease. Critical issues related to total population sampling, active and passive surveillance and capture-recapture methods are discussed. Challenges in risk factor research and related to therapeutic or preventive trials are presented. Examples from epidemiologic practice are given.

[Cancer screening for women is less frequently visited in regions with lower household income--analysis of data from health insurances in Bavaria]. / Die Krebsfrüherkennungsuntersuchung für Frauen wird in Regionen mit niedrigerem Haushaltseinkommen seltener in Anspruch genommen--Analyse von Daten der Kassenärztlichen Vereinigung Bayerns.

AIM OF THE STUDY: Differences in health care in Germany have rarely been analysed. Recent research, however, indicates that subjects of the lower social class participate in cancer screening less frequently. METHODS: Participation in screening for cervical cancer among women older than 20 years has been analysed using billing information of the KVB (Kassenärztlichen Vereinigung Bayern) for the period from 2002-2005. Women were assigned to one of the 96 Bavarian districts based on their postal code. The following variables were used: Participation rate in cervical cancer screening; age; average household income; gynaecologists per 10,000 women. Multivariate analyses were based on age-stratified linear regressions. RESULTS: There are considerable regional differences in participation in screening for cancer among older women. Participation rates are lower in districts with lower average household income. The correlation between participation rates and average household income shows an almost linear dependence on the level of districts. This association could not be explained by the variable "gynaecologists per 10,000 women". CONCLUSION: In order to provide social equality in health care, regional differences in cancer screening participation should be targeted. This is especially important in districts with lower average household incomes.

Participation in cervical cancer screening by age and region--a cohort study with a 3 1/2 year follow-up on 2,223,135 women in Bavaria.

OBJECTIVE OF THE STUDY: Cervical cancer rates are higher in Germany than in comparable European countries. While other European countries have implemented invitation programs, Germany relied on annual free access only. Are sufficient screening participation rates achieved? METHODS: We analyzed data from 2,223,135 Bavarian women between 2002/3 and 2005/4 in a retrospective cohort, to evaluate screening participation, frequency, age dependencies and regional differences. RESULTS: The highest screening participation was amongst women between 20 and 29 (54.6% had at least one visit after one year, 84% within three years) and decreased progressively with increasing age. Participation was lowest for women above 70 in rural areas (in some regions less than 20% had at least one screening within three years). CONCLUSION: Poor participation rates in general are unlikely to account for the high cervical cancer rates in Germany. Low participation rates in elderly women, particularly those in rural regions might contribute to the well-known peak of cervical cancer in elderly women.

Growth around puberty as predictor of adult obesity.

OBJECTIVES: To contribute to the early risk identification of adult obesity, the anthropometric development in the first 23 years of life as a potential predictor for adult obesity was assessed. To identify the period (7-11 years, 11-16 years and 16-23 years) and type of anthropometric measure difference (weight, height and body mass index (BMI) gains) accounting for the best prediction of obesity at 33 years. SUBJECTS/METHODS: A total of 4952 members of the 1958 British birth cohort with full information on anthropometric measures. Follow-up examinations at 7, 11, 16, 23 and 33 years were analyzed with receiver-operating characteristics (ROCs). RESULTS: Overall 505 cohort members (10.2%) were obese at 33 years. BMI and weight gains between 7 and 11 years were the best-observed predictors for obesity at 33 years with an area under the ROC curve of 0.72 (95% confidence interval (CI): 0.69; 0.74) and 0.73 (95% CI: 0.71; 0.76), respectively. Height gain failed as a significant predictor at any lifetime interval. BMI gain between 7 and 11 years yielded a positive predictive value of 20% (95% CI: 19; 21) compared to 19% (95% CI: 18; 20) for weight gain. The prediction of BMI and weight gains between 7 and 11 years seemed to be unrelated to sex and the onset of puberty. CONCLUSIONS: High weight or BMI gain from 7 to 11 years should be considered as risk factor of later obesity. These predictors combined with others might allow for targeting preventive measures at a high-risk sub-population.