Trauma to the Superior Mesenteric Artery and Superior Mesenteric Vein: A Narrative Review of Rare but Lethal Injuries.

Mesenteric vessels, including the superior mesenteric artery (SMA) and vein (SMV), provide and drain the rich blood supply of the midgut and hindgut. SMA and SMV injuries are rare and often lethal. Clinical management of these injuries is not well established, but treatment options include operative, non-operative, and endovascular strategies. A narrative review of the literature was conducted using MEDLINE Complete-EBSCO. Relevant studies, specifically those focusing on diagnosis and management of SMA and SMV injuries, were selected. Only original reports and collected series were selected to prevent duplication of cases. A search of the literature for mesenteric arterial injuries yielded 87 studies. Vessel-specific breakdown of the studies yielded 40 with SMA injuries and 41 with SMV injuries. These searches were winnowed to 26 individual studies, which were included in this collective review. Limitations of this study are similar to all narrative literature reviews: the dependence on previously published research and availability of references as outlined in our methodology. Although historically rare, mesenteric vessel injuries are seen with increasing incidence and continue to present a challenge to trauma surgeons due to their daunting mortality rates. Currently, universal treatment guidelines do not exist, but the various options for their management have been extensively reviewed in the literature.

Evaluation of an ear-tag-based accelerometer for monitoring rumination in dairy cows.

The objective of this study was to evaluate the ear-tag-based accelerometer system Smartbow (Smartbow GmbH, Weibern, Austria) for detecting rumination time, chewing cycles, and rumination bouts in indoor-housed dairy cows. For this, the parameters were determined by analyses of video recordings as reference and compared with the results of the accelerometer system. Additionally, we tested the intra- and inter-observer reliability as well as the agreement of direct cow observations and video recordings. Ten Simmental dairy cows in early lactation were equipped with 10-Hz accelerometer ear tags and kept in a pen separated from herd mates. A total mixed ration was fed twice a day via a roughage intake control system. During the study, cows' rumination and other activities were directly observed for 20 h by 2 trained observers. Additionally, cows were video recorded for 19 d, 24 h a day. After exclusion of unsuitable videos, 2,490 h of cow individual 1-h video sequences were eligible for further analyses. Out of this, one hundred 1-h video sequences were randomly selected and visually and manually classified by a trained observer using professional video analyses software. Based on these analyses, half of the data was used for development (based on data of 50-h video analyses) and testing (based on data of additional 50-h video analyses) of the Smartbow algorithms, respectively. Inter- and intra-observer reliability as well as the comparison of direct against video observations revealed in high agreements for rumination time and chewing cycles with Pearson correlation coefficients >0.99. The rumination time, chewing cycles, as well as rumination bouts detected by Smartbow were highly associated (r > 0.99) with the analyses of video recordings. Algorithm testing revealed in an underestimation of the average ± standard deviation rumination time per 1-h period by the Smartbow system of 17.0 ± 35.3 s (i.e., -1.2%), compared with visual observations. The average number ± standard deviation of chewing cycles and rumination bouts was overestimated by Smartbow by 59.8 ± 79.6 (i.e., 3.7%) and by 0.5 ± 0.9 (i.e., 1.6%), respectively, compared with the video analyses. In summary, the agreement between the Smartbow system with video analyses was excellent. From a practical and clinical point of view, the detected differences were negligible. However, further research is necessary to test the system under various field conditions and to evaluate the benefit of incorporating rumination data into herd management decisions.

[Seasonal and pandemic influenza vaccination: coverage and attitude among private physicians in Germany]. / Saisonale und pandemische Influenzaimpfung: Impfquoten und Einstellung niedergelassener Ärzte in Deutschland.

BACKGROUND: General practitioners serve as important multipliers for seasonal influenza vaccination in risk groups such as elderly or chronically ill persons, for whom vaccination is recommended in Germany by the Standing Committee on Vaccination (STIKO). Moreover, physicians are a target group for influenza vaccination themselves. METHODS: Data from 1 590 telephone interviews were analysed. The study population comprised private physicians from 4 different disciplines (general and internal medicine, gynaecology, paediatrics). We assessed seasonal and pandemic vaccination coverage, attitudes and informational needs related to vaccination in general, and opinions about the pandemic situation 2009. RESULTS: Of the interviewed physicians, 61% stated that they have been vaccinated against seasonal influenza regularly. Main reasons for not/only occasionally having received a flu shot were: the belief that seasonal influenza vaccination is not necessary for them (78%) or having forgotten about the vaccination (28%). The interviewed physicians expressed a great demand for active information on STIKO recommendations and certain aspects of the seasonal influenza vaccination. There was a significant association between physicians' own influenza vaccination status and the provision of vaccination information materials, utilisation of a data management system for the vaccination of patients, and active vaccination reminders in the physicians' office. In 2009/10, almost 60% had received a pandemic influenza A(H1N1) vaccination. A major barrier to vaccine uptake was the mistrust in the safety of H1N1 vaccines (stated by 54% of non-vaccinees). Information for the public and physicians by the German public health authorities during the pandemic was rather critically appraised by the respondents. CONCLUSION: Compared to other subgroups of health-care workers, among private physicians seasonal and pandemic vaccine uptake was rather high. The physicians' need for more information on vaccination topics can be met by intensified publishing and communication activities of STIKO and by using existing physician-information channels.

Effects of forage type, body condition and single-nucleotide polymorphisms in the bovine cytochrome P450 regulatory region on cow productivity.

Single-nucleotide polymorphisms (SNP) in the coding sequence of cytochrome p450 (CYP3A28) have been associated with milk yield and composition, and calving traits in cows. In this study, we aimed to determine whether (i) the CYP3A28 regulatory region was polymorphic and (ii) SNP genotype, forage type, body condition and their interactions affect cow productivity. Primers for CYP3A28 promoter were designed to amplify a 483-bp segment by PCR. Amplicon sequences revealed seven SNP (T-318C, T-113A, C-189T, T-78G, A6G, G17A and T21C) in Brahman (38 cows), Brahman x Angus reciprocal crosses (47 cows) and crossbreds (98 cows). Angus cows (n = 41) appeared to be fixed at those SNP locations. Genotype and forage {endophyte-infected tall fescue [KY+; Lolium arundinaceum (Schreb.) S. J. Darbyshire] vs. bermudagrass [Cynodon dactylon (L.) Pers.]} effects on lifetime (8-years) calving rate, and calf weaning weights and heights were determined in Herd 1 (126 cows); genotype and BC (low vs. moderate) effects on calving date and calving percent were determined in Herd 2 (98 cows). Four SNP (T-318C, T-113A, A06G and T21C) appeared to be related to cattle productivity, CC cows at T-318C having a lower (p < 0.05) lifetime calving rate than TC or TT cows (65%, 85% and 81% respectively). Cows that grazed KY+ and were TT at T-318C produced calves that tended (p < 0.07) to weigh less than their contemporaries. Moreover, calves of TT cows were shorter (p < 0.05) at weaning than calves of CC or TC cows. In Herd 2, moderate-BC cows that were TT or AA at T-318C, T-113A, T-78G, A6G and T21C had greater (p < 0.05) calving rates (74-80%) than heterozygous cows (46-60%), and low-BC cows that were AA at G17A calved at least 6 days earlier (p < 0.05) than heterozygous cows. Our findings suggest that SNP in the CYP3A28 regulatory region of Brahman-influenced cows are associated with cattle productivity.

[Factors influencing the uptake of vaccines by adolescents with migration background. A qualitative study of adolescents, mothers, and physicians]. / Einflussfaktoren auf die Inanspruchnahme von Impfungen durch Jugendliche mit Migrationshintergrund. Eine qualitative Untersuchung mit Jugendlichen, Müttern und Ärzten.

One of the special challenges in immunization policy is communication and access to adolescents. To identify barriers and enablers for the immunization of this specific target group, we conducted 11 focus group discussions with adolescents with and without migration background, mothers with Turkish and Russian migration background, and physicians in private practice in March 2011. The results showed that for adolescents, the utilization of immunization was guided by informational and organizational processes in families and by the consulting physician. The low awareness of immunization-related issues that was observed among adolescents is especially challenging, because routine visits to the doctor often stop with the transition from pediatric to adult health care. Immigration-related factors may additionally affect the utilization of immunization services. Besides improving access to information and lowering the barriers to immunization for adolescents in general, culturally sensitive interventions may be a promising approach for improving communication between mothers and the immunizing physician and thereby improving vaccination coverage in the adolescent target group.

Management of glucocorticoid-induced osteoporosis.

This review summarizes the available evidence-based data that form the basis for therapeutic intervention and covers the current status of glucocorticoid-induced osteoporosis (GIOP) management, regulatory requirements, and risk-assessment options. Glucocorticoids are known to cause bone loss and fractures, yet many patients receiving or initiating glucocorticoid therapy are not appropriately evaluated and treated. An European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis workshop was convened to discuss GIOP management and to provide a report by a panel of experts. An expert panel reviewed the available studies that discussed approved therapeutic agents, focusing on randomized and controlled clinical trials reporting on bone mineral density and/or fracture risk of at least 48 weeks' duration. There is no evidence that GIOP and postmenopausal osteoporosis respond differently to treatments. The FRAX algorithm can be adjusted according to glucocorticoid dose. Available antiosteoporotic therapies such as bisphosphonates and teriparatide are efficacious in GIOP management. Several other agents approved for the treatment of postmenopausal osteoporosis may become available for GIOP. It is advised to stop antiosteoporotic treatment after glucocorticoid cessation, unless the patient remains at increased risk of fracture. Calcium and vitamin D supplementation as an osteoporosis-prevention measure is less effective than specific antiosteoporotic treatment. Fracture end-point studies and additional studies investigating specific subpopulations (pediatric, premenopausal, or elderly patients) would strengthen the evidence base and facilitate the development of intervention thresholds and treatment guidelines.

Risk perception and information-seeking behaviour during the 2009/10 influenza A(H1N1)pdm09 pandemic in Germany.

During the influenza A(H1N1)pdm09 pandemic in 2009/10, a total of 13 consecutive surveys were carried out of the general population in Germany to monitor knowledge, attitude and behaviour concerning the disease and vaccination against pandemic influenza in real time. In total, 13,010 persons aged 14 years or older were interviewed by computer-assisted telephone techniques between November 2009 and April 2010. During the peak of the pandemic, only 18% of participants stated that they perceived the risk of pandemic influenza as high; this proportion fell to 10% in January 2010. There was a significant difference in information-seeking behaviour among population subgroups concerning the disease and vaccine uptake. However, in all subgroups, conventional media sources such as television, radio and newspapers were more frequently used than the Internet. While the majority of participants (78%) felt sufficiently informed to make a decision for or against vaccination, overall vaccination coverage remained low. Among those who decided against vaccination, fear of adverse events and perception that the available vaccines were not sufficiently evaluated were the most frequently stated reasons. Such mistrust in the vaccines and the perceived low risk of the disease were the main barriers that contributed to the low vaccination coverage in Germany during the pandemic.

Estimating vaccination coverage in the absence of immunisation registers--the German experience.

Immunisation registers are regarded as an appropriate solution to measure vaccination coverage on a population level. In Germany, a decentralised healthcare system and data protection regulations constrain such an approach. Moreover, shared responsibilities in the process of immunisation and multiple providers form the framework for public health interventions on vaccination issues. On the national level, those interventions consist mainly of conceptualising immunisation strategies, establishing vaccination programmes, and issuing recommendations. This paper provides an overview on sources and methods for collecting appropriate coverage data at national level and their public health relevance in Germany. Methods of data collection and available information on immunisations are described for three approaches: school entrance health examination, population surveys and insurance refund claim data. School entrance health examinations allow regional comparisons and estimation of trends for a specific cohort of children and for all recommended childhood vaccinations. Surveys deliver population based data on completeness and timeliness of selected vaccinations in populations defined by age or socio-demographic parameters and on knowledge and attitudes towards vaccination. Insurance refund claim data inform continuously on immunisation status (e.g. of children aged two years) or on vaccination incidence promptly after new or modified recommendations. In a complex healthcare system, the German National Public Health Institute (Robert Koch Institute, RKI) successfully compiles coverage data from different sources, which complement and validate one another. With the German approach of combining different data sources in the absence of immunisation registers, it is possible to gain solid and reliable data on the acceptance of vaccination programmes and target groups for immunisation. This approach might be of value for other countries with decentralised healthcare systems.

Bruxism, oral parafunctions, anamnestic and clinical findings of temporomandibular disorders in children.

The reported prevalence of temporomandibular disorders (TMD) present during childhood and adolescence ranges between 7% and 68%. The range of the reported prevalence of sleep bruxism in children is also wide. The purpose of the current study was threefold: (i) determine the prevalence of oral parafunctions, sleep bruxism and of anamnestic and clinical findings of TMD among Israeli children with primary or mixed dentition; (ii) to establish whether the parafunctional activities are associated with anamnestic and clinical findings of TMD in this population and (iii) to examine the possible impact of stressful life events on the prevalence of bruxism, oral parafunctions, and anamnestic and clinical findings of TMD in children. A total of 244 children (183 girls and 61 boys) aged 5-12 years were included in the study. Each participant underwent a full TMD examination. Parents, in collaboration with their children, completed a questionnaire on TMD symptoms, oral parafunctions and stressful life events in their children's life. Most participants (78·8%) reported at least one oral habit. Of these, only 'jaw play' was associated with TMD anamnestic and clinical findings. Stressful life events were associated only with the performance of multiple oral habits. These findings indicate that the performance of oral parafunctions is commonplace during childhood, with younger children exhibiting fewer oral parafunctions than adolescents. Stressful life events are related with an increase in the performance of multiple oral parafunctions in children but the later are not necessarily associated with anamnestic and clinical findings of TMD in the paediatric population.

Masticatory muscle disorders diagnostic criteria: the American Academy of Orofacial Pain versus the research diagnostic criteria/temporomandibular disorders (RDC/TMD).

In this study, relevant cases were retrospectively reviewed to identify patients who were diagnosed as suffering from myofascial pain only according to the research diagnostic criteria/temporomandibular disorders (RDC/TMD) criteria, in order to examine whether or not they could fulfil the American Academy of Orofacial Pain (AAOP) diagnostic criteria for TMD-related masticatory muscle disorders. One hundred and twenty-seven patients, diagnosed according to the RDC/TMD criteria as having myofascial pain with or without limited jaw opening only, were allocated to two groups according to their answers to the RDC/TMD 'jaw disability checklist'. The two groups were compared for Axis I and II data taken from the RDC/TMD questionnaire. Thirty-eight of the patients (29·9%) did not associate their symptoms with jaw functions (e.g. chewing and yawning). This group was characterised by increased range of motion (ROM) and older average age. The AAOP diagnostic criteria for TMD require pain on function in all subtypes of TMD-related muscle disorders. An association between pain and jaw function is common and research is needed to determine whether this should be categorised differently to muscle pain unrelated to jaw function. There may well be different pathophysiological mechanisms and consequently different management strategies for these two pain conditions.

Effects of bovine cytochrome P450 single-nucleotide polymorphism, forage type and body condition on production traits in cattle.

Relating single-nucleotide polymorphisms (SNP) to cows with acceptable productivity could benefit cattle breeders in areas where tall fescue is the predominant forage. This study aimed to (i) identify SNPs in bovine cytochrome P450 3A28 (CYP3A28) and (ii) determine the associations between SNP genotype, forage and cow body condition (BC). Genotype (CC, CG or GG) and forage [Kentucky-31 wild-type endophyte-infected tall fescue (KY+) vs. bermudagrass] effects on milk volume and quality were determined in Herd 1 cows (123 cows); in Herd 2 (99 cows), genotype and BC (low vs. moderate) effects on ovarian follicle size, calving date and calving per cent were determined; and in Herd 3 (114 cows), effects of genotype and fescue cultivar [KY+ vs. non-toxic endophyte-infected tall fescue (HiMag4)] were related to calving per cent, calving date and weaning weights of both cow and her calf. A cytosine (C) to guanine (G) transversion at base 994 (C994G) in CYP3A28 was identified. There was a genotype × forage type interaction (p < 0.05) on milk protein in Herd 1 cows; CC cows grazing bermudagrass had greater milk protein percentage in relation to other cows in the herd. In Herd 2, BC and genotype × BC tended (p < 0.10) to influence follicle size and Julian calving date respectively. Diameter of the largest follicle tended to be larger in moderate BC than in low-BC cows; whereas, CC and CG cows in moderate BC and homozygous (CC and GG) cows in low BC tended to calve 14 days earlier in relation to CG cows in low BC. In Herd 3, there was a genotype × forage type interaction (p < 0.05) on calving per cent, Julian calving date and calf weaning weight. In this study, genetic alterations (G allele at C994G) coupled with nutritional factors (low BC and toxic tall fescue) resulted in overall lower productivity in cows.

[Recommendations for symptomatic therapy of rheumatic pain with opioid analgetics]. / Empfehlungen zur symptomatischen Therapie mit Opioidanalgetika bei rheumatischen Schmerzen.

The treatment of musculoskeletal pain is often difficult. For this reason opioids are increasingly being used for chronic musculoskeletal complaints despite poor or lacking evidence for their pain relieving and function improving effects. However, side effects are common and can be severe. Opioid-induced hyperalgesia can lead to higher doses and stronger pain and increase the risk of side effects. Long-term treatment of rheumatic pain with opioids should be carried out with caution.

Biomarkers and personalised medicine in rheumatoid arthritis: a proposal for interactions between academia, industry and regulatory bodies.

Rheumatoid arthritis (RA) is one of the most appropriate conditions for the application of personalised medicine as a high degree of heterogeneity has been recognised, which remains to be explained. Such heterogeneity is also reflected in the large number of treatment targets and options. A growing number of biologics as well as small molecules are already in use and there are promising new drugs in development. In order to make the best use of treatment options, both targeted and non-targeted biomarkers have to be identified and validated. To this aim, new rules are needed for the interaction between academia and industry under regulatory control. Setting up multi-centre biosample collections with clear definition of access, organising early, possibly non-committing discussions with regulatory authorities, and defining a clear route for the validation, qualification and registration of the biomarker-drug combination are some of the more critical areas where effective collaboration between the drug industry, academia and regulators is needed.

Cheilitis glandularis: clinico-histopathological diagnostic criteria.

OBJECTIVES: To present a combination of clinical and histopathological criteria for diagnosing cheilitis glandularis (CG), and to evaluate the association between CG and squamous cell carcinoma (SCC). MATERIALS AND METHODS: The medical literature in English was searched from 1950 to 2010 and selected demographic data, and clinical and histopathological features of CG were retrieved and analysed. RESULTS: A total of 77 cases have been published and four new cases were added to the collective data. The clinical criteria applied included the coexistence of multiple lesions and mucoid/purulent discharge, while the histopathological criteria included two or more of the following findings: sialectasia, chronic inflammation, mucous/oncocytic metaplasia and mucin in ducts. Only 47 (58.0%) cases involving patients with a mean age of 48.5 ± 20.3 years and a male-to-female ratio of 2.9:1 fulfilled the criteria. The lower lip alone was most commonly affected (70.2%). CG was associated with SCC in only three cases (3.5%) for which there was a clear aetiological factor for the malignancy. CONCLUSIONS: The proposed diagnostic criteria can assist in delineating true CG from a variety of lesions with a comparable clinical/histopathological presentation. CG in association with premalignant/malignant epithelial changes of the lower lip may represent secondary, reactive changes of the salivary glands.

Classifying degenerative joint disease by the RDC/TMD and by panoramic imaging: a retrospective analysis.

The purposes of the study were to evaluate the utility of diagnosing degenerative joint disease (DJD) by the clinical finding of coarse crepitus alone, without supporting imaging studies, as defined by the RDC/TMD, and to evaluate the contribution of panoramic radiography as an aid in the diagnosis of DJD. A retrospective analysis of 372 consecutive patients with TMD was conducted. Their panoramic radiographs were evaluated for the extent of their contribution to the final diagnosis. Panoramic radiography was of no diagnostic value in 94.4% of the cases when the group was considered as a whole. When patients diagnosed with DJD were considered separately, panoramic radiography was completely sufficient for reaching the final diagnosis in 20.0% of the cases. In almost 90% of these patients, however, the clinical examination did not support the diagnosis of DJD (no coarse crepitus was found). This raises some doubts about the effectiveness of the clinical examination according to the RDC/TMD and about the utility of panoramic radiography in the definitive diagnosis of DJD, because both techniques have low accuracy (11.1% and 20%, respectively). The present study supports the current recommendations that panoramic radiography should not be ordered routinely to assess DJD, but still it is first choice when any dental problem is suspected. Further additional imaging (computerized tomography, magnetic resonance imaging) should be considered only if there is reason to expect that the findings might affect diagnosis and management. This study adds to recent criticisms of the clinical validity of the RDC/TMD, with regard to DJD.

["Triage"-primary assessment of patients in the emergency department : An overview with a systematic review]. / "Triagierung" ­ Ersteinschätzung von Patienten in der zentralen Notaufnahme : Eine Übersicht mit systematischem Review.

BACKGROUND: "Triage" means the primary assessment of a previously unknown patient with an acute health disorder, initially considered a medical emergency. The initial triage is part of the primary assessment, which also includes the registration of administrative data and patient's mode of arrival. OBJECTIVES: The aim of the work is to provide an overview of frequently used structured primary assessment tools and the underlying evidence for their use in the emergency room. METHODS: Based on a systematic literature search in PubMed, 41 articles were selected according to predefined criteria. RESULTS: The most frequently used primary assessment systems in Germany are the Emergency Severity Index (ESI) and the Manchester Triage System (MTS). Scientific evidence exists for the accuracy and reliability of the primary assessment with these instruments. However, there are no gold standards for measuring urgency, so that separate criteria must be defined. Sufficient data to determine a treatment sector or the necessary staffing levels are lacking. CONCLUSIONS: Structured primary assessment using formalized systems alone is inadequate to categorize the urgency of emergency and acute patients. In fact, a combination of different measures in an interprofessional team is required. Primary assessment systems and processes generally do not allow patients to be referred to downstream structures without a thorough medical examination.

EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis: report of a task force of ESCISIT.

OBJECTIVES: To develop evidence-based recommendations for the diagnosis of hand osteoarthritis (OA). METHODS: The multidisciplinary guideline development group, representing 15 European countries, generated 10 key propositions regarding diagnosis using a Delphi consensus approach. For each recommendation, research evidence was searched for systematically. Whenever possible, the sensitivity, specificity and likelihood ratio (LR) were calculated; relative risk and odds ratios were estimated for risk factors for hand OA. Quality of evidence was categorised using the European League Against Rheumatism (EULAR) hierarchy, and strength of recommendation was assessed by the EULAR visual analogue scale. RESULTS: Diagnostic topics included clinical manifestations, radiographic features, subgroups, differential diagnosis, laboratory tests, risk factors and comorbidities. The sensitivity, specificity and LR varied between tests depending upon the cut-off level, gold standard and controls. Overall, no single test could be used to define hand OA on its own (LR <10) but a composite of the tests greatly increased the chance of the diagnosis. The probability of a subject having hand OA was 20% when Heberden nodes alone were present, but this increased to 88% when in addition the subject was over 40 years old, had a family history of nodes and had joint space narrowing in any finger joint. CONCLUSION: Ten key recommendations for diagnosis of hand OA were developed using research evidence and expert consensus. Diagnosis of hand OA should be based on assessment of a composite of features.

A retrospective analysis of temporomandibular findings among Israeli-born patients based on the RDC/TMD.

The purpose of this study was to evaluate temporomandibular disorders (TMD) Axis I and II among Israeli-Jewish patients using the Hebrew version of the Research Diagnostic Criteria (RDC) for TMD and to compare the results with Swedish, United States, Asian and Israeli-Arab populations. The study consisted of 298 Israeli-born, Jewish patients (male/female ratio 3.5:1), arriving at an Orofacial Pain Clinic during the year 2001-2004. A complete clinical examination was carried out according to the RDC/TMD protocol. Axis I diagnoses: 65% of the Israeli-Jewish patients exhibited myofacial pain (Group I disorder), 38% disc displacement (Group II disorder) and 18% arthralgia, osteoarthritis or osteoarthrosis (Group III disorder). Axis II diagnoses: 20% of the patients scored severe depression and 35% scored somatization. Pain was reported in 82% of the patients (mean pain duration 35.7-33.8 months for women, 44.1 for men). Patients had an average disability score of 30.0 +/- 30.2. Chronic pain grade IV was present in 4% of the patients. Israeli-Jewish temporomandibular disorder patients showed results similar to those reported for other countries, further supporting the use of the RDC/TMD internationally as a reliable epidemiological tool. Globally, Axis I scores were similar, while Axis II scores were more susceptible to geographic/ethnic differences. Gender can influence Axis I and Axis II as well as possible gender specific association with socio-economic status. In future comparisons, men and women should be considered separately.

[Current vaccination coverage and immunization gaps of children and adolescents in Germany]. / Aktuelle Entwicklung von Impfquoten und Impflücken bei Kindern und Jugendlichen in Deutschland.

Available data show increasing vaccination coverage of children and adolescents in recent years in Germany. Vaccination coverage of children against diphtheria, tetanus, polio and haemophilus influenzae Type b is high. Vaccination gaps exist for pertussis, hepatitis B and for the second measles, mumps and rubella doses. Coverage is still insufficient to achieve effective herd immunity and measles elimination. Data from the representative German Health Interview and Examination Survey for Children and Adolescents reveal that vaccination of infants is markedly delayed compared to recommendations of the German Standing Committee on Vaccination (STIKO). Particularly older children and adolescents are often not fully vaccinated or are even unvaccinated. A high proportion is missing the recommended booster doses against diphtheria, tetanus, pertussis and polio. Vaccination compliance especially regarding completeness and timeliness is lower in western than eastern Germany, as well as in children of vaccine sceptics and foreign-born children. More comprehensive surveillance of vaccination coverage and adverse events following immunization as well as the implementation of a national immunization plan focussing on closure of immunization gaps could lead to improved vaccination coverage.