frühzeitigen Erkennen von gesundheitsrelevanten Problemen in der Allgemeinbevölkerung und in Risikogruppen,

Hintergrund: Im theoretischen Konzept der Lebensverlaufforschung spielen kritische und sensible Perioden, Risikokumulation und Risikoketten eine wichtige Rolle. Der frühen Lebensperiode kommt dabei eine besondere Bedeutung zu. Expositionen – wie Tabakrauch – während der intrauterinen und der späteren kindlichen Entwicklung und der Jugendzeit können den Anfang einer Risikokette bilden, die Gesundheit bis ins Erwachsenenalter beeinflusst.

Lyme borreliosis (LB), caused by Borrelia burgdorferi (Bb) sensu lato is the most common tickborne disease of the northern hemisphere. Major clinical manifestations include Erythema migrans, Neuroborreliosis and Lyme arthritis. Central Europe including Germany is regarded a highly endemic area; however, data on the extent of endemicity and on risk factors are limited. Our objectives were to conduct a representative survey among adults in Germany to assess the seroprevalence of LB in different geographical regions and to identify potential risk factors. Sera from a nationwide representative survey for adults (DEGS) (2008 to 2011) were analysed by ELISA to assess the prevalence of anti-Bb IgG-antibodies in adults (18 – 79 years). An immunoblot was carried out as a confirmatory test. Data collected by interview were used to evaluate possible associated factors. Univariable and multivariable statistical analyses used sampling weights and accounted for the cluster structure of the survey design. Out of a total of 6,965 individuals 741 were seropositive. Seroprevalence in men (13.0%; 95%-CI: 11.4 – 14.8%) was twice as high as in women (5.8%; 95%-CI: 4.9 – 6.7%). Seropositivity increased from 6.0% in the 18 – 29-age-group to 20.0% in the 70 – 79-age-group without effect modification by sex. The largest increase was observed in the elderly (60 – 79 years). Residence in rural areas (OR = 2.50; 95%-CI:1.85 – 3.30) and living in Southern Germany (OR = 1.43; 95%-CI:1.08 – 1.88) were independent risk factors. LB is endemic all over Germany. A previous study recognized children and adolescents (1 – 17 years) as a risk-group, this study identified elderly (60 – 79 years) as a second risk-group. This is compatible with recreational behaviour. Alternatively, this might be explained by a birth cohort effect of a previous time frame of lower risk of seroconversion. Seropositivity is not equivalent with clinical manifestation. Thus, differences between groups may not necessarily be reflected by the real disease burden. Identified risk factors are useful for targeted campaigns.

To estimate susceptibility to the swine-origin influenza A(H3N2) variant virus (A(H3N2)v) in the German population, we investigated cross-reactive antibodies against this virus and factors associated with seroprotective titre using sera from representative health examination surveys of children and adolescents (n = 815, 2003–06) and adults (n = 600, 2008–10). Antibodies were assessed by haemagglutination inhibition assay (HI); in our study an HI titre ≥ 40 was defined as seroprotective. We investigated associated factors by multivariable logistic regression. Overall, 41% (95% confidence interval (CI): 37–45) of children and adolescents and 39% (95% CI: 34–44) of adults had seroprotective titres. The proportion of people with seroprotective titre was lowest among children younger than 10 years (15%; 95% CI: 7–30) and highest among adults aged 18 to 29 years (59%; 95% CI: 49–67). Prior influenza vaccination was associated with higher odds of having seroprotective titre (odds ratio (OR) for children and adolescents: 3.4; 95% CI: 1.8–6.5; OR for adults: 2.4; 95% CI: 1.7–3.4). Young children showed the highest and young adults the lowest susceptibility to the A(H3N2)v virus. Our results suggest that initial exposure to circulating seasonal influenza viruses may predict long-term cross-reactivity that may be enhanced by seasonal influenza vaccination.

BACKGROUND/OBJECTIVES:The assessment of urinary excretion of specific nutrients (e.g. iodine, sodium) is frequently used to monitor a population's nutrient status. However, when only spot urines are available, always a risk of hydration-status-dependent dilution effects and related misinterpretations exists. The aim of the present study was to establish mean values of 24-h creatinine excretion widely applicable for an appropriate estimation of 24-h excretion rates of analytes from spot urines in adults.SUBJECTS/METHODS:Twenty-four-hour creatinine excretion from the formerly representative cross-sectional German VERA Study (n=1463, 20-79 years old) was analysed. Linear regression analysis was performed to identify the most important influencing factors of creatinine excretion. In a subsample of the German DONALD Study (n=176, 20-29 years old), the applicability of the 24-h creatinine excretion values of VERA for the estimation of 24-h sodium and iodine excretion from urinary concentration measurements was tested.RESULTS:In the VERA Study, mean 24-h creatinine excretion was 15.4 mmol per day in men and 11.1 mmol per day in women, significantly dependent on sex, age, body weight and body mass index. Based on the established 24-h creatinine excretion values, mean 24-h iodine and sodium excretions could be estimated from respective analyte/creatinine concentrations, with average deviations <10% compared with the actual 24-h means.CONCLUSIONS:The present mean values of 24-h creatinine excretion are suggested as a useful tool to derive realistic hydration-status-independent average 24-h excretion rates from urinary analyte/creatinine ratios. We propose to apply these creatinine reference means routinely in biomarker-based studies aiming at characterizing the nutrient or metabolite status of adult populations by simply measuring metabolite/creatinine ratios in spot urines.

Preliminary iodine concentration (UIC) measurements in spot urines of the representative German adult study DEGS indicated a severe worsening of iodine status compared to previous results in German children (KiGGS study). Therefore, we aimed to evaluate adult iodine status in detail and to investigate the impact of hydration status on UIC.

A high dietary salt intake is a serious risk factor for the development of hypertension. Daily salt intake in most of the European countries substantially exceeds the current recommendations of salt intake. For Germany, so far, no valid biomarker-based data on current daily salt intake are available.

Die erste Folgebefragung der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS Welle 1), die von 2009 bis 2012 als kombinierte Quer- und Längsschnitterhebung durchgeführt wurde, liefert u. a. aktuelle Daten zu allergischen Erkrankungen. Die Datenerhebung erfolgte mittels Telefoninterviews. Insgesamt nahmen 6093 Mädchen und 6275 Jungen bzw. deren Eltern teil, darunter 4455 Ersteingeladene (0 bis 6 Jahre; Response 38,8 %) und 7913 Wiedereingeladene (7 bis 17 Jahre; Response 72,9 %). Laut Elternangaben war aktuell knapp ein Sechstel der Kinder und Jugendlichen von mindestens einer atopischen Erkrankung betroffen (15,6 %, 95 %-Konfidenzintervall 14,7–16,5). Die 12-Monats-Prävalenzen von Heuschnupfen, Neurodermitis und Asthma bronchiale betrugen 9,1 % (8,4–9,8), 6,0 % (5,4–6,6) bzw. 4,1 % (3,6–4,6). 2,2 % (1,9–2,6) der Kinder und Jugendlichen litten aktuell an einem allergischen Kontaktekzem. Im Vergleich zur KiGGS-Basiserhebung von 2003 bis 2006 hat in KiGGS Welle 1 ein höherer Anteil von Eltern die Frage nach dem Auftreten von Asthma bronchiale in den letzten 12 Monaten bei ihren Kindern und Jugendlichen bejaht (4,1 vs. 3,2 %; p = 0,0034). Der Gesamtanstieg ist auf gestiegene Prävalenzen bei 0- bis 6-Jährigen und hier vor allem bei Mädchen zurückzuführen. Für Heuschnupfen fallen höhere 12-Monats-Prävalenzen ebenfalls in den beiden unteren Altersgruppen und auch hier vor allem bei Mädchen auf. Der Gesamtanstieg ist aber nicht statistisch signifikant (9,1 vs. 8,3 %; p = 0,08). Für Neurodermitis war insgesamt ein rückläufiger Trend in der aktuellen Betroffenheit zu beobachten [6,8 % (2003–2006) vs. 5,4 % (2009–2012); p = 0,0015].

The first follow-up of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 1) was conducted from 2009 to 2012 as a combined cross-sectional and longitudinal study and provides, among other things, data on allergic diseases. Data collection was carried out by telephone interviews. In total, 6,093 girls and 6,275 boys were included, among them 4,455 newly recruited 0- to 6-year-olds (response 38.8 %) and 7,913 KiGGS follow-up participants aged 7-17 years (response 72.9 %). Based on parent reports, 15.6 % (95 % confidence interval 14.7-16.5) of children and adolescents aged 0-17 years were currently affected by at least one atopic disease. The 12-month prevalence rates of hay fever, atopic dermatitis, and asthma were 9.1 % (8.4-9.8), 6.0 % (5.4-6.6), and 4.1 % (3.6-4.6), respectively. In all, 2.2 % (1.9-2.6) of the children and adolescents were currently suffering from contact dermatitis. Compared with the baseline KiGGS survey from 2003 to 2006, a higher percentage of participants reported the occurrence of asthma within the past 12 months in the recent KiGGS Wave 1 (4.1 vs. 3.2 %; p = 0.0034). The total increase is mainly due to higher prevalence rates among 0- to 6-year-olds, especially in girls. Higher 12-month prevalence rates can be also observed for hay fever among 0- to 6-year-olds, especially in girls, although the total increase is not statistically significant (9.1 vs. 8.3 %; p = 0.08). There was a declining trend for atopic dermatitis: 6.8 % (2003-2006) vs. 5.4 % (2009-2012); p = 0.0015.

Ten years after seroepidemiological data were obtained in the German National Health Interview and Examination Survey 1998 (GNHIES98), German Health Interview and Examination Survey (DEGS1) data contribute to a population-based, representative surveillance of hepatitis A and B immunity and of the serological markers for hepatitis C in Germany. The prevalence of antibodies against the hepatitis A virus is 48.6 %. In comparison to the situation 10 years ago, seroprevalence is significantly higher among 18- to 39-year-old adults and is significantly lower in those aged 50-79 years. The association between age and seroprevalence has changed, indicating a decrease in naturally acquired hepatitis A immunity. Individual and population immunity has to be achieved through vaccination. Prevalence of hepatitis B antibodies indicates that 5.1 % of adults have been exposed to the virus, significantly fewer than 10 years ago (7.9 %). Prevalence of hepatitis B surface antibodies indicates that 22.9 % of adults have been vaccinated against hepatitis B. Vaccination coverage has increased in all age groups and is highest in the younger age groups. These positive trends can be attributed to the general recommendation since 1995 to vaccinate against hepatitis B. For hepatitis C, the prevalence of antibodies in the general population is 0.3 %. Germany thus remains a low-HCV-endemic country. An English full-text version of this article is available at SpringerLink as supplemental.

Die Daten aus der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) ermöglichen 10 Jahre nach der seroepidemiologischen Erhebung im „Bundes-Gesundheitssurvey 1998“ (BGS98) die Abschätzung der aktuellen Durchseuchung mit Hepatitis-A-, Hepatitis-B- und Hepatitis-C-Viren und der Immunitätslage gegen Hepatitis A und B sowie diesbezüglicher zeitlicher Trends in der Bevölkerung. Die Seroprävalenz von Antikörpern gegen das Hepatitis-A-Virus beträgt 48,6 %. Im Vergleich zu den Werten vor 10 Jahren liegt sie bei den 18- bis 39-Jährigen signifikant höher, bei den 50- bis 79-Jährigen dagegen signifikant niedriger. Das veränderte Muster in der altersabhängigen Seroprävalenz zeigt einen Rückgang der natürlichen Durchseuchung mit dem Hepatitis-A-Virus. Ein individueller Schutz vor Hepatitis A und eine gute Immunität auf Bevölkerungsebene sind daher nur durch Schutzimpfungen zu erreichen. 5,1 % der Erwachsenen weisen Marker für eine Hepatitis-B-Virus-Infektion auf; dieser Wert ist signifikant niedriger als vor 10 Jahren. Bei 22,9 % der Frauen und Männer kann auf eine durch Impfung hervorgerufene Immunität gegen Hepatitis B geschlossen werden. Dieser Anteil sinkt mit dem Alter, ist aber über alle Altersgruppen hinweg signifikant gestiegen. Es zeigen sich bereits deutliche Erfolge der seit 1995 allgemein empfohlenen Hepatitis-B-Impfung. Die Durchseuchung mit Hepatitis-C-Viren liegt bei 0,3 %; damit gehört Deutschland weiterhin zu den Ländern mit einer diesbezüglich niedrigen Prävalenz.

High blood pressure is one of the most important risk factors for cardiovascular diseases and chronic kidney disease. It is a main determinant of morbidity and mortality in Germany. In the German Health Interview and Examination Survey for Adults (DEGS1) the blood pressure of 7,096 adults aged 18-79 years was measured in a standardised way using oscillometric blood pressure devices (Datascope Accutorr Plus). The average of the second and third measurements was used for analysis. The mean systolic blood pressure was 120.8 mmHg in women and 127.4 mmHg in men, while the mean diastolic blood pressure was 71.2 mmHg in women and 75.3 mmHg in men. Blood pressure values were hypertensive (systolic blood pressure a parts per thousand yenaEuro parts per thousand 140 mmHg or diastolic blood pressure a parts per thousand yenaEuro parts per thousand 90 mmHg) in 12.7 % of women and in 18.1 % of men. Hypertension (defined as having hypertensive blood pressure or taking antihypertensive medication in known cases of hypertension) was present in 29.9 % of women and 33.3 % of men. Almost 75 % of the survey's highest age group, 70-79, had hypertension. DEGS1 demonstrates that high blood pressure remains a highly prevalent risk factor in the population at large. The methodology employed in measuring blood pressure has been improved as compared to that of the German National Health Interview and Examination Survey 1998 (GNHIES98) and it will be possible to draw comparisons soon, once a procedure for calibrating the 1998 data has been finalised. An English full-text version of this article is available at SpringerLink as supplemental.

Infections with Chlamydia trachomatis (CT) can lead to severe sequelae; however, they are not notifiable in Germany. We tested urine samples from participants of KiGGS (German Health Interview and Examination Survey for Children and Adolescents) for CT infections and linked the results to demographic and behavioural data from 1,925 participants (girls aged 15-17 years and boys aged 16-17 years) to determine a representative prevalence of CT infection in adolescents in Germany and to assess associated risk factors. Prevalence of CT infection was 2.2% (95% CI: 1.4-3.5) in girls and 0.2% (95% CI: 0.1-0.7) in boys. CT infection in girls was associated with higher use of alcohol, marijuana and cigarettes, lower social status, oral contraceptive use, pregnancy, repeated lower abdominal pain and higher rates of doctors' consultations within the preceding three months and consultation of gynaecologists within the last 12 months. In multiple logistic regression, we identified two predictors for CT infection: marijuana consumption often or several times within the last 12 months (F(1,164)=7.56; p<0.05) and general health status less than 'very good' (F(1,164)=3.83; p=0.052). Given our findings, we recommend enhancing sex education before sexual debut and promoting safe sex practices regardless of the contraceptive method used. Well-informed consumption of alcohol should be promoted, the risky behaviour of people intoxicated through consumption of marijuana highlighted and doctors' awareness of CT screening enhanced.

Aufgrund der Zunahme von Allergien in Deutschland sind aktuelle Daten zur Prävalenz allergischer Sensibilisierungen von großem Interesse. Im Rahmen der „Studie zur Gesundheit Erwachsener in Deutschland (DEGS1)“ (2008–2011) wurden an einer bevölkerungsbezogenen Stichprobe von 7025 18- bis 79-Jährigen Blutproben auf spezifische IgE-Antikörper gegen 50 verbreitete Einzelallergene untersucht sowie 2 Tests mit jeweils einer Mischung aus Inhalationsallergenen (SX1) und Gräserpollen (GX1) durchgeführt. 48,6% der Teilnehmer wiesen mindestens eine Sensibilisierung auf. Mehr Männer als Frauen waren gegen mindestens ein Allergen sensibilisiert. Zudem waren mehr jüngere als ältere Teilnehmer und mehr Personen mit höherem Sozialstatus von mindestens einer Sensibilisierung betroffen. Gegen Inhalationsallergene waren 33,6% der Teilnehmer sensibilisiert, gegen Nahrungsmittelallergene 25,5% und gegen Insektengifte 22,5%. Im Vergleich zum Bundes-Gesundheitssurvey 1998 (BGS98) hat die Prävalenz einer Sensibilisierung gegen Inhalationsallergene von 29,8% auf 33,6% zugenommen. Dieser Trend war nur bei Frauen signifikant. Die Ergebnisse des DEGS1 zeigen eine nach wie vor hohe Prävalenz allergischer Sensibilisierungen.

Hoher Blutdruck gehört zu den wichtigsten Risikofaktoren für Herz-Kreislauf-Krankheiten und chronische Niereninsuffizienz. Er ist eine wesentliche Determinante für Morbidität und Mortalität in Deutschland. Im Rahmen der bundesweiten Studie zur Gesundheit Erwachsener in Deutschland DEGS1 wurde bei 7096 Erwachsenen im Alter von 18 bis 79 Jahren der Blutdruck standardisiert mit einem oszillometrischen Blutdruckmessgerät (Datascope Accutorr Plus) gemessen und der Durchschnitt der zweiten und dritten Messung ausgewertet. Der mittlere Blutdruck betrug systolisch bei Frauen 120,8 mmHg, bei Männern 127,4 mmHg, diastolisch bei Frauen 71,2 mmHg, bei Männern 75,3 mmHg. Die Blutdruckwerte waren hyperton (systolischer Blutdruck ≥ 140 mmHg oder diastolisch ≥ 90 mmHg) bei 12,7 % der Frauen und 18,1 % der Männer. Eine Hypertonie (definiert als hypertoner Messwert oder Einnahme antihypertensiver Medikamente bei bekannter Hypertonie) lag bei 29,9 % der Frauen und 33,3 % der Männer vor. In der höchsten untersuchten Altersgruppe der 70- bis 79-Jährigen hatten fast 75 % eine Hypertonie. DEGS1 zeigt, dass Bluthochdruck nach wie vor ein weit verbreiteter Risikofaktor in der Bevölkerung ist. Die Methodik der Blutdruckmessung ist im Vergleich zu der im Bundes-Gesundheitssurvey 1998 verbessert worden, sodass Vergleiche erst in Kürze, nach Fertigstellung eines Kalibrierungsverfahrens der Daten von 1998, möglich sein werden.

Background Men who have sex with men (MSM) with frequent sexual interactions are assumed to be at higher risk for HBV-infection. Due to partly similar transmission routes, HBV is a frequent coinfection in HIV-positive patients. HIV-coinfection accelerates disease progression of HBV-infection resulting in earlier and more frequent occurrence of liver cirrhosis and hepatocellular carcinoma. Thus, HBV-vaccination for HIV-positive MSM is recommended in Germany. Methods On basis of the nationwide, multicenter, open, prospective cohort study of HIV 1-seroconverters, we screened all available, yearly collected serum samples of HIV-infected MSM for anti-HBc, anti-HBs, HBs-AG, anti-HCV and Syphilis antibodies. Samples with signs of acute/chronic HBV-infection were confirmed by PCR. Prevalences were calculated on patient basis (at least one sample tested positively). Results 5.603 samples of 1.945 MSM were screened. Median age at HIV 1-seroconversion was 33 years. In all screened MSM, prevalences of active acute/chronic HBV were 1.9%, of cleared HBV 28.0%. 4.8% had signs of occult HBV-infection (solely anti-HBc positive). 48.6% were effectively vaccinated against HBV (titre > 10mIU/ml), of those 24.2% already at timepoint of HIV-seroconversion. Prevalences of cleared HBV and of vaccination against HBV differed significantly between age groups (table 1). 50.6% of MSM who ever had a HBV-coinfection had a further coinfection with Syphilis, 13.3% with HCV. Discussion Despite extensive vaccination campaigns regarding HBV-infections in MSM in Germany, less than half of all screened MSM were vaccinated. Consequentially, we found a high proportion of MSM who ever had a HBV-coinfection. Of special interest was a significant subgroup of patients having signs of occult HBV-infection, a phenomenon known to occur in immune-suppressed patients. High rates of coinfections with Syphilis and HCV in HBV/HIV-coinfected MSM stress the demand for more extensive and tailored campaigns for HBV-vaccination and prevention of STI in general for MSM in Germany, especially for higher age groups.