Christina Poethko-Müller

Vaccination coverage and predictors for vaccination level. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

ZusammenfassungDer Impfstatus der Bevölkerung ist ein wichtiger Indikator für gesundheitliche Prävention. In Deutschland besteht keine Impfpflicht, und repräsentative Daten zum Impfstatus werden nur im Rahmen der Schuleingangsuntersuchungen der Bundesländer erhoben. Von Mai 2003 bis Mai 2006 wurde mit dem bundesweiten Kinder- und Jugendgesundheitssurvey (KiGGS) auch der Impfstatus von 16.460 Kindern und Jugendlichen im Alter von 0–17 Jahren auf Grundlage der vorgelegten Impfausweise erfasst und damit eine differenzierte Analyse der Durchimpfung von Kindern und Jugendlichen aller Altersgruppen in Deutschland ermöglicht. Die Durchimpfung wurde unter Berücksichtigung des verwendeten Impfstoffs definiert. Im Durchschnitt liegen die Quoten der vollständigen Grundimmunisierung gegen Tetanus, Diphtherie und Polio sowie der ersten Impfungen gegen Masern, Mumps und Röteln für 2- bis 17-Jährige über 90%. Die Durchimpfung gegen Pertussis, Hib und Hepatitis B ist in den jüngeren Altersgruppen deutlich besser als bei älteren Kindern und Jugendlichen. Die Empfehlungen von zweiten Masern-, Mumps- und Röteln-Impfungen und zur Nachholung nicht erfolgter Impfungen gegen Hepatitis B und Pertussis sind insbesondere bei älteren Kindern und Jugendlichen noch nicht ausreichend umgesetzt. Bei 7- bis 17-Jährigen fehlen häufig die Auffrischimpfungen gegen Tetanus und Diphtherie.AbstractThe level of childhood immunisation is an acknowledged indicator for health prevention. In Germany, vaccination is not compulsive. Continuous representative data derive only from school health examinations. From May 2003 until May 2006 the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was conducted and vaccination information on 16,460 participants was obtained. Using data on the vaccination cards, it was possible to make detailed analyses of vaccination coverage in children up to the age of 17. Different vaccine types were taken into consideration in defining the term ‘immunisation coverage’. The average prevalence of full immunisation for tetanus, diphtheria und polio as well as the coverage for the first dose of measles, mumps and rubella (MMR) vaccination was above 90% in children aged 2–17 years. Vaccination coverage for pertussis, Hib and hepatitis B is higher in younger than in older age groups. Compliance with the recommendation to have a second MMR dose and to make up of hepatitis B and pertussis immunisation is still low, especially in adolescents. In 7- to 17-year-old children the additional booster (recommended for 5- to 6-year-old children) is frequently missing.

Vaccination coverage against measles in German-born and foreign-born children and identification of unvaccinated subgroups in Germany.

Data from the representative German Health Interview and Examination Survey for Children and Adolescents were used to identify unvaccinated subgroups that should be targeted by vaccination programmes in order to interrupt measles transmission. Measles vaccination coverage was low among children below the age of 3, having > or =3 siblings and in foreign-born migrants. Multivariate analyses show that vaccination coverage was strongly related to the place of birth in migrants: foreign-born children have a three-fold odds of being unvaccinated. Odds were also higher in children living in former West Germany, having > or =3 siblings, and it was especially high in children with parents reporting reservations against vaccinations.

Seroprevalence of Measles-, Mumps- and Rubella-Specific IgG Antibodies in German Children and Adolescents and Predictors for Seronegativity

We have undertaken a seroprevalence study with more than 13,000 children, who had been included in the German KIGGS survey, a representative sample of children and adolescents 0–17 years of age. The IgG titres against measles, mumps and rubella were determined in 1 to 17 year olds While 88.8% of the children were MMR-vaccinated at least once, 76.8% of children aged 1 to 17 years showed prevalence of antibodies to MMR. The highest seronegativity was seen with respect to mumps. Gender differences were most pronounced with regard to rubella IgG titres: girls aged 14 to 17 years were best protected, although seronegativity in 6.8% of this vulnerable group still shows the need of improvement. Search for predictors of missing seroprevalence identified young age to be the most important predictor. Children living in the former West and children born outside of Germany had a higher risk of lacking protection against measles and rubella, while children with a migration background but born in Germany were less often seronegative to measles antibodies than their German contemporaries. An association of seronegativity and early vaccination was seen for measles but not for mumps and rubella. A high maternal educational level was associated with seronegativity to measles and rubella. In vaccinated children, seronegativity was highest for mumps and lowest for rubella. For mumps, high differences were observed for seronegativity after one-dose and two-dose vaccination, respectively. Seronegativity increases as time since last vaccination passes thus indicating significant waning effects for all three components of MMR.

Impfstatus von Erwachsenen in Deutschland

In the absence of an immunisation register, vaccination coverage in Germany must be estimated. Ten years after the German National Health Interview and Examination Survey 1998 (GNHIES98), the population survey DEGS1 is one of the data sources to be used for monitoring vaccination coverage. In the survey, data on vaccination history were obtained from vaccination cards and self-reports. The prevalence of immunisation for tetanus and diphtheria was higher compared to the prevalence estimated ten years previously in GNHIES98. Nonetheless, 28.6 % of adults have not been vaccinated against tetanus and 42.9 % have not been vaccinated against diphtheria within the last ten years. Vaccination is especially low among the elderly, among adults with low socio-economic status and in western Germany. During the last ten years, only 11.8 % of women and 9.4 % of men were vaccinated against pertussis in western Germany; vaccination coverage was twice as high in eastern Germany. In 2009, recommendations were published to combine the next tetanus immunisation with a pertussis immunisation; therefore pertussis vaccination coverage might improve in the coming years. The lifetime prevalence of influenza vaccination obtained in DEGS1 is higher than the annual vaccination rate for influenza. However, the lifetime prevalence among adults aged 60 years or older is still below the annual rate of 75 % recommended by the WHO. An English full-text version of this article is available at SpringerLink as supplemental.

Die Seroepidemiologie der Hepatitis A, B und C in Deutschland

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.

[Epidemiology of hepatitis A, B, and C among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)].

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.

Körperlich-sportliche Aktivität und Nutzung elektronischer Medien im Kindes- und Jugendalter

Physical activity during childhood and adolescence has numerous health benefits, while sedentary behavior, especially electronic media use, is associated with the development of overweight. Therefore, the promotion of physical activity during childhood and adolescence is an integral part of national public health efforts. The aim of this article is to describe the physical activity behavior of German children and adolescents based on the nationwide data of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS wave 1). Furthermore, the association between physical activity and sports participation and use of screen-based media in youth aged 11 to 17 years was analyzed. The analyses included data from 10,426 children and adolescents aged 3-17 years collected by telephone interviews. Children older than 11 years answered the questions by themselves, whereas a parent was interviewed for younger children. The descriptive analyses were performed under consideration of social and demographic factors. According to the results of KiGGS wave 1 a total of 77.5% (95% Cl 76.0-78.9 %) of the children and adolescents participated in sports activities, and 59.7% (58.1-61.3 %) were members of a sports club. The recommendation of the World Health Organization (WHO) to be physically active at least 60 min per day was achieved by 27.5% (26.0-28.9 %). Children and adolescents with a low socioeconomic status (SES) participated less in sports activities than children of higher SES groups. Excessive use of screen-based media was more likely to be associated with lack of sports participation than with a lack of physical activity. In the future, preventive measures should promote the daily physical activity of children and adolescents and additionally encourage children and adolescents with low SES to participate in sports activities.

Sero-epidemiology of measles-specific IgG antibodies and predictive factors for low or missing titres in a German population-based cross-sectional study in children and adolescents (KiGGS)

BACKGROUND AND OBJECTIVE In the European Region, measles elimination is now targeted to 2015. To measure progress towards elimination age-group specific susceptibility targets have been defined. Age-specific measles susceptibility in children and adolescents was evaluated in Germany. Taking into account a broad range of socio-demographic, health- and vaccination status related variables, populations for vaccination campaigns were identified. METHOD We analysed data from children aged 1-17 years in the representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Measles immunoglobulin G antibodies were measured in 13,977 participants by enzyme immunoassay (ELISA). Bivariate and multivariate logistic regression analyses were used to determine parental and infant related factors associated with measles susceptibility. RESULTS The overall prevalence of seronegativity in children tested for measles IgG aged 1-17 years was 10.0% (95% CI 9.4-10.7). The prevalence of seronegativity in the German population was below the WHO targets for measles elimination in children aged 2-9 year-olds but exceeded the target for 10-17 year-olds. Age differences in the level of seronegativity were found to be mainly due to differences in vaccination coverage. A higher level of susceptibility was observed if parents did not comply with the request to present the childs vaccination card. In vaccinated children, immigration, male gender, very young age at first vaccination and a longer time period since last vaccination were associated with a higher level of susceptibility. CONCLUSION Further increase of the two-dose vaccination coverage is necessary in order to achieve the WHO targets. Catch up vaccination campaigns should focus on adolescents and immigrants.

Durchimpfung und Determinanten des Impfstatus in Deutschland : Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS)

ZusammenfassungDer Impfstatus der Bevölkerung ist ein wichtiger Indikator für gesundheitliche Prävention. In Deutschland besteht keine Impfpflicht, und repräsentative Daten zum Impfstatus werden nur im Rahmen der Schuleingangsuntersuchungen der Bundesländer erhoben. Von Mai 2003 bis Mai 2006 wurde mit dem bundesweiten Kinder- und Jugendgesundheitssurvey (KiGGS) auch der Impfstatus von 16.460 Kindern und Jugendlichen im Alter von 0–17 Jahren auf Grundlage der vorgelegten Impfausweise erfasst und damit eine differenzierte Analyse der Durchimpfung von Kindern und Jugendlichen aller Altersgruppen in Deutschland ermöglicht. Die Durchimpfung wurde unter Berücksichtigung des verwendeten Impfstoffs definiert. Im Durchschnitt liegen die Quoten der vollständigen Grundimmunisierung gegen Tetanus, Diphtherie und Polio sowie der ersten Impfungen gegen Masern, Mumps und Röteln für 2- bis 17-Jährige über 90%. Die Durchimpfung gegen Pertussis, Hib und Hepatitis B ist in den jüngeren Altersgruppen deutlich besser als bei älteren Kindern und Jugendlichen. Die Empfehlungen von zweiten Masern-, Mumps- und Röteln-Impfungen und zur Nachholung nicht erfolgter Impfungen gegen Hepatitis B und Pertussis sind insbesondere bei älteren Kindern und Jugendlichen noch nicht ausreichend umgesetzt. Bei 7- bis 17-Jährigen fehlen häufig die Auffrischimpfungen gegen Tetanus und Diphtherie.AbstractThe level of childhood immunisation is an acknowledged indicator for health prevention. In Germany, vaccination is not compulsive. Continuous representative data derive only from school health examinations. From May 2003 until May 2006 the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was conducted and vaccination information on 16,460 participants was obtained. Using data on the vaccination cards, it was possible to make detailed analyses of vaccination coverage in children up to the age of 17. Different vaccine types were taken into consideration in defining the term ‘immunisation coverage’. The average prevalence of full immunisation for tetanus, diphtheria und polio as well as the coverage for the first dose of measles, mumps and rubella (MMR) vaccination was above 90% in children aged 2–17 years. Vaccination coverage for pertussis, Hib and hepatitis B is higher in younger than in older age groups. Compliance with the recommendation to have a second MMR dose and to make up of hepatitis B and pertussis immunisation is still low, especially in adolescents. In 7- to 17-year-old children the additional booster (recommended for 5- to 6-year-old children) is frequently missing.

Durchimpfung und Determinanten des Impfstatus in Deutschland

ZusammenfassungDer Impfstatus der Bevölkerung ist ein wichtiger Indikator für gesundheitliche Prävention. In Deutschland besteht keine Impfpflicht, und repräsentative Daten zum Impfstatus werden nur im Rahmen der Schuleingangsuntersuchungen der Bundesländer erhoben. Von Mai 2003 bis Mai 2006 wurde mit dem bundesweiten Kinder- und Jugendgesundheitssurvey (KiGGS) auch der Impfstatus von 16.460 Kindern und Jugendlichen im Alter von 0–17 Jahren auf Grundlage der vorgelegten Impfausweise erfasst und damit eine differenzierte Analyse der Durchimpfung von Kindern und Jugendlichen aller Altersgruppen in Deutschland ermöglicht. Die Durchimpfung wurde unter Berücksichtigung des verwendeten Impfstoffs definiert. Im Durchschnitt liegen die Quoten der vollständigen Grundimmunisierung gegen Tetanus, Diphtherie und Polio sowie der ersten Impfungen gegen Masern, Mumps und Röteln für 2- bis 17-Jährige über 90%. Die Durchimpfung gegen Pertussis, Hib und Hepatitis B ist in den jüngeren Altersgruppen deutlich besser als bei älteren Kindern und Jugendlichen. Die Empfehlungen von zweiten Masern-, Mumps- und Röteln-Impfungen und zur Nachholung nicht erfolgter Impfungen gegen Hepatitis B und Pertussis sind insbesondere bei älteren Kindern und Jugendlichen noch nicht ausreichend umgesetzt. Bei 7- bis 17-Jährigen fehlen häufig die Auffrischimpfungen gegen Tetanus und Diphtherie.AbstractThe level of childhood immunisation is an acknowledged indicator for health prevention. In Germany, vaccination is not compulsive. Continuous representative data derive only from school health examinations. From May 2003 until May 2006 the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was conducted and vaccination information on 16,460 participants was obtained. Using data on the vaccination cards, it was possible to make detailed analyses of vaccination coverage in children up to the age of 17. Different vaccine types were taken into consideration in defining the term ‘immunisation coverage’. The average prevalence of full immunisation for tetanus, diphtheria und polio as well as the coverage for the first dose of measles, mumps and rubella (MMR) vaccination was above 90% in children aged 2–17 years. Vaccination coverage for pertussis, Hib and hepatitis B is higher in younger than in older age groups. Compliance with the recommendation to have a second MMR dose and to make up of hepatitis B and pertussis immunisation is still low, especially in adolescents. In 7- to 17-year-old children the additional booster (recommended for 5- to 6-year-old children) is frequently missing.