Martin Schlaud

The challenge of comprehensively mapping children's health in a nation-wide health survey: Design of the German KiGGS-Study

BackgroundFrom May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Aim of this first nationwide interview and examination survey was to collect comprehensive data on the health status of children and adolescents aged 0 to 17 years.Methods/DesignParticipants were enrolled in two steps: first, 167 study locations (sample points) were chosen; second, subjects were randomly selected from the official registers of local residents. The survey involved questionnaires filled in by parents and parallel questionnaires for children aged 11 years and older, physical examinations and tests, and a computer assisted personal interview performed by study physicians. A wide range of blood and urine testing was carried out at central laboratories. A total of 17 641 children and adolescents were surveyed – 8985 boys and 8656 girls. The proportion of sample neutral drop-outs was 5.3%. The response rate was 66.6%.DiscussionThe response rate showed little variation between age groups and sexes, but marked variation between resident aliens and Germans, between inhabitants of cities with a population of 100 000 or more and sample points with fewer inhabitants, as well as between the old West German states and the former East German states. By analysing the short non-responder questionnaires it was proven that the collected data give comprehensive and nationally representative evidence on the health status of children and adolescents aged 0 to 17 years.

Habitual snoring, intermittent hypoxia, and impaired behavior in primary school children.

Objectives. Sleep-disordered breathing is associated with impaired behavior and poor academic performance in children. We aimed to determine the extent of behavioral problems in snoring children, clarify the role of intermittent hypoxia, and test the reversibility of impaired behavior and poor academic performance. Methods. In 1144 children, habitual snoring (HS; snoring frequently or always) and impaired behavior were assessed using parental questionnaires. Intermittent hypoxia (ie, presence of ≥5 arterial oxygen desaturations by ≥4% or ≥1 desaturation to ≤90%) was investigated with pulse oximetry. Poor academic performance (grade 4–6 on a 6-point scale in mathematics, science, or spelling) was based on the last school report. HS, impaired behavior, and academic performance were reevaluated after 1 year. Adjusted odds ratios (ORs) were calculated using unconditional logistic regression. Results. HS was significantly associated with hyperactive (OR: 2.4) and inattentive behavior (OR: 4.0), daytime tiredness (OR: 7.1), and sleepiness (OR: 2.6–4.8). These associations were independent of intermittent hypoxia. HS was also significantly associated with bad conduct (OR: 2.8), emotional symptoms (OR: 5.5), and peer problems (OR: 9.7). At follow-up, hyperactive and inattentive behavior but not academic success had significantly improved in children in whom HS had ceased. Conclusions. We suggest that impaired behavior is a key feature of HS independent of intermittent hypoxia and improves when HS ceases.

Inanspruchnahme medizinischer Leistungen

The use of operations, visits to doctors and early diagnostic tests for children are examples of different services selected from the whole spectrum of preventative and therapeutic health service provisions in childhood and adolescence. In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which is representative for Germany, 17,641 children and adolescents aged 0-17 or their parents were questioned on subjects such as their use of medical services. The use made of individual early diagnostic tests for children remains above the 90 % limit until the U7 test and drops to 89.0 % at U8, falling to 86.4 % at U9. 81 % of children took part in all the early diagnostic tests provided until age 6 (U3 to U9). Another 16 % only took advantage of some parts of this service and 3 % of the children never went to one of these check-ups. As was to be expected, the annual rate of visits to paediatricians drops as children get older from 95.1 % for 0-2-year-olds to 25.4 % of the 14-17-year-olds, while the rate of visits to general practitioners rises from 11.8 % to 53.1 %. If one tracks the rate of visits to specialist doctors all the way across childhood and adolescence, different paths emerge: while children aged 3-6 most often visit the ear, nose and throat doctor, at primary school age they mainly see opticians, and 14-17-year-olds most often visit doctors of internal medicine, dermatologists and surgeons. 37.1 % of the 0-17-year-old children and adolescents had undergone an operation. In order of declining frequency, the operations named were adenoidectomy (15.2 %), tonsillectomy (5.9 %), herniotomy (3.6 %) and appendectomy (2.4 %). Circumcisions had been carried out on 10.9 % of the boys. The different way medical services are used in different subgroups may not only depend on medical factors but also on social factors, medical attitudes and the availability of services provided.ZusammenfassungInanspruchnahmen von Kinderfrüherkennungsuntersuchungen und niedergelassenen Ärzten sowie Operationen stellen eine Auswahl unterschiedlicher Leistungsbereiche aus dem Gesamtspektrum präventiver und therapeutischer Leistungen des Gesundheitswesens im Kindes- und Jugendalter dar. Im Rahmen des bundesweit repräsentativen Kinder- und Jugendgesundheitssurveys (KiGGS) wurden 17.641 Kinder und Jugendliche im Alter von 0–17 Jahren bzw. deren Eltern unter anderem zur Inanspruchnahme medizinischer Leistungen befragt. Die Inanspruchnahme einzelner Kinderfrüherkennungsuntersuchungen bleibt bis zu U7 über der 90 %-Grenze und geht bei der U8 auf 89,0 % zurück, um dann bei der U9 auf 86,4 % zu fallen. 81 % der Kinder nahmen an allen Früherkennungsuntersuchungen teil, die bis zum sechsten Lebensjahr angeboten werden (U3–U9). Weitere 16 % haben dieses Angebot nur teilweise in Anspruch genommen, 3 % der Kinder waren nie bei einer dieser Vorsorgeuntersuchungen. Wie zu erwarten war, sinkt die jährliche Inanspruchnahmerate von Kinderärzten mit zunehmendem Alter von 95,1 % bei den 0- bis 2-Jährigen auf 25,4 % bei den 14- bis 17-Jährigen, während die Rate bei Allgemeinmedizinern von 11,8 % auf 53,1 % steigt. Verfolgt man die Inanspruchnahmeraten von Fachärzten über das gesamte Kindes- und Jugendalter, so zeichnen sich unterschiedliche Verlaufskurven ab: Während der Hals-Nasen-Ohren-Arzt von Kindern im Alter von 3–6 Jahren am häufigsten in Anspruch genommen wird, werden Augenärzte insbesondere im Grundschulalter und Internisten, Hautärzte und Chirurgen am häufigsten von den 14- bis 17-Jährigen aufgesucht. 37,1 % der 0- bis 17-jährigen Kinder und Jugendlichen sind schon einmal operiert worden. In absteigender Häufigkeit wurden bei den Operationen die Adenotomie (15,2 %), Tonsillektomie (5,9 %), Herniotomie (3,6 %) und Appendektomie (2,4 %) genannt. Eine Zirkumzision ist bei 10,9 % der Jungen durchgeführt worden. Das unterschiedliche Inanspruchnahmeverhalten medizinischer Leistungen in verschiedenen Untergruppen ist möglicherweise nicht nur von medizinischen, sondern auch von sozialen Faktoren, ärztlichen Einstellungen und der Verfügbarkeit von Versorgungsangeboten abhängig.AbstractThe use of operations, visits to doctors and early diagnostic tests for children are examples of different services selected from the whole spectrum of preventative and therapeutic health service provisions in childhood and adolescence. In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which is representative for Germany, 17,641 children and adolescents aged 0–17 or their parents were questioned on subjects such as their use of medical services. The use made of individual early diagnostic tests for children remains above the 90 % limit until the U7 test and drops to 89.0 % at U8, falling to 86.4 % at U9. 81 % of children took part in all the early diagnostic tests provided until age 6 (U3 to U9). Another 16 % only took advantage of some parts of this service and 3 % of the children never went to one of these check-ups. As was to be expected, the annual rate of visits to paediatricians drops as children get older from 95.1 % for 0–2-year-olds to 25.4 % of the 14–17-year-olds, while the rate of visits to general practitioners rises from 11.8 % to 53.1 %. If one tracks the rate of visits to specialist doctors all the way across childhood and adolescence, different paths emerge: while children aged 3–6 most often visit the ear, nose and throat doctor, at primary school age they mainly see opticians, and 14–17-year-olds most often visit doctors of internal medicine, dermatologists and surgeons. 37.1 % of the 0–17-year-old children and adolescents had undergone an operation. In order of declining frequency, the operations named were adenoidectomy (15.2 %), tonsillectomy (5.9 %), herniotomy (3.6 %) and appendectomy (2.4 %). Circumcisions had been carried out on 10.9 % of the boys. The different way medical services are used in different subgroups may not only depend on medical factors but also on social factors, medical attitudes and the availability of services provided.

Primary snoring in school children: prevalence and neurocognitive impairments

PurposeWe aimed to investigate the prevalence of primary snoring (PS) and its association with neurocognitive impairments.MethodsData from a community-based study in 1,114 primary school children were used to identify children who never (N = 410) or habitually snored (N = 114). In order to separate children with PS from those with upper airway resistance syndrome (UARS) or obstructive sleep apnoea (OSA), home polysomnography was conducted in all habitually snoring children. Neurocognitive impairments and poor school performance were compared between children who never snored, PS, and UARS/OSA.ResultsPolysomnography was successfully conducted in 92 habitual snorers. Of these, 69 and 23 had PS and UARS/OSA, respectively. Prevalence [95% confidence interval (95% CI)] of PS was 6.1% (4.5–7.7). Compared to children who had never snored, children with PS had more hyperactive (39% vs. 20%) and inattentive behaviour (33% vs. 11%), as well as poor school performance in mathematics (29% vs. 16%), science (23% vs. 12%), and spelling (33% vs. 20%; all P values <0.05). PS was a significant risk factor (odds ratio; 95% CI) for hyperactive behaviour (2.8; 1.6–4.8), inattentive behaviour (4.4; 2.4–8.1), as well as daytime sleepiness (10.7; 4.0–28.4). PS was also an independent risk factor for poor school performance in mathematics (2.6; 1.2–5.8), science (3.3; 1.2–8.8), and spelling (2.5; 1.1–5.5). Odds ratios throughout were similar to the UARS/OSA group.ConclusionsChildren with non-hypoxic, non-apnoeic PS may exhibit significant neurocognitive impairments. Consequences may be similar to those associated with UARS or OSA. If confirmed, PS is not “benign” and may require treatment.

Prävalenz von somatischen Erkrankungen bei Kindern und Jugendlichen in Deutschland

ZusammenfassungIm Kinder- und Jugendgesundheitssurvey (KiGGS) wurden von 2003–2006 an einer bevölkerungsbezogenen Stichprobe von 17.641 0- bis 17-Jährigen Daten zu akuten/ansteckenden und chronischen Erkrankungen erhoben. Die Jahresprävalenzen einzelner akuter Erkrankungen sind sehr unterschiedlich. Am häufigsten sind Kinder und Jugendliche durch akute (infektiöse) Atemwegserkrankungen betroffen. 88,5 % der befragten Kinder und Jugendlichen hatten innerhalb der letzten 12 Monate mindestens eine Erkältung bzw. einen grippalen Infekt. Von den übrigen akuten Atemwegserkrankungen kamen Bronchitis und Mandelentzündung mit jeweils 19,9 % und 18,5 % am häufigsten vor. Die 12-Monats-Prävalenz von Otitis media und Pseudokrupp lag jeweils bei 11 % und 6,6 %. Eine Lungenentzündung hatten 1,5 % der Kinder und Jugendlichen durchgemacht. Neben Infektionen der Atemwege wurden mit 46,8 % sehr häufig Magen-Darm-Infekte als akuter Erkrankungsgrund genannt. Weiterhin waren 12,8 % der Kinder und Jugendlichen durch eine Herpesinfektion, 7,8 % durch eine Bindehautentzündung und 4,8 % durch eine Harnwegsinfektion betroffen. Für die infektiösen Kinderkrankheiten wurden folgende Lebenszeitprävalenzen ermittelt: Keuchhusten 8,7 %, Masern 7,4 %, Mumps 4,0 %, Röteln 8,5 %, Windpocken 70,6 %, Scharlach 23,5 %. Verschiedene chronische somatische Erkrankungen im Kindes- und Jugendalter weisen unterschiedliche Lebenszeitprävalenzen auf. Am häufigsten sind Kinder und Jugendliche von obstruktiver Bronchitis (13,3 %), Neurodermitis (13,2 %) sowie Heuschnupfen (10,7 %) betroffen. Eine vom Arzt diagnostizierte Wirbelsäulenverkrümmung/Skoliose bzw. Asthma kommen jeweils bei 5,2 % bzw. 4,7 % der 0- bis 17-Jährigen vor. Die Lebenszeitprävalenzen der übrigen Krankheiten schwanken zwischen 0,14 % bei Diabetes mellitus und 3,6 % bei Krampfanfällen/epileptischen Anfällen. Die Ergebnisse liefern erstmals bundesweit repräsentative Aussagen zur Prävalenz von akuten/ansteckenden und chronischen Erkrankungen für das Kindes- und Jugendalter auf der Grundlage einer bevölkerungsrepräsentativen Stichprobe.AbstractIn the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which was conducted from 2003 to 2006, data on acute/infectious and chronic diseases were collected from a population-based sample of 17,641 subjects aged 0 to 17 years. The annual prevalence rates among acute diseases vary widely. Children and adolescents are most frequently affected by acute (infectious) respiratory conditions. 88.5 % of the surveyed children and adolescents experienced at least one episode of common cold within the last 12 months. Among the other acute respiratory infections, bronchitis and tonsillitis were the most frequently encountered conditions with 19.9 % and 18.5 %, respectively. The 12-month prevalence of otitis media and pseudocroup was 11 % and 6.6 %, respectively. 1.5 % of the children and adolescents experienced an episode of pneumonia. Apart from respiratory infections, gastrointestinal infections were very frequently stated as reasons for acute illness. Furthermore, 12.8 % of the children and adolescents experienced a herpetic infection, 7.8 % a conjunctivitis and 4.8 % a urinary tract infection. Lifetime prevalence rates of infectious diseases were as follows: pertussis 8.7 %, measles 7.4 %, mumps 4.0 %, rubella 8.5 %, varicella 70.6 %, scarlet fever 23.5 %. The various chronic somatic diseases in children and adolescents had different lifetime prevalence rates. Most frequently, children and adolescents were affected by obstructive bronchitis (13.3 %), neurodermatitis/atopic eczema (13.2 %) and hay fever (10.7 %). Scoliosis and asthma had been diagnosed by a doctor in 5.2 % and 4.7 % of subjects aged 0–17 years, respectively. The lifetime prevalence rates of the remaining diseases varied between 0.14 % for diabetes mellitus and 3.6 % for convulsions/epileptic fits. For the first time ever, these survey results provide nationwide representative information on the prevalence rates of acute/infectious and chronic diseases in children and adolescents which is based on a population-representative sample.

Sexuelle Reifung von Kindern und Jugendlichen in Deutschland

ZusammenfassungNach einem Stillstand in der Reifeakzeleration in den 80er-Jahren des 20. Jahrhunderts wird international und auch in Deutschland eine weitere Verschiebung der Reifeentwicklung in das jüngere Lebensalter diskutiert. Mit der Erhebung von Reifemerkmalen bei Mädchen und Jungen im Rahmen des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS) sollen bevölkerungsrepräsentative Angaben zur sexuellen Reifung ermittelt und Zusammenhänge zwischen Reifestatus und ausgewählten Gesundheits- und Sozialdaten geprüft werden. Mädchen wurden nach der ersten Regelblutung (Menarche) und Jungen nach Veränderungen in der Stimmlage, dem Stimmbruch (Mutation) gefragt (Status-quo-Methode). Die Schambehaarung (Pubes) wurde nach definierten Entwicklungsstufen (Tanner) anhand von Zeichenvorlagen von den Kindern und Jugendlichen vom vollendeten 10.–17. Lebensjahr selbst eingeschätzt. Das mittlere Alter (Median) für die Menarche, für die Mutation und die Pubesstufen wurde über ein Logit-Modell berechnet. Mit 10 Jahren berichten 42,4 % der Mädchen und 35,7 % der Jungen über die Entwicklung von Schamhaaren. Mit 17 Jahren haben die Mehrzahl der Mädchen und Jungen die Stufen PH5 (Mädchen 57,5 %, Jungen 47,8 %) und PH6 (Mädchen 23,6 %, Jungen 46,5 %) nach Tanner erreicht. Das Durchschnittsalter für die einzelnen Pubesstufen ist bei Mädchen niedriger (PH2 10,8; PH3 11,7; PH4 12,3; PH5 13,4 Jahre) als bei Jungen (PH2 10,9; PH3 12,6; PH4 13,4; PH5 14,1). Der Menarchemedian beträgt 12,8 Jahre, der Median für die Mutation (Stimme tief) 15,1 Jahre. Signifikante Unterschiede im Menarchealter bestehen zwischen Mädchen in Abhängigkeit vom Sozialstatus (12,7/12,9/13,0 Jahre für niedrigen/ mittleren/hohen Sozialstatus) und zwischen Mädchen mit und ohne Migrationshintergrund (12,5/12,9 Jahre). Keine Unterschiede sind im Menarchealter nach Ost/West und nach Wohnortgröße nachweisbar. Zusammenhänge zwischen Reifestatus und BMI sind bei Mädchen stärker ausgeprägt als bei Jungen. Insgesamt beginnt die Reifeentwicklung deutscher Kinder und Jugendlicher im Vergleich zu anderen europäischen Studien nicht signifikant früher.AbstractFollowing the standstill in maturity acceleration in the eighties of the twentieth century, now a further shift in maturity development towards younger ages is the issue of an international and also German discussion. The collection of sexual maturity data in boys and girls as part of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) is intended to pro vide population-representative information on sexual maturation and to evaluate associations between maturity status and selected health and social data. Girls were interviewed regarding their first menstrual period (menarche) and boys regarding voice change (status-quo method). Pubic hair was self-assessed by children and adolescents from 10 to 17 years of age, based on drawings of Tanners defined developmental stages. The median age for menarche, for voice change and pubic hair stages were calculated using a logit model. At an age of 10 years, 42.4 % of girls and 35.7 % of boys report the development of pubic hair. At 17 years of age, the majority of girls and boys have reached the stages PH5 (girls 57.5 %, boys 47.8 %) and PH6 (girls 23.6 %, boys 46.5 %) according to Tanner. The average age for each pubic hair stage is lower in girls (PH2 10.8; PH3 11.7; PH4 12.3; PH5 13.4 years) than in boys (PH2 10.9; PH3 12.6; PH4 13.4; PH5 14.1). The median age at menarche is 12.8 years, the median for voice change (voice low) 15.1 years. Significant differences in age at menarche are found in girls depending on socioeconomic status (12.7/12.9/13.0 years for low/middle/high status) and between girls with and without migration background (12.5/12.9 years). No differences in age at menarche can be seen between East and West Germany or cities and rural areas. The association between maturity status and BMI is more pronounced in girls than in boys. Overall, the onset of maturity development in German children and adolescents is not significantly earlier than in other European studies.

Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

ZusammenfassungIm Kinder- und Jugendgesundheitssurvey (KiGGS) wurden von 2003–2006 an einer bevölkerungsbezogenen Stichprobe von 17.641 0- bis 17-Jährigen Daten zu akuten/ansteckenden und chronischen Erkrankungen erhoben. Die Jahresprävalenzen einzelner akuter Erkrankungen sind sehr unterschiedlich. Am häufigsten sind Kinder und Jugendliche durch akute (infektiöse) Atemwegserkrankungen betroffen. 88,5 % der befragten Kinder und Jugendlichen hatten innerhalb der letzten 12 Monate mindestens eine Erkältung bzw. einen grippalen Infekt. Von den übrigen akuten Atemwegserkrankungen kamen Bronchitis und Mandelentzündung mit jeweils 19,9 % und 18,5 % am häufigsten vor. Die 12-Monats-Prävalenz von Otitis media und Pseudokrupp lag jeweils bei 11 % und 6,6 %. Eine Lungenentzündung hatten 1,5 % der Kinder und Jugendlichen durchgemacht. Neben Infektionen der Atemwege wurden mit 46,8 % sehr häufig Magen-Darm-Infekte als akuter Erkrankungsgrund genannt. Weiterhin waren 12,8 % der Kinder und Jugendlichen durch eine Herpesinfektion, 7,8 % durch eine Bindehautentzündung und 4,8 % durch eine Harnwegsinfektion betroffen. Für die infektiösen Kinderkrankheiten wurden folgende Lebenszeitprävalenzen ermittelt: Keuchhusten 8,7 %, Masern 7,4 %, Mumps 4,0 %, Röteln 8,5 %, Windpocken 70,6 %, Scharlach 23,5 %. Verschiedene chronische somatische Erkrankungen im Kindes- und Jugendalter weisen unterschiedliche Lebenszeitprävalenzen auf. Am häufigsten sind Kinder und Jugendliche von obstruktiver Bronchitis (13,3 %), Neurodermitis (13,2 %) sowie Heuschnupfen (10,7 %) betroffen. Eine vom Arzt diagnostizierte Wirbelsäulenverkrümmung/Skoliose bzw. Asthma kommen jeweils bei 5,2 % bzw. 4,7 % der 0- bis 17-Jährigen vor. Die Lebenszeitprävalenzen der übrigen Krankheiten schwanken zwischen 0,14 % bei Diabetes mellitus und 3,6 % bei Krampfanfällen/epileptischen Anfällen. Die Ergebnisse liefern erstmals bundesweit repräsentative Aussagen zur Prävalenz von akuten/ansteckenden und chronischen Erkrankungen für das Kindes- und Jugendalter auf der Grundlage einer bevölkerungsrepräsentativen Stichprobe.AbstractIn the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which was conducted from 2003 to 2006, data on acute/infectious and chronic diseases were collected from a population-based sample of 17,641 subjects aged 0 to 17 years. The annual prevalence rates among acute diseases vary widely. Children and adolescents are most frequently affected by acute (infectious) respiratory conditions. 88.5 % of the surveyed children and adolescents experienced at least one episode of common cold within the last 12 months. Among the other acute respiratory infections, bronchitis and tonsillitis were the most frequently encountered conditions with 19.9 % and 18.5 %, respectively. The 12-month prevalence of otitis media and pseudocroup was 11 % and 6.6 %, respectively. 1.5 % of the children and adolescents experienced an episode of pneumonia. Apart from respiratory infections, gastrointestinal infections were very frequently stated as reasons for acute illness. Furthermore, 12.8 % of the children and adolescents experienced a herpetic infection, 7.8 % a conjunctivitis and 4.8 % a urinary tract infection. Lifetime prevalence rates of infectious diseases were as follows: pertussis 8.7 %, measles 7.4 %, mumps 4.0 %, rubella 8.5 %, varicella 70.6 %, scarlet fever 23.5 %. The various chronic somatic diseases in children and adolescents had different lifetime prevalence rates. Most frequently, children and adolescents were affected by obstructive bronchitis (13.3 %), neurodermatitis/atopic eczema (13.2 %) and hay fever (10.7 %). Scoliosis and asthma had been diagnosed by a doctor in 5.2 % and 4.7 % of subjects aged 0–17 years, respectively. The lifetime prevalence rates of the remaining diseases varied between 0.14 % for diabetes mellitus and 3.6 % for convulsions/epileptic fits. For the first time ever, these survey results provide nationwide representative information on the prevalence rates of acute/infectious and chronic diseases in children and adolescents which is based on a population-representative sample.

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.

Reference Values for Nocturnal Home Polysomnography in Primary Schoolchildren

Abbreviated home polysomnography may be an alternative to laboratory polysomnography in children but is not yet generally accepted, partly due to a lack of reference values. Also, there are no normative data on respiratory events obtained using nasal prongs. We determined the prevalence and frequency of central, obstructive, and mixed apneas and hypopneas in a population-based sample of 50 children (mean age 10.1 years) using abbreviated home polysomnography and nasal prongs. We also determined the frequency of movements/arousals and body position changes. All children had central apneas. Obstructive apneas, mixed apneas, and hypopneas were found in 36%, 6%, and 14% of children, respectively. Average number of central, obstructive, and mixed apneas; hypopneas; movement/arousals; and body position changes per hour of sleep was 1.5, 0.1, 0.01, 0.02, 8.2, and 3.7, respectively. The corresponding cutoff values (mean plus 2 standard deviations or 95th centile) were 3.7, 0.7, 0.1, 0.2, 13.4, and 9.1, respectively. We did not find significant gender differences regarding any sleep variable under study. The presented reference values may help clinicians and researchers to improve the interpretation of abbreviated home polysomnography in school-age children.

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.