A super-spreading ewe infects hundreds with Q fever at a farmers' market in Germany.

BACKGROUND: In May 2003 the Soest County Health Department was informed of an unusually large number of patients hospitalized with atypical pneumonia. METHODS: In exploratory interviews patients mentioned having visited a farmers' market where a sheep had lambed. Serologic testing confirmed the diagnosis of Q fever. We asked local health departments in Germany to identify notified Q fever patients who had visited the farmers market. To investigate risk factors for infection we conducted a case control study (cases were Q fever patients, controls were randomly selected Soest citizens) and a cohort study among vendors at the market. The sheep exhibited at the market, the herd from which it originated as well as sheep from herds held in the vicinity of Soest were tested for Coxiella burnetii (C. burnetii). RESULTS: A total of 299 reported Q fever cases was linked to this outbreak. The mean incubation period was 21 days, with an interquartile range of 16-24 days. The case control study identified close proximity to and stopping for at least a few seconds at the sheep's pen as significant risk factors. Vendors within approximately 6 meters of the sheep's pen were at increased risk for disease compared to those located farther away. Wind played no significant role. The clinical attack rate of adults and children was estimated as 20% and 3%, respectively, 25% of cases were hospitalized. The ewe that had lambed as well as 25% of its herd tested positive for C. burnetii antibodies. CONCLUSION: Due to its size and point source nature this outbreak permitted assessment of fundamental, but seldom studied epidemiological parameters. As a consequence of this outbreak, it was recommended that pregnant sheep not be displayed in public during the 3rd trimester and to test animals in petting zoos regularly for C. burnetii.

Salmonella agona outbreak from contaminated aniseed, Germany.

A nationwide outbreak of Salmonella Agona caused by aniseed-containing herbal tea occurred from October 2002 through July 2003 among infants in Germany. Consumers should adhere strictly to brewing instructions, although in exceptional cases this precaution may not be protective, particularly when preparing tea for vulnerable age groups.

[The use of macrolides, lincomycin and tiamulin as animal feed drugs for pigs in Schleswig-Holstein]. / Zum Einsatz von Makroliden, Lincomycin und Tiamulin in Fütterungsarzneimitteln für Schweine in Schleswig-Holstein.

An evaluation of production orders for medicated feedingstuffs for pigs given in 1998 in Schleswig-Holstein showed macrolides, lincomycin and tiamulin as frequently used antibiotical ingredients. The presented study analyses the production orders which include macrolides, lincomycin or tiamulin in more detail. There were large deviations to the rules of good clinical practise for the use of antibiotics (2000). The applied dosage was often lower than suggested in the literature.

[The use of sulfonamides and sulfonamide/trimethoprim combinations as animal feed drugs for pigs in Schleswig-Holstein]. / Zum Einsatz von Sulfonamiden und Sulfonamid/Trimethoprim-Kombinationen in Fütterungsarzneimitteln für Schweine in Schleswig-Holstein.

An evaluation of production orders for medicated feedingstuffs for pigs given in 1998 in Schleswig-Holstein showed sulphonamides and combinations of sulphonamides and trimethoprim as frequently used antibiotical ingredients. The presented study analyses the production orders which include sulphonamides and combinations of sulphonamides and trimethoprim in more detail. There were large deviations to the rules of good clinical practise for the use of antibiotics. The applied dosage was often lower than suggested in the literature.

[The use of aminoglycosides, colistin and beta-lactam antibiotics as animal feed drugs for pigs in Schleswig-Holstein]. / Zum Einsatz von Aminoglykosiden, Colistin und beta-Laktam-Antibiotika in Fütterungsarzneimitteln für Schweine in Schleswig-Holstein.

An evaluation of production orders for medicated feedingstuffs for pigs given in 1998 in Schleswig-Holstein showed aminoglycosides, colistin and beta-lactam antibiotics as regularly used antibiotical ingredients. The presented study analyses the production orders which include these antibiotics more in detail particularly with regard to the prescribed dosages. In part, there were deviations to the rules of good clinical practise for the use of anitbiotics. The applied dosage of spectinomycin and apramycin was often lower than suggested in the literature. The low oral bioavailability of amoxicillin was not considered when using amoxicillin in medicated feedingstuffs.

[The occurrence of Echinococcus multilocularis in red foxes in lower Saxony: identification of a high risk area by spatial epidemiological cluster analysis]. / Zum Vorkommen von Echinococcus multilocularis bei Rotfüchsen in Niedersachsen: Identifikation eines Hochrisikogebietes mit Methoden der räumlichen epidemiologischen Clusteranalyse.

There is considerable interest in the spatial distribution of Echinococcus multilocularis in red foxes (Vulpes vulpes L.), because this parasite causes the zoonoses of alveolar echinococcosis which is potentially of high fatality rate. High risk areas are known from France, Switzerland and the Swabian Alb in Germany for a long time. In this work, the spatial scan statistic is introduced as an instrument for identification and localisation of high risk areas, so called disease clusters in spatial epidemiology. The use of the spatial scan statistic along with data about the distribution of the parasite in 5365 red foxes in Lower Saxony, that were collected during 1991 to 1997, led to the identification of another high risk area. The relative risk for this disease cluster is approximated by RR = 5.03 (CI0.95(RR) = [4.27; 6.58]) for the period of 1991 to 1994 and by RR = 4.45 (CI0.95(RR) = [3.53; 5.59]) for the period of 1994 to 1997, respectively.

Calculating sample size bounds for logistic regression.

The calculation of a study's required sample size is one of the most important aspects of the validity of an epidemiological study. Logistic regression often is used in modelling in epidemiology. A simplified method to calculate the sample size for the multiple logistic-regression model was proposed by Hsieh et al. [Stat. Med. 17 (1998) 1623]. The approach for estimating the sample size is described and then applied in the planning of an epidemiological cross-sectional study of the associations of different risk factors with Toxoplasma infection among pregnant women. Although the method demands some additional information which is often difficult to obtain, it is a very useful tool in veterinary epidemiology.