Prevalence and Medications of Atopic Dermatitis in Germany: Claims Data Analysis.

BACKGROUND: Information on the prevalence of atopic dermatitis (AD) varies greatly, and so far, only a few studies describe the healthcare of patients with AD in Germany. OBJECTIVE: The aim of the study is to describe the prevalence and medications of people with AD in Germany. METHODS: Health insurance data for the year 2019 were examined. Prevalence rates, the severity of disease, comorbidities and pharmaceutical supply were analyzed. Insured persons with AD were identified with at least one outpatient or inpatient International Classification Code of Diseases (L20). RESULTS: In 2019, 4.21% [95% CI 4.21-4.22%] of insured persons had AD (3.6 million). Women were affected slightly more frequently than men (4.74% [95% CI 4.73-4.74%] and 3.64% [95% CI 3.64-3.65%]). Adolescents and children under the age of 15 had the highest prevalence of AD compared to other age groups (9.44% [95% CI 9.42-9.46%]). Majority of the insured persons with AD were affected by a mild to moderate form of the disease. The most common co-morbidity was infections of the skin (RR 5.00 [95% CI 4.97-5.02%]). Some patients were treated by a dermatologist, while others by a general practitioner, 39.10% and 36.74%, respectively. Of the anti-inflammatory drugs, systemic glucocorticosteroids preparations were used most frequently and were most frequently prescribed by the general practitioner. With a total of 42,841 prescriptions (1.53%), methotrexate (third-line treatment option) was prescribed more frequently than ciclosporin with 19,628 prescriptions (0.70%) or azathioprine with 25,696 prescriptions (0.92%). Ciclosporin (first-line treatment option) was prescribed much more frequently by a dermatologist (44.00% versus 14.32% by general practitioner). The biological dupilumab was prescribed 30,801 times (1,10%) and was also primarily prescribed by a dermatologist (66.67%). CONCLUSION: The present results reveal that a specialist treats approximately one-third of the patients with AD and that there is still a drug undersupply in some cases, especially concerning innovative drugs.

Laboratory investigations of vaccinated patients with varicella.

BACKGROUND: Accompanying varicella vaccination in children in Germany recommended with one (2004) and two (2009) doses, sentinel surveillance of varicella with a sample (n∼900) of private physicians was established in 2005. Physicians reported monthly aggregated data on all varicella cases and case-based on vaccinated patients, of whom skin lesion samples were laboratory investigated to identify varicella-zoster virus (VZV). We analyzed the impact of vaccination frequency on the number of cases and on laboratory results within the sentinel. METHODS: Swabs were obtained with a Teflon tip and sent together with a case-based questionnaire to the reference laboratory. VZV wild-type and vaccine-type was identified by polymerase chain-reaction (PCR) and pyrosequencing methods. Case-based data and laboratory results were analyzed descriptively. RESULTS: From April 2005 to March 2014, of all monthly reported cases (n=111,456) 4789 were vaccinated and eligible for further analysis. No differences were found between laboratory investigated and not investigated cases (1017 vs. 3772) except that the proportion of cases vaccinated twice was higher in lab-cases (29.4% vs. 16.1%). PCR remained negative in 69.6% (197/283) of breakthrough-cases vaccinated twice, in comparison to 22.7% (147/649) breakthrough-cases vaccinated once. VZV was confirmed in 500 (81) patients with breakthrough varicella after one (two) vaccination(s); identification of VZV wild-type, vaccine-type, or no further differentiation was possible in 485 (72), 5 (6), and 10 (3) cases, respectively. CONCLUSION: Varicella breakthrough disease is rare in Germany and suspected clinical cases require laboratory confirmation. The lower confirmation rate of VZV after two vaccine doses suggests a better protection compared to one dose.

Hospitalization with varicella and shingles before and after introduction of childhood varicella vaccination in Germany.

In Germany, one dose of varicella vaccination has been recommended for children aged <24 months since 2004, and 2 doses have been recommended since 2009. Vaccination coverage (VC) is above 80% for one dose and 60% for 2 doses. In this study, data on varicella- and shingles-associated hospitalizations before and after vaccine introduction were assessed. Based on ICD-coded data of the main diagnosis of hospitalized cases from 1995-2012 in Germany, annual age-adjusted and age-specific hospitalization incidences (cases/100,000; HI) were calculated. HI means 1995-2003 (pre-vaccination-period) versus 2005-2012 (post-vaccination-period) were compared. Age-specific trends and annual percentage change rates (APC) were assessed by joinpoint regression. Overall age-adjusted varicella-HI decreased from 3.3/100,000 pre-vaccination to 1.9/100,000 post vaccination. The decline was greatest in regions with the highest VC. The post-vaccination decline was greatest in children aged <1, 1-4, and 5-9 y, who had APCs of -18.2,-27.2 and -15.2, respectively, and significant joinpoints. In all other age groups no post-vaccination joinpoints were detected or they did not lead to a consistent trend. Age-adjusted shingles-HI increased from 8.8/100,000 (1995) to 16.8/100,000 (2012). Shingles-HI increased in all age groups with no significant post-vaccination joinpoints, except in children<1 and 1-4 y, where APCs of -5.6 and -3.6 were detected. Varicella vaccination significantly reduced varicella-HI in children below 10 y, but was not definitely related to varicella-HI in older age groups. A consistent increase of shingles-HI began before varicella vaccination was introduced and was not affected by vaccination.