Surveillance of Lyme borreliosis in Germany, 2002 and 2003.

Lyme borreliosis is a potentially serious infection common in Germany, but little data about its incidence, distribution, and clinical manifestations are available. Lyme borreliosis is not a notifiable disease in Germany, but six of Germany's 16 states - Berlin, Brandenburg, Mecklenburg-Vorpommern, Sachsen, Sachsen-Anhalt and Thüringen, have enhanced notification systems, which do include Lyme borreliosis. The efforts made in these states to monitor confirmed cases through notification are therefore an important contribution to understanding the epidemiology of Lyme borreliosis in Germany. This report summarises the analysis of Lyme borreliosis cases submitted to the Robert Koch-Institut during 2002-2003. The average incidence of Lyme borreliosis of the six East German states was 17.8 cases per 100,000 population in 2002 and increased by 31% to 23.3 cases in 2003, respectively. Patient ages were bimodally distributed, with incidence peaks among children aged 5- 9 and elderly patients, aged 60- 64 in 2002, and 65- 69 in 2003. For both years, 55% of patients were female. Around 86% of notified cases occurred from May to October. Erythema migrans affected 2697 patients (89.3%) in 2002 and 3442 (86.7%) in 2003. For a vector-borne disease, like Lyme borreliosis, the risk of infection depends on the degree and duration of contact between humans and ticks harbouring Borrelia burgdorferi. As infectious ticks probably occur throughout Germany, it is likely that the situation in the remaining 10 German states is similar to that of the states in this study.

Surveillance of Lyme borreliosis in Germany, 2002 and 2003.

Lyme borreliosis is a potentially serious infection common in Germany, but little data about its incidence, distribution, and clinical manifestations are available. Lyme borreliosis is not a notifiable disease in Germany, but six of Germany's 16 states - Berlin, Brandenburg, Mecklenburg-Vorpommern, Sachsen, Sachsen-Anhalt and Thüringen, have enhanced notification systems, which do include Lyme borreliosis. The efforts made in these states to monitor confirmed cases through notification are therefore an important contribution to understanding the epidemiology of Lyme borreliosis in Germany. This report summarises the analysis of Lyme borreliosis cases submitted to the Robert Koch-Institut during 2002-2003. The average incidence of Lyme borreliosis of the six East German states was 17.8 cases per 100 000 population in 2002 and increased by 31% to 23.3 cases in 2003, respectively. Patient ages were bimodally distributed, with incidence peaks among children aged 5- 9 and elderly patients, aged 60- 64 in 2002, and 65- 69 in 2003. For both years, 55% of patients were female. Around 86% of notified cases occurred from May to October. Erythema migrans affected 2697 patients (89.3%) in 2002 and 3442 (86.7%) in 2003. For a vector-borne disease, like Lyme borreliosis, the risk of infection depends on the degree and duration of contact between humans and ticks harbouring Borrelia burgdorferi. As infectious ticks probably occur throughout Germany, it is likely that the situation in the remaining 10 German states is similar to that of the states in this study.

[Epidemiology and clinical symptomatology of Creutzfeldt-Jakob disease]. / Epidemiologie und klinische Symptomatik der Creutzfeldt-Jakob-Krankheit.

OBJECTIVE: Analogous to prospective studies in other countries, prevalance and symptoms of sporadic Creutzfeldt-Jakob disease (CJD) were recorded in order to assess irregularities in the incidence of the disease in Germany since the onset of bovine spongioform encephalopathy (BSE). PATIENTS AND METHODS: SInce 1993 all suspected case of CJD reported in the Federal Republic of Germany have been analysed by a unified schema and classified by standardised criteria. In addition to voluntary reporting two other systems were accessed: (1) compulsory reporting to the Robert Koch Institute via the appropriate Health Department and (2) cause of death statistics of the Federal Office of Statistics. RESULTS: Between June 1993 and May 2001, a total of 1247 patients with suspected CJD, obtained by the angle quotation mark, rightStudy of the epidemiology and early diagnosis of human spongioform encephalopathiesangle quotation mark, left at Göttingen University, were examined. The suspected disease was confirmed by autopsy in 404 cases, the diagnosis of probable CJD was made in 369 cases on the basis of clinical data and additional investigation. At the beginning of the Göttingen Study in 1993 the incidence in Germany was 0.7 per mill. population, while in the year 2000 it had risen to 1.3 per mill. population. Corresponding increases in the number of cases since 1993 have been noted also by the Robert Koch Institute and the Federal Office of Statistics. CONCLUSIONS: The increased incidence can be explained primarily by a decrease in previously unknown cases. Concerted action as part of the Göttingen Study has increased the cooperation of associated clinics. In addition to sporadic cases of CJD, genetic and, more rarely, iatrogenic forms have been seen in Germany. But no cases of new variant CJD have been reported so far.

Radioiodine therapy during an unknown remained pregnancy and radiation exposure of the fetus. A case report.

PURPOSE: A papillary thyroid cancer staged as p T2N3M0 was treated in a 28-year-old woman by surgery, percutaneous radiation and radioiodine therapy (10 single applications ranging from 3300 to 3840 MBq with an average radioactivity of 3350 MBq). In the course of radioiodine therapy an attended gynaecologist found the woman pregnant in the 24th week of gravidity. Because the pregnancy remained unknown until this time radioiodine was administered during the 2nd and the 22nd week of pregnancy, each time 3700 MBq. Because of the risk of malformations this pregnancy was interrupted after consultation and taking the recommendations of the so-called Danish rule as a basis for the decision. METHODS: Ovarian and fetal doses as well as the fetal thyroid exposure has been estimated as exactly as possible using data at hand. The fetus was studied with regard to possible consequences of radiation exposure by pathologico-anatomical, cytogenetic and radiobiological methods. RESULTS: The accumulated ovarian doses resulting from the radioiodine administrations before pregnancy was estimated to 2200 mGy, the fetal doses resulting from the two administrations during pregnancy to 250 mGy in each case, and the fetal thyroid dose to between 90 Gy and 900 Gy for the 2nd therapy during pregnancy. In the fetus the most important changes were found within the thyroid gland (atrophy, sclerosis, subcapsular interstitial fibrosis, necrobiosis of follicular epithelial cells). On the other hand, analysing the karyotype using dermal fibroblastic cell cultures, no radiation induced chromosomal aberrations were seen. CONCLUSION: Despite of all precautionary measures it seems to be conceivable that in extremely rare cases--in our 35-year experience with more than 20,000 radioiodine therapies only the present case--an early pregnancy may remain undetected. The results of these studies give useful information on effects to be expected as a result of radioiodine application during certain periods of pregnancy. They may help to extend the radiobiological knowledge with regard to the fetal period.

[Occupational and non-occupational effects of asbestos]. / Uber berufliche und ausserberufliche Asbestwirkungen.

Forty-eight cases of mesothelioma from the National Cancer Register, and 19 cases of pleural plaques were investigated for non-occupational exposure to asbestos, and compared with results obtained in earlier studies on occupational asbestos-induced lesions. The results of the investigation confirmed reports in the literature indicating that even in the non-occupational area, asbestos represents a non-negligible risk, in particular for diseases of the lungs. Individual causes proved to be the cleaning by members of the family of working clothes contaminated with asbestos in 46% of the cases, followed by the use of asbestos-containing materials in the household (20.9%) or in connection with leisure activities (14.9%). In addition, exposure to asbestos fibre emissions of people living close to an asbestos-processing plant were observed. Recognition of the condition as an occupation-related disease is not possible. The consequence to be drawn from these data is that, in accordance with present regulations, the use of asbestos-free materials in the home and in the area of leisure activities must be promoted. In this way, such lesions can be avoided in the future.

[Malignant tumors of the lung and bronchi in children and adolescents. 2. Analysis of 66 cases of the East German National Cancer Registry (1961-1985)]. / Maligne Tumoren von Lunge und Bronchien bei Kindern und Jugendlichen. 2. Mitteilung: Analyse von 66 Fällen aus dem Nationalen Krebsregister der DDR (1961-1985).

In the National Cancer Registry of the GDR from 1961 to 1985 only 66 cases malignant (and semimalignant) tumors of the bronchi and lung in patients under 20 years of age were collected. These amounted to 0,037 per cent of all tumor cases of this localization. These tumors affected 37 boys and 29 girls. Tumors of mesenchymal origin prevailed (32 cases = 48.4 per cent) in comparison to those of epithelial (37.8 per cent) and embryonal origin (10.7 per cent). Among these cases were 10 bronchial carcinomas and 10 bronchial adenomas. 51.5 per cent of all patients died in the clinic. Less than half of the patients were due to adequate therapy discharged free of any tumor. Data about the late prognosis of these patients were not available.

[Malignant neoplasms of the breast and female genital organs and carcinoma in situ of the uterine cervix in East Germany 1986. Statistical data of the national cancer register]. / Bösartige Neubildungen der Mamma und der weiblichen Geschlechtsorgane sowie Carcinomata in situ der Cervix uteri in der DDR im Jahre 1986. Statistische Angaben aus dem Nationalen Krebsregister.

29,105 cases of cancer in the female population of the GDR have been registered 1986. The five most frequent localizations (breast, colon, uterine cervix, stomach, uterine corpus) had 15,130 cases (53.1%). The number of breast cancers continuously increased, whereas since the seventies a decrease of female genital cancers could be observed. 44 per cent of all cancers in the female had to be correlated to breast and genital organs. 96 per cent of cancers of breast and genital organs were histologically proved. More than 67 per cent of tumors of this group could be allotted to stage I or II. Cancers of breast and female genital organs participated with 5,883 deaths e.g. 33.2% of all female cancer deaths in the GDR 1986.

[Lung cancer in the DDR with special reference to histological types and cigarette consumption]. / Lungenkrebs in der DDR unter besonderer Berücksichtigung der histologischen Typen und des Zigarettenkonsums.

By an analysis in detail of incidences of lung cancer of the years 1971 to 1984 and of the data of consumption of cigarettes per head in GDR during the years 1960 to 1984 we discussed the further trends of morbidity and mortality in lung cancer in our country. We pointed out: 1. From 1972 to 1985 the mortality of lung cancer in males dropped from 6,023 per year to 5,213, while that of females increased from 698 to 959. 2. In the time from 1971 to 1983 the over-all incidence (crude rates) of lung cancer in males decreased from 87.1 per 100,000 to 75.5 per 100,000, but came up to 77.2 per 100,000 in 1984. The females rose from 9.7 to 12.3 per 100,000 in the same interval. 3. The age related incidences showed different courses not regarding the different levels of both sexes. In the age group of 30-59 we found a significant incidence rise. The incidence of the 60-69 year old males dropped in a range of 10%; that of the females with the same age had an undulating course with rising trend. Males and females of an age of 70 years and older also had an undulating course with increasing trend. 4. Between 1970 and 1979 the proportions of histological types moved. The adenocarcinomas of males rose significantly from 10.0 to 12.6% and that of large cell carcinomas from 3.6 to 6.0%. In the females the proportions of large cell cancers rose also from 4.2 to 7.5%. 5. The histological types of lung cancer have a significant age relation: Undifferentiated cancers and adenocarcinomas decrease with the age while proportions of squamous cell cancers rise with the age. 6. During 1960 to 1969 the market share of filter cigarettes changed from less than 10% to 79% and rose to 91% until 1975. In the same time the cigarette consumption per head of population increased continuously until now (1984: consumption of cigarettes per head 1,845). 7. In the age group of 18-25 the proportions of smokers is 50% and their middle consumption of cigarettes per day amounts to 11 cigarettes. In the age group of 45-55 the proportion of smokers runs to 34% and their cigarette consumption per day comes to 15 cigarettes. The proportion of male smokers amounts to 47%. The proportion of female smokers amounts to 18%.(ABSTRACT TRUNCATED AT 400 WORDS)

A mortality study of a cohort of slate quarry workers in the German Democratic Republic.

Following reports from other countries indicating an excess risk of lung cancer among silicotics, a historical cohort of workers employed for at least one year at a company in charge of slate extraction and processing during the period 1953-1985 in the German Democratic Republic has been constructed and followed up for mortality from 1970 to 1985. The results of the study show a mortality excess for infectious and respiratory diseases. The overall lung cancer mortality is not in excess but shows a tendency to increase with time since first exposure. A mortality excess from lung cancer is concentrated among workers receiving compensation for silicosis, suggesting a possible carcinogenic risk for individuals suffering from this pathological condition.

[Malignant neoplasms of the breast and female genital organs in East Germany in 1985. Statistical data of the National Cancer Register]. / Bösartige Neubildungen der Mamma und der weiblichen Geschlechtsorgane in der DDR im Jahre 1985. Statistische Angaben aus dem Nationalen Krebsregister.

29,288 cases of cancer in the female population of the GDR have been registered 1985. The five most frequent localizations (breast, uterine cervix, colon, stomach, uterine corpus) had 15,297 cases (53.6%). The number of breast cancers continuously increased, whereas since the seventies a decrease of female genital cancers could be observed. 44 per cent of all cancers in the female had to be correlated to breast and genital organs. 88 per cent of all tumours were histologically proved. More than 50 per cent of all cases could be alloted to stage I or II. Cancers were the with 17,952 deaths the second by frequency reason of death in the GDR 1985 following cardiovascular cause.

[Integration of malignant tumors of the head and neck region into the strategy of cancer control in the GDR]. / Einordnung maligner Geschwülste des Kopf-Hals-Gebietes in die Strategie der Krebsbekämpfung der DDR.

Mainly caused by an increase of carcinomas of the mouth and of the pharynx, the incidence of malignant tumours of the head and neck increased continuously, the incidence of these tumours has doubled in males. During the last twenty years, the age distribution clearly points the younger group of patients. In addition, the percentage of advanced tumours stages III and IV are increased. A more unfavourable prognosis with an increased mortality results despite of improved therapeutic techniques. The ways how to influence this development are discussed to reach the same positive situation as in total cancer treatment in the GDR.

Trends and patterns in lung cancer incidence in four cities of Eastern Europe, 1971-1980.

The trends of age-adjusted and age-specific lung cancer incidence rates showed over the period of 1971-1980 substantial differences in four selected towns of Eastern Europe. The downward age-adjusted trends in males coincided in Berlin with the possible beginning of their downturn in the whole country, while their decline in both sexes in Bratislava could be related to the change of demographis factors. In the other two towns studied--Cracow and Tallinn--the substantial increase of lung cancer incidence in males corresponded with the similar evolution in both respective countries (Poland and Estonia). The rising trends in females in both mentioned towns could be more or less compared with their dramatic increase in some developed countries. The rising trends of age-specific rates in younger age groups of males do not indicate meanwhile the positive influence of low-tar or filter-tipped cigarettes on lung cancer incidence in males observed recently in some countries.

Risk of leukaemia in ovarian tumour and breast cancer patients following treatment by cyclophosphamide.

A case-control study was conducted to determine whether the development of leukaemia was associated with chemotherapy for neoplasms of the ovary or breast, in a population where most such chemotherapy consisted of cyclophosphamide alone. Cases and controls were identified from the National Cancer Registry of the German Democratic Republic. Cases were women who had developed leukaemia as a second primary after an initial diagnosis, at least one year before, of an ovarian or breast tumour. Controls were patients with an ovarian tumour or breast cancer who had survived to the year when the case developed a leukaemia but who had not themselves developed a second malignancy. Controls were matched to cases by the site of the first primary and its year of diagnosis, as well as year of birth. The relative risk for acute leukaemia following treatment with cyclophosphamide alone was significantly elevated (P less than 0.05), at 14.6 for ovarian tumour patients and 2.7 for breast cancer patients. Among breast cancer patients the increased risk of leukaemia associated with chemotherapy was confined to women who had been under 50 years of age at the time of diagnosis of the breast cancer (for whom the relative risk was 13.1). No excess risk of leukaemia was observed in association with radiotherapy for either ovarian or breast cancer patients. The present findings strongly suggest that cyclophosphamide as a single chemotherapeutic agent is capable of inducing leukaemia in humans.

A case-control study of leukaemia as a second primary malignancy following ovarian and breast neoplasms.

The National Cancer Registry of the German Democratic Republic identified 105 leukaemias which had developed during 1968-1980 as second primary malignancies in women previously registered with a tumour of the breast or ovary. Matched controls were selected who had been diagnosed with the same first tumour, but had survived without further malignancy as long as the corresponding case. Treatment records were abstracted for leukaemia cases and controls, and a comparison made of the therapy received. There was a ten-fold increase in the risk of leukaemia following ovarian cancer among those treated with chemotherapy, which was almost exclusively cyclophosphamide. Among the breast cancer survivors, the relative risk of acute leukaemia associated with cyclophosphamide was 2.7.

[Epidemiology of colorectal tumors with special reference to the status in East Germany]. / Zur Epidemiologie der kolorektalen Tumoren unter besonderer Berücksichtigung der Situation in der DDR.

Colorectal cancers are a major cause of morbidity and mortality in the GDR and affect almost 3% of the population by age 75. The age-standardized incidence rate has increased and this probably reflects a true rise in the frequency of carcinomas of these sites. At the beginning of the treatment only 42% were in a sufficiently localized stage of the disease so that curative radical surgery might be attempted. Such operations are widely decentralized in the GDR. Only 15% of all patients were alive 5 after treatment was initiated.