[Evaluation of tuberculosis control in the region of the former East Germany 1945-1990]. / Bilanz der Tuberkulosebekämpfung auf dem Gebiet der ehemaligen DDR 1945-1990.

During the forty years of existence of the German Democratic Republic (GDR) tuberculosis decreased continuously. The incidence of all types of tuberculosis decreased from 567.6 cases per 100,000 inhabitants in 1949 to 17.3 cases in 1989. During the same time the mortality rate dropped from 148.3 cases of tuberculosis deaths per 100,000 men and 74.7 cases per 100,000 women in 1949 to 1.2 respectively 0.8 death cases 1989. In the 'eighties the yearly reduction rates slowed down. Characteristics of the epidemiologic situation in this last decade were: very low incidence rates in children--varying between 0.6 and 1.1 per 100,000 persons of the age group 0-15ys, with increasing incidence rates in persons of advanced age, an unequal regional and territorial distribution of the disease and a raised proportion of immigrants and persons with alcoholism. Whereas with this epidemiological situation the GDR was in a top position compared to the other East European countries, it was in a fair-to-middling position among the European countries as a whole. The attained level could be reached by a centralistic structure and by a consequent application of a modern most fully supervised chemotherapy. However, it must be stated retrospectively that the general BCG vaccination of the newborn and school leavers, which was continued until 1990, had already lost its effectivity and should be replaced earlier by a vaccination of the risk groups.

[Tuberculosis relapses in East Germany--a community related retrograde analysis 1984-1986]. / Tuberkulose-Rückfallerkrankungen in der DDR--eine kommunitätsbezogene retrograde Analyse der Jahre 1984-1986.

Basing on a retrospective analysis of 169 cases of relapses of tuberculosis that had been confirmed by bacteriological examinations, we explored possible causes and/or factors favouring a relapse. 6.5% of the mycobacteria cultivated when the relapse was discovered, were resistant to one antibiotic, and 5.3% to two ore more antibiotics. On treating the previous disease, side effects were seen in 31.6%, in 22.3% chemotherapy of the previous disease had been insufficient in respect of duration and/or continuity and/or combination, and in 22.5% the intake of drugs had lacked controlled supervision. In 56% of the relapses there were concomitant diseases (alcoholism in 24.5%, silicosis in 14.9%, diabetes mellitus in 9.7% and gastrointestinal diseases in 5.2%).

[Tuberculin sensitivity and tolerance of "direct" BCG vaccination of youths leaving school]. / Tuberkulin-Sensitivität und Verträglichkeit der "direkten" BCG-Impfung der Schulabgänger.

In 3,296 school-leavers (girls and boys aged 16 years with preceding BCG-vaccination as newborns and without boosting by tuberculin-testing or revaccination during the meantime) simultaneously with compulsory BCG-revaccination tuberculin testing with 2 TU PPD Dessau + Tween 80 was performed in 3 regions of the GDR (Cottbus, Erfurt, Neubrandenburg) in the 2nd half of 1985 and in the 1st quarter of 1986. Sensitivity to tuberculin was found in 7.3% considering reactions with greater than or equal to 6 mm induration as positive, and in 2.9% considering reactions with greater than or equal to 10 mm only. Positive reactions greater than or equal to 6 mm include remaining allergy caused by BCG and non-specific tuberculin sensitivity while a reaction limit greater than or equal to 10 mm is suitable to define tuberculosis infection prevalence. In contrast to studies performed 1973 and 1979 in the same territories a significant decrease in tuberculin sensitivity was evident (43.8% positive reactions (greater than or equal to 6 mm) in 1973 and 11.7% in 1979). The acceptability of "direct" BCG-revaccination has been estimated by evaluation of local reactions 4 weeks after vaccination in 2,123 school-leavers. The ulceration rate in tuberculin positive adolescents was significantly higher than in tuberculin negative. It showed highly significant decrease in comparison with 1979.

[Tuberculosis relapse in the GDR--causes and development]. / Tuberkulose-Rezidive in der DDR--Ursachen und Entwicklung.

In a cooperative study 169 bacteriologically confirmed tuberculosis relapses of the years 1984-1986 were analysed with regard of causes or relapse favouring factors. In 58.5% relapse occurred 3 or more years after cessation of previous treatment. Relapse was presumedly caused in 22.3% by inadequate chemotherapy (considering duration and/or continuation and/or combination), in 25% by alcoholism and in 14.9% by silicosis. Resistance to 2 or more antituberculotic drugs was found only in 5.3%. Advanced age and polymorbidity are relapse favouring factors. Consideration of adequate chemotherapy is the most important factor to avoid relapse.

[Tuberculosis control strategy after 1988]. / Tuberkulosebekämpfungsstrategie nach 1988.

The early detection of new cases of tuberculosis, especially such with positive sputum, and the application of potent chemotherapy aiming at an early and lasting elimination of potential infection sources are urgent requirements of the basic strategy to combat the disease. The case finding must mainly aim at patients with bronchopulmonary complaints lasting over 3 to 4 weeks. X-ray testing of the whole population is no longer necessary. It should be abandoned in favour of careful screening of well defined high-risk-groups. Bacteriological diagnostics and tuberculin testing are now of greater importance within the changing case-finding-strategy. Major changes of therapeutical principles are not to be expected. Generalized protection and isolation measures should be critically scrutinized and reduced to the strictly necessary. Until the final eradication of tuberculosis a generally acceptable strategy related to the dynamic is required.

[Recommendations for the therapy of atypical immunization courses and complications of BCG vaccination (Position: April, 1988)]. / Empfehlungen für die Therapie von atypischen Impfverläufen und Komplikationen der BCG-Impfung (Stand: April 1988).

After introduction of the "direct" BCG-vaccination of the 16 years old youngsters in 1981 a small increase of atypical reactions and complications of the vaccination was probable. References and experiences about different therapy methods of these atypical reactions and complications gave rise to recommend uniform guide-lines for definition, diagnostic and therapy.

[Specific and nonspecific tuberculin sensitivity in school children in East Germany. East German draft report of a multinational epidemiologic study of the prevalence of specific and nonspecific tuberculin sensitivity in Europe]. / Spezifische und unspezifische Tuberkulin-Sensitivität bei Schulkindern in der DDR. DDR-Teilbericht einer multinationalen epidemiologischen Studie über die Prävalenz spezifischer und unspezifischer Tuberkulin-Sensitivität in Europa.

By means of dual-testing with tuberculin (2 TU PPD RT 23 and 2 TE PPD Dessau) and sensitin Scrophulaceum (5 TU PPD scroph.) evidence and degree of specific and non-specific tuberculin sensitivity in schoolchildren aged 7-14 years was examined under the conditions of preceding BCG-vaccination as newborns in the counties of Cottbus, Erfurt and Neubrandenburg. In a cohort of 2,792 children sensitivity to tuberculin was found in 5.98% considering positive reactions with greater than or equal to 6 mm induration and in 1.50% considering reactions with greater than or equal to 10 mm only. Reactions with induration of 6 mm and more comprehend remaining allergy caused by BCG while the limit greater than or equal to 10 mm seems to be suitable to define tuberculosis infection prevalence. Tuberculin sensitivity shows frequencies corresponding with the epidemiology of tuberculosis. Sensitivity to PPD scroph. increases from north to south with significant difference between the counties of Neubrandenburg and Erfurt. Nonspecific tuberculin sensitivity is partly prevalent in the counties of Cottbus and Erfurt.

[Diagnostic value of various tuberculin preparations]. / Untersuchungen zur diagnostischen Wertigkeit verschiedener Tuberkulin-Präparationen.

Despite declining incidence of tuberculosis in developed countries importance of tuberculin testing has not subsided. Previous investigations of the equivalence of 7 tuberculin preparations from 6 countries to RT 23 have shown differences in the diagnostic value of the tuberculin preparations. The smallest rates of negative skin-reactions in cases with bacteriologically confirmed tuberculosis were found with the hungarian tuberculin PPD-5 TU (HU 5 TU) and RT 23. The national tuberculin PPD Dessau 2 TU showed highest rates of non-reactors in tuberculous patients. In 400 cases of active bacteriologically confirmed tuberculosis further investigations were carried out to compare biologic equivalence of RT 23, HU 5 TU, tuberculin PPD Dessau 2 TU and the test-preparation PPD Dessau 5 TU with and without Tween addition and 7.5 TU without Tween. The results showed that with increase of antigen concentration to 5 TE or 7.5 TU the smaller reactions of 6 to 10 mm could be strengthened with a small, statistically not significant, increase of the mean value of reaction size but no increase of larger reactions of more than 20 mm. The rate of false negative reactions decreased using the test-preparation PPD 7.5 TU. The results allow to recommend the production of a national tuberculin preparation with higher antigen concentration biologically equivalent to RT 23 or HU 5 TU.

[Reproducibility of bronchial provocative testing in bronchitis (author's transl)]. / Zur Reproduzierbarkeit von Testergebnissen bronchialer Reaktivitätsprüfungen bei Bronchitispatienten.

Bronchial reactivity was examined every 3 month in a follow-up study of 40 subjects mostly showing chronic nonspecific lung disease and all having bronchial hyperreactivity at the beginning of the study. Only 7 of them (17.5%) had constant hyperreactivity for the time of observation. There has been parallelism between test results and complaints in 72% of patients with chronic bronchitis and in 65.2% of the second group (mostly subjects with bronchitis). Seasons had no strong influence on bronchial reactivity. Bronchial provocative testing has proved as a valuabel method for verification of obstructive complaints. The test results shouldn't be interpreted without regarding clinical data. Using as a screening test a more detailed diagnostic and follow-up are necessary to avoid false and premature consequences. As to expert opinions and decisions on compensation the test results can correctly be interpreted only if reproducibility in the single case has been proved and if they are in agreement with the clinical signs and symptoms of the case.