Background
Reliable data on the adult SARS-CoV-2 infection fatality rate in Germany are still scarce. We performed a federal state-wide cross-sectional seroprevalence study named SaarCoPS, that is representative for the adult population including elderly individuals and nursing home residents in the Saarland.
Methods
Serum was collected from 2940 adults via stationary or mobile teams during the 1st pandemic wave steady state period. We selected an antibody test system with maximal specificity, also excluding seroreversion effects due to a high longitudinal test performance. For the calculations of infection and fatality rates, we accounted for the delays of seroconversion and death after infection.
Results
Using a highly specific total antibody test detecting anti-SARS-CoV-2 responses over more than 180 days, we estimate an adult infection rate of 1.02% (95% CI: [0.64; 1.44]), an underreporting rate of 2.68-fold (95% CI: [1.68; 3.79]) and infection fatality rates of 2.09% (95% CI: (1.48; 3.32]) or 0.36% (95% CI: [0.25; 0.59]) in all adults including elderly individuals, or adults younger than 70 years, respectively.
Conclusion
The study highlights the importance of study design and test performance for seroprevalence studies, particularly when seroprevalences are low. Our results provide a valuable baseline for evaluation of future pandemic dynamics and impact of public health measures on virus spread and human health in comparison to neighbouring countries such as Luxembourg or France.
In Germany, the incidence of cervical cancer, a disease caused by human papillomaviruses (HPV), is higher than in neighboring European countries. HPV vaccination has been recommended for girls since 2007. However, it continues to be significantly less well received than other childhood vaccines, so its potential for cancer prevention is not fully realized. To find new starting points for improving vaccination rates, we analyzed pseudonymized routine billing data from statutory health insurers in the PRÄZIS study (prevention of cervical carcinoma and its precursors in women in Saarland) in the federal state Saarland serving as a model region. We show that lowering the HPV vaccination age to 9 years led to more completed HPV vaccinations already in 2015. Since then, HPV vaccination rates and the proportion of 9- to 11-year-old girls among HPV-vaccinated females have steadily increased. However, HPV vaccination rates among 15-year-old girls in Saarland remained well below 50% in 2019. Pediatricians vaccinated the most girls overall, with a particularly high proportion at the recommended vaccination age of 9–14 years, while gynecologists provided more HPV catch-up vaccinations among 15-17-year-old girls, and general practitioners compensated for HPV vaccination in Saarland communities with fewer pediatricians or gynecologists. We also provide evidence for a significant association between attendance at the children´s medical check-ups “U11” or “J1” and HPV vaccination. In particular, participation in HPV vaccination is high on the day of U11. However, obstacles are that U11 is currently not financed by all statutory health insurers and there is a lack of invitation procedures for both U11 and J1, resulting in significantly lower participation rates than for the earlier U8 or U9 screenings, which are conducted exclusively with invitations and reminders. Based on our data, we propose to restructure U11 and J1 screening in Germany, with mandatory funding for U11 and organized invitations for HPV vaccination at U11 or J1 for both boys and girls.
Background
Spring waters, which are fed mainly by near-surface groundwater, provide a comprehensive picture of emissions of nitrate and other pollutants caused by the type and intensity of land use in the topographic catchment area. One aim of this study was to develop a model for predicting the contribution of nonpoint-source inputs to the nitrate load of small- and medium-sized watercourses based on the type of agricultural use in the catchment areas.
Methods
Fifty-five springs in the German Land Saarland and the adjacent Rhineland-Palatinate were monitored for pollutants during three monitoring periods of at least 12 months between 2000 and 2019. The catchment areas are representative of the natural regions in the study area and are outside the influence of settlements and other developments. In addition to nitrate and other physicochemical parameters, 25 agriculturally impacted springs were screened for pesticides and their metabolites.
Results
Since the first measurements were taken in 2000, the vast majority of agriculturally impacted springs have consistently exhibited high nitrate concentrations of between 20 and 40 mg/L NO3−. Springs not influenced by agriculture contained an average of 3.6 mg/L nitrate. The extreme values observed in the early 2000s decreased to the limit value of 50 mg/L, but most of the springs with moderate levels exhibited an increase to approximately 30 mg/L. The number of pesticidal agents detected in the spring waters demonstrated a clear correlation with the watershed’s amount of arable land and the nitrate content detected. Moreover, we found a highly significant correlation between nitrate content and the share of cropland in the catchment area. From this, we derived a regression model that could be used to quantify the share of nitrate pollution attributable to nonpoint-source inputs for larger catchments in the region under investigation.
Conclusion
Nitrate discharged from farmland has not decreased since the European Water Framework Directive (EU WFD) entered into force. At the historically extremely heavily polluted sites, measures have been implemented that have led to compliance with the limit value of the Nitrate Directive. However, below this limit, nitrate levels have increased significantly almost everywhere in the last two decades. We therefore recommend introducing stricter requirements for official water pollution control, such as the marine ecological target value.
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