¾«¶«´«Ã½

Berlin

GERMAN scientists are demanding a crash programme to strengthen the
country’s defences against infectious diseases. The country’s famed efficiency
in record keeping, they say, is almost entirely absent when it comes to
monitoring diseases such as hepatitis, salmonella poisoning and even measles.
Immunisation programmes have been neglected, data on the frequency of infectious
outbreaks are unreliable or nonexistent and when local outbreaks occur often
little effort is made to track down their source.

Later this year, the German government plans to introduce a law that will
require doctors to report all cases of infectious disease. A draft of the
proposed law will be released for public comment next month. Yet according to
Rüdiger Fock, head of infectious disease epidemiology at the Robert Koch
Institute in Berlin, this law is only a small part of what is needed.

Fock claims that German doctors currently report only about 10 per cent of
hepatitis cases, for instance, because they realise that their information is
vanishing into a “black hole”. In contrast, they voluntarily report almost all
AIDS cases because they know these reports are closely watched by the
government.

Fock warns that some of the neglected diseases pose a real threat. For
example, only about 30 per cent of the German population are adequately
immunised against diphtheria. With people streaming back and forth between
Germany and the former Soviet Union, where diphtheria has reached epidemic
levels, Fock says he would not be surprised if the disease soon takes hold in
Germany. What is needed, he says, is a revival of epidemiology, which has all
but died out in Germany.

To promote this message, the Robert Koch Institute has begun to emulate the
American Centers for Disease Control and Prevention (CDC). Last year it began
publishing a weekly bulletin, which is modelled on the CDC’s Morbidity and
Mortality Weekly Report. Lyle Peterson, an epidemiologist from the CDC, has
been based permanently in Berlin since last year. Other CDC scientists travel
regularly to Germany to conduct short training sessions for local health
officials.

Within the past year, Peterson has led investigative teams to regions of
Germany where there have been outbreaks of Escherichia coli O157 and
salmonella poisoning. Those were the first such investigations in Germany since
the Second World War, says Peterson.

Some German scientists blame the country’s poor epidemiology on its strict
data protection laws, which prohibit local health authorities and doctors from
disclosing to researchers the identities or other personal details of patients.
But Ulrich Keil, a leading epidemiologist at the University of Münster,
says these difficulties can be overcome with a bit of persistence. The problem
is not so much the law, he claims, as “laziness”.