Latent class analysis of diagnostic tests for adenovirus, Bordetella pertussis and influenza virus infections in German adults with longer lasting coughs.

Laboratory tests in adult outpatients with longer lasting coughs to identify a potential causal pathogen are rarely performed, and there is no gold standard for these diagnostic tests. While the diagnostic validity of serological tests for pertussis is well established their potential contribution for diagnosing adenovirus and influenza virus A and B infections is unclear. A sentinel study into the population-based incidence of longer lasting coughs in adults was done in Rostock (former East Germany) and Krefeld (former West Germany). A total of 971 outpatients who consulted general practitioners or internists were included. Inclusion criteria were coughing for ⩾1 week and no chronic respiratory diseases. We evaluated the performance of polymerase chain reaction (PCR) as well as IgG and IgA serology, applying a latent class model for diagnosing infections with adenovirus, B. pertussis, and influenza virus A and B. The adult outpatients first sought medical attention when they had been coughing for a median of 3 weeks. In this situation, direct detection of infectious agents by PCR had a low sensitivity. Modelling showed that additional serological tests equally improved sensitivity and specificity for diagnosis for adenovirus, B. pertussis and influenza virus A and B infections. The combination of serology and PCR may improve the overall performance of diagnostic tests for B. pertussis and also for adenovirus, and influenza virus A and B infections.

Antibody decay after immunisation of health-care workers with an acellular pertussis vaccine.

Antibody decay after a single dose of acellular pertussis vaccine containing 25 microg of pertussis toxin (PT), 25 microg of filamentous hemagglutin (FHA), and traces of pertactin (PRN) was monitored in health-care workers. Blood was sampled 4 weeks (n = 246), 1 year (n = 187), 2 years (n = 53), 3 years (n = 134), and 4 years (n = 37) after vaccination. IgG anti-PT, IgG anti-FHA and IgG anti-PRN were measured by ELISA. Peak median antibodies to PT, FHA, and PRN were 314, 785, and 84 EU/ml respectively. IgG anti-PT decreased to a median of 29% (76 EU/ml), 18% (64 EU/ml), 19% (58 EU/ml), and 20% (63 EU/ml) of the peak value after 1, 2, 3, and 4 years respectively. IgG anti-FHA decreased more slowly, but showed similar decay patterns. In German health-care workers antibodies to pertussis antigens decayed rapidly within the first year after vaccination, but remained stable after 2, 3, and 4 years. This observation may have implications for the timing of booster vaccinations in adults.

[Pertussis: incidence, symptoms and costs]. / Pertussis bei Erwachsenen: Häufigkeit, Symptome und Kosten.

BACKGROUND AND OBJECTIVE: A prospective sentinel study into the population-based incidence of pertussis in adults was done between 2001 and 2004 in Rostock (former East Germany) and Krefeld (former West Germany). PATIENTS AND METHODS: 971 outpatients, who consulted general practitioners or internists, were included. Clinical inclusion criteria were coughing for one week or more and no chronic respiratory diseases. Bordetella infection was diagnosed by PCR on nasopharyngeal swabs and ELISA for serology (IgG-anti-PT, IgA-anti-PT, IgG-anti-FHA, IgA-anti-FHA). RESULTS: We found a total of 97 cases of pertussis in this cohort. The main symptom was coughing for a median of 7-8 weeks. Population-based incidence was estimated in Krefeld at 169 cases/100000 population per year, and in Rostock at 160/100000 per year. Resource use was 120 EUR of direct medical cost and 434 euro of indirect medical cost, not including hospitalization in this study. CONCLUSIONS: Pertussis is a frequent cause of longer lasting cough in German adults, and it causes significant morbidity and costs.

[Hygiene status of ambulances and equipment in rescue services]. / Hygienestatus von Fahrzeugen und Ausrüstung im Rettungsdienst.

PURPOSE: Focus on hygienic management in ambulances is presented based on findings from hygienic microbiological sampling. METHODS: In 44 ambulances, the handwashing area, equipment for artificial respiration, insufflation, intubation, aspiration, intravasal catheterisation, blood-pressure measurement, and sterile materials storage were examined hygienically and microbiologically using the following methods: water sampling, imprint technique, and swab technique with subsequent cultivation on blood-, endo-, and Sabouraud agar. RESULTS: The highest contamination was found in the hand-washing area and on insufflation equipment (up to > or = 100,000 cfu/ml), where proof of the potential pathogens Pseudomonas, Acinetobacter, and Alcaligenes spp. was found. The second highest contamination level was found on the sphygmomanometer cuffs, stethoscopes, and respirator masks (e.g., Enterococci and S. aureus were identified). Apparently, the germs chiefly originate from the drinking water at the handwashing station, from the environment and mucous membranes from the skin, and intestines of the ambulance personnel. The predominant hygienic deficiensies were found in the equipment of the handwashing areas, and in the storage of resuscitation equipment and sterile materials. CONCLUSIONS: Based on the results of hygienic microbiological analysis, the main focus of hygienic measures--besides hand disinfection--should be on spray disinfection of the sphygmomanometer cuffs and stethoscopes as well as disinfection of ambulance equipment and storage areas for sterile devices, supplemented by dust protection of ready-to-use materials and devices. Stationary dispensers for hand disinfection possessing at least midlength levers must become the standard in ambulances, and conventional handwashing basins with plastic drinking-water containers and pump must be eliminated entirely.

[Epidemiologic and serologic studies of pneumococcal infections with reference to the new STIKO recommendations]. / Epidemiologische und serologische Untersuchungen von Pneumokokken-Infektionen im Hinblick auf die neuen STIKO-Empfehlungen.

Pneumococcal diseases play an important role especially for babies and toddlers (otitis media) and for older persons (pneumonia). 28% of the 481 reported cases of bacterial meningitides (without meningococcus) in Mecklenburg-Vorpommern were caused by pneumoniae streptococcus. A pneumococcus antibody study by the land register confirms the high contamination in older people. Therefore STIKO recommends since March 1998 to effect pneumococcal vaccination with every person from the age of 60 and dove as well as for children, adolescents and adults with higher risk due to a primary disease.

[Toxoplasmosis-antibody seroprevalence in Mecklenburg-Western Pomerania]. / Toxoplasmose-Durchseuchungsstudie in Mecklenburg-Vorpommern.

OBJECTIVE: The aim of this study was to get a general idea of the antibody prevalence of toxoplasmosis within the different agegroups of the population of Mecklenburg-Western Pomerania. 4854 serums (collected between 1994 and 1996) from different institutions of the federal state were investigated with the "Toxo-Competitions Test LTXC)" at the Mini-Vidas divice (bio Merieux). MATERIAL AND METHODS: An antibody prevalence rate of 59% was found. As expected, with rising age a continuing increase was recognisable. The antibody prevalence rate with the male test persons amounted to 58.5%, with the female test persons to 59.3%, and within the pregnant women 63.2%. RESULTS: Therefore 36.8% of pregnant women have got no toxoplasmosis antibodies, i.e. they are exposed to the danger of a primary infection. Within pregnant women aged between 20 and 40 an increase of antibody prevalence of 1% per year of age was recognisable. There was only a small share of pregnant women (10.5%), but they confirm the facts known from literature. CONCLUSIONS: More than 1/3 of our test persons hadn't had toxoplasmosis antibodies. Therefore in order to reduce the danger of a primary infection in pregnant women a screening before pregnancy in recommendable.

[Diphtheria protection in the population of Mecklenburg-Vorpommern]. / Untersuchungen zum Diphtherieschutz in der Bevölkerung Mecklenburg-Vorpommerns.

Evaluation of the diphtheria protection in 764 healthy volunteers before and after the vaccination showed that 56.3% had a reliable immunity, 22.8% a doubtful and 20.9% had no immunity. A high risk is in the age group 41-50 years. Young medical personal and alcoholics also have insufficient diphtheria immunity. The results of 41 healthy volunteers with a basic immunisation of more than 10 years ago prove that one booster shot is sufficient irrespective of the moment of the last vaccination.

[Incidence of Lyme borreliosis in Mecklenburg-Vorpommern]. / Zur Verbreitung der Lyme-Borreliose in Mecklenburg-Vorpommern.

In 1992/93 6202 ticks (Ixodes ricinus) were tested in Mecklenburg-Vorpommern for Borrelia burgdorferi via dark-field microscopy. The prevalence of infected ticks was 7.8%. The sera of 1182 forest workers in Mecklenburg-Vorpommern were tested for antibodies against Borrelia burgdorferi. In 31.4% antibodies to B. burgdorferi were found in the sera of forest workers.

[Effect of air pollutants on the organism of the child]. / Untersuchungen über den Einfluss von Luftschadstoffen auf den kindlichen Organismus.

The Institute of Hygiene at Rostock initiated studies in 1980 on schoolchildren (1st to 4th form) in air-hygienically differently affected areas of the former GDR, as well as studies on probationers of the same age in non-polluted areas. The spectrum of methods included besides clinical, sensorial and psycho-diagnostical investigations, also haematological, immunological and pulmonary functions tests. The results indicate that the state of health of children living in industrial areas is impaired. After a recuperating for four weeks under clean air conditions the changed values were normalised and adapted to the values of the non-exposed control group. The long-term effect of the recuperating stay lasts for 9 months.

[Epidemiological surveys of formaldehyde and nitrogen dioxide levels in indoor air]. / Epidemiologische Untersuchungen zur Formaldehyd- und Stickstoffdioxidbelastung in Innenräumen.

The influence of HCHO and NO2 on clinical, haematological, immunological, sensory and lung function parameters were tested in 129 children out of 3 classes. As part of a biological monitoring programme formic acid content in urine was determined. Concentration of the pollutants in indoor air was measured by means of passive samples.

[Epidemiologic study of indoor formaldehyde and nitric oxide pollution]. / Epidemiologische Untersuchung zur Formaldehyd- und Stickoxidbelastung in Innenräumen.

The authors report on some selected results of an 87-pilot study, by means of which has been started to analyse the influence of formaldehyde, nitrogenous oxide and tobacco smoke on school children visiting 3. classes in old and new buildings in their schools and dwellings.

[Epidemiologic studies of the effect of air pollution on children]. / Epidemiologische Untersuchungen über die Wirkung von Luftverunreinigungen auf den kindlichen Organismus.

During a seven-year study investigations were carried out on school children from areas with varying concentrations of harmful substances. Psychodiagnostic, anthropometric, clinical, haematological and immunological results are presented and evaluated.