Long-term persistence of anti-HAV antibodies following active immunization with hepatitis A vaccine.

Seventy-one anti-hepatitis A virus (HAV) negative volunteers were immunized against hepatitis A. An inactivated hepatitis A vaccine (HAVRIX, SmithKline Beecham), derived from tissue cell cultures, at single doses of 720 ELISA units was used following a schedule of vaccinations at month 0.1 and 6. The vaccines were tested for the presence of HAV antibodies 1 month after each vaccination and then after 2, 3, 4 and 5 years. The annual decrease of anti-HAV titres was 25%. Five years after vaccination a protective antibody titre, varying between 20 and 5200 mIU ml-1, could be demonstrated in all 47 retested volunteers with a geometric mean titre (GMT) of 442 mIU ml-1. Levels of anti-HAV-antibodies following active immunization were significantly higher in female volunteers. This could be consistently demonstrated throughout the observation period. Based on these data the antibody persistence was calculated over time. GMTs at protective levels higher than 20 mIU ml-1 can be expected to persist for at least 15 years.

Adverse reactions to Japanese encephalitis vaccine in travellers.

Vaccination against Japanese Encephalitis (JE) has been carried out extensively in many Asian countries for the past 20 years. The vaccine was generally considered to be effective and of low reactogenity. However, since 1989 an unusual number of systemic reactions characterized mainly by generalized urticaria and/or angioedema following JE vaccination were reported from Australia, Canada and Denmark, 860 travellers were recruited during a period of 16 months for a prospective study with the aim to investigate the type and incidence of side effects following JE vaccination (JEV) in German travellers. 826 received a primary immunization (2 injections at days 0 and 7-14) and 34 received a single booster injection. A detailed standardized questionnaire was distributed to all vaccinees after the first injection. A total of 509 questionnaires could be evaluated, which represents a return rate of 59.2%. 46% of the vaccinees reported about no adverse events at all. 54% reported about one or more adverse effects. Local reactions at the injection site were observed by 209 vaccinees, while 65 reported about systemic side effects like headache, fever, dizziness and generalized rash. There was no significant difference following first or second injection of the primary immunization or the booster injection, respectively, regarding incidence, severity or type of side effects. 2.2% of the vaccinees reporting reactions sought medical advice and 1.8% were judged unfit for work for an average of 2.2 days. The amount of systemic reactions might indicate a potential hazard of serious anaphylactic reactions. Unlike hepatitis A. Japanese encephalitis is an extremely rare disease in travellers. Therefore, the risk of acquiring the disease when travelling to affected areas without prior immunization should be considered against the risk of developing serious side effects after vaccination. We conclude that JEV should remain restricted to travellers with an increased risk of acquiring JE.

Stand-by treatment of suspected malaria in travellers.

Travellers to malarious areas are increasingly advised to carry an emergency medication for self-treatment of suspected malaria in absence of medical attention. However, no data are available so far how travellers cope with self-diagnosis and stand by treatment (SBT). We therefore investigated the frequency, circumstances and outcome of emergency self-treatment for suspected malaria in German travellers. 3434 travellers were recruited for an open prospective study by 28 different travel clinics in Germany. 2867 travellers (90.1%) who returned questionnaires after their journey were analyzed. 40 travellers (1.4%) reported about SBT during their journey. Significant Plasmodium falciparum antibody levels could be demonstrated in only 4 of 37 SBT users (10.4%). In another 127 travellers with febrile episodes but without SBT use, no malaria was indicated by follow-up and/or serology.

Cutaneous larva migrans in travelers: synopsis of histories, symptoms, and treatment of 98 patients.

The symptoms, medical history, and treatment of 98 patients with cutaneous larva migrans (creeping eruption) who attended a travel-related-disease clinic during a period of 4 years are reviewed. This condition is caused by skin-penetrating larvae of nematodes, mainly of the hookworm Ancylostoma braziliense and other nematodes of the family Ancylostomidae. Despite the ubiquitous distribution of these nematodes, in the investigated group only travelers to tropical and subtropical countries were affected; 28.9% of the patients had symptoms for > 1 month, and for 24.5% the probable incubation period was > 2 weeks. The efflorescences typically were on the lower extremities (73.4% of all locations). The buttocks and anogenital region were affected in 12.6% of all locations, and the trunk and upper extremities each were affected in 7.1%. Only a minority of patients presented with eosinophilia or an elevated serum level of IgE. No other laboratory data appeared to be related to the disease. Therapy with topical thiabendazole was successful for 98% of the patients. Systemic antihelmintic therapy was necessary in two cases because of disseminated, extensive infection.

Hepatitis A vaccination: schedule for accelerated immunization.

Hepatitis A vaccine, strain HM175, was investigated for immunogenicity and tolerability in a prospective multicentre trial. The following vaccination schedules and antigen contents were evaluated: days 0 and 14 with 720 ELISA units (El.U) of antigen, days 0 and 28 with 720 El.U and days 0 and 28 with 360 El.U. In all study groups, the seroconversion rates following two vaccinations were between 95 and 100%. Higher geometric mean concentrations of antibody to hepatitis A virus (anti-HAV) were reached by the vaccine containing 720 El.U of HAV antigen. The vaccine was equally well tolerated in all groups. In addition, an abbreviated schedule, in which 720 El.U of HAV antigen was given on days 0 and 14, resulted in 100% seroconversion by day 28 and a level of anti-HAV that was substantially higher than that observed after passive immunization. This implies that such a vaccine could replace immune globulin administration if time permits.

Reactogenicity and immunogenicity of three different lots of a hepatitis A vaccine.

To study the immunogenicity and reactogenicity of an inactivated hepatitis A vaccine, 204 healthy individuals were randomized into three equal groups, each to receive a different vaccine lot. Each subject received a total of three doses, each of 720 ELISA units of hepatitis A vaccine HM175, according to a 0 and 1 month primary vaccination schedule, with a booster dose given at month 6. Side effects were low and were < 30% after the second injection. All subjects but one had antibodies to hepatitis A virus two months after the first dose of vaccine. At month 6 all vaccinees had seroconverted. There were no differences between the three vaccine lots with respect to side effects, seroconversion rates and geometric mean titre of antibodies. We conclude that the three lots of inactivated hepatitis A vaccine are safe, well tolerated and equally immunogenic.

Effect of gum chewing on the pH of dental plaque.

Saliva stimulation by gum chewing has been reported to neutralize plaque acidity. We compared the plaque pH response to bread with honey followed by sucrose-or sorbitol-sweetened gum chewing for 20 minutes. Bread and honey was chosen as previous work in our laboratory found this a worst case challenge in terms of the extent and duration of the pH decline. The study design was factorial with: 4 subjects x 2 replicates x 3 treatments. Each subject received each of the 3 treatments: food (bread and honey), food followed by sorbitol chewing gum, and food followed by sucrose chewing gum. Subjects accumulated plaque for 3 days on a partial prosthesis with a glass electrode set in the approximal space in the gap left by a missing first molar. Plaque pH was monitored for 150 min: baseline (0-10), food (11-30), +/- gum chewing (31-50), post-chew monitoring (51-150). ANOVA of mean plaque pH showed no difference between treatments at baseline. Significantly higher pH levels (p < 0.01) were shown with both gums compared to no gum during the chew and post-chew phases. Plaque pH data were also converted to absolute acid values (cH). Food alone produced 1703 mumol/min.; food followed by sorbitol chewing gum produced 53 mumol/min.; and food followed by sucrose gum produced 156 mumol/min. While the post-chew pH curves were not identical for sucrose vs. sorbitol chewing gums, both neutralized plaque acidity, probably due to the induced salivary action.

A modified plaque pH telemetry method.

Previous plaque-pH telemetry studies reported the acidogenicity of various foods and dietary patterns to estimate potential cariogenicity. To avoid patient discomfort, improve compliance, and minimize electrode malfunctions, we have simplified our telemetry method and compared it to our previously published model. A removable partial prosthesis with a glass electrode set in the approximal space left by a missing first molar was used in 2 subjects. In the modified method, subjects suspended oral hygiene for 3 days, the prosthesis was then installed on the 3rd day, and accumulated plaque was spread on the electrode and covered with gauze for retention. In comparative tests, the same subjects wore the prosthesis in the mouth during plaque accumulation. Test sessions compared the plaque pH response to 4 treatments: a 10% sucrose rinse, a 10% sorbitol rinse, a snack roll with marmalade and coffee, and the snack followed by gum chewing. Overall, pH curves were similar (mean baselines and minimas) and no significant differences in mean pH response were noted between the 2 methods. The modified method improved subject participation, demonstrated greater reliability, and showed Stephan curves comparable to conventional methods.

[Cariogenic potential of in-between-meals--results of oral plaque-pH-telemetry]. / Das kariogene Potential von Zwischenmahlzeiten-Ergebnisse der oralen Plaque-pH-Telemetrie.

Using oral plaque-pH-telemetry the cariogenic potential of a sucrose-solution (10%), a sorbitol-solution (10%), of a roll with honey, a roll with jam together with sweetened coffee and the "Milchschnitte" has been examined. All sugar containing products cause a deep pH-drop in dental plaque. The duration of demineralization (time of plaque-pH below 5.5)-amounts to 75 min. after mouthrinsing with sucrose-solution, 80 min. after consuming a half roll with honey, 140 min. after eating a roll with jam and drinking sweetened coffee and 82 min. after consuming a "Milchschnitte". All these products shouldn't be used as in-between-meals or snacks without a consequent oral hygiene afterwards.

[Periodontitis apicalis? Case report]. / Apikale Periodontitis? Ein Fallbericht.

An apical radiolucent area shown by an X-ray examination of vital teeth 11 and 21 was supposed an apical chronic inflammation. The explanation was the projection of a deep nose botton.

[Therapy of fractured crown of juvenile permanent tooth]. / Die Therapie der Kronenfraktur beim jugendlichen bleibenden Zahn.

Above all the treatment of fractured juvenile frontal teeth doesn't represent a restoration problem but a problem of conservation of the tooth. In cases of uncomplicated crown-fractures the covering of all opened dentin tubuli must be recommended. In complicated crown-fractures the method of partial pulpotomy is preferred instead of pulp amputation regarding special indication. A closed cooperation with the orthodontist should be in the treatment of juvenile frontal teeth with a vital pulp.

[Caries prevalence in 6 to 14 years old children--results of the Rostock cross-sectional study]. / Kariesprävalenz bei 6- bis 14 jährigen Kindern. Ergebnisse der Rostocker Querschnittsstudie.

The results of a cross-sectional study of caries prevalence in 22,112 children age 6 to 14 years in Rostock Country are classified as moderate to high according to WHO criterions. Territorial differences in the caries prevalence have a strong connection to the degree of realisation of preventive measures. Over a control period of 20 years the average caries experience in children showed only little changes, a general caries decline couldn't be watched.

[Evaluation of efficiency of dental care for children--results of a cross-sectional study]. / Effektivitätsbewertung der kinderstomatologischen Betreuung im Ergebnis einer Querschnittstudie.

Using special parameters like the percentage of treated children, degree of treatment and the rate of secondary caries, a retrospective estimation of dental care for children in Rostock County was performed. After that the best results in dental care could be recorded in children of towns. The degree of treatment generally was worse in children of a rural population. On the one hand there is demanded an equalizing of the disproportions in the personal situation in dentistry for children, on the other side there is recommended a yearly analysis of the efficiency of treatment and based on this a territorial program for dental care in children.

[Longterm study of the effectiveness of different dental care programs in school children]. / Langzeitstudien zur Effektivität von unterschiedlichen Betreuungsstrategien bei Schulkindern.

The caries prevalence was examined in children from the first to the tenth grade in Rostock and Krakow between 1974 and 1988. In Krakow, a town with a preventive orientated dental care program, a significance caries reduction was found. Therefore there is an increase of health and an improvement of oral situation for the children on the way to the goals of WHO for oral health by the year 2000.

[Oral health status of apprentices]. / Der orale Gesundheitszustand von Berufsschulern.

3011 students of vocational schools in Rostock were examined for obtaining informations about their caries prevalence (DMF/T and DMF/S) and the periodontal treatment needs (CPITN). Those students, who need a special proof to be good for their occupation and therefore had a regular dental care, have a much more better oral health status than other students in vocational schools (successful treated 40%:20%, degree of treatment (FM/T) 80%:71%, DMF/T 8.5:10.3). Concerning the periodontal status of the 6 sextants 55.6% of the students hat code 0 of CPITN, 33.5% the 1, 10.3% code 2 and 0.6% the code 3. Summarizing recommendations are given for the improvement of passing from the regular dental care for young adults to dental care of the adult population.

[The oral health status and the tasks of pediatric dental care for mentally handicapped children and adolescents]. / Oraler Gesundheitszunstand und Aufgaben der kinderstomatologischen Betreuung bei zerebral geschädigten Kindern und Jugendlichen.

1,018 cerebrally handicapped children were examined and the results were compared with the data of a study of 22,112 children. The caries prevalence (DMF/T and DMF/S), the oral hygiene (OHI-S) and the periodontal treatment needs (CPITN) were recorded. The caries prevalence of the retarded is nearly the same in children without handicap, but the caries prevalence is less in imbeciles and idiots. The degree of treated teeth is lower in the group of handicapped children. The periodontal status is more too bad but there are found no series periodontal diseases. Summarizing it must be demanded an early cooperation between the "dispensary of handicapped children" and the dentist for children and a realization of an intensive preventive care.

[Caries prevalence in 12-year-olds compared to the WHO indicator]. / Kariesverbreitung bei 12jährigen im Vergleich mit dem WHO-Indikator.

In relation to the goals for oral health by the year 2000 a detailed territorial analysis of caries prevalence in 12 years-old children in performed. There from a prognosis of the future caries development in this age group considering regional conditions is given.

[The periodontal treatment needs of children and young people]. / Periodontale Behandlungsnotwendigkeit bei Kindern und Jugendlichen.

Using CPITN recommended from the WHO periodontal treatment needs in 22,118 children between 6 and 14 years from Rostock County were estimated. According to that the need of periodontal care in the examined young population is low and preventive care has precedence. For children until 12 years of age the evaluation of CPITN has some problems. The routine application of the CPITN is recommended as a screening for high-risk patients.

[Long-term use of fluoride lacquer in preventive care of school children in area of basic care]. / Langzeiteinsatz von Fluoridlack zur präventiven Betreuung von Schulkindern im Rahmen der Grundbetreuung.

The spread of caries in the city of Rostock was studied from 1979 to 1988 in pupils from classes 1 to 8 where the fluoride varnish application three times a year (Duraphat) was the most important caries prophylaxis measure. All children were included in the evaluation, even those who had entered the school for the first time during the study period and had not had any prior prophylactic treatment. A special study was also made in a single class in the 1st and 6th years, respectively, to compare varnish application by cotton swabs with barrel ampoule injection. A significant reduction in caries was registered in all age groups. The application with barrel ampoule injection proved to be more economical and practical than the cotton swab application. On the whole Duraphat fluoride varnish reasserted its importance in caries prophylaxis and can be regarded as extremely well suited for individual and collective prevention.