[Evaluation of a pilot study on measles vaccination in Bavarian preschool children]. / Evaluation einer Pilotstudie zu Masern-Impfraten in bayerischen Kindergärten.

Several areas of Bavaria show measles vaccination coverage in preschool children below 95%. Repeated outbreaks could be attributed to this situation. A recollection model in nurseries was tested in order to document the vaccination rate in this age group and to measure the percentage of vaccinations due to intervention. Parents of new entrants to nurseries in a randomly selected rural district were asked to provide measles vaccination records of their kids and to fill in a questionnaire. 121 out of 144 vaccination records (85%) documented a complete immunisation status for measles. 12 children had not been vaccinated against measles, 10 children had received one vaccination. Eight out of these 22 children obtained supplementary measles immunisation at the time of ascertainment. The results provided are of limited statistical significance due to the small sample size. Further intervention studies have to be conducted and should even include measures supported by legal regulations.

Atopic disease and its determinants -- a focus on the potential role of childhood infection.

BACKGROUND: Atopic diseases develop on a genetic background and are modulated by environmental factors among which some infectious diseases are thought to have a protective influence. OBJECTIVE: The aim of this study was to determine the influence of infectious diseases in younger ages, bacterial and viral, on atopic diseases and sensitization to aero- and food-allergens in adults. METHODS: A population-based sample of 4262 subjects aged 25-74 years were interviewed concerning their history of infectious disease within the first 18 years of life. Information about allergic disease, including atopic eczema, allergic rhinitis (AR), and asthma was obtained. A blood sample was drawn and analysed for allergen-specific IgE antibodies against food- and aero-allergens. RESULTS: Multiple logistic regression analyses identified viral infection to be associated with AR (adjusted odds ratio (OR) = 1.39; 95% confidence interval (95% CI): 1.13-1.72) and sensitization to aeroallergens (OR = 1.21; 95% CI: 1.05-1.41). Bacterial disease was a negative predictor for atopy development in the subgroup of patients sensitized to nutritional allergens with concomitant atopic eczema (OR = 0.34; 95% CI: 0.11-0.99), AR (OR = 0.67; 95% CI: 0.42-1.07), or asthma (OR = 0.41; 95% CI: 0.19-0.87). Influences of viral and bacterial infection on AR differed with regard to family history of atopic disease. CONCLUSION: In our study population, history of viral infection was consistently positively associated with AR. Our data suggests that bacterial infections might be preventive for specific subgroups of atopy.

Risk factors for undervaccination against measles in a large sample of preschool children from rural Bavaria.

BACKGROUND: Due to insufficient vaccination rates, measles outbreaks still pose a threat to public health in Germany. The purpose of this study was to identify risk factors for undervaccination against measles. PATIENTS AND METHODS: Datasets from two cross-sectional surveys were analyzed by logistic regression models. The surveys had been done prior to and after an intervention aiming to raise measles, mumps, and rubella vaccination rates among children entering primary school in five Bavarian counties. Subjects were 9,582 children aged 6 to 7 years and their parents. RESULTS: Main independent predictors of non-immunization were doctors advising against vaccination (OR 84.8; 95% CI 19.9-360.4), doctors abstaining from advice (OR 6.3; 95% CI 4.8-8.4), and parental reservations due to alternative health beliefs (OR 27.9; 95% CI 17.6-44.1). CONCLUSION: Doctors advising against measles vaccination and doctors not giving any advice proved to be important risk factors for childhood undervaccination against measles. Future strategies to increase measles vaccination rates in Germany should focus more on family doctors.

Surveillance of measles-mumps-rubella vaccine-associated aseptic meningitis in Germany.

BACKGROUND: The study objective was to detect any incidence of aseptic meningitis associated with measles-mumps-rubella (MMR) vaccines that would be considered of public health importance subsequent to the introduction of a new MMR vaccine (Priorix). PATIENTS AND METHODS: Adverse drug reaction (ADR) rates were calculated by relating the number of cases to the number of doses of the different MMR vaccines distributed during a 2-year period in Germany. RESULTS: During the 2-year study period 1,575,936 doses of Priorix and 1,907,875 doses of other MMR vaccines were distributed in Germany. There were no confirmed cases of aseptic meningitis associated with MMR vaccination during this period. Thus, the ADR rates (rejectable with 5% alpha error) were lower than 1/525,312 for Priorix and lower than 1/635,958 for other MMR vaccines. CONCLUSION: The safety profile of the Priorix is similar to that of other MMR vaccines used in Germany.

Psychological factors associated with the uptake of measles immunization: findings and implications for prevention.

A cross-sectional study of 8204 children was performed to investigate the prevalence of immunization against measles, mumps and rubella and possible determinants of immunization uptake. The study was approached from a Lewinian perspective on preventive behaviour. Seventy-one questions referring to the guardian of the child, his or her partner, the household and the child, as well as to immunization-related experiences and situational topics were asked. Two psychological variables were studied: health locus of control and subjective relevance concerning measles. The immunization rate was 77.7 percent [95 percent confidence interval 76.8-78.6]. Multiple logistic regression yielded the following odds ratios for non- uptake of measles immunization: natural health orientation 8.74 [6.72-11.37]; advice of paediatrician 6.02 [4.67-7.75]; dangerousness of measles 2.00 [1.53-2.60]; marital status 1.87 [1.31-2.51]; assessed reliability of vaccination 1.57 [1.23-2.01]; smoking 1.55 [1.21-1.98]; and number of siblings 1.55 [1.21- 1.98]. Parents or guardians of immunized children were more internal and assessed measles as more relevant than those of non- immunized children.

[Measles, mumps and rubella vaccination status of school beginners in Munich]. / Masern-, Mumps- und Rötelnimpfstatus bei Münchner Schulanfängern.

A cross-sectional study was performed on all of 10029 school-beginners in Munich in 1994 to investigate the vaccination status of measles, mumps and rubella immunisation. The objective of the study was to determine socio-demographic and psychological factors affecting the MMR vaccination rate. Data were received from 81.8% of all 10029 school-beginners. The vaccination rate was 86.1% for measles, 84.5% for mumps and 72.9% for rubella (missing values not included). Low overall vaccination rate was found in not first-born children, children of parents with non-german nationality, in children of parents with a low socio-economic status, in children accompanied by a working parent, and in children accompanied by a smoking parent. Children without any denomination also showed a lower vaccination rate. Girls had a higher vaccination rate for rubella than boys. A higher overall vaccination rate for MMR was associated with parents considering these infections to have a high impact for people's health. Vice versa children of parents considering adverse effects of vaccination against MMR as an important impact on health had significant lower vaccination rate. The results of a multiple logistic regression model showed two factors significantly affecting the MMR vaccination rate: Physician's recommendation and individual attitude towards medicine seem to have the most important influence on decision making for or against vaccination. In conclusion MMR vaccination strategies have to be improved. New ways such as, no vaccination--no school's should be considered for Germany.

Prevalence of antibodies to hepatitis C virus in patients on peritoneal dialysis--a multicenter study.

The prevalence of antibodies to the hepatitis C virus (HCV) was determined in 333 peritoneal dialysis (PD) patients from 10 German dialysis units, using an enzyme-linked immunosorbent assay of the second generation (ELISA 2nd gen) which detects antibodies to a structural (C22) and to non-structural (C33c, C100, 5-1-1) recombinant antigens of HCV. Sera from 18/333 (5.4%) patients were anti-HCV positive versus 11/295 (3.7%) when the sera were tested by an ELISA of the first generation (ELISA 1st gen) containing only a nonstructural antigen (C100). In the 18 sera positive by ELISA 2nd gen, antibodies against at least one viral protein were found by recombinant immunoblot assay (RIBA) in 15/333 (4.5%) patients. In the sera of 11/15 (73.3%) patients HCV RNA was detected by nested PCR. Epidemiological evaluation of the patients revealed that the prevalence of anti-HCV was correlated to the female sex (p = 0.005), presence of anti-HBc (p = 0.006), duration of total dialysis (hemodialysis HD and PD) (p = 0.012), duration of HD alone (p = 0.025) and previous renal transplantation (p < 0.001). Only a weak correlation was found to blood transfusions (p = 0.041) and elevation of serum ALT concentration (p = 0.055). But no correlation was found to diagnoses of renal failure (p = 0.129), duration of PD (p = 0.963) and past surgical procedures (p = 1.0). Four of nine peritoneal dialysates of anti-HCV positive patients were found positive for HCV RNA.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of hepatitis C virus infections in dialysis patients and their contacts using a second generation enzymed-linked immunosorbent assay.

The prevalence of antibodies to the hepatitis C virus (HCV) was determined in 498 hemodialysis patients from three german dialysis units, 121 staff members and 42 family members using an enzyme-linked immunosorbent assay (ELISA) of the second generation which detects antibodies to a structural (C22) and to non-structural (C33c, C100, 5-1-1) recombinant antigens to HCV. Using the second generation ELISA 115 patients (23.1%) were anti-HCV positive versus 77 (15.5%) when sera were tested by an ELISA of the first generation containing only a non-structural antigen (C100). In 34 of these 40 discordant sera antibodies against at least one viral protein was found by a recombinant immunoblot assay. Of 5 sera containing antibodies to only one viral protein (C22) 3 were HCV RNA positive by polymerase chain reaction. Epidemiological evaluation of the patients revealed that the prevalence of anti-HCV was correlated to the duration of dialysis but not to the number of blood transfusions. Of 121 staff members 2 (1.6%) and 2 of 42 family members (4.7%) were positive indicating a low risk of the patients' contacts of acquiring HCV infection.

[Hepatitis C virus]. / Das Hepatitis-C-Virus.

The hepatitis C virus is a single-stranded RNA virus and is composed of at least three structural proteins. Viral RNA can be detected in the serum shortly after infection (earliest after three days). Specific antibodies, however, are detected not earlier than 3-4 months after infection. The second generation ELISA detects antibodies to structural (core/C22) and nonstructural (C100, 3c) proteins. Patients with complete recovery may lose antibodies within 2-3 years. However, patients with chronic outcome show a long time persistence of antibodies (anti-C100). Risk groups, such as hemophiliacs (70-95%), i.v. drug addicts (30-80%) and hemodialysis patients (0-45%), show a high prevalence of chronic HCV infection. The current tests seem to be good diagnostic tools for chronic HCV infection, but not for acute and past HCV infection.

Different outcomes of chronic hepatitis delta virus infection in woodchucks.

Hepatitis delta virus (HDV) superinfection of woodchuck chronic carriers of woodchuck hepatitis virus (WHV) results in acute and chronic disease. The different courses of disease mimicked the outcome of human HDV superinfection, making woodchucks valuable models for clinical studies of HDV. Ten of 11 woodchuck chronic carriers of WHV superinfected with HDV developed acute HDV infection with markers of viral replication in the serum and liver. One animal (DW128) had no serological markers of acute HDV infection. Nine of 11 (82%) superinfected animals developed chronic HDV infection. An unusual course of chronic HDV infection occurred in one woodchuck (DW128): no serum markers of acute or chronic HDV infection appeared but HDV RNA was detected in the liver, indicating that chronic HDV infection can occur without serological markers.

[Parvovirus B19 infections in Germany 1987-1988]. / Parvovirus B19-Infektionen in Deutschland 1987-1988.

3289 sera of patients were tested for Parvovirus B19 specific antibodies (IgM/IgG) by ELISA for routine virological diagnostics in 1987/1988. Acute B19 infection could be confirmed in 14.5%, while 24.4% were already immune and in 61.1% antibodies could not be detected. Only 0.12% of all sera were B19-DNA positive by nucleic acid hybridisation. The highest rate of acute B19 infections could be detected in the age-group of the 6-15 year old. Infections occurred above all in the period of January to July resp. August. The most frequent clinical manifestation of acute B19 infection was exanthema (54.4%) and arthritis/arthralgia (6.5%).

Nosocomial and endemic infections with a genome type of adenovirus type 5.

A unique genome type of adenovirus 5 was isolated from 37 specimens of 25 patients. DNA restriction analysis was performed with seven endonucleases. Part of the patients were treated at a bone marrow transplantation unit in Munich. Nosocomial spread, rather than activation of endogenous adenovirus infection, was likely for many of them. In addition, sporadic cases suggested an endemicity of this genome type in Bavaria.

Epidemiological studies on the prevalence of hepatitis Delta virus infections in the Federal Republic of Germany.

This study evaluated the prevalence of hepatitis Delta virus (HDV) infections in various groups of HBsAg carriers including drug addicts and patients with hemophilia in the Federal Republic of Germany. HDV was found only occasionally (less than 1%) in individuals found HBsAg positive during an examination as potential blood donors or in hemodialysis patients, but in 3% in patients with chronic hepatitis and up to 50% in drug addicts and hemophilia patients. These findings are in agreement with data reported from other European countries. Presence of antibodies to HDV in two hemodialysis patients indicates the presence of HDV in this group and screening for HDV infections in hemodialysis units is indicated to prevent outbreaks of this disease in HBsAg-positive patients with possibly serious consequences.

[Frequency of delta infections in Heidelberg]. / Häufigkeit von Delta-Infektionen in Heidelberg.

The frequency of delta infection was studied in sera of 203 patients with acute hepatitis B, further 461 hepatitis B virus surface antigen-(HBsAg)-positive patients and 117 HBsAg-negative controls by determination of anti-delta by a competitive enzyme immunoassay. Sera have been collected since 1974. None of the sera of acute hepatitis B was anti-delta-positive whereas seven of the HBsAg-positive carriers were anti-delta-positive. Two of the anti-delta-positive patients had chronic hepatitis, four had liver cirrhosis. One of the anti-delta-positive patients with liver cirrhosis died of liver failure. Risk factors included Italian origin and parenteral routes of infection. All sera of 19 relatives of three anti-delta-positive index cases remained anti-delta-negative.

[Hepatitis B and the delta agent]. / Hepatitis B und Delta-Agens.

The delta agent seems to be a defective RNA virus which is dependent on a helper function provided by hepatitis B-virus. Delta agent infection occurs by parenteral transmission either together with hepatitis B-virus, or superimposed on chronic HBV infection. In the first case biphasic hepatitis may result, whereas in the second case mostly an acute delta agent infection develops, which is often followed by chronic delta hepatitis. The delta agent is endemic to certain areas, and also in certain risk groups such as drug addicts, hemophiliacs and polytransfused patients. A delta agent infection should be suspected in case of acute hepatitis in a hitherto clinical inapparent chronic carrier, especially if he belongs to one of the above mentioned risk groups. There is no specific therapy for delta infection, the only prophylactic measure is vaccination against hepatitis B.