[Infection surveillance in North Rhine-Westphalia--standard reports, barometer and early warning system]. / Infektionssurveillance in NRW--Standardberichte, Barometer und Frühwarnsystem.

The increasing significance of communicable diseases requires new surveillance tools. Modern electronic instruments in analysis and communication replace the former "handbased" statistics and allow the development of early warning systems. In North Rhine-Westphalia (NRW) the Institute of Public Health started an approach to develop a modular surveillance system prior to the the implementation of the new German infectious disease protection act. The first module called "Automated infectious disease notifications and information system (AIM+)" generates various standard hypertext reports which are published as "Infectious disease reports NRW" on the internet (www.loegd.nrw.de). In addition the infectious disease information is linked with a geographical information system (GIS) giving spatial and temporal patterns. The second module called "Infectious disease barometer NRW" offers a quick actual overview highlighting several selected diseases. It can be electronically sent out to any interested person. The third module "Early warning system" realizes an effective early detection system by combining six statistical procedures with a total of 11 separate methods. In case of detecting clusters and outbreaks it automatically generates warning reports to the responsible parties. All three modules together improve the epidemiological surveillance of the population in NRW, support the translation of information to prevention and control measures, and therefore strengthen epidemiological policy-making.

Evaluation of two enzyme immunoassays for detection of human rotaviruses in fecal specimens.

The two assays evaluated in this study (the Ridascreen rotavirus and the Pathfinder rotavirus) exhibited comparable sensitivities (100%) but highly divergent positive predictive values (93.74 and 57.7%, respectively) when compared on 393 specimens. This difference should be considered when using these tests on collectives with an unknown or low prevalence.

Infectious disease surveillance in North Rhine-Westphalia: first steps in the development of an early warning system.

It is often difficult to detect warning signals on infectious disease outbreaks from raw surveillance data. Data need to be used for a timely generation and distribution of information on the current state of infectious diseases. This offers the opportunity to detect outbreaks and to initiate preventive measures. To improve the surveillance system in North Rhine-Westphalia we have introduced an infectious disease barometer, a simple tool based on weekly notification data. The aim of this tool is not to provide in depth data analysis, but to help to detect clusters or outbreaks. This can be the first step in the development of an early warning system and can support epidemiological investigation and policy making.

Long-term persistence of immunoglobulin A (IgA) and IgM antibodies against human cytomegalovirus in solid-organ transplant recipients.

The retrospective analysis of 494 solid-organ transplant recipients revealed that during the follow-up period (mean duration, 3.2 years) 184 (88%) of 209 anti-human cytomegalovirus (HCMV) immunoglobulin A (IgA)-positive patients remained IgA positive, as did 128 (74.85%) of 171 anti-HCMV IgM-positive patients. We conclude that anti-HCMV IgA and IgM testing for management of clinically relevant HCMV infections in solid-organ transplant recipients is dispensable.

Detection of human rotavirus by nucleic acid analysis in comparison to enzyme-linked immunoassay and electron microscopy.

The results of RNA analysis for the detection of rotavirus were compared with those of a standard enzyme-linked immunosorbent assay (ELISA) and electron microscopy using 212 faecal specimens obtained from 200 children with gastroenteritis. Rotavirus was extracted directly from faecal specimens and RNA segments were made visible by polyacrylamide gel electrophoresis using a silver staining technique. Of the 212 faecal specimens 137 were found to be positive in ELISA, 125 in RNA analysis and 121 in both methods. Forty-nine of the 212 specimens were also investigated by electron microscopy. Thirty-five were positive when examined by electron microscopy, 37 were positive in ELISA and 33 in RNA analysis. RNA analysis of 119 faecal samples in outbreaks and sporadic cases of rotavirus infection yielded 42 different rotavirus electrophoretypes. The results indicated that no one method was sufficient to detect all positive specimens and that RNA analysis is useful in epidemiological studies.

Coronavirus-like particles as aetiological agents of acute non-bacterial gastroenteritis in humans.

The morphology of coronavirus-like particles found in faecal extracts of neonates and infants with acute gastroenteritis show similarities with the structure of human coronaviruses. These coronavirus-like particles can be detected in faeces of sick neonates and infants in higher frequency than in healthy children of the same age, their association with this clinical syndrome is discussed. The significance of enteric coronavirus-like particles in acute gastroenteritis of adults is questionable since the particles can be found in faeces of diseased persons and of healthy adults with equal frequency.

Isolation and identification of enteric adenoviruses.

Thirty-four out of 64 faecal samples with adenovirus particles, as seen by electron microscopy, were found to contain adenovirus 40 or 41 by direct isolation and neutralization in Chang's conjunctival cells, mostly within one week. (Ad40 and 41 candidate viruses are serologically related.) 6 other adenovirus species were isolated; 6 samples gave equivocal results, and 18 were negative. A genus-specific ELISA with an antihexon coat yielded positive results in 40 out of 55 samples; the test failed to identify adenovirus antigen in 10 out of 17 specimens, which were found negative by culture. All of them were negative by immunfluorescence of inoculated Chang cell cultures. Hence the failures are probably due to insufficient amount of virus in the samples. The predominance of only two adenovirus species associated with gastroenteritis in children and the ease of cultivating and identifying them should help to elucidate their etiological significance.

[Visualization by electronmicroscopy of 28 nm virusparticles (astroviruses) in faeces of newborns with acute nonbacterial gastroenteritis (author's transl)]. / Elektronenmikroskopischer Nachweis von 28 nm-Viruspartikeln (Astroviren) in Faeces Neugeborener mit akuter abakterieller Gastroenteritis.

On occasion of an epidemic of acute nonbacterial gastroenteritis virus particles were visualized by electronmicroscopy in the faeces of 76 newborns; these particles had the following properties: mean diameter 28 nm; ether-resistent, stable at pH 3.0; buoyant density 1.33--1.34 g/ml in CsCl. About 10% of these particles had a definite star-like structure on their surface. Due to these properties the virusparticles were considered to be astroviruses. The virus was not cytopathogenic for cell cultures susceptible for enteroviruses, and not pathogenic for newborn mice.

Diarrhea in newborn cynomologus monkeys infected with human rotavirus.

Of six newborn cynomolgus monkeys (Macaca fascicularis) naturally delivered and normally nursed five developed diarrhea after oral administration of human rotavirus. Virus excretion was observed in the stool of four animals. This virus was transmitted to four out of six other monkeys causing diarrhea in only one animal.

[Viruses as causal agents of gastroenteritis in infants and young children (author's transl)]. / Viren als Ursache der akuten Gastroenteritis bei Säuglingen und Kleinkinder.

Electron microscopic examination of stool samples from 195 infants and young children with acute gastroenteritis revealed rota virus in 31 samples (= 16%), corona virus in 44 samples (= 23%) and adenovirus in 13 samples (= 7%). Viruses were excreted for between 4 and 8 days in patients infected with rota virus and corona virus respectively. An outbreak of acute gastroenteritis in a premature baby unit with 24 cases is reported: corona virus was found in the stools of 15 infants. It is suggested that corona virus as well as rota virus may cause gastroenteritis in infants and small children.

[Poliomyelitis in the German Federal Republic 1974-1975 (author's transl)]. / Poliomyelitis in der Bundesrepublik Deutschland

The virological surveillance of poliomyelitis in 1974-1975 led to the detection of specific characteristics of wild viruses in 57 out of 221 cases of poliovirus isolation. The disease symptoms were typical for poliomyelitis in 36 of these cases, less characteristic in 13. Polio wildvirus was isolated 8 times from the surroundings of the patients. In 36 foreign patients and one German the causative agent was imported from an endemic area. In these cases and in a further 7 German patients the disease was sporadic. In contrast 5 cases in German children in late autumn 1975 constitute a local epidemic of poliomyelitis.

[Electronmicroscopic visualization of virusparticles in cases of gastroenteritis of infants and children (author's transl)]. / Elektronenmikroskopischer Direktnachweis von Viruspartikeln bei Gastroenteritis im Säuglings- und Kleinkindesalter

In 72 faecal extracts examined from babies and infants with an acute gastroenteritis, virus particles were found in 29 cases. These particles could be classified as reovirus-like in 16 cases, coronaviruses in 11 cases and adenoviruses in 2 cases. The electron microscopic investigation of 11 faecal extracts from healthy babies did not show any of these particles. Comparative studies on the concentration methods were performed.