[3rd Workshop on Epidemiology, Prevention and Treatment of Invasive Meningococcal Disease in Würzburg 2006]. / 3. Würzburger Workshop zur Epidemiologie, Prävention und Therapie der invasiven Meningokokkenerkrankung 2006.

On October 5th, 2006, the German Reference Centre for Meningococci (NRZM) held the 3rd Workshop on Epidemiology, Prevention and Treatment of Invasive Meningococcal Disease, in collaboration with the German Society for Hygiene and Microbiology (DGHM). Given the recent recommendation of the German Standing Committee on Vaccination (STIKO) for conjugate meningococcal C vaccination of all children in the second year of life, observations from meningococcal C conjugate vaccination campaigns in other European countries were presented and compared to the German situation. Moreover, the newly implemented cluster detection routines employed at the NRZM and their integration into the interactive geographical information system EpiScanGIS were shown. Based on recent experiences from regional outbreaks in Oberallgäu, Sangerhausen, and Greater Aachen, examples for public health intervention were given at the conference. In addition, current developments in the area of meningococcal research, as well as trends in antimicrobial susceptibility were covered. Finally, the latest evidence concerning the clinical management and chemoprophylaxis of this invasive bacterial disease was discussed.

[Cluster of meningococcal diseases in Allgaeu -- strategies for intervention]. / Cluster von Meningokokkenerkrankungen im Allgäu -- Interventionsstrategien.

In spring 2004 an accumulation of cases of invasive meningococcal disease was observed in the Allgaeu/Bavaria. Investigations of the isolates showed, that four cases in neighbouring municipalities of the district Oberallgaeu were caused by an identical strain of serogroup C. The particular strain was a rare variant of the so called ET-15 clone, which had caused several outbreaks of severe meningococcal disease among young people in the past, for example in Rottal/Inn (1998), Karlsruhe (1999 - 2000) and Schwerte (2003). The involved health authorities had to decide, which intervention strategies were reasonable and appropriate to the given situation. An epidemiological assessment of the situation was made by the Bavarian Health and Food Safety Authority (LGL) using the recommendations of the permanent immunization committee at the Robert Koch-Institute and of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) . The LGL together with the Robert Koch-Institute and the national meningococcal reference centre concluded that the situation fulfilled the criteria for a vaccination indication in accordance with section sign 20 Abs. 5 of the infectious disease control act (Infektionsschutzgesetz, IfSG). On the basis of this assessment the responsible regional health authority issued a public recommendation for vaccination and the district health authority of the Oberallgaeu was assigned to implement a vaccination campaign. The Oberallgaeu health authority offered vaccination sessions to the public in the concerned communities. The target group comprised babies, children, young people and adults up to twenty years, who lived in the concerned communities in the northern part of Oberallgaeu, as well as close contacts of cases and members of the above age group, who had visited communal facilities in the communities concerned. Our report describes the implementation of the vaccination campaign.

Anthropogenic radioactivity in the Arctic Ocean--review of the results from the joint German project.

The paper presents the results of the joint project carried out in Germany in order to assess the consequences in the marine environment from the dumping of nuclear wastes in the Kara and Barents Seas. The project consisted of experimental work on measurements of radionuclides in samples from the Arctic marine environment and numerical modelling of the potential pathways and dispersion of contaminants in the Arctic Ocean. Water and sediment samples were collected for determination of radionuclide such as 137Cs, 90Sr, 239 + 240Pu, 238Pu, and 241Am and various organic micropollutants. In addition, a few water and numerous surface sediment samples collected in the Kara Sea and from the Kola peninsula were taken by Russian colleagues and analysed for artificial radionuclide by the BSH laboratory. The role of transport by sea ice from the Kara Sea into the Arctic Ocean was assessed by a small subgroup at GEOMAR. This transport process might be considered as a rapid contribution due to entrainment of contaminated sediments into sea ice, following export from the Kara Sea into the transpolar ice drift and subsequent release in the Atlantic Ocean in the area of the East Greenland Current. Numerical modelling of dispersion of pollutants from the Kara and Barents Seas was carried out both on a local scale for the Barents and Kara Seas and for long range dispersion into the Arctic and Atlantic Oceans. Three-dimensional baroclinic circulation models were applied to trace the transport of pollutants. Experimental results were used to validate the model results such as the discharges from the nuclear reprocessing plant at Sellafield and subsequent contamination of the North Sea up the Arctic Seas.

The outflow of radionuclides from Novaya Zemlya bays--modeling and monitoring strategies.

Hydrodynamic model results are used to evaluate possible monitoring strategies for a continuous survey of underwater dump sites. The Hamburg Shelf Ocean Model (HAMSOM) is applied to Abrosimov Bay and forced with realistic, transient wind fields and air temperatures. The three-dimensional circulation model is coupled to a dynamic-thermodynamic ice model that accounts for surface heat fluxes, fractional ice cover and ice thickness. Model results show significant variations in the bay circulation due to a pronounced seasonality in the wind forcing and the ice cover. The circulation is weakest in early summer when wind speeds are low and the ice still covers most parts of the bay. In autumn, circulation and flushing of the bay is most enhanced, due to increasing wind speeds and the absence of an ice cover. Dispersion scenarios were carried out assuming a leakage at dumped objects. During most of the year the obtained tracer concentrations in the bay are higher in the upper layers than close to the bottom, indicating an outflow at the surface and a compensatory inflow below. This general pattern is only reversed during spring and early summer, when the wind directions change. Since ice problems make it almost impossible to monitor surface waters or even the whole water column in a shallow bay, the only way to install a monitoring system, is at the bottom of the bay, as close as possible to dumped objects. Data transmission via satellite or radio could be realized from a small station located on the bay's edge.

Benchmarking of numerical models describing the dispersion of radionuclides in the Arctic Seas.

As part of the International Arctic Seas Assessment Project (IASAP) of the International Atomic Energy Agency (IAEA), a working group was created to model the dispersal and transfer of radionuclides released from radioactive waste disposed of in the Kara Sea. The objectives of this group are: (1) development of realistic and reliable assessment models for the dispersal of radioactive contaminants both within, and from, the Arctic ocean; and (2) evaluation of the contributions of different transfer mechanisms to contaminant dispersal and hence, ultimately, to the risks to human health and environment. With regard to the first objective, the modelling work has been directed towards assessment of model reliability and asone aspect of this, a benchmarking exercise has been carried out. This paper briefly describes the benchmark scenario, the models developed and used, and discusses some of the benchmarking results. The role of the exercise within the modelling programme of IASAP will be discussed and future work described.

[Malaria relapse in the puerperium]. / Malaria-Rezidive im Wochenbett.

During the last six years we observed four malaria relapses shortly after delivery. In three cases the relapse occurred subsequent to Caesarean section, and in one case shortly after normal uncomplicated delivery. Case histories revealed that these women had previously stayed in the tropical or subtropical zones. The longest period without relapse was five years, the shortest interval four months. In all cases, microscopic examination revealed a relapse of Malaria tertiana. All the patients were cured within a short time by administration of chloroquine; the clinical signs disappeared. If, in fever of unknown origin, malaria is suspected, diagnosis and therapy will be an easy matter. Good anamnesis will provide a pointer to appropriate therapeutic action.

Comparison of microscopy, culture and enzyme immunoassay (Gonozyme) for the detection of Neisseria gonorrhoeae in urogenital specimens.

Urogenital specimens of male patients and female prostitutes were examined for gonorrhoea in a gonococcal antigen enzyme immunoassay (Gonozyme), by microscopic examination of stained smears and by bacterial culture. Out of 18 male patients, 14 showed positive reactions (all 14 by Gonozyme and by microscopy, but only eight by culture also). The sensitivity and specificity of Gonozyme was 100% in reference to microscopy. The predictive value for a positive test and for a negative test was 100%. The sensitivity of Gonozyme in reference to culture was also 100%, but the specificity was only 40%, because of the low yield of positive cultures. The predictive value for a positive test was 57% and for a negative test 100%. Out of 189 female prostitutes, 41 (22%) had a positive reaction in at least one test (Gonozyme, microscopy and culture were positive in 10; Gonozyme and culture in three; Gonozyme and microscopy in 14; Gonozyme alone in 11; culture alone in three). The sensitivity of Gonozyme was 100% and specificity 92% in reference to microscopy. The predictive value for a positive test was 63% and for a negative test 100%. In reference to culture, the sensitivity was 81% and specificity 86%. The predictive value for a positive test was 34% and for a negative test 98%. In prostitutes, the rate of asymptomatic infections was 14%, if one assumed that all Gonozyme-positive results were truly positive. Gonozyme proved to be the most sensitive method for screening female patients. To discriminate possibly false positive reactions, Gonozyme-positive specimens should be corroborated, preferably by bacterial cultivation.