Immunity status against poliomyelitis in Germany: Determination of cut-off values in International Units

Background: To prevent importations of wild polioviruses into a polio free region a high level of population immunity must be kept. Standard methodology for determination of polio antibodies is a feature aimed at obtaining consistent results. An International Standard Serum for polio antibodies exists, but no protective level in International Units is defined. Methods: A representative study was carried out in order to determine the serological status against poliomyelitis in Germany (n = 2564, age 18–79 years). Furthermore, sera from persons aged less than 18 years were included (n = 881). Microneutralization test has been used for determination of antibody levels. Results have been expressed in International Units. Results: The results of this study indicate that the cut-off level for polio antibodies is 0.075 IU/ml for Polio 1, 0.180 IU/ml for Polio 2 and 0.080 IU/ml for Polio 3. Neutralizing antibodies against poliovirus type 1, 2 and 3 were detected in 96.2%, 96.8% and 89.6% of samples, respectively. Conclusions: Overall, this seroprevalence indicates a very high level of immunity of the general population. It must be kept after the switch of immunization strategy from attenuated to inactivated vaccine in Germany

Chronic Norovirus Infection after Kidney Transplantation: Molecular Evidence for Immune-Driven Viral Evolution

Background. Norovirus infection is the most common cause of acute self-limiting gastroenteritis. Only 3 cases of chronic norovirus infection in adult solid organ transplant recipients have been reported thus far. Methods. This case series describes 9 consecutive kidney allograft recipients with chronic norovirus infection with persistent virus shedding and intermittent diarrhea for a duration of 97-898 days. The follow-up includes clinical course, type of immunosuppression, and polymerase chain reaction for norovirus. Detailed molecular analyses of virus isolates from stool specimens over time were performed. Results. The intensity of immunosuppression correlated with the diarrheal symptoms but not with viral shedding. Molecular analysis of virus strains from each patient revealed infection with different variants of GII.4 strains in 7 of 9 patients. Another 2 patients were infected with either the GII.7 or GII.17 strain. No molecular evidence for nosocomial transmission in our outpatient clinic was found. Capsid sequence alignments from follow-up specimens of 4 patients showed accumulation of mutations over time, resulting in amino acid changes predominantly in the P2 and P1-2 region. Up to 25 amino acids mutations were accumulated over a 683-day period in the patient with an 898-day shedding history. Conclusion. Norovirus infection may persist in adult renal allograft recipients with or without clinical symptoms. No evidence for nosocomial transmission in adult renal allograft recipients was found in our study. Molecular analysis suggests continuous viral evolution in immunocompromised patients who are unable to clear this infectio

Aetiology of community-acquired, acute gastroenteritis in hospitalised adults: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>The aetiology of severe gastroenteritis leading to hospitalisation in adults frequently remains unclear. Our objective was to study the causes and characteristics of community-acquired, acute gastroenteritis in adult hospitalized patients to support the clinical management of these patients.</p> <p>Methods</p> <p>From August 2005 to August 2007, we conducted a prospective cohort study among patients ≥18 y hospitalized with community-acquired gastroenteritis in a university hospital in Berlin, Germany. Stool specimens were examined for 26 gastrointestinal pathogens, supplemented by serologic tests for antibodies to <it>Campylobacter spp.</it>, <it>Yersinia spp.</it>, and <it>Entamoeba histolytica</it>. Patient data on demographics and clinical presentation were recorded and analyzed. Coexisting medical conditions were assessed using the Charlson Comorbidity Index score.</p> <p>Results</p> <p>Of 132 patients presenting with acute community-acquired gastroenteritis, 104 were included in the study. A non-infectious aetiology was diagnosed in 8 patients (8%). In 79 (82%) of the remaining 96 patients at least one microorganism was identified. <it>Campylobacter spp. </it>(35%) was detected most frequently, followed by norovirus (23%), <it>Salmonella spp. </it>(20%), and rotavirus (15%). In 46% of the patients with <it>Campylobacter spp. </it>infection, the diagnosis was made solely by serology. More than one pathogen was found in seventeen (22%) patients. Simultaneous infection was significantly more likely in patients with rotavirus and salmonella infections (RR 3.6; 95% CI: 1.8–7.4; RR 2.5; 95%CI: 1.2–5.5). Length of hospital stay (median: 5.5 days) was independent of the pathogen, but was associated with coexisting medical conditions (OR 4,8; 95%CI:2,0–11,6).</p> <p>Conclusion</p> <p>Known enteric pathogens were detected in 82% of adult patients who were hospitalized with acute gastroenteritis. We found that currently used culture-based methods may miss a substantial proportion of <it>Campylobacter </it>infections, and additional serological testing for <it>Campylobacter </it>should be considered. Viral infections emerged as an important cause of severe gastroenteritis in adults, and viral-bacterial co-infections in adults are probably underrecognized so far. The presence of coexisting medical conditions – but not the etiological agent – was a predictor for the duration of the hospital stay.</p

Aseptic meningitis in Germany associated with echovirus type 13

BACKGROUND: Echoviruses are the commonest cause of aseptic meningitis. Echovirus type 13 which has not been isolated in Germany over a long period of time was the predominant enterovirus serotype associated with different local outbreaks of aseptic meningitis in Germany in 2000. METHODS: Virus isolation was performed from cerebrospinal fluid and stools. In order to study the genetic relationship of echovirus type 13 isolates, sequence analysis of a part of VP1 (~300 nt) was carried out. Isolates from different geographic regions were compared to each other as well as to elder viruses (prototype strain from 1953, four isolates from 1965–1986). RESULTS: Overall, 55 isolates of echovirus type 13 were obtained from different parts of Germany. It was shown that the new isolated strains have a very high degree of homology on the nucleotide level (> 98%)) but differ significantly from the old strains (76–85%). CONCLUSIONS: a) Rare enterovirus serotypes can cause serious illness. b) The molecular drift has also been shown for other enterovirus serotypes

Major Outbreak of Hepatitis A Associated with Orange Juice among Tourists, Egypt, 2004

In 2004, a major outbreak of hepatitis A among tourists returning from Egypt involved 351 case-patients from 9 European countries who were infected with a single strain (genotype 1b). The case-control study identified orange juice as the most likely infection vehicle. Vaccination against hepatitis A virus is strongly recommended before travel to disease-endemic areas

Detection of Norovirus genogroup I and II by multiplex real-time RT- PCR using a 3'-minor groove binder-DNA probe

BACKGROUND: Due to an increasing number of norovirus infections in the last years rapid, specific, and sensitive diagnostic tools are needed. Reverse transcriptase-polymerase chain reactions (RT-PCR) have become the methods of choice. To minimize the working time and the risk of carryover contamination during the multi-step procedure of PCR the multiplex real-time RT-PCR for the simultaneous detection of genogroup I (GI) and II (GII) offers advantages for the handling of large amounts of clinical specimens. METHODS: We have developed and evaluated a multiplex one-tube RT-PCR using a combination of optimized GI and GII specific primers located in the junction between ORF1 and ORF2 of the norovirus genome. For the detection of GI samples, a 3'- minor groove binder-DNA probe (GI-MGB-probe) were designed and used for the multiplex real-time PCR. RESULTS: Comparable results to those of our in-house nested PCR and monoplex real-time-PCR were only obtained using the GI specific MGB-probe. The MGB-probe forms extremely stable duplexes with single-stranded DNA targets, which enabled us to design a shorter probe (length 15 nucleotides) hybridizing to a more conserved part of the GI sequences. 97 % of 100 previously norovirus positive specimens (tested by nested PCR and/or monoplex real-time PCR) were detected by the multiplex real-time PCR. A broad dynamic range from 2 × 10^1 to 2 × 10^7 genomic equivalents per assay using plasmid DNA standards for GI and GII were obtained and viral loads between 2.5 × 10^2 and 2 × 10^12 copies per ml stool suspension were detected. CONCLUSION: The one-tube multiplex RT real-time PCR using a minor groove binder -DNA probe for GI is a fast, specific, sensitive and cost-effective tool for the detection of norovirus infections in both mass outbreaks and sporadic cases and may have also applications in food and environmental testing

Emergence of New Norovirus Variants on Spring Cruise Ships and Prediction of Winter Epidemics

A reporting system could provide early warning

Acute childhood diarrhoea in northern Ghana: epidemiological, clinical and microbiological characteristics

<p>Abstract</p> <p>Background</p> <p>Acute diarrhoea is a major cause of childhood morbidity and mortality in sub-Saharan Africa. Its microbiological causes and clinico-epidemiological aspects were examined during the dry season 2005/6 in Tamale, urban northern Ghana.</p> <p>Methods</p> <p>Stool specimens of 243 children with acute diarrhoea and of 124 control children were collected. Patients were clinically examined, and malaria and anaemia were assessed. Rota-, astro-, noro- and adenoviruses were identified by (RT-) PCR assays. Intestinal parasites were diagnosed by microscopy, stool antigen assays and PCR, and bacteria by culturing methods.</p> <p>Results</p> <p>Watery stools, fever, weakness, and sunken eyes were the most common symptoms in patients (mean age, 10 months). Malaria occurred in 15% and anaemia in 91%; underweight (22%) and wasting (19%) were frequent. Intestinal micro-organisms were isolated from 77% of patients and 53% of controls (<it>P </it>< 0.0001). The most common pathogens in patients were rotavirus (55%), adenovirus (28%) and norovirus (10%); intestinal parasites (5%) and bacteria (5%) were rare. Rotavirus was the only pathogen found significantly more frequently in patients than in controls (odds ratio 7.7; 95%CI, 4.2–14.2), and was associated with young age, fever and watery stools. Patients without an identified cause of diarrhoea more frequently had symptomatic malaria (25%) than those with diagnosed intestinal pathogens (12%, <it>P </it>= 0.02).</p> <p>Conclusion</p> <p>Rotavirus-infection is the predominant cause of acute childhood diarrhoea in urban northern Ghana. The abundance of putative enteropathogens among controls may indicate prolonged excretion or limited pathogenicity. In this population with a high burden of diarrhoeal and other diseases, sanitation, health education, and rotavirus-vaccination can be expected to have substantial impact on childhood morbidity.</p

Physics, Astrophysics and Cosmology with Gravitational Waves

Gravitational wave detectors are already operating at interesting sensitivity levels, and they have an upgrade path that should result in secure detections by 2014. We review the physics of gravitational waves, how they interact with detectors (bars and interferometers), and how these detectors operate. We study the most likely sources of gravitational waves and review the data analysis methods that are used to extract their signals from detector noise. Then we consider the consequences of gravitational wave detections and observations for physics, astrophysics, and cosmology.Comment: 137 pages, 16 figures, Published version <http://www.livingreviews.org/lrr-2009-2

Kinder- und Jugendgesundheitssurvey (KiGGS): Immunitätslage gegen Poliomyelitis

Die WHO geht davon aus, dass in den nächsten Jahren eine weltweite Eradikation der Poliomyelitis erreicht werden kann. Obwohl Europa 2002 als poliofrei zertifiziert wurde, ist die Gefahr der Wiedereinschleppung von Poliowildviren nach wie vor gegeben. Der Aufrechterhaltung einer hohen Populationsimmunität kommt daher als Schutz gegen importierte Wildviren eine besondere Bedeutung zu. Im Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS) wurden erstmalig nach der Umstellung der Impfstrategie in Deutschland vom Lebend- zum Totimpfstoff (OPV/IPV) Daten zur Immunitätslage gegen Poliomyelitis gewonnen. Eine Stichprobe aus der Gesamtheit der KiGGS-Seren wurde auf das Vorhandensein von Antikörpern gegen die 3 Poliovirustypen getestet (n=2046). Die Bestimmung der Antikörper erfolgte mit dem Mikroneutralisationstest auf RD-Zellen. Bezogen auf die einzelnen Serotypen konnten bei 97,4% Polio- 1-; 97,6% Polio-2- und 93,6% Polio-3-Antikörper nachgewiesen werden. Der Anteil von Probanden mit Antikörpern gegen alle 3 Poliovirustypen betrug über alle Altersgruppen 91,7%. Nur 26 Probanden hatten keine nachweisbaren neutralisierenden Antikörper gegen alle 3 Serotypen (1,3%). Die Unterteilung nach Geschlecht, Region (Ost/West) und Herkunft (mit/ohne Migrationshintergrund) ergab keine signifikanten Unterschiede bei den Antikörperprävalenzen. Die Prävalenzen von Antikörpern gegen alle 3 Poliovirusserotypen sprechen für eine hohe Populationsimmunität bei Kindern. Diese muss auch weiterhin durch konsequentes Impfen aufrechterhalten werden.One of the goals of the WHO is the worldwide eradication of poliomyelitis in the coming years. Europe was declared poliofree in 2002, but increasing migration may lead to a come-back of circulating polioviruses. A high level of population immunity protects against imported wild viruses from endemic areas. The first seroprevalence data since the switch from live to inactivated vaccine in Germany (OPV to IPV) are provided. A serum panel was tested (n=2,046) in order to study the serological status against poliomyelitis. The microneutralization test on RD cells was used. Overall, neutralizing antibodies against poliovirus types 1, 2 and 3 were detected in 97.4%, 97.6%, and 93.6% of samples, respectively. Of the test persons, 91.7% had antibodies against all three virus types. Only 26 children simultaneously lacked neutralizing antibodies for all three serotypes (1.3%). No significant correlation between gender, region (East/West)), migration status (with/without migration background) and antibody prevalence to polioviruses was found. The seroprevalence of antibodies against all three types of polioviruses indicates a very high level of population immunity in German children. It must be maintained through consequently performed vaccination programmes