Risk Factors for Hantavirus Infection in Germany, 2005

In 2005, a marked increase in hantavirus infections was observed in Germany. Large cities and areas where hantaviruses were not known to be endemic were affected. A case–control study identified the following independent risk factors for infection: occupational exposure for construction workers, living <100 m from forested areas, and exposure to mice

Loss of AQP3 protein expression is associated with worse progression-free and cancer-specific survival in patients with muscle-invasive bladder cancer

Purpose Urothelial carcinoma has recently been shown to express several aquaporins (AQP), with AQP3 being of particular interest as its expression is reduced or lost in tumours of higher grade and stage. Loss of AQP3 expression was associated with worse progression-free survival (PFS) in patients with pT1 bladder cancer. The objective of this study was to investigate the prognostic value of AQP3 expression in patients with muscle-invasive bladder carcinoma (MIBC). Methods Retrospective single-centre analysis of the oncological outcome of patients following radical cystectomy (Cx) due to MIBC. Immunohistochemistry was used to assess AQP3 protein expression in 100 Cx specimens. Expression levels of AQP3 were related to clinicopathological variables. The impact of biomarker expression on progression-free, cancer-specific and overall survival was determined by multivariate Cox regression analysis (MVA). Results High expression of AQP3 by the tumour was associated with a statistically significantly improved PFS (75 vs. 19 %, p = 0.043) and CSS (75 vs. 18 %, p = 0.030) and, alongside lymph node involvement, was an independent predictor of PFS (HR 2.871, CI 1.066–7.733, p = 0.037), CSS (HR 3.325, CI 1.204–8.774, p = 0.019) and OS (HR 2.001, CI 1.014–3.947) in MVA. Conclusions Although the results of the study would be strengthened by a larger, more appropriately powered, prospective, multi-institutional study, our findings strongly suggest that AQP3 expression status may represent an independent predictor of PFS and CSS in MIBC and may help select patients in need for (neo-)adjuvant chemotherapy

Measles transmission from an anthroposophic community to the general population, Germany 2008

<p>Abstract</p> <p>Background</p> <p>In Germany, measles vaccination coverage with two doses is not yet sufficient to prevent regional outbreaks. Among the 16 German federal states, vaccination coverage was lowest in Bavaria with 85% in 2008. From March to mid-April 2008, four neighbouring Bavarian counties reported 55 measles-cases mostly linked to an ongoing measles outbreak in an anthroposophic school in Austria. We investigated this outbreak to guide future public health action.</p> <p>Methods</p> <p>We applied the German national case-definition for measles and collected data using the national surveillance system and a questionnaire. Measles cases with disease onset a maximum of 18 days apart and spatial contact (e.g. same household, same school) were summed up in clusters. Two different interventions, which were implemented in schools and kindergartens in Bavaria, were compared by their impact on the size and duration of measles clusters. Susceptible persons were excluded from schools or kindergartens either with the first (intervention A) or second (intervention B) measles case occurring in the respective institution.</p> <p>Results</p> <p>Among the 217 Bavarian measles cases identified from March-July 2008, 28 (13%) cases were attendees of the anthroposophic school in Austria. In total, vaccination status was known in 161 (74%) cases and 156 (97%) of them were not vaccinated. The main factor for non-vaccination was "fear of vaccine-related adverse events" (33%). Twenty-nine (18%) of 161 cases suffered complications. Exclusively genotype D5 was detected. Overall, 184 cases could be epidemiologically grouped into 59 clusters. Of those, 41 clusters could be linked to households and 13 to schools or kindergartens. The effect of intervention A and B was analysed in 10 school or kindergarten clusters. Depending on the respective intervention A or B, the median number of cases per cluster was 3 versus 13 (p = 0.05), and the median duration of a cluster was 3 versus 26 days (p = 0.13).</p> <p>Conclusions</p> <p>Introduction of measles virus into a pocket of susceptible persons (e.g. vaccination opponents or sceptics) may lead to large outbreaks in the general population, if the general population's vaccination coverage is below the WHO recommended level. Education on the safety of measles vaccine needs to be strengthened to increase measles vaccination coverage. Early intervention may limit spread in schools or kindergartens. Suspected measles has to be reported immediately to the local health authorities in order to allow intervention as early as possible.</p

Sequential treatment of ADHD in mother and child (AIMAC study): importance of the treatment phases for intervention success in a randomized trial

Background: The efficacy of parent-child training (PCT) regarding child symptoms may be reduced if the mother has attention-deficit/hyperactivity disorder (ADHD). The AIMAC study (ADHD in Mothers and Children) aimed to compensate for the deteriorating effect of parental psychopathology by treating the mother (Step 1) before the beginning of PCT (Step 2). This secondary analysis was particularly concerned with the additional effect of the Step 2 PCT on child symptoms after the Step 1 treatment. Methods: The analysis included 143 mothers and children (aged 6–12 years) both diagnosed with ADHD. The study design was a two-stage, two-arm parallel group trial (Step 1 treatment group [TG]: intensive treatment of the mother including psychotherapy and pharmacotherapy; Step 1 control group [CG]: supportive counseling only for mother; Step 2 TG and CG: PCT). Single- and multi-group analyses with piecewise linear latent growth curve models were applied to test for the effects of group and phase. Child symptoms (e.g., ADHD symptoms, disruptive behavior) were rated by three informants (blinded clinician, mother, teacher). Results: Children in the TG showed a stronger improvement of their disruptive behavior as rated by mothers than those in the CG during Step 1 (Step 1: TG vs. CG). In the CG, according to reports of the blinded clinician and the mother, the reduction of children’s disruptive behavior was stronger during Step 2 than during Step 1 (CG: Step 1 vs. Step 2). In the TG, improvement of child outcome did not differ across treatment steps (TG: Step 1 vs. Step 2). Conclusions: Intensive treatment of the mother including pharmacotherapy and psychotherapy may have small positive effects on the child’s disruptive behavior. PCT may be a valid treatment option for children with ADHD regarding disruptive behavior, even if mothers are not intensively treated beforehand. Trial registration: ISRCTN registry ISRCTN73911400. Registered: 29 March 2007

Outbreak of salmonellosis after a wedding party, Bavaria, Germany, summer 2010: the importance of implementing food safety concepts

An outbreak of salmonellosis in the summer of 2010 after a wedding party in Bavaria, Germany, was investigated, to identify vehicles and source of the outbreak and any flaws in food safety procedures. A cohort study targeting all wedding participants was carried out in addition to laboratory and environmental investigations. The overall attack rate was 59% (52/88). A group of buffet dishes containing mayonnaise was associated with the highest relative risk: 6.6 (95% CI: 1.7–25.0). Subtyping of a subset of Salmonella isolates cultured from stool samples from wedding participants and catering staff and from food samples showed the isolates to be indistinguishable (S. Enteritidis, lysotype 4/6, ribotype 3). European laws require food business operators to establish and implement food safety procedures. Investigation of the practices of the catering company revealed a lack of staff training and the absence of records of a food safety concept. Nonedible flower decorations in cold dishes were identified as a potential source of secondary contamination because their cultivation and processing are not subject to the food safety regulations minimising the risk of contamination of crops intended for human consumption. The outbreak demonstrated the importance of staff training and food safety concepts to identify and mitigate hazards to food safety

Der Masernausbruch in Coburg: Was lässt sich daraus lernen?

Im November 2001 begann in der Stadt und im Landkreis Coburg ein Masernausbruch, der insgesamt acht Monate dauerte. In dieser Zeit wurden 1 191 Masernfälle gemeldet, entsprechend einer kumulativen Inzidenz von 882/100 000 Einwohner mit 43 (4 Prozent) gemeldeten stationären Masernfällen. 398 Patienten konnten anhand von Fragebögen untersucht werden; in dieser Gruppe traten bei 28 Prozent Komplikationen auf, es kam jedoch zu keinen Masernenzephalitiden oder Todesfällen. Neun Prozent der Masernpatienten waren geimpft. Bei Durchimpfungsraten von 90 Prozent oder höher in den Nachbarlandkreisen blieb der Ausbruch auf Stadt und Landkreis Coburg beschränkt, wo die Durchimpfungsrate bei 77 Prozent lag. Im Rahmen einer Interventionsmaßnahme während des Ausbruchs, bei der die Eltern persönlich angesprochen wurden, stiegen die Verkaufszahlen des Masernimpfstoffs kurzfristig drastisch an. Schätzungsweise bis zu 50 Prozent der für Masern empfänglichen Population der unter 15-Jährigen konnte dadurch zusätzlich geschützt werden. Durch diese Interventionsmaßnahme wurde ein relevanter Anteil der Bevölkerung für eine Impfung motiviert. Mittels einer kleinräumigen Gesundheitsberichterstattung können Regionen mit einem erhöhten Risiko für Masernausbrüche identifiziert werden. Möglicherweise lässt sich bei einem beginnenden Ausbruch durch personenbezogene Interventionsmaßnahmen die Durchimpfungsrate auch in diesen Regionen mit einem hohen Anteil an Ungeimpften und Impfgegnern kurzfristig erheblich steigern