Akute Otitis media: Einfluss der Pneumokokkenimpfung auf die Prävalenz

Zusammenfassung: Die Pneumokokkenimpfung mit Konjugatimpfstoff schützt vor invasiven und auch lokalen Infektionen, z. B. akuter Otitis media (AOM). In der Zulassungsstudie des 7-valenten Konjugatimpfstoffs (Prevenar®) wurde eine Schutzrate von 67% gegen AOM durch im Impfstoff enthaltene Pneumokokkenserotypen ermittelt. Gegenüber jeglicher AOM betrug sie 9%. Der Impfstoff ist neuerdings in der EU auch für die Indikation AOM zugelassen. Seit der Einführung des Pneumokokkenimpfprogramms in den USA im Jahr 2000 bei Kindern bis zum Alter von 2 Jahren liegen nunmehr auch Daten zur klinischen Effizienz vor. So war in einer repräsentativen Erhebung in den USA in den ersten Jahren nach Beginn des Programms ein Rückgang der ambulanten Behandlungen wegen AOM bei unter 2Jahre alten Kindern um 20% zu verzeichnen. Manche Untersuchungen deuten darauf hin, dass dieser Rückgang mit einer relativen Zunahme von AOM durch nicht im Impfstoff enthaltene Serotypen einhergeht ("replacement"). Sorgfältige epidemiologische Untersuchungen begleitend zu Impfprogrammen sind erforderlich, um solche Entwicklungen erkennen zu könne

Nachholimpfungen und Impfungen von Ungeimpften

Zusammenfassung: Die von der Ständigen Impfkommission (STIKO) empfohlenen Standardimpfungen für Kinder und Jugendliche werden von den Eltern nicht immer zum empfohlenen Zeitpunkt akzeptiert. Auch werden häufig empfohlene Auffrischimpfungen nicht verabreicht. Wenn dann zu einem späteren Zeitpunkt Nachholimpfungen gewünscht werden, wirft dies oft Fragen zur erforderlichen Anzahl an Impfdosen sowie zur Reihenfolge und zum Abstand verschiedener Impfungen auf. Bei der individuellen Planung von Nachholimpfungen sind dann bereits dokumentierte Impfungen ("jede Dosis zählt"), das Alter des Patienten und das Geschlecht zu berücksichtigen. Ziel ist es, binnen kurzer Zeit mit möglichst wenigen Injektionen den Impfstatus zu aktualisieren. Hierfür wird eine pragmatische Anleitung gebote

The respiratory pathology in infants with sudden unexpected deaths in whom respiratory specimens were initially PCR-positive or PCR-negative for Bordetella pertussis

Background: In a previous controlled study, we investigated the relationship between Bordetella pertussis infections and sudden unexpected deaths among German infants (sudden infant death syndrome, SIDS). In this present study, we investigated further the respiratory pathology in a subset of infants in the original study. Methods: Originally, there were 234 infants with SIDS and, of these, 12 had either a nasopharyngeal swab (NPS) or a tracheal swab specimen (TS) that was positive for B. pertussis by polymerase chain reaction (PCR). Here, tissue specimens from eight infants who were originally PCR-positive were compared with tissue specimens from seven infants in whom the original PCR studies were negative. Results: The histopathologic diagnoses were as follows: 14 of 15 had pulmonary edema and the remaining case had early diffuse alveolar damage. Although 14 of 15 cases had some histologic or clinical evidence suggesting respiratory tract infection, the features were more consistent with a viral etiology, and in none were the findings typical of respiratory disease attributable to B. pertussis. Conclusions: The findings in this present investigation do not support a direct role of B. pertussis at the site of infection (ciliated epithelium) in the causation of SIDS. The clinical aspects of this study were carried out in the 1990s when pertussis was widespread in Germany. Therefore, the original finding of some PCR-positive cases is not surprising. The possibility that B. pertussis infection could still be a factor in some SIDS cases, e.g., by a systemic release of toxins, cannot be definitely ruled ou

Influenza-Associated Myositis in Children

Abstract. : Background: : Influenza-associated myositis (IAM) is an infrequent and poorly known complication of influenza virus infection in children. The aim of this study was to describe five cases of IAM and to review the literature on IAM in children. Patients and Methods: : We conducted a retrospective analysis of cases of IAM diagnosed at two university children's hospitals in Switzerland during two consecutive influenza seasons. Findings were compared with 39 individual case reports and five publications summarizing an additional 272 cases identified by a medical online library (MEDLINE) search. Results: : Overall, 316 cases were analyzed. IAM typically occurred in school-aged children with a 2:1 male predominance. Influenza B and A viruses were identified in 76% and 24% of cases, respectively. The median interval between onset of influenza and onset of IAM was 3 days (range 0-18). The calf muscles were involved alone or together with other muscle groups in 69% and 31% of cases, respectively. Blood creatine phosphokinase (CPK) concentration was invariably elevated. Median duration to clinical recovery was 3 days (range 1-30). Rhabdomyolysis occurred in ten of 316 patients (3%), was more common in girls (80%), more often associated with influenza A (86%), and led to renal failure in eight patients (80%). Conclusion: : Clinical and laboratory findings of IAM are highly characteristic and allow a rapid diagnosis during the influenza seaso

Role of Chlamydia pneumoniae and Mycoplasma pneumoniae as Causative Agents of Community-Acquired Pneumonia in Hospitalised Children and Adolescents

The aim of the study presented here was to determine the prevalence of Chlamydia pneumoniae versus Mycoplasma pneumoniae infections in paediatric patients with community-acquired pneumonia. A total of 50 patients (mean age, 5.5 years; median, 3.9 years) with community-acquired pneumonia were enrolled. Four patients were found to have Chlamydia pneumoniae infection (1 culture positive, 1 PCR positive and 2 serology positive) and 16 patients had Mycoplasma pneumoniae infection (2 PCR positive, 4 PCR and serology positive, 10 serology positive), including three patients with coinfection. The rates of Mycoplasma pneumoniae infection were 22%, 35% and 40% in children aged 1-3, >3-7 and >7 years, respectively. Acute Chlamydia pneumoniae infection was substantially less common than Mycoplasma pneumoniae infection in our study cohor

The Role of Bordetella Infections in Patients with Acute Exacerbation of Chronic Bronchitis

Abstract : Background: : Acute exacerbations of chronic bronchitis (AECB) are associated with a variety of viral and bacterial infectious agents, some of which are potentially preventable by immunization. Bordetella pertussis, which causes whooping cough, has not been studied in this context. We aimed to assess the role of Bordetella infections in patients with AECB. Patients and Methods: : Patients with AECB, who presented to participating private practices in Basel, Switzerland, between October 2000 and June 2002, were evaluated by a standardized questionnaire, nasopharyngeal swabs for culture (Bordetella spp.), and PCR (Bordetella spp. and selected other respiratory pathogens) and paired blood samples for serologic diagnosis of Bordetella infection. Results: : A total of 26 patients (34-86 years of age) were recruited. All culture and PCR samples were negative. Serology revealed Bordetella infection in eight (31%) patients. Duration of cough was shorter in patients with Bordetella infection compared to those without Bordetella infection (mean 15 days vs 41 days, p = 0.04). Cough ≥ 21 days duration was present in three (43%) of seven patients with evidence of Bordetella infection compared to 17 (94%) of 18 controls (p = 0.012). Progression to convalescence from initial to follow-up visit after 4-6 weeks was comparable between both groups. Conclusion: : Bordetella infections appear to play a significant role in AECB and preventive measurements such as immunization with acellular pertussis vaccines should be considered. Extended investigations are necessary to confirm our preliminary and provocative finding

Assessment of varicella vaccine effectiveness in Germany: a time-series approach

A multivariate time-series regression model was developed in order to describe the 2005-2008 age-specific time-course of varicella sentinel surveillance data following the introduction of a varicella childhood vaccination programme in Germany. This ecological approach allows the assessment of vaccine effectiveness under field conditions by relating vaccine coverage in cohorts of 24-month-old children to the mean number of cases per reporting unit in the sentinel network. For the 1-2 years age group, which is directly affected by the vaccination programme, a one-dose vaccine effectiveness of 83·2% (95% CI 80·2-85·7) was estimated which corresponds to previous approaches assessing varicella vaccine effectiveness in the field in the US

Gastrointestinal pathogens detected by multiplex nucleic acid amplification testing in stools of pediatric patients and patients returning from the tropics

Background: Gastrointestinal infections are caused by a broad spectrum of pathogens. Conventional diagnostic procedures are resource and time consuming due to single pathogen testing, often in different laboratories. Method: We analyzed 312 consecutive stool samples from pediatric patients (n=127) with gastroenteritis or from adult travelers returning from the tropics with suspected parasite infestation (n=185) using commercial multiplex nucleic acid amplification testing (NAT) (xTAG gastrointestinal pathogen panel, Luminex) covering 15 diarrhea-causing pathogens. The results of the positive samples and a representative number of negative samples were compared to standard methods, including NAT, direct antigen detection (DAD), bacterial culture and microscopy. Results: Of the 185 samples from adult travelers, 21 (11%) were multiplexNAT-positive, with enterotoxigenic Escherichia coli (4%) being the predominant pathogen. Microscopic examination revealed Blastocystis hominis in 23% not covered by the panel. MultiplexNAT scored positive in 66 pediatric samples (52%), with rotavirus (27%) being the most prevalent. All adenovirus-, rotavirus-, Clostridium difficile- and Cryptosporidium-positive samples were confirmed in external laboratories, but only 40% of norovirus- and 29% of Giardia-positive samples. Analysis of frozen specimens by bacterial culture showed the highest discrepancies with the multiplexNAT. Conclusion: Our study demonstrates broad detection of relevant gastroenteritis pathogens by multiplexNAT with a short turnaround time. This is important for diagnosis, infection control and empiric management of gastroenteritis patients, but may be selectively complemented by bacterial culture and resistance testing

Clinical course and therapeutic approach to varicella zoster virus infection in children with rheumatic autoimmune diseases under immunosuppression.

To analyze the clinical presentation and complications of varicella zoster virus (VZV) infection in children with rheumatic diseases treated with immunosuppressive medication such as biological disease-modifying antirheumatic drugs (bDMARDs) and/or conventional disease-modifying antirheumatic drugs (cDMARDs), and to analyze the therapeutic approach to VZV infections with respect to the concomitant immunosuppressive treatment. Retrospective multicenter study using the Swiss Pediatric Rheumatology registry. Children with rheumatic diseases followed in a Swiss center for pediatric rheumatology and treated with cDMARD and/or bDMARD with a clinical diagnosis of varicella or herpes zoster between January 2004 and December 2013 were included. Twenty-two patients were identified, of whom 20 were treated for juvenile idiopathic arthritis, 1 for a polyglandular autoimmune syndrome type III, and 1 for uveitis. Of these 22 patients, 16 had varicella and 6 had herpes zoster. Median age at VZV disease was 7.6 years (range 2 to 17 years), with 6.3 years (range 2 to 17 years) for those with varicella and 11.6 years (range 5 to 16 years) for those with herpes zoster. The median interval between start of immunosuppression and VZV disease was 14.1 months (range 1 to 63 months). Two patients had received varicella vaccine (1 dose each) prior to start of immunosuppression. Concomitant immunosuppressive therapy was methotrexate (MTX) monotherapy (n = 9) or bDMARD monotherapy (n = 2), or a combination of bDMARD with prednisone, MTX or Leflunomide (n = 11). Four patients experienced VZV related complications: cellulitis in 1 patient treated with MTX, and cellulitis, sepsis and cerebellitis in 3 patients treated with biological agents and MTX combination therapy. Six children were admitted to hospital (range of duration: 4 to 9 days) and 12 were treated with valaciclovir or aciclovir. The clinical course of varicella and herpes zoster in children under immunosuppression is variable, with 4 (18 %) of 22 children showing a complicated course. Thorough assessment of VZV disease and vaccination history and correct VZV vaccination according to national guidelines at diagnosis of a rheumatic autoimmune disease is essential to minimize VZV complications during a later immunosuppressive treatment