Evaluation of two HIV antibody confirmatory assays: Geenius™ HIV1/2 Confirmatory Assay and the recomLine HIV-1 & HIV-2 IgG Line Immunoassay.

The laboratory diagnosis of an HIV infection mainly depends on the detection of HIV-specific antibodies/HIV p24 antigen whereby different algorithms for the confirmation of reactive screening assays exist. The objective of the present study was to compare the performance of two supplemental HIV antibody confirmatory assays: the Geenius™ HIV1/2 Confirmatory Assay and the recomLine HIV-1 & HIV-2 IgG Line Immunoassay. Therefore 279 serum samples previously analyzed for HIV during routine diagnostics at the Institute for Medical Virology, National Reference Center for Retroviruses, University Hospital Frankfurt, were analyzed retrospectively. 96.8% samples had concordant results in both HIV confirmatory assays, whereby the Geenius Assay showed a discrimination rate of 100% while two HIV-1 samples were not typeable with the recomLine Assay. Overall assay sensitivity was 100% in both assays and specificity was 99.0% (recomLine Assay) and 93.4% (Geenius Assay), respectively. The κ-values for both assays indicated high agreement. Overall nine samples had discordant results from which four were from acutely EBV/CMV-infected patients and one from a patient with primary HIV-1 infection during seroconversion. In conclusion, both assays are well suited for the detection, confirmation and discrimination of HIV-1- and -2-specific antibodies.

[Immunity against measles among healthcare personnel at the University Hospital Frankfurt, 2003-2013]. / Immunität gegen Masern beim medizinischen Personal des Universitätsklinikums Frankfurt, 2003-2013.

BACKGROUND: Despite aiming for the elimination of measles by 2015, the current epidemiological situation in Germany shows that there is still insufficient vaccination coverage among the population. During the present pre-elimination period, nosocomial measles are gaining in importance. AIM: The purpose of our study was to determine the immune status of measles among healthcare personnel and medical students at the University Hospital Frankfurt. Moreover, the knowledge of study participants regarding the WHO's goal of the elimination of measles and the general attitude towards vaccination recommendations were investigated. METHODS: A retrospective study of measles seroprevalence was conducted among healthcare personnel and students at the University Hospital Frankfurt with an observation period of 11 years. In spring 2014, medical students were asked to complete an anonymous questionnaire regarding vaccination status, knowledge of measles and acceptance of measles vaccination recommendations. RESULTS: In total, 9,933 serologies were evaluated and 85.7% of the participants had sufficient immunity against measles. Significant changes in immunity to measles over time were not observed. However, a significant difference in the immunity rate of participants born before 1970 and those born after1970 was found. Participants born before 1970 significantly more often showed sufficient immunity against measles compared to those born later (96.4 vs. 83.3 %, p < 0.0001). Almost 20 % of the medical students were not aware of their measles vaccination status and merely 70.7 % indicated that they had received two measles vaccinations. Furthermore, only 45.4 % of the medical students were familiar with the WHO's goal of eliminating measles by 2015; however 95 % could be classified as vaccination-supporters on the basis of the questionnaire. CONCLUSIONS: Overall, the immunity rate of measles determined by serology within the study population did not reach the WHO goal of ≥ 95 %, and this gap was even greater in group of medical students. Despite the medical students' positive attitude towards vaccination guidelines, the awareness in this field awaits improvement.

Detection of herpesvirus EBV DNA in the lower respiratory tract of ICU patients: a marker of infection of the lower respiratory tract?

Epstein-Barr virus (EBV) is a lymphotropic herpesvirus causing clinically self-limiting but lifelong persisting infections. Although several severe diseases (e.g., Hodgkin's disease) are associated with EBV, its role in lower respiratory tract infections is still elusive. The prevalence of EBV, herpes simplex virus (HSV) and cytomegalovirus (CMV) in bronchoalveolar fluid (BAL) samples was evaluated in a retrospective study. BAL samples from 135 patients in the intensive or coronary care unit (ICU/ICC) at University Hospital Frankfurt/Main (Germany) were investigated using an in-house real-time PCR to detect EBV-, HSV- and CMV-specific DNA. Overall, herpesvirus DNA was detected in n = 82/135 BAL samples (60.7 %). Besides mono-infections with either EBV or HSV, concomitant infection with EBV and HSV DNA was most frequent, whereby the relative HSV viral load was typically higher. Patients with HSV-positive BAL required mechanical ventilation on average 5 days longer than patients with HSV-negative BAL (p = 0.006). Additionally, the proinflammatory cytokine IL-6 was significantly elevated in sera of patients positive for EBV in comparison with patients with EBV-negative BAL (p = 0.01). This study demonstrates a high prevalence of herpesviruses in BAL samples of ICU/ICC patients. The detection of one or more herpesvirus in BAL is strongly associated with the duration of ventilation and patient's age. The association between IL-6 levels and EBV detection should be evaluated in further studies.

"Trivalent influenza vaccination of healthy adults 3 years after the onset of swine-origin H1N1 pandemic: restricted immunogenicity of the new A/H1N1v constituent?".

Influenza vaccination is advised annually to reduce the burden of influenza disease. For sufficient vaccine campaigns also a continuous adoption of influenza vaccines are necessary, due to particularly high genetic variability of influenza A virus. Therefore, we evaluate the effectiveness of the trivalent influenza vaccine 2010/2011, against influenza A (H1N1, H3N2) and influenza B. Immune response was investigated in paired sera from 92 healthcare workers with the hemagglutination inhibition assay (HI). Protective antibody levels (HI titer ≥40) were found after vaccination for influenza A/California/07/2009(H1N1): 84.71 % [GMT: 115.34]; for influenza A/Perth/16/2009(H3N2): 94.94 % [GMT: 268.47] and for influenza B/Brisbane/60/2008: 96.20 % [GMT: 176.83]; matching with the currently circulating virus strains. However, the highest seroprevalence rate was found against influenza B; pre- and post-vaccination titers as well, which may be due to comparatively high virus preservation. Remarkable, lowest seropositivity was seen against H1N1. Despite the significant titer rise, sufficient H1N1 herd immunity was still not achieved. It can be assumed that a high influenza A herd immunity may be a requirement for a successful booster vaccination.

[Seroprevalence of antibodies against infectious pathogens relevant to pregnancy among healthcare workers]. / Seroprävalenz von Antikörpern gegen schwangerschaftsrelevante virale Infektionserreger bei Mitarbeiterinnen im Gesundheitswesen.

Healthcare workers (HCWs) are exposed to infectious diseases throughout the course of their work. The concerns of pregnant HCWs are considerable because certain otherwise mild infections may affect fetal development. We studied 424 pregnant HCWs at the University Hospital Frankfurt between March 2007 and July 2011. Serological tests were carried out for varicella zoster virus (VZV), measles, mumps, rubella (MMR), cytomegalovirus (CMV) and parvovirus B19. Our overall seroprevalence data with regard to VZV, MMR, CMV and parvovirus B 19 corresponded to the general population. However, physicians demonstrated lower seroprevalence towards the two non-vaccine-preventable diseases (CMV: 37.5% [KI 27.4-48.5]; parvovirus B19: 69.3% [KI 58.6-78.7]) compared with nurses (CMV: 53.4% [KI 46.1-60.6], parvovirus B19: 75.1% [68.4-81.1]). It was striking that, only one in five of the study population showed IgG antibodies against all of the six pregnant-relevant viral diseases tested, of the physicians as few as one in six. A routine exclusion from the workplace due to non-immunity would mean that it would not be possible to employ the majority of pregnant staff in healthcare and childcare.

[Measles: immunity and vaccination status in Greater Frankfurt on the Main]. / Masern: Immunität und Impfstatus im Grossraum Frankfurt am Main.

BACKGROUND AND OBJECTIVE: The elimination of measles is a goal of the WHO which has not been achieved in Europe yet. As measles is a vaccine-preventable disease and can be eliminated by immunization the Standing Committee on Vaccination (STIKO) has updated the recommendation of measles vaccination. The goal of this study was to evaluate the immune status by serological testing and by raising immunisation status. METHODS: Antibody-testing from the routine diagnostic of the Institute of Medical Virology (Frankfurt/Main) for patients, health care workers and medical students was investigated retrospectively. RESULTS: Overall all significant increase in seropositivity was shown from 64.8 to 86.2 %. Nevertheless immunity gaps still exist in population, especially in persons under 19 years of age. In 1999 80.7 % of the 5-9 year age group and 75.3 % of the 10-19 year age group were seropositive. In 2009 the percentage in these age groups has decreased to 68.2 % and 71.1 % respectively. By obtaining the immunity status of 230 travellers at our vaccination centre immunity gaps have been recognised as well. Only 29.6 % were completely immunized (at least two vaccination). 54.4 % have been vaccinated incomplete and in 16.1 % vaccination status was unknown. CONCLUSION: Our results indicated that measles immunization status and seroprevalence are still not sufficient to achieve the elimination of measles.

H1N1v at a seroepidemiological glance: is the nightmare over?

When the second wave of pandemic influenza A H1N1v 2009 (H1N1v) emerged in the winter of 2010/2011, public health authorities were afraid of dangerous implications and severe clinical courses again. As further H1N1v waves might appear, achievement of sufficient herd immunity is a matter of urgency. The objective of this study was to determine the seroprevalence of antibodies against H1N1v by hemagglutination-inhibition test (HI) after the second wave. We compared our recent findings with our data obtained after the first pandemic in 2009/2010. Between March and May 2011 we collected serum samples from 600 persons aged 1 to 84 years admitted to University Hospital Frankfurt/Main and analysed the titres of anti-H1N1v by HI. The overall seroprevalence of anti-H1N1v has risen from 36.9% (95% confidence interval (95%CI), 33-41) in unvaccinated persons after the first wave to 57.3% (95%CI, 53.1-61.2) in vaccinated and unvaccinated. The highest rate of seropositivity was detected in the age group of 10-19 years (66%; 95%CI, 55.8-75.2), whereas the lowest was found in the age group 40-59 years (51%; 95%CI, 40.8-61.1). Although seroprevalence has significantly increased, sufficient herd immunity is still not achieved. Therefore, general vaccination programs have to be propagated continuously by public health authorities.

Acute and chronic infections of the ear, nose and throat.

The article focuses on infections that present with external signs, require surgery and carry the risk of life-threatening complications. This contribution looks at the infections of the ear, nose, oral cavity and neck.

Endolymphatic hydrops in asymptomatic ears in unilateral Ménière's disease.

OBJECTIVES/HYPOTHESIS: The aim of our study was the objective assessment of endolymphatic hydrops in asymptomatic ears in unilateral Ménière's disease with a noninvasive electrophysiological test and investigation of significant clinical signs. The null hypothesis was that there would be no signs of endolymphatic hydrops in the asymptomatic ear. STUDY DESIGN: Prospective study using the traveling wave velocity test for endolymphatic hydrops. METHODS: The traveling wave velocity test was used in conjunction with standard audiological tests to investigate both ears of 181 Ménière's patients attending the Medical Research Council Institute of Hearing Research in Southampton, United Kingdom. The test uses derived auditory brainstem responses to estimate the velocity of the cochlear traveling wave that is altered in endolymphatic hydrops. Ménière's disease was assessed using Arenberg's five staging criteria. Significant correlations were evaluated using standard statistical methods. RESULTS: Of 100 patients with clinically unilateral Ménière's disease, 27% showed evidence of endolymphatic hydrops in their asymptomatic ear. There was a significant correlation between signs of hydrops and the mean air-conduction threshold at 500 Hz. CONCLUSIONS: We recommend that a full assessment of incipient disease in the asymptomatic ear in unilateral Ménière's disease should be undertaken before offering any treatment options to patients. Any suspicion of early disease in the asymptomatic ear in unilateral Ménière's disease should lead to full electrophysiological assessment to assess the evidence of endolymphatic hydrops in that ear.

Patients' recollection of day case knee arthroscopy procedure.

A prospective study of 103 consecutive patients who underwent day case knee arthroscopy was performed. The purpose was to evaluate the information delivery system, patient comprehension, and issues of informed consent pertaining to day case arthroscopy procedures. There were 34 females and 69 males in the study group and their mean age was 38.6 years (range: 14.4 to 74.9 years). The diagnosis, procedure, and aftercare were explained to the patients in the outpatients clinic by a trained nurse and by the operating surgeon just prior to the operation. The nurse before the operation gave the patients an information booklet. Postoperatively the patients were informed about the findings and diagnosis prior to their discharge from the day care facility. Patients were requested to complete a questionnaire. Three weeks later they were given the same questionnaire, prior to consultation, in the outpatient clinic. These two forms were compared with the operative findings and diagnosis documented in the copy, of the questionnaire completed by the surgeon as well as the case notes. Most patients (38.8%; 40 patients) had no recollection; 3.9% (4 patients) had partial recollection at their consultation three weeks later; 19.4% (20 patients) found that the arthroscopic photograph was not helpful in making them understand the procedure; and 9.7% (10 patients) found the information booklet to be unhelpful. Further, 23.3% (24 patients) said that it would not help if the booklet were sent to them prior to the operation. The recollection rate was also correlated to their position on the operating list, to ascertain the effect of the anesthetic. There was a 65.9% (58 patients) recollection rate in those patients who were on the first half of the list and there was only a 33.33% recollection rate in those patients who were last or second to the last [p = 0.0225]. We recommend regular evaluation and improvement in the communication and information delivery system provided to patients.