Low hepatitis B immunogenicity of a hexavalent vaccine widely used in Germany: results of the German Health Survey for Children and Adolescents, 2003-2006.

The success of childhood vaccination against hepatitis B relies on persistence of immunity into adolescence and adulthood. In 2000, two hexavalent vaccines with a hepatitis B component (Hexavac, Infanrix hexa) were introduced in Germany. Hexavac was withdrawn in 2005 amidst concerns about its long-term hepatitis B protection. We compared hepatitis B surface antibody (anti-HBs) levels in children fully vaccinated with Hexavac or Infanrix hexa (n=477) in a secondary data analysis of a large cross-sectional health survey in Germany. On average 2.4 years after vaccination, 25.3% of Hexavac vaccinees had anti-HBs levels <10 mIU/ml (95% CI 19.0-32.8) compared to 4.7% of Infanrix hexa vaccinees (95% CI 2.4-8.9). These findings suggest that short-term hepatitis B immunogenicity in Hexavac vaccinees may also be weaker. Further studies are warranted to assess whether Hexavac vaccinees should be re-vaccinated or receive a booster vaccination before these birth cohorts reach adolescence.

Preliminary case report of fatal anthrax in an injecting drug user in North-Rhine-Westphalia, Germany, December 2009.

A fatal case of anthrax occurred in an injecting drug user in Germany, in December 2009. A potential link to similar cases in Scotland in the same time period is currently under investigation.

[Hepatitis B and C risk factors in Germany--results of the national surveillance]. / Risikofaktoren der Hepatitis B und C in Deutschland--Ergebnisse der bundesweiten Surveillance.

Collection of risk factor data is part of the national surveillance of hepatitis B and C in Germany. After modifications of risk factor surveillance had been implemented in September 2003, the response rate for data on risk factors increased markedly. For the period between September 2003 and August 2004, information on risk factors (at least one "yes" or "no" answer) was available for 66% (1853) of all notified hepatitis B cases and for 67% (5813) of all notified hepatitis C cases. More than 30% of those hepatitis B cases occurred among risk groups for whom hepatitis B immunisation is recommended by the German Advisory Committee on Immunisation (STIKO). Of the hepatitis C cases with risk factor data, 40% reported previous or continuing injecting drug use (IDU). IDU was predominant among young men (78% among men, aged 15 to 29 years) and can explain the comparatively high incidence observed in young adults, especially among men. The impact of other risk factors (e. g. medical interventions) cannot be quantified without a proper control group. The results of this study demonstrate that--in addition to the hepatitis B immunisation of children and adolescents--vaccination coverage of specific risk groups, as defined by the STIKO, should be increased. Measures to prevent hepatitis C have to focus on intravenous drug users and clearly have to be intensified.

SARS: retrospective cohort study among German guests of the Hotel 'M', Hong Kong.

Hong Kong played a pivotal role in the international spread of the Severe Acute Respiratory Syndrome (SARS): a doctor who spent the night of 21-22 February 2003 at Hotel 'M' was identified as the index case for four national and international clusters of SARS. In parallel to the international collaborative study led by WHO and United States, a retrospective study on the cohort of German persons staying at Hotel 'M' was conducted. The inclusion criteria covered a period from 21 February to 3 March 2003 to allow the detection of cases possibly due to environmental contamination. In the twenty-one German guests traced as having stayed at Hotel "M" during this period, one case of laboratory confirmed SARS was found. The case history suggests that close vicinity to the index patient may have played a role in transmission. In line with findings of environmental investigations in the hotel, environmental contamination should be considered as a possible source of infection.

Influence of anti-Helicobacter triple-therapy with metronidazole, omeprazole and clarithromycin on intestinal microflora.

BACKGROUND: Proton pump inhibitor-based therapy including two antibiotics is the treatment of choice for Helicobacter pylori infection. Oral antibiotic treatment can lead to intestinal overgrowth of potentially pathogenic bacteria. AIM: To investigate the intestinal microflora before and at different times after H. pylori treatment with omeprazole, clarithromycin and metronidazole. METHODS: Bacterial growth in faecal samples from 51 patients infected with H. pylori was determined qualitatively and quantitatively. During the same period of time, stool samples from 27 H. pylori-negative controls were taken and investigated at the same intervals. RESULTS: The microflora of H. pylori-infected patients was different from that in H. pylori negative controls. It was characterized by a high concentration of lactobacilli, mainly Lactobacillus acidophilus. Immediately after therapy there was an increased colonization with yeasts, while the growth of lactobacilli and other species was inhibited. Clostridium difficile was cultured from three cases, but without clinical manifestations of pseudomembranous colitis. After 4 weeks of therapy, the microflora returned to normal and was not different from that of the H. pylori-negative control group. CONCLUSIONS: In H. pylori-positive patients the intestinal flora is characterized by an increase in growth of acid-tolerant L. acidophilus. Eradication therapy exerts only a short-term influence on intestinal flora, whereas in the long term, the intestinal microflora is restored to a pattern similar to that of the control group.

Generalized AA-amyloidosis in a 58-year-old Caucasian woman with an 18-month history of gastrointestinal tuberculosis.

We report on a 58-year-old Caucasian woman who went to a general practitioner about recurrent abdominal pain, night sweats and weight loss of a few weeks' duration. Once gynaecological disease had been ruled out, the patient was admitted to hospital with severe abdominal pain and intestinal obstruction and a right-sided hemicolectomy was performed. Following the investigation of osteolytic lumbar vertebrae, 18 months after visiting the general practitioner the patient was finally found to be suffering from generalized AA-amyloidosis secondary to gastrointestinal tuberculosis. This had been misinterpreted as Crohn's disease. Re-examination of the specimens from the right-sided hemicolectomy demonstrated that scanty deposits of AA-amyloid were present 9 months after the first presentation. AA-amyloid can thus be present in serious inflammatory disease even during the first 9 months after the initial clinical presentation.

[Chronic pancreatitis: conservative therapy]. / Chronische Pankreatitis: Konservative Therapie.

Chronic pancreatitis is mainly due to longstanding alcoholism. In general treatment is based on drug therapy. The clinical appearance is determined by chronic pain, steatorrhoea and eventually by the onset of diabetes mellitus. Beyond other measures total avoidance of alcohol ingestion provides a condition of a more benign course of the disease. Treatment of pain consists of symptomatic therapy and prescription of pancreatic enzymes in order to lessen pancreatic stimulation by inhibition of feedback mechanisms. The same principle applies to the prescription of octreotide which is used only in selected cases since it has failed to prove general effectiveness. Symptoms of exocrine insufficiency are alleviated by substitution of pancreatic enzymes. Attention must be directed on dose and preparation of pancreatic enzymes being used. Treatment of pancreatogenic diabetes resembles therapy of type I diabetes mellitus. In principle treatment of chronic pancreatitis should be adjusted to the highly variable clinical appearance of the disease and requires a systematic approach. It has to be kept in mind that some complications of chronic pancreatitis [e.g. pseudocysts] may require surgical intervention.