Measles outbreak spreading from the community to an anthroposophic school, Berlin, 2011.

Between April and July 2011 there was an outbreak of measles virus, genotype D4, in Berlin, Germany. We identified 73 case-patients from the community and among students of an anthroposophic school, who participated in a 4-day school trip, as well as their family and friends. Overall, 27% were aged ≥ 20 years, 57% were female and 15% were hospitalized. Of 39 community case-patients, 38% were aged ≥ 20 years, 67% were female and 63% required hospitalization. Unvaccinated students returning from the school trip were excluded from school, limiting transmission. Within the group of 55 school-trip participants, including 20 measles case-patients, a measles vaccine effectiveness of 97.1% (95% confidence interval 83.4-100) for two doses was estimated using exact Poisson regression. Our findings support school exclusions and the recommendation of one-dose catch-up vaccination for everyone born after 1970 with incomplete or unknown vaccination status, in addition to the two-dose routine childhood immunization recommendation.

[Follow-up of encopresis in children]. / Der Verlauf der Enkopresis im Kindesalter.

The course of encopresis in 41 children who had been presented at a child and adolescent university clinic was examined by means of a follow-up interview which took place on an average of 3;6 years after the initial visit. The symptoms in this sample diminished considerably: 76% of the children were free of symptoms at the time of the follow-up interview, whereby most of these children had experienced a spontaneous remission. Eighty-one percent of the children were evaluated as having improved in regards to their whole development while in about one third of all the children new problems arose. Remission occurred within the first two years of the initial consultation in 81% of the sample. An examination of the prognostic factors yielded the following relationships: the total remission of symptoms was considerably greater if the frequency of encopresis had been low, if the subjects were male, and if there had not been any therapeutic intervention. However, treatment was usually reserved for relatively serious cases. Favorable outcome tended to be marked by the following factors: normal psychosocial conditions, higher intelligence, the absence of constipation, a concurrently presenting enuresis, and a low degree of behavioral disorders as evaluated by a parental questionnaire. A comparison of the behavioral disorders at the time of the initial consultation and at follow-up revealed a significant reduction of emotional disturbances and hyperactivity. This favorable development was not evident for conduct disorders.

[Molecular epidemiology of Candida infections in HIV-infected mothers and their offspring]. / Molekulare Epidemiologie von Candida-Infektionen bei HIV-infizierten Müttern und ihren Kindern.

In a prospective study 15 consecutive children and 12 HIV-infected mothers were examined according to their colonization with Candida species in the oral cavity and on the hands. From 39 samples a total of 49 Candida isolates could be recovered (26 C. albicans, 4 C. glabrata, 9 Rhodotorula rubra, 4 C. dubliniensis, 3 C. tropicalis, 2 C. famata, 1 S. cerevisiae). Antifungal susceptibility testing revealed fluconazole MICs from 0.09 microgram/ml to 100 micrograms/ml. Genotyping was done with an AP-PCR technique using the primer "M13" and "(GACA)4". From the mycologic culture identical yeast isolates were found in 10 families. However, with PCR typing identical findings were seen only in 5 families. A C. albicans isolate resistant to fluconazole in vitro was found in a child and the mother of the same family. It could be summarized that yeast strains are transmitted between HIV infected mothers and their children. With PCR typing diversity among yeast isolates could be demonstrated even between members of the same family.

Genotypic relatedness of yeast isolates from women infected with human immunodeficiency virus and their children.

The objective of this study was to compare polymerase chain reaction (PCR) fingerprinting with other molecular typing methods as an epidemiologic tool to investigate the transmission of Candida strains between HIV-positive mothers and their children. Forty-nine yeast strains (including Candida albicans, Candida glabrata, Rhodotorula rubra, Candida tropicalis, Candida famata, Candida dubliniensis, Saccharomyces cerevisiae) from 30 individuals (15 children and 15 HIV-infected mothers or accompanying person) were isolated. Colonization/infection with yeast was observed in 80% of all individuals in the oral cavity, and in 33% from hand cultures, respectively. Thirteen out of 15 children (86%) and 12 out of 15 adults (80%) were colonized/infected with yeasts. Candida dubliniensis strains were found in four HIV-infected women but not in children. The results with an arbitrarily primed (AP)-PCR mediated genotyping assay using phage M13 core sequence were compared with the hybridization patterns using the species-specific DNA probe CARE-2 for the C. albicans isolates. Typing of non-C. albicans strains was done using AP-PCR in comparison with pulsed-field gel electrophoresis (PFGE). Twenty-six C. albicans strains gave two different genotypes by AP-PCR but 16 genotypes by CARE-2 hybridization. The CARE-2 probe appeared to have a higher discriminatory power compared with the primer 'M13'-mediated AP-PCR in typing C. albicans isolates.