Multidisciplinary expert group: communication measures to increase vaccine compliance in adults.

The WHO categorized vaccine hesitancy as one of the greatest threats to global health worldwide. Vaccination of elderly persons is of increasing relevance, given that they represent a growing segment in the population and considering the burden diseases pose to them. Many factors leading to vaccine hesitancy are related to inadequate communication. In the present report, experts from various academic fields present recommendations to support communication strategies that may help to initiate targeted communication measures to enhance vaccination compliance in adults.

[Immunizing is not only a children's matter! : Why vaccinations are also important for adults]. / Impfen ist nicht nur Kindersache! : Warum Impfungen auch für Erwachsene wichtig sind.

Vaccinations belong to the ten most effective public health achievements worldwide. While immunization programms for children are installed in Europe, vaccinations for adults are not established. However, adult vaccination is extremely meaningful: increasing age means a higher susceptibility to infectious diseases, health problems and multimorbidity will increase. The burden of vaccine-preventable diseases is still high in Europe. Due to immunosenescence (older) adults are less protected against pathogens, antibody titers after vaccinations are lower and immunity lasts shorter. There is striking lack of data of adult vaccination rates and an international consensus regarding adult vaccination recommendations or guidelines are not available in Europe. In only six countries a comprehensive document describing recommended vaccinations for adults is available, among them Austria. The awareness of the importance of adult vaccination over the whole lifetime is not present to the necessary extent in Europe and has to be promoted.

Influenza vaccination in Austria: Persistent resistance and ignorance to influenza prevention and control.

OBJECTIVE: In the Austrian population approximately 350,000-400,000 cases and 1,000-1,200 deaths are observed during an average epidemic, which puts influenza-related deaths on top of the list of vaccine-preventable cases of death. In face of extensive vaccination recommendations, the current vaccination rate of the general population of about 6% is one of the lowest worldwide. The objective of this study was to provide an update regarding the use of influenza vaccination in Austria over the period 1982-2015. METHODS: This paper presents data on influenza vaccine use in Austria displayed by the number of distributed doses per 1,000 population over a period of 33 years. Further data was collected from representative population-based telephone surveys. RESULTS: Austria has always been among the countries with a low number of distributed doses of influenza vaccine. The highest number ever was reached in 2006 with 142 doses/1,000. From 2007 onwards, a steady decrease happened to 62 doses/1,000 in the 2015/16 season, which corresponds to the level of the mid-nineties. CONCLUSION: Despite the fact that Austria is a country with comprehensive recommendations for influenza vaccination, this vaccination continues to be misjudged by the Austrian population and many areas of the medical system. From a public health point of view, this situation is not acceptable. Efforts must be increased to attain a much higher vaccination rate, e.g. the importance of the healthcare workers' influence must be recognized, the options of social marketing have to be utilized and studies on the main barriers in Austria are urgently needed.

THE AUSTRIAN VACCINATION PARADOX: TICK-BORNE ENCEPHALITIS VACCINATION VERSUS INFLUENZA VACCINATION.

This paper describes a paradoxical situation in Austria. The vaccination rate against tick-borne encephalitis (TBE) in the general population is 82%, which is the highest worldwide, whereas the vaccination rate against influenza is about 8% and is among the lowest worldwide. A high awareness of TBE among the Austrian population achieved by an annual social marketing programme and the wide use of effective and well-tolerated vaccines have led to a successful containment of that disease. The vaccination coverage increased from 6% in 1980 to 82% in 2013 and exceeds 90% in some high-risk areas. This has led to a steady decline in the number of TBE cases from several hundred cases to 50 to 100 cases per year. The situation in regard to influenza vaccination is the opposite. Although Austria has issued one of the most extensive recommendations for influenza vaccination worldwide, the vaccination rate of the general population is extremely low. The possible reasons for the failure in the implementation of recommendations are ignorance, lack of social marketing and the predominance of a distinct discordance within the health system in general, and the Austrian medical fraternity in particular.

[Tick-borne encephalitis (TBE) and TBE-vaccination in Austria: Update 2014]. / Frühsommer-Meningo-Enzephalitis (FSME) und FSME-Schutzimpfung in Österreich: Update 2014.

TBE is a public health problem well under control in Austria because of a mass vaccination programme. There have been 50-100 registered cases per year for many years, the vaccination rate of the population is currently 85 %. Special attention has to be given to the "older" generation 40 plus as this is the segment of the population where the majority of cases are observed annually. In comparison of the counties, Tyrol and Upper Austria finished first and second after a long time when Styria and Carynthia had observed most of the cases. For TBE applies the same as for Tetanus, namely the principle of disease control or disease elimination: The virus cannot be eliminated and vaccination provides individual protection. The both available TBE vaccines have proven to be very effective with an effectivity of 96-99 %, also when given irregular vaccinations the protection rate is still very high (>90 %). More than 4000 prevented cases between 2000 and 2011 prove this impressively.

Biomarkers of dementia: comparison of electrochemiluminescence results and reference ranges with conventional ELISA.

We compared the performance of the Meso Scale Diagnostics electrochemiluminescence (MSD) multiplex assay for t-tau and p-tau(231), originally developed for measurement of brain cell extract and tissue cultures, with the established standard method, the Innogenetics ELISA for total and p-tau(181). The methods were also clinically evaluated with 120 samples from our mono center population. The established Innogenetics ELISA procedures have been well optimized to measure patient samples in the normal and pathological range. Compared to the MSD they were superior in the limit of detection for total as well as p-tau. The obtained reference values for our normal controls were in the upper third of the published studies. Innogenetics tau, Innogenetics p-tau(181) and MSD t-tau differentiated the Alzheimer's (n=44) and minimal impairment group (MCI, n=39) from normal controls (n=37), but the MCI group was not statistically different from the normal controls. The MSD multiplex assay measured t-tau adequately but p-tau(231) could not differentiate normal from pathological results in CSF due to the high limit of detection. Both procedures however, have to be further standardized and complemented by adequate internal and external quality control schemes to qualify for routine analysis in a medical laboratory.

Gender differences in lung cancer epidemiology - do Austrian male lung cancer patients still die earlier in life?

Objective: Previous analyses reported an unexpected decline of mean age of death of Austrian male lung cancer patients until 1996 and a subsequent turnaround of this epidemiological trend after the mid-1990s until 2007. In light of ongoing changes in smoking behavior of men and women, this study aims to investigate the development of mean age of death from lung cancer in Austria during the past three decades. Materials and methods: This study used data about the annual mean age of death from lung cancer, including malignant neoplasm of trachea, bronchus and lung, between 1992 and 2021 obtained from Statistics Austria, Federal Institution under Public Law. One-way analysis of variance (ANOVA) and independent samples t-tests were applied to explore any significant differences of mean values in the course of time as well as between men and women. Results: Overall, mean age of death of male lung cancer patients increased consistently throughout the observed time periods, whereas women did not show any statistically significant change in the last decades. Conclusion: Possible reasons for the reported epidemiological development are discussed in this article. Research and Public Health measures should increasingly focus on smoking behaviors of female adolescents.

["Hardly a house without ill people" The Spanish Flu in Styria]. / "Kaum ein Haus in dem nicht Kranke lagen." Die Spanische Grippe in der Steiermark.

This article examines the impact of the Spanish flu at the microscopic level. Main question was if the pandemic killed more people in a selected mountain village than the total men of the village who were being killed during the First World War. Other topics are the reaction of the local government on the flu and which prophylaxis was ordered. The main focus lies on the analysis of the parish registers by graphs.

Anticholinergic and Sedative Medications Are Associated With Neurocognitive Performance of Well Treated People With Human Immunodeficiency Virus.

Background: We previously showed that anticholinergic (ACH) medications contribute to self-reported neurocognitive impairment (NCI) in elderly people with human immunodeficiency virus (PWH). The current cross-sectional study further evaluated the effect of ACH and sedative drugs on neurocognitive function in PWH who underwent comprehensive neuropsychological evaluation. Methods: A medication review was performed in PWH enrolled in the prospective Neurocognitive Assessment in Metabolic and Aging Cohort within the Swiss HIV Cohort Study. Neurocognitive functions were analyzed in 5 domains (motor skills, speed of information, attention/working memory, executive functions, and verbal learning memory). The effect of ACH and sedative medications on neurocognitive functioning was evaluated using linear regression models for the continuous (mean z-score) outcome and multivariable logistic regression models for the binary (presence/absence) outcome. Results: A total of 963 PWH (80% male, 92% Caucasian, 96% virologically suppressed, median age 52) were included. Fourteen percent of participants were prescribed ≥1 ACH medication and 9% were prescribed ≥1 sedative medication. Overall, 40% of participants had NCI. Sedative medication use was associated with impaired attention/verbal learning and ACH medication use with motor skills deficits both in the continuous (mean z-score difference -0.26 to -0.14, P < .001 and P = .06) and binary (odds ratio [OR], ≥1.67; P < .05) models. Their combined use was associated with deficits in overall neurocognitive functions in both models (mean z-score difference -0.12, P = .002 and OR = 1.54, P = .03). These associations were unchanged in a subgroup analysis of participants without depression (n = 824). Conclusions: Anticholinergic and sedative medications contribute to NCI. Clinicians need to consider these drugs when assessing NCI in PWH.

Tick-borne encephalitis: new paradigms in a changing vaccination environment.

The International Scientific Working Group on Tick-Borne Encephalitis (ISW TBE) held its 13th Annual Meeting in February 2011 to discuss epidemiological developments, news in TBE research, initiatives of the European Union, vaccination-immune response, clinical cases and TBE consequences, awareness of TBE prevention and the role of the ISW TBE to break vaccination fatigue. TBE may be considered a complex system, characterized by an intricate interplay between tick biology and socioeconomic conditions. The same may be said about vaccination behaviour. Thus, although the facts are simple--vaccination is the best prevention--the socioeconomic conditions keep changing, and with them the ability or willingness of people to get vaccinated. The ISW TBE is part of this complex system, and because the world keeps changing--so should the strategies.

TBE--awareness and protection: the impact of epidemiology, changing lifestyle, and environmental factors.

The International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE) held its 12th Annual Meeting in January 2010. The international awareness among the issue of TBE is on the rise, as the European Center for Disease Control considers TBE of high relevance and has launched a series of activities aimed at improving awareness of this tick-transmissible infection and also the World Health Organization has taken up the cause of TBE. The epidemiology of TBE in Europe is characterized by two distinct trends, i.e., a consistent expansion of risk areas on the one hand and major fluctuations in case numbers on the other. TBE risk areas have spread both northward and to higher altitudes - a development thought to be attributable to climate changes having created more favorable living conditions for ticks. Social, political, ecological, economic, and demographic factors also have a role in this development. Preliminary data from 12 European countries show that TBE case numbers in 2009 amounted to 95.8% of those reported in 2006 when Russia is included and to 88% of 2006 data when Russia is excluded. Overall, the level of knowledge of TBE in endemic countries is quite high, but actual vaccination coverage has not kept pace.

Report of the 21st Annual Meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE): TBE - record year 2018.

The 21st Meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE) - a group of neurologists, general practitioners, clinicians, travel physicians, virologists, pediatricians, ecologists, and epidemiologists - was held under the theme "TBE - record year 2018″. Several key topics in the field of TBE were extensively discussed, among them current epidemiological developments in different countries, expansion of risk areas, virological and clinical aspects, importance of awareness, traveling and mobility, and latest news on TBE vaccination. The main goals that have been achieved by the ISW-TBE so far are, among others, an increased awareness in endemic and non-endemic countries, an increase of vaccination rates in various countries, getting TBE acknowledged and established as a travel-related risk, and building contact with the European Centre for Disease Prevention and Control.

Self-reported vaccination status and attitudes towards mandatory vaccinations for health care workers among medical students.

Health care workers (HCWs) are exposed to a high risk of infectious diseases at work, and of transmitting these to their patients and colleagues. Medical students constitute an important, yet neglected, group within HCW because of their contact with patients in the course of compulsory or voluntary practical training courses at health care institutions. The aim of this study was to determine the current vaccination status of medical students at the Medical University of Vienna and assess their attitudes towards occupationally indicated mandatory vaccinations for doctors and other HCW. Nearly 80% of the students considered mandatory vaccinations for doctors an appropriate measure and 88% would recommend them in settings involving immunocompromised patients. The acceptance of mandatory immunisation differs very markedly for individual vaccinations; it ranges from 82.8% for hepatitis B to 40% for influenza. The self-reported vaccination status among medical students was 90.1%, 89.9%, 88.1% and 84.4% for hepatitis B, tetanus, polio and hepatitis A, respectively. Inadequately low rates of 78%, 70.5% and 70.5%, and 28.7% were reported for MMR, varicella, pertussis and influenza (2014/15 season), respectively. CONCLUSION: The majority of medical students at the MUW had a positive attitude towards vaccinations and considered mandatory vaccinations for doctors and HCW an appropriate measure. However, the large majority of the vaccination rates are worthy of improvement.

Report of the 20th annual meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE): ISW-TBE: 20 years of commitment and still challenges ahead.

The 20th Meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE) - a group of neurologists, general practitioners, clinicians, travel physicians, virologists, pediatricians, ecologists, and epidemiologists - was held under the theme "ISW-TBE: 20 years of commitment & still challenges ahead". On the occasion of the 20th anniversary of the ISW-TBE several key topics in TBE were extensively discussed, among them current epidemiological developments and investigations, expansion of risk areas, clinical aspects and cases, traveling and mobility, and latest news on TBE vaccination. The main goals that have been achieved by the ISW-TBE so far are, among others, an increased awareness in endemic and non-endemic countries, an increase of vaccination rates in various countries, getting TBE acknowledged and established as a travel-related risk, and building contact with the European Centre for Disease Prevention and Control.

Is there a need for a travel vaccination against tick-borne encephalitis?

Tick - borne encephalitis is a vector-borne disease primarily transmitted to humans by the bite of infected ticks. Clinical presentations range from mild meningitis to severe encephalitis with or without myelitis and may result in long-term neurological equelae or death. The disease can successfully be prevented through active immunization. BE is endemic in regions of at least 26 European countries. The risk of contracting TBE in the most affected countries has increased in the past 20 to 30 years, between 1974 and 2003, the number of reported clinical TBE cases increased by an appalling 400%, the only exception having been Austria. Because of increasing international travel streams of tourists from non-endemic countries to TBE risk areas, the infection is now becoming a more important issue of travel medicine.The risk depends on both the travelling season and the degree of unprotected outdoor exposure to forest areas (e.g. bicycling, camping, hiking, etc.). Tourists are by no means aware of the actual risk potential, especially when travelling to a knowingly 'safe' Europe. Vaccination against tick-borne encephalitis may be required for some tourists, depending on travel destination and behaviour. Implementing general guidelines for the use of TBE travel vaccination should be put on the agenda for travel medicine.

Report of the 19th Annual Meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE) - TBE in a changing world.

The 19th meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE) - a group of neurologists, general practitioners, clinicians, travel physicians, virologists, pediatricians and epidemiologists-was held under the title "TBE in a changing world". Key topics within virology, current epidemiological developments and investigations, expansion of risk areas, clinical aspects and cases, traveling and mobility, vaccination rates, and latest news on vaccination were presented and extensively discussed. Over the past four decades, TBE has become a growing public health challenge in Europe and parts of Asia. It may be considered a complex eco-epidemiological system, characterized by an intricate interplay between the virus, ticks and tick hosts on the one hand and human exposure strongly influenced by socioeconomic conditions on the other hand. Although the facts are simple - vaccination is the best prevention - the socioeconomic conditions keep changing, and with them the ability or willingness of people to get vaccinated.

The International Scientific Working Group on Tick-Borne Encephalitis (ISW TBE): Review of 17 years of activity and commitment.

Tick-borne encephalitis (TBE) has been a growing public health problem in Europe and other parts of the world for the past 20 years. In 1999, in order to encourage the control of TBE, international experts created a new body: The International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE). This Working Group has been composed of internationally recognized scientific experts from tick-borne encephalitis virus (TBEv)-endemic and non-endemic regions with extensive personal expertise in the field and a high level of commitment to improve the knowledge of TBE and to increase the public awareness of TBE. Since the foundation of the Working Group, ISW-TBE members meet annually. Every meeting is dedicated to a specific topic, and since 2004 a yearly conference report has been published to inform the scientific community about the latest developments. Among the specific issues that have been extensively discussed over the years were the following: clinical aspects of the disease, TBE in children and golden agers, epidemiology, possible causes for the increase in TBE incidence in Europe, TBE and awareness, TBE and travel, (low) vaccination rates, and the cooperation with the European Centre for Disease Prevention and Control (ECDC). This paper gives an overview of the most important activities and achievements of the ISW-TBE over the past 17 years.

Tick-borne encephalitis-still on the map: Report of the 18th annual meeting of the international scientific working group on tick-borne encephalitis (ISW-TBE).

The 18th meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE)-a group of neurologists, general practitioners, clinicians, travel physicians, virologists, pediatricians and epidemiologists-was held under the title 'Tick-borne encephalitis-still on the map'. The conference agenda was divided into six sessions: 'National Implementation of EU notifiable disease status', 'Virology', 'Epidemiology and Risk areas & Poster Walk Epidemiological Update', 'Clinic', 'Environmental Factors' and 'New Findings and Diagnosis'. Key topics such as 'TBE as a notifiable disease-results of the third European survey', 'TBE vaccines over the years', 'Overview of flaviviruses', 'TBE virus phylogenetics', 'Current epidemiological developments and investigations', 'Clinical aspects', 'TBE in veterinary medicine', 'Laboratory diagnostic', 'Occupational risk', 'Allergy, obesity, and vaccination' were presented and extensively discussed.

Tick-borne encephalitis as a notifiable disease--Status quo and the way forward. Report of the 17th annual meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE).

The 17th meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE), a group of neurologists, general practicioners, clinicians, travel physicians, virologists, pediatricians, and epidemiologists, was held under the title "Tick-borne encephalitis as a notifiable disease--status quo and the way forward". The conference agenda was divided into three parts on the first day: "Epidemiology & Risk areas", "Poster Walk: Epidemiological Update in Europe", and "News in TBE Research". On the second day, a World Café Working Session took place where the participants could choose three tables out of six to join for discussion. Key topics on current epidemiological developments and investigations, risk areas, cases, travel and mobility, TBE in children, vaccination rates, and latest news on vaccination were presented and extensively discussed.

Tick-borne encephalitis - a notifiable disease, a review after one year: report of the 16th Annual Meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE).

The 16th Meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE) - a group of neurologists, general practitioners, clinicians, travel physicians, virologists, paediatricians, and epidemiologists - was held under the title "Tick-borne Encephalitis - a Notifiable Disease, a Review after One Year". With the inclusion of TBE in the list of notifiable diseases in 2012, an important measure was established to continue improving the level of evidence on TBE in Europe to better help guide policies and methods to lower the burden of this disease. The conference agenda was divided into six parts concerning Travel Medicine, Epidemiology & Risk Areas, Poster Session with an Epidemiological Update in Europe, Interactive Debate, Cases, and Social Communication and Recommendations. Important topics regarding current epidemiological investigations, risk areas, mobility, cases, TBE in children, treatment options, vaccination rates, and latest news on vaccination were presented and extensively discussed.