RESUMEN
We investigated data from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected 0-19 year olds, who attended schools/childcare facilities, to assess their role in SARS-CoV-2 transmission after these establishments' reopening in May 2020 in Baden-Württemberg, Germany. Child-to-child transmission in schools/childcare facilities appeared very uncommon. We anticipate that, with face mask use and frequent ventilation of rooms, transmission rates in schools/childcare facilities would remain low in the next term, even if classes' group sizes were increased.
Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Coronavirus/aislamiento & purificación , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Instituciones Académicas , Adolescente , Betacoronavirus , COVID-19 , Prueba de COVID-19 , Niño , Preescolar , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Alemania/epidemiología , Humanos , Lactante , Recién Nacido , Control de Infecciones , Neumonía Viral/epidemiología , SARS-CoV-2 , Adulto JovenRESUMEN
In May 2016, two cases of tick-borne encephalitis (TBE) were confirmed by serology (positive IgM and IgG antibodies against TBE virus (TBEV) in serum), with a possible link to raw milk and cheese from a goat farm in a region in Baden-Württemberg, Germany not previously known as TBE-endemic. The outbreak investigation identified 32 consumers of goat dairy products (29 consumers, one farm employee, two owners) of whom none had IgM antibodies against TBEV 3-8 weeks after consumption. Of the 27 notified TBE cases in the State, none reported consumption of raw goat milk or cheese from the suspected farm. Five of 22 cheese samples from 18 different batches were RT-qPCR-positive for TBEV -genome, and two of the five samples were confirmed by virus isolation, indicating viability of TBEV in the cheese. Nine of the 45 goats had neutralising TBEV antibodies, two of them with a high titre indicating recent infection. One of 412 Ixodes ricinus was RT-qPCR-positive, and sequencing of the E gene from nucleic acid extracted from the tick confirmed TBEV. Phylogenetic analyses of tick and cheese isolates showed 100% amino acid homology in the E gene and a close relation to TBEV strains from Switzerland and Austria.
Asunto(s)
Queso/virología , Virus de la Encefalitis Transmitidos por Garrapatas/aislamiento & purificación , Encefalitis Transmitida por Garrapatas/diagnóstico , Ixodes/virología , Leche/virología , Animales , Anticuerpos Antivirales/sangre , Virus de la Encefalitis Transmitidos por Garrapatas/genética , Encefalitis Transmitida por Garrapatas/virología , Cabras , Humanos , ARN Viral/sangre , ARN Viral/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa , Análisis de Secuencia de ADNRESUMEN
In industrialized countries, scabies occurs sporadically or in the form of protracted epidemics, typically in nursing homes for elderly people. Outbreaks of scabies in a kindergarten are very rare. The main goal of our study was to investigate an outbreak of scabies in a kindergarten and to identify risk factors for the infestation with the ectoparasitosis. We investigated an outbreak of scabies in a kindergarten in the City of Constance, southern Germany, with a particular pedagogical concept. Risk factors indicating a transmission of Sarcoptes mites through body contact or via fomites were assessed using questionnaires and by following the daily routine in the kindergarten. A total of 16 cases were identified. The attack rate was significantly higher in nursery teachers (risk ratio 42.1) compared to children (risk ratio 10.5). In all cases, scabies had developed rather recently, with minimal clinical manifestations. In nursery teachers, the probability of scabies was 4.4 times higher in those teachers who hugged children regularly. Children who preferably played with their own soft toys had a lower probability of developing scabies [risk ratio 0.14, 95 % confidence interval (CI) 0.05-0.42; p = 0.04]. It seems conceivable that the particular pedagogical concept of the kindergarten favored the spread of Sarcoptes mites. We were unable to show whether transmission had preferably occurred through body contact or via fomites.
Asunto(s)
Guarderías Infantiles , Brotes de Enfermedades , Escabiosis/epidemiología , Adolescente , Adulto , Niño , Preescolar , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Escabiosis/transmisión , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Between December 2009 and the end of January 2010, the largest hitherto known outbreak of Legionella in Germany took place in the cities of Ulm and Neu-Ulm. Of a total of 64 patients involved, 60 patients had to be hospitalized, and 5 patients died from the infection. This event was caused by a wet cooling tower of a large air conditioning system in the city center of Ulm. The search for the source of the Legionella emission was extremely difficult, since these plants are neither notifiable nor subject to authorization in Germany. We report about the search for the source and the measures to control the outbreak. We also discuss communication and coordination during these investigations. Regulatory measures as proposed by the World Health Organization (WHO) and the European Network for Legionellosis (EWGLI) and already implemented in numerous other European countries would be desirable to prevent such outbreaks in the future.
Asunto(s)
Aire Acondicionado , Conducta Cooperativa , Brotes de Enfermedades/prevención & control , Comunicación Interdisciplinaria , Enfermedad de los Legionarios/prevención & control , Causas de Muerte , Análisis por Conglomerados , Control de Enfermedades Transmisibles/métodos , Trazado de Contacto , Notificación de Enfermedades , Alemania , Hospitales Universitarios , Humanos , Enfermedad de los Legionarios/mortalidad , Enfermedad de los Legionarios/transmisión , Tasa de Supervivencia , Microbiología del AguaRESUMEN
Currently an investigation is ongoing to explore and control an outbreak of Legionnaires disease, affecting 65 people as of 22 January 2010, in the cities of Ulm and Neu-Ulm, south-west Germany. A hitherto unidentified wet cooling system in these twin cities is considered as the most likely source of infection.
Asunto(s)
Brotes de Enfermedades , Enfermedad de los Legionarios/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Humanos , Enfermedad de los Legionarios/diagnóstico , Enfermedad de los Legionarios/terapia , Masculino , Persona de Mediana EdadRESUMEN
From January to April 2010, 396 hantavirus infections were notified in Germany, a considerable increase compared with previous years (mean: 83 for January-April 2004-2009) including the record-setting year, 2007 (n=232 January-April). Most patients are residents of known Puumala virus endemic areas in southern Germany. The recent increase in notified hantavirus infections is probably due to an increased population density of the main animal reservoir, the bank vole (Myodes glareolus).
Asunto(s)
Notificación de Enfermedades , Infecciones por Hantavirus/epidemiología , Orthohantavirus/aislamiento & purificación , Adolescente , Adulto , Anciano , Animales , Niño , Preescolar , Vectores de Enfermedades , Alemania/epidemiología , Infecciones por Hantavirus/etiología , Humanos , Persona de Mediana Edad , Adulto JovenRESUMEN
During the influenza season 2007-8, the proportion of seasonal influenza A(H1N1) viruses resistant to the neuraminidase inhibitor oseltamivir increased worldwide. We conducted an investigation to compare patients infected with oseltamivir-resistant (ose-R) and oseltamivir- susceptible (ose-S) influenza A(H1N1) viruses regarding risk factors for resistance and the capability to transmit in the household setting. Within a cohort of 396 laboratory confirmed influenza patients from sentinel physicians we conducted a nested case-control study among patients infected with A(H1N1). Thirty patients in the cohort were infected with influenza B, none with influenza A(H3N2) and 366 with A(H1N1). Of the 366 A(H1N1) viruses 52 (14%) were ose-R. Demographic characteristics, oseltamivir exposure, travel history and outcome were not significantly different between ose-S and ose-R patients. Among 133 households in the nested case-control study, secondary household attack rates in households with ose-R cases and households with ose-S cases were similar (23 versus 26%; p-value=0.54). Ose-R household status and occurrence of secondary cases were associated with an odds ratio of 0.85 (95% confidence interval 0.38-1.88). We conclude that seasonal ose-R influenza A(H1N1) viruses have transmitted well in the household setting.
Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Vivienda/estadística & datos numéricos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Gripe Humana/transmisión , Oseltamivir/uso terapéutico , Estaciones del Año , Antivirales/uso terapéutico , Estudios de Cohortes , Farmacorresistencia Viral , Femenino , Alemania/epidemiología , Humanos , Incidencia , Gripe Humana/tratamiento farmacológico , Masculino , Medición de Riesgo , Factores de RiesgoRESUMEN
The skeletons of demosponges, such as Ianthella basta, are known to be a composite material containing organic constituents. Here, we show that a filigree chitin-based scaffold is an integral component of the I. basta skeleton. These chitin-based scaffolds can be isolated from the sponge skeletons using an isolation and purification technique based on treatment with alkaline solutions. Solid-state (13)C NMR, Raman, and FT-IR spectroscopies, as well as chitinase digestion, reveal that the isolated material indeed consists of chitin. The morphology of the scaffolds has been determined by light and electron microscopy. It consists of cross-linked chitin fibers approximately 40-100 nm in diameter forming a micro-structured network. The overall shape of this network closely resembles the shape of the integer sponge skeleton. Solid-state (13)C NMR spectroscopy was used to characterize the sponge skeleton on a molecular level. The (13)C NMR signals of the chitin-based scaffolds are relatively broad, indicating a high amount of disordered chitin, possibly in the form of surface-exposed molecules. X-ray diffraction confirms that the scaffolds isolated from I. basta consist of partially disordered and loosely packed chitin with large surfaces. The spectroscopic signature of these chitin-based scaffolds is closer to that of alpha-chitin than beta-chitin.
Asunto(s)
Quitina/química , Poríferos/anatomía & histología , Poríferos/química , Animales , Espectroscopía de Resonancia Magnética , Espectroscopía Infrarroja por Transformada de Fourier , Espectrometría Raman , Difracción de Rayos XRESUMEN
In Baden-Wuerttemberg, a federal state in south-west Germany, a large outbreak of 1089 laboratory-confirmed human Puumala virus (PUUV) infections occurred in 2007. We conducted a survey to describe the disease burden and a case-control study to identify risk factors for acquiring PUUV. Case-patients were interviewed about clinical outcome and both case-patients and randomly recruited controls were interviewed about exposure. We calculated matched odds ratios (mOR) using a conditional logistic regression model. Multivariable analysis of 191 matched case-control pairs showed that case-patients were more likely than controls to have seen small rodents/their droppings (mOR 1.9, 95% CI 1.2-3.0), cleaned utility rooms (mOR 1.8, 95% CI 1.0-3.4) and visited forest shelters (mOR 3.9, 95% CI 1.1-14.3). Two thirds of case-patients required hospitalization. During PUUV epidemics rodent control measures and use of protective equipment should be considered in utility rooms and shelters.
Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica con Síndrome Renal/epidemiología , Virus Puumala/aislamiento & purificación , Factores de Riesgo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Niño , Femenino , Alemania/epidemiología , Fiebre Hemorrágica con Síndrome Renal/virología , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: Repeated outbreaks of salmonellosis caused by Salmonella enterica serovar Infantis at a rehabilitation clinic in Germany were investigated microbiologically from August 2002 to August 2009. AIM: To identify the sources of transmission and characterize the S. enterica serovar Infantis isolates. METHODS: Associated with these outbreaks, isolates from 98 patients, two kitchen staff, five food samples, four swabs of kitchen facilities, three samples of chicken faeces and one sample of sewage water were evaluated by phage typing. All S. enterica serovar Infantis isolates investigated (N=113) were related to phage type (PT) 29. Additionally, 44 of the 113 isolates were selected at random for typing by XbaI macrorestriction and pulsed-field gel electrophoresis (PFGE). FINDINGS: Typing of the 44 isolates showed that the recurrent infections were caused by the single clone PT 29/XB27+44 (42/44, 95.5%). The most likely route of transmission was only identified in the last outbreak in 2009 within the present study. It was found to be cross-contamination in the kitchen facilities (emanating from a contaminated wooden panel), in combination with carriers among the kitchen staff. CONCLUSIONS: This study demonstrated important details of hospital-specific epidemiological processes, and alludes to a long-term reservoir of an epidemic clone of S. enterica serovar Infantis either in a backyard flock of poultry or in an inanimate kitchen reservoir.
Asunto(s)
Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Infecciones por Salmonella/epidemiología , Salmonella enterica/aislamiento & purificación , Infección Hospitalaria/microbiología , Infección Hospitalaria/transmisión , Transmisión de Enfermedad Infecciosa , Electroforesis en Gel de Campo Pulsado , Microbiología Ambiental , Heces/microbiología , Microbiología de Alimentos , Genotipo , Alemania/epidemiología , Humanos , Tipificación Molecular , Recurrencia , Centros de Rehabilitación , Infecciones por Salmonella/microbiología , Infecciones por Salmonella/transmisión , Salmonella enterica/clasificación , Salmonella enterica/genética , Serogrupo , Aguas del Alcantarillado/microbiologíaRESUMEN
Canine babesiosis in Europe is generally caused by Babesia canis canis and Babesia canis rossi. Here we describe the first two autochthonous cases of Babesia gibsoni (Asian genotype) infection in Germany. Two American pit bull terriers showed clinical and hematologic signs consistent with babesiosis. Polymerase chain reaction (PCR) analysis of the 18S rDNA of blood samples revealed 486 bp fragments. The sequences were 100% identical to each other and 100% identical to Babesia gibsoni (Asian genotype). These results represent the first genetic evidence of Babesia gibsoni (Asian genotype) parasites in dogs in Western Europe.
Asunto(s)
Babesia/aislamiento & purificación , Babesiosis/veterinaria , ADN Protozoario/análisis , Enfermedades de los Perros/epidemiología , Animales , Babesiosis/epidemiología , Babesiosis/parasitología , ADN Ribosómico/análisis , Enfermedades de los Perros/parasitología , Perros , Genotipo , Alemania/epidemiología , Reacción en Cadena de la Polimerasa/métodos , Reacción en Cadena de la Polimerasa/veterinaria , Alineación de SecuenciaRESUMEN
In summer 2001, an outbreak of Salmonella München occurred in Germany. We conducted descriptive epidemiology and hypothesis-generating interviews among case patients, two retrospective cohort studies, and a case-control study of suboutbreaks. We performed pulsed-field gel electrophoresis (PFGE) from selected patient isolates and a limited trace-back investigation for analytical purposes. Four states were consecutively affected: Saxonia (SX), Brandenburg (BB), Berlin (BE), and Baden-Württemberg (BW). Although hypothesis-generating interviews failed to identify a plausible food item, descriptive data and investigations of the suboutbreaks suggested pork meat as a probable source in three states (SX, BB, and BE) but not in BW. The PFGE profiles from isolates of case patients in the first three states were indistinguishable but differed from PFGE profiles of case patients in BW. Trace-back investigation suggested that contamination of pork meat occurred early in the rearing-production chain. This outbreak demonstrates how contamination early in the production process that can yield different end products may complicate multistate outbreaks. Investigation of suboutbreaks and use of the trace-back method as investigational tools may be useful adjuncts in solving the problem of multistate outbreaks.
Asunto(s)
Contaminación de Alimentos/análisis , Carne/microbiología , Intoxicación Alimentaria por Salmonella/epidemiología , Intoxicación Alimentaria por Salmonella/etiología , Salmonella/aislamiento & purificación , Distribución por Edad , Animales , Estudios de Casos y Controles , Estudios de Cohortes , Brotes de Enfermedades , Electroforesis en Gel de Campo Pulsado , Femenino , Contaminación de Alimentos/prevención & control , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Salmonella/clasificación , Distribución por Sexo , PorcinosRESUMEN
OBJECTIVE: To identify the effect of human immunodeficiency virus (HIV) infection on the clinical course of pelvic inflammatory disease (PID). METHODS: Women hospitalized with PID at an urban hospital serving a population at high risk for HIV were studied cross-sectionally. Data abstracted from medical records of 349 women, admitted between July 1992 and April 1994 were linked anonymously to HIV serology. Main outcome measures were length of hospital stay, prolonged fever, tubo-ovarian abscess, surgery, and change in antibiotics. RESULTS: Among the 349 women with PID, 27 were HIV-positive. These HIV-positive women had lower mean white blood cell counts at admission (7411 versus 11,266, P < .01), lower mean lymphocyte counts (1411 versus 1928, P < .01), greater febrile morbidity (54 versus 28.3%, P < .01), and longer hospital stays (10.5 versus 6.4 days, P < .01) than HIV-negative women. Women who were HIV-positive required more time for defervescence and needed to change their antibiotic regimen more frequently (41 versus 12.7%, P < .01); differences in tubo-ovarian abscesses (19 versus 14%, P = .52) or surgery (15 versus 6.2%, P = .10) were not significant. The differences in hospital course between HIV-positive and HIV-negative women were modest, and they were resolved largely by the fourth or fifth hospital day. All HIV-positive women were treated successfully with first- or second-line antibiotic regimens. CONCLUSION: Despite more severe initial presentation and a prolonged hospital course, HIV-positive women with PID, but without other acute illnesses, were treated successfully with standard therapeutic regimens. These observations support current recommendations for hospitalization of HIV-positive women with PID and treatment according to current standards.
Asunto(s)
Infecciones por VIH/complicaciones , Enfermedad Inflamatoria Pélvica/complicaciones , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Seronegatividad para VIH , Seropositividad para VIH/complicaciones , Humanos , Modelos Logísticos , Enfermedad Inflamatoria Pélvica/epidemiología , Enfermedad Inflamatoria Pélvica/terapiaRESUMEN
The purpose of this study was to evaluate the enamel-sealant interface following the use of standard sealant placement techniques and an air-polishing system. Twenty-five caries-free premolars were extracted and stored in distilled water for 2 days. Five teeth were randomly assigned to each of five treatment groups. The occlusal surface was (1) air polished for 20 seconds, (2) cleaned with pumice for 20 seconds, or (3) not cleaned. Following treatment, 35% orthophosphoric acid was applied for 60 seconds. In two control groups, the acid-etching procedure was eliminated, and one group (4) was air polished for 20 seconds, while the other group (5) was not cleaned. Tinted self-curing sealant was applied to the entire occlusal surface of each tooth. Following the treatment, scanning electron photomicrographs were taken at X 1000 magnification. To evaluate the enamel-resin interface, the number of resin tags were counted by one precalibrated rater. A statistically significant difference was found among the treatment groups and the control groups. Air polishing combined with acid etching resulted in an improved surface for resin wetting as determined by the number of resin tags formed; however, the differences among the treatment groups were not large enough to be statistically significant.
Asunto(s)
Esmalte Dental/ultraestructura , Profilaxis Dental , Selladores de Fosas y Fisuras , Grabado Ácido Dental , Humanos , Microscopía Electrónica de Rastreo , Propiedades de SuperficieRESUMEN
The purposes of this study were to compare the amount of aerosols generated from ultrasonic and sonic scalers and to measure the potential depth of respiratory tract penetration. Forty subjects were randomly assigned to receive instrumentation with the magnetostrictive, piezoelectric, or air turbine scaler. The Anderson Air Sampler collected total baseline airborne microbes for 20 minutes prior to treatment and for 20 minutes during instrumentation. This cascade impactor system measures the degree of microbial penetration in a simulated respiratory system. Blood agar plates from the sampler were incubated for 24 hours at 37 degrees C. Colony forming units per cubic foot of air (CFUs/cu. ft.) were enumerated by one blind examiner using a Lab Line Colony Counter. Data for total microbial CFUs/cu.ft. and CFUs/cu.ft. by sampler level were analyzed on the log-transformed data using ANCOVA. Baseline values of airborne bacteria served as the covariate. Results showed no significant difference in mean combined total CFUs/cu.ft. for the magnetostrictive, piezoelectric, or air turbine sonic scalers. The magnetostrictive scaler generated the lowest CFUs/cu.ft. at the deepest level of penetration; however, no significant difference in level of penetration was found among the three scalers.
Asunto(s)
Microbiología del Aire , Raspado Dental/efectos adversos , Raspado Dental/instrumentación , Sonicación/instrumentación , Terapia por Ultrasonido/efectos adversos , Aerosoles , Análisis de Varianza , Recuento de Colonia Microbiana , Humanos , Sonicación/efectos adversosRESUMEN
BACKGROUND: Skin defects of the foot, ankle and distal lower leg often require coverage by local or distant flaps. We aimed to compare functional outcome and donor-site morbidity following transfer of distally based delayed sural (DSFs) or peroneus brevis flaps (PBFs). METHODS: Between 2003 and 2006, 52 patients (24 DSFs and 28 PBFs) were included. For increased reliability, all extended sural flaps were delayed for 3-15 days. At the end of the follow-up period (minimum 12 months), patients were asked to fill out a modified foot and ankle score (Foot and Ankle Outcome Score (FAOS)) questionnaire. In addition, a chart review and a physical examination were performed. RESULTS: Total hospital stay and total number of operations were significantly lower in the PBF group. Minor flap necrosis (<10%) was observed in 21% of the DSF and 7% of the PBF group, and partial (>10%) or total flap loss occurred in one and three patients from the DSF group, respectively. Patient satisfaction, FAOS results and range of motion were comparable in both groups. Defect aetiology and patient age did not influence surgical outcome. CONCLUSION: Donor-site morbidity and functional outcome after DSF and PBF are comparable. A higher rate of complications was observed in the DSF group. Based on our findings, the PBF is recommended as first-line procedure for reconstruction of small- to medium-sized defects at the distal tibia, fibula, ankle and heel. The sural flap might be chosen for extended skin defects especially when a larger arc of rotation is required.