Respiratory viruses in medicolegal autopsies during the winter season 2021/2022: observations after reduction of coronavirus disease-19 (COVID-19) pandemic restrictions.

In the context of the coronavirus disease (COVID-19) pandemic, measures were taken to protect the population from infection. These were almost completely lifted in several countries in the spring of 2022. To obtain an overview of the spectrum of respiratory viruses encountered in autoptical routine case work, and their infectivity, all autopsy cases at the Institute of Legal Medicine in Frankfurt/M. with flu-like symptoms (among others) were examined for at least 16 different viruses via multiplex PCR and cell culture. Out of 24 cases, 10 were virus-positive in PCR: specifically, 8 cases with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 with respiratory syncytial virus (RSV), and 1 with SARS-CoV-2 and the human coronavirus OC43 (HCoV-OC43), as a double infection. The RSV infection and one of the SARS-CoV-2 infections were only detected due to the autopsy. Two SARS-CoV-2 cases (postmortem interval of 8 and 10 days, respectively) showed infectious virus in cell culture; the 6 other cases did not show infectious virus. In the RSV case, virus isolation by cell culture was unsuccessful (Ct value of 23.15 for PCR on cryoconserved lung tissue). HCoV-OC43 was measured as non-infectious in cell culture, with a Ct value of 29.57. The detection of RSV and HCoV-OC43 infections may shed light on the relevance of respiratory viruses other than SARS-CoV-2 in postmortem settings; however, further, more extensive studies are needed for a robust assessment of the hazard potential due to infectious postmortem fluids and tissues in medicolegal autopsy settings.

Detection and infectivity of SARS-CoV-2 in exhumated corpses.

Postmortem detection of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) after the exhumation of a corpse can become important, e.g. in the case of subsequent medical malpractice allegations. To date, data on possible detection periods [e.g. by reverse transcription polymerase chain reaction (RT-PCR)] or on the potential infectivity of the virus after an exhumation are rare. In the present study, these parameters were examined in two cases with a time span of approximately 4 months between day of death and exhumation. Using SARS-CoV-2 RT-PCR on swabs of both lungs and the oropharynx detection was possible with cycle threshold (Ct) values of about 30 despite signs of beginning decay. RT-PCR testing of perioral and perinasal swabs and swabs collected from the inside of the body bag, taken to estimate the risk of infection of those involved in the exhumation, was negative. Cell culture-based infectivity testing was negative for both, lung and oropharyngeal swabs. In one case, RT-PCR testing at the day of death of an oropharyngeal swab showed almost identical Ct values as postmortem testing of an oropharyngeal swab, impressively demonstrating the stability of viral RNA in the intact corpse. However, favorable climatic conditions in the grave have to be taken into account, as it was wintertime with constant low temperatures. Nevertheless, it was possible to demonstrate successful postmortem detection of SARS-CoV-2 infection following exhumation even after months in an earth grave.

[High-risk needlestick injuries and virus transmission : A prospective observational study]. / Hochrisikonadelstichverletzungen und Virustransmission : Eine prospektive Beobachtungsstudie.

BACKGROUND: Needlestick injuries (NSI) of healthcare personnel (HCP) are work-related accidents with a risk of transmission of blood-borne human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV, HCV). Along with preventive measures to avoid accidental NSI, preventing the risk and diagnosis of an infection from NSI are given a high priority. Thus, follow-up monitoring of NSI is of great interest. OBJECTIVE: Evaluation of the follow-up monitoring after NSI with respect to early recognition of transmission of HIV, HCV and HBV as well as adherence and psychological burden of HCP. METHODS: Clinical and serological investigations of the injured HCP including determining the individual risk of infection in the situation of NSI, analysis of accident protocols by the accident insurance consultant and use of a self-developed standardized questionnaire. RESULTS: No virus transmissions from NSI were found during the observation period (23 March 2014 until 31 October 2017). A total of 112 NSI with infectious index patients (HIV 35.7%, HCV 54.5%, HBV 2.7%, coinfection 7.1%) and 3 incidents from unknown index patients were analyzed. Of the index patients six received the first diagnosis of a blood-borne infection (2 HCV infections, 4 HIV infections) after NSI. In nearly all incidents (98.3%) the HCP took measures to disinfect and flush the injury and 85.1% of the HCP exposed to HIV or unknown infection risk undertook postexposure prophylaxis (HIV-PEP) within 2 h and another 12.8% within 10 h. Follow-up examination was attended by 97.4% of the HCP, three quarters of the HCP felt concerned following NSI and 12.2% were very concerned. CONCLUSION: Through adequate management and follow-up of NSI low transmission rates can be achieved after exposure to blood-borne viruses within the occupational environment.

[Viral Infections Among the Nursing Personnel - a Survey]. / Arbeitsbedingte virale Infektionen in der Pflege ­ eine Umfrage.

BACKGROUND AND AIM: Healthcare workers (HCW) are at risk of occupational infections and can also transmit diseases to patients. The acceptance of measures to improve safety is linked to knowledge and risk awareness of HCW. The purpose of our study was to ascertain the knowledge and risk awareness of nursing staff regarding occupational infections and vaccinations as well as the frequency of needlestick injuries (NSI) in relation to the level of education. METHODS: In the context of a conference on nursing, an anonymous questionnaire was distributed to the participants. RESULTS AND CONCLUSIONS: Nursing staff had insufficient knowledge of viral occupational infections with regard to the actual hazard. At the same time, more than 60 % of the respondents rated the probability of contracting occupational infections as "pretty high" to "very high". In addition, 62.1 % of the study participants also stated that they did not feel sufficiently trained to care for patients with highly contagious or rare infectious diseases. Intensified training and awareness programs for nursing personnel are required to increase the knowledge of occupational infections.

[Risk estimation of blood-borne infections by emergency room personnel]. / Risikoeinschätzung von blutübertragbaren Infektionen durch die Schockraummitarbeiter.

BACKGROUND: Emergency department personnel are at risk of occupational exposure to blood-borne pathogens. Previous studies have shown that the prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) virus infections among trauma patients is higher compared to the general population. OBJECTIVES: The aim of the study was to investigate the compliance rates of trauma team members in applying standard precautions, knowledge about the transmission risk of blood-borne infections and perceived risk of acquiring HIV, HBV and HCV. METHODS: An anonymous questionnaire was distributed to 100 trauma team members including physicians, nurses and medical students from different medical departments (e.g. surgery, radiology, anesthesia and internal medicine). RESULTS: The results of the questionnaire showed that trauma team members had insufficient knowledge of the risk of blood-borne pathogens, overestimated the risk of HCV infection and underused standard precautions during treatment of emergency trauma patients. CONCLUSION: Further educational measures for emergency department personnel are required to increase the knowledge of occupational infections and compliance with standard precautions. Every healthcare worker needs to be sufficiently vaccinated against HBV. In the case of injury awareness of all measures of post-exposure prophylaxis is of utmost importance for affected personnel.

[Prevalence of blood-borne pathogens among 275 trauma patients : A prospective observational study]. / Prävalenz blutübertragbarer Virusinfektionen bei 275 Schockraumpatienten : Eine prospektive Beobachtungsstudie.

BACKGROUND: Previous studies have indicated that the prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) virus infections among trauma patients seems to be higher compared to the general population. OBJECTIVE: This study investigated the seroprevalence of blood-borne pathogens among patients with suspected severe multiple trauma in a German university hospital (level I trauma center). METHODS: Routine blood samples taken from trauma patients at the university hospital Frankfurt were tested for HBV, HCV and HIV (from 1 February 2014 to 31 January 2015). RESULTS: Overall, 275 patients with a median injury severity score (ISS) of 9 points (range 0-54) were included in the study representing 84.4 % of all trauma room admissions during this time period. Altogether 3.3 % (n = 9) of the patients were infected with blood-borne pathogens, where 7 patients were infected with HCV and 2 patients had an active HBV infection. None of the patients were tested HIV positive and only one initial diagnosis for HCV was made. A further six samples (five HCV and one HIV) showed a weak reaction in the screening assay that could not be verified by the confirmatory assay. CONCLUSION: To the best of our knowledge this study is the first report on the prevalence of blood-borne infections among trauma patients at a level I trauma center in an urban area in Germany. Compared to the general population the prevalence of blood-borne infections was higher but considerably lower than indicated in previous international studies. Considering the broad implications of occupationally transmitted blood-borne infections occupational safety is of paramount importance.

[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.

Needlestick injuries: causes, preventability and psychological impact.

Needlestick injuries (NSI) pose a significant health hazard among healthcare personnel (HCP). The aim of our prospective observational study was to evaluate the psychological impact of NSI and assess measures to prevent NSI. The target group was the medical staff and students of Frankfurt University Hospital who had experienced a NSI (n = 370) during the 12-month study period. Data were retrieved from accident insurance reports, occupational follow-up examinations and a standardized anonymous questionnaire sent to the affected HCP. Analysis of the completed questionnaires (232/370) revealed that stress (48.3 %) and tiredness (36.6 %) were common factors contributing to the NSI and that >80 % of the respondents were concerned about the consequences of the NSI. Higher levels of anxiety were reported when the patient was known to have a chronic virus infection. Stressful working conditions, lack of adequate protective medical/technical equipment and poor work routines were suggested as factors contributing to NSI.

[Early diagnosis of hepatitis C transmission after needlestick injury]. / Frühzeitige Diagnose einer Hepatitis-C-Übertragung nach Nadelstichverletzung.

Occupational transmission of hepatitis C (HCV) is rare but has been repeatedly described in the published literature. Early diagnosis and therapy of acute hepatitis C is associated with an excellent chance of permanent HCV elimination. The majority of chronic HCV infections, however, lead to a slowly progressive hepatitis with associated morbidity and risk of liver cirrhosis. For this reason the need for antiviral therapy has to be evaluated immediately.

[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.

[Influenza vaccination rates in Hessian hospitals]. / Influenzaimpfquoten in hessischen Krankenhäusern.

Influenza infections have been shown to spread in hospitals rapidly; nosocomial transmissions occur frequently. Influenza vaccination of health care personnel (HCP) is an effective strategy for preventing influenza infections among personnel and patients. In summer 2011 we conducted an anonymous questionnaire among Hessian hospitals assessing influenza vaccination rates, kind and concept of vaccination programmes. Overall, 95.8% (68/71) of hospitals surveyed offered influenza vaccinations for HCP free of charge. Influenza vaccination rates have been recorded only by 70.4% (50/71). Over 80% (season 2009/2010: 41/50- season 2010/2011: 44/50) of hospitals questioned, mentioned influenza vaccination rates under 20%. Our findings confirm that the influenza vaccination rates might be less than the generally assumed and communicated influenza vaccination rates of 20-25%. Thirty years since the German Standing Committee on Vaccination (STIKO) recommended that all HCP get vaccinated against influenza, vaccination rates still remain below 30%. Measures to improve influenza vaccination rates among HCP are required. Monitoring of vaccination rates is a precondition to assess the acceptance of a vaccination programme.

[Prevention of nosocomial transmission of human immunodeficiency virus (HIV) from HIV-positive healthcare workers. Recommendations of the German Association for the Control of Viral Diseases (DVV) e.V. and the Society for Virology (GfV) e.V]. / Prävention der nosokomialen Übertragung von humanem Immunschwächevirus (HIV) durch HIV-positive Mitarbeiterinnen und Mitarbeiter im Gesundheitswesen. Empfehlungen der Deutschen Vereinigung zur Bekämpfung der Viruskrankheiten (DVV) e.V. und der Gesellschaft für Virologie (GfV) e.V.

To the best of our knowledge, the German Association for the Control of Viral Diseases (DVV) e.V. and the Society for Virology (GfV) e.V. are the first in Europe to provide precise recommendations for the management of health care workers (HCWs) who are infected with human immunodeficiency virus (HIV). Requirements for HIV-infected HCWs need to be clearly defined. With a permanent viral burden of less than or equal to 50 copies/mL, HIV-positive HCWs are allowed to perform any surgery and any invasive procedure, as long as the infected HCW uses double-gloving, undergoes follow-up routinely by occupational medicine professionals, undergoes a quarterly examination of viral burden, and has a regular medical examination by a physician who has expertise in the management of HIV. Unrestricted professional activity is only possible with a strict compliance to take antiretroviral therapy and if the HIV-infected HCW strictly adheres to the recommended infection control procedures. Complete compliance with the recommendation almost certainly leads to no HIV transmission risk in patient care.

Assessment of mumps virus-specific antibodies by different serological assays: which test correlates best with mumps immunity?

Mumps is one of the vaccine-preventable childhood diseases and it has not yet been eradicated in Germany. This raises the question as to whether the available mumps vaccines are effective enough to prevent mumps and which antibody test system allows the authentic assigning of mumps-specific immunity. In an attempt to answer this question, we analysed 227 sera samples from medical students of the University Hospital Frankfurt/Main, Germany, using different test systems: indirect immune fluorescence, neutralisation assay, routine ELISA and newly developed immunoassays, which contain the mumps nucleoprotein and the wild-type strain Enders ATCC VR106, respectively. Mumps vaccination coverage of the screened collective amounted to 75.1%, which differs notably from the detected mumps-specific seropositivity rates in the literature (range 53.3% to 82.4%). In contrast, a small group of unvaccinated students had much higher seropositivity rates. Of course, assigned vaccination coverage and calculated seropositivity rates are not effective enough to interrupt the transmission of the mumps virus. The often-occurring mumps outbreaks, some in highly vaccinated populations, may not always demonstrate vaccine failure. The investigation of newly developed test systems and the occurrence of different mumps virus genotypes should also be considered.

The impact of the 2009 influenza A(H1N1) pandemic on attitudes of healthcare workers toward seasonal influenza vaccination 2010/11.

The emergence of the influenza A(H1N1)2009 virus provided a major challenge to health services around the world. However, vaccination rates for the public and for healthcare workers (HCWs) have remained low. We performed a study to review the reasons put forward by HCWs to refuse immunisation with the pandemic vaccine in 2009/10 and characterise attitudes in the influenza season 2010/11 due to the emergence of influenza A(H1N1)2009. A survey among HCWs and medical students in the clinical phase of their studies was conducted, using an anonymous questionnaire, at a German university hospital during an influenza vaccination campaign. 1,366 of 3,900 HCWs (35.0%) were vaccinated in the 2010/11 influenza season. Of the vaccinated HCWs, 1,323 (96.9%) completed the questionnaire in addition to 322 vaccinated medical students. Of the 1,645 vaccinees who completed the questionnaire, 712 had not been vaccinated against the influenza A(H1N1)2009 virus in the 2009/10 season. The main reason put forward was the objection to the AS03 adjuvants (239/712, 33.6%). Of the HCWs and students surveyed, 270 of 1,645 (16.4%) stated that the pandemic had influenced their attitude towards vaccination in general. Many German HCWs remained unconvinced of the safety of the pandemic (adjuvanted) influenza vaccine. For this reason, effective risk communication should focus on educating the public and HCWs about influenza vaccine safety and the benefits of vaccination.

[Measles in 2010. Knowledge and vaccination status of medical students]. / Masern im Jahr 2010. Wissensstand und Impfstatus von Medizinstudenten.

OBJECTIVES: In 2002, the WHO Regional Office for Europe developed a strategic plan for measles in the WHO European Region. WHO recommends that at least 95% of children receive two doses of measles vaccine. This plan targeted the elimination of measles for the year 2010 and is supported by the Federal Republic of Germany. METHODS: Questionnaire survey, serological tests and check-up of the certificates of vaccination were offered to second year medical students of Goethe University Frankfurt/Main, Germany. RESULTS: Only 62.3% of medical students had received two doses of measles vaccine. Serological data showed that 23.1% were not immune against measles. Important gaps of knowledge were identified in the knowledge test of the survey; less than one third of the students (n=95/324) were able to answer more than 50% of the questions correctly. DISCUSSION: The suboptimum measles-vaccination coverage shows that the goal of eliminating measles will not be met across Europe by the target year 2010. Both occupational and public health measures need to make sure that vaccination programs should achieve a minimum of 95% coverage with two doses. In addition, the obligation to notify the authorities even of suspected cases serve the same purpose and measures to improve the knowledge of medical students are required. Consequent surveillance systems are necessary to investigate chains of measles infections. Healthcare workers play a decisive role in this issue.

[Low influenza vaccination rates among healthcare workers. Time to take a different approach]. / Niedrige Influenzaimpfquoten bei Mitarbeitern im Gesundheitswesen. Zeit für einen neuen Ansatz.

Despite decades of effort to encourage healthcare workers (HCWs) to be immunized against influenza, vaccination levels remain insufficient in Germany, with only one in five HCWs receiving the annual influenza vaccination. To prevent nosocomial influenza outbreaks and to ensure the protection of patients and HCWs, new approaches to increase vaccination rates are needed. The experience in the USA has shown that declination forms have increased vaccination coverage. One possible approach for Germany would be a combination of declination forms with the exclusive use of vaccinated staff in defined areas. This approach would respect a HCWs decision to refuse medical treatment, while at the same time protecting vulnerable patients. In addition, the influenza vaccination rates of HCWs should be collected in order to evaluate the implementation of vaccination policies. Similar to the setting of desired vaccination coverage for the chronically ill, a clearly defined vaccination goal should be established for HCWs.