[Vaccination during pregnancy]. / Impfen in der Schwangerschaft.

Background: Due to characteristics of the immune system, pregnant women, fetuses and infants show an increased infection-related morbidity and mortality, which can be reduced by vaccinations during pregnancy. Objective: This article elucidates the mechanisms, the evidence of expected effects, contraindications and possible adverse effects of vaccinations in pregnancy. Method: A selective literature search was carried out with particular attention to the recommendations of the Standing Committee on Vaccinations of the Robert Koch Institute (STIKO) and the pertinent guidelines. Results: Vaccinations during pregnancy protect expectant mothers from a severe course of a number of different infectious diseases and therefore the associated pregnancy complications. Moreover, neonates are given passive immune protection against life-threatening infections by the vertical transmission of maternal antibodies. The efficacy and safety of vaccination in pregnancy is well-established for inactivated vaccines against tetanus, influenza and pertussis; vaccinations with live-attenuated vaccines are contraindicated due to a theoretical risk for the fetus. Currently available data on the deployment of vaccines against coronavirus disease 2019 (COVID 19) are still limited. Conclusion: The goals of vaccination during pregnancy are to directly protect pregnant women by active immunization and/or the child by natural passive immunization. Pregnant women should not be excluded from an indicated vaccination for their own protection and that of the child. Additional reasonable measures to protect the health of mother and child include the vaccination of other persons in close contact as well as the closure of relevant vaccination gaps among young adults, particularly for women of childbearing age.

Identification of hypoglycin A binding adsorbents as potential preventive measures in co-grazers of atypical myopathy affected horses.

BACKGROUND: Intestinal absorption of hypoglycin A (HGA) and its metabolism are considered major prerequisites for atypical myopathy (AM). The increasing incidence and the high mortality rate of AM urgently necessitate new therapeutic and/or preventative approaches. OBJECTIVES: To identify a substance for oral administration capable of binding HGA in the intestinal lumen and effectively reducing the intestinal absorption of the toxin. STUDY DESIGN: Experimental in vitro study. METHODS: Substances commonly used in equine practice (activated charcoal composition, di-tri-octahedral smectite, mineral oil and activated charcoal) were tested for their binding capacity for HGA using an in vitro incubation method. The substance most effective in binding HGA was subsequently tested for its potential to reduce intestinal HGA absorption. Jejunal tissues of 6 horses were incubated in Ussing chambers to determine mucosal uptake, tissue accumulation, and serosal release of HGA in the presence and absence of the target substance. Potential intestinal metabolism in methylenecyclopropyl acetic acid (MCPA)-conjugates was investigated by analysing their concentrations in samples from the Ussing chambers. RESULTS: Activated charcoal composition and activated charcoal were identified as potent HGA binding substances with dose and pH dependent binding capacity. There was no evidence of intestinal HGA metabolism. MAIN LIMITATIONS: Binding capacity of adsorbents was tested in vitro using aqueous solutions, and in vivo factors such as transit time and composition of intestinal content, may affect adsorption capacity after oral administration. CONCLUSIONS: For the first time, this study identifies substances capable of reducing HGA intestinal absorption. This might have major implications as a preventive measure in cograzers of AM affected horses but also in horses at an early stage of intoxication.

Background paper to the recommendation for the preferential use of live-attenuated influenza vaccine in children aged 2-6 years in Germany.

The German Standing Committee on Vaccination (STIKO) recommends seasonal influenza vaccination for children and adolescents with chronic medical conditions that put them at risk for severe influenza illness. In addition to trivalent inactivated influenza vaccines (TIV), a trivalent live-attenuated influenza vaccine (LAIV) was licensed for children and adolescents aged 2-17 years in the European Union in 2011. Employing the methodology of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group, we examined the evidence for efficacy and safety of LAIV relative to TIV to guide STIKO's decision on whether LAIV should be preferentially recommended for at-risk children. In our meta-analysis of data from two randomized trials directly comparing LAIV and TIV in children aged ≤ 6 years, the protective efficacy of LAIV against laboratory-confirmed influenza was 53 % [95 % confidence interval (CI): 45-61 %] higher than that of TIV. A similar study in individuals aged 6-17 years showed a 32 % (95 % CI: 3-52 %) higher efficacy of LAIV. The quality of the evidence for a superior protective efficacy of LAIV against all relevant clinical outcomes was rated 'moderate' for children aged 2-6 years and 'low' for the age group 7-17 years. Regarding safety outcomes, the available data suggest no significant differences between LAIV and TIV. Based on these results, STIKO recommends that LAIV should be used preferentially for influenza vaccination of at-risk children aged 2-6 years. In children and adolescents aged 7-17 years, either LAIV or TIV may be used without specific preference. Possible contraindications and the vaccinee's and his/her guardians' preferences should be taken into account.

Rapid quantification of conjugated and unconjugated bile acids and C27 precursors in dried blood spots and small volumes of serum.

The aim of the study was to develop a method for fast and reliable diagnosis of peroxisomal diseases and to facilitate differential diagnosis of cholestatic hepatopathy. For the quantification of bile acids and their conjugates as well as C(27) precursors di- and trihydroxycholestanoic acid (DHCA, THCA), in small pediatric blood samples we combined HPLC separation on a reverse-phase C18 column with ESI-MS/MS analysis in the negative ion mode. Analysis was done with good precision (CV 3,7%-11.1%) and sufficient sensitivity (LOQ: 11-91 nmol/L) without derivatization. Complete analysis of 17 free and conjugated bile acids from dried blood spots and 10 microL serum samples, respectively, was performed within 12 min. Measurement of conjugated primary bile acids plus DHCA and THCA as well as ursodeoxycholic acid was done in 4.5 min. In blood spots of healthy newborns, conjugated primary bile acids were found in the range of 0.01 to 2.01 micromol/L. Concentrations of C(27) precursors were below the detection limit in normal controls. DHCA and THCA were specifically elevated in cases of peroxysomal defects and one Zellweger patient.

Newborn screening for congenital adrenal hyperplasia: additional steroid profile using liquid chromatography-tandem mass spectrometry.

BACKGROUND: Neonatal screening programs for congenital adrenal hyperplasia (21-CAH) using an immunoassay for 17alpha-hydroxyprogesterone (17-OHP) generate a high rate of positive results attributable to physiological reasons and to cross-reactions with steroids other than 17alpha-OHP, especially in preterm neonates and in critically ill newborns. METHODS: To increase the specificity of the screening process, we applied a liquid chromatography-tandem mass spectrometry method quantifying 17alpha-OHP, 11-deoxycortisol, 21-deoxycortisol, cortisol, and androstenedione. The steroids were eluted in aqueous solution containing d8-17alpha-OHP and d2-cortisol and quantified in multiple reaction mode. RESULTS: Detection limit was below 1 nmol/liter, and recovery ranged from 64% (androstenedione) to 83% (cortisol). Linearity was proven within a range of 5-100 nmol/liter (cortisol, 12.5-200 nmol/liter), and total run time was 6 min. Retrospective analysis of 6151 blood samples and 50 blood samples from newborns with clinically confirmed 21-CAH, as well as prospective analysis of 1609 samples of a total of 242,500 testing positive in our routine 17-OHP immunoassay, allowed clear distinction of affected and nonaffected newborns. High levels of 21-deoxycortisol were only found in children with 21-hydroxylase deficiency. Calculating the ratio of 17alpha-OHP to 21-deoxycortisol divided by cortisol further increased the sensitivity of the method. CONCLUSION: Our liquid chromatography-tandem mass spectrometry procedure as a second-tier test can be used to reduce false-positive results of standard 21-CAH screening. The short total run time of 6 min allows for immediate reanalysis of all immunoassay results above the cutoff.

[The vaccination coverage among children aged 24 - 30 months in pediatric offices November 1999 - May 2001. The influence of socio-demographic characteristics]. / Die Durchimpfung von 24 - 30 Monate alten Kindern in pädiatrischen Praxen im Zeitraum von November 1999 bis Mai 2001 - Der Einfluss soziodemografischer Faktoren.

BACKGROUND: The goal of this study was to investigate the influence of socio-demographic factors on vaccination coverage of 24-30 month old children in paediatric practices. METHODS: Vaccination coverage (VC) was documented for 15,682 children in 196 paediatric practices mainly in the region of Nordrhein. Data on socio-demographic factors were collected for 8,457 children and their influence on the vaccination status (VS) was investigated by means of logistic regression analysis. RESULTS: Complete age-appropriate VC for all vaccines recommended by the Standing Committee for Vaccination (STIKO) was 49.9 %. Complete VC for Diphtheria/Tetanus (DT) was 74.6 % and for first dose measles/mumps/rubella (MMR), 82.1 %. The following factors were associated with complete VS for DT and MMR: completion of last recommended well-child visit, parents living together, low number of siblings, short time to reach practice, parents stating they felt adequately informed about vaccinations. Complete vaccination for DT was inversely associated with being health insured through social security and for MMR with the mother having graduated from high school. CONCLUSIONS: A high proportion of 24-30 month old children did not have an age appropriate VS. Targeted parental education and timely vaccination strategies that take into account socio-demographic risk factors for low vaccination uptake are required.