The change in the sex ratio in multiple sclerosis is driven by birth cohort effects.

BACKGROUND AND PURPOSE: Birth cohort effects have greatly shaped long-term trends in multiple sclerosis (MS). This study examined whether birth cohort effects have also determined trends in the sex ratio. METHODS: Age-period-cohort analyses were applied to Swiss mortality data, 1901-2010, using logit models. Sex was introduced as an additional main effect (overall effect) and in interaction terms with A, P and C. RESULTS: Birth cohort effects strongly impacted the trends of MS risk in Switzerland, with a peak in cohorts born in the 1910s and 1920s. Similarly, birth cohort effects accounted for the change in the sex ratios during the 20th century. The balanced sex ratio at the beginning of the 20th century has been superseded by a ratio with a preponderance of women. Despite similarities in timing, the patterns of overall and sex-specific birth cohort estimates were not congruent. CONCLUSION: The change in the sex ratio in MS is driven by birth cohort related factors. Overall and sex-specific trends indicate that the appearance of MS has changed dramatically in the 20th century. The driving force behind these trends is related to yet unknown environmental factors.

Measles associated with international travel in the region of the Americas, Australia and Europe, 2001-2013: a systematic review.

BACKGROUND: Travel volumes are still increasing resulting in a more interconnected world and fostering the spread of infectious diseases. We aimed to evaluate the relevance of travel-related measles, a highly transmissible and vaccine-preventable disease. METHOD: Between 2001 and 2013, surveillance and travel-related measles data were systematically reviewed according to the PRISMA guidelines with extraction of relevant articles from Medline, Embase, GoogleScholar and from public health authorities in the Region of the Americas, Europe and Australia. RESULTS: From a total of 960 records 44 articles were included and they comprised 2128 imported measles cases between 2001 and 2011. The proportion of imported cases in Europe was low at 1-2%, which reflects the situation in a measles-endemic region. In contrast, imported and import-related measles accounted for up to 100% of all cases in regions with interrupted endemic measles transmission. Eleven air-travel related reports described 132 measles index cases leading to 47 secondary cases. Secondary transmission was significantly more likely to occur if the index case was younger or when there were multiple infectious cases on board. Further spread to health care settings was found. Measles cases associated with cruise ship travel or mass gatherings were sporadically observed. CONCLUSIONS: Within both, endemic and non-endemic home countries, pretravel health advice should assess MMR immunity routinely to avoid measles spread by nonimmune travelers. To identify measles spread as well as to increase and sustain high vaccination coverages joint efforts of public health specialists, health care practitioners and travel medicine providers are needed.

Clinical and immune response to undiluted and diluted smallpox vaccine.

QUESTION UNDER STUDY: To assess clinical reactions, immune responses and adverse events to undiluted, three- and sixfold diluted Lister strain vaccine stockpiled in Switzerland. METHODS: A prospective, triple-blinded, randomised, parallel group clinical trial was performed. RESULTS: From 2001 to 2007 104 persons with an indication for vaccinia vaccination were recruited. They had a median age of 33 years (range 18-65), 56 (53.8%) were re-vaccinees and 48 (46.2%) primary vaccinees. There was no statistically significant variation in the proportion of revaccinees between diluted and undiluted vaccine groups (75% vs 51%, p = 0.118). With an overall clinical take rate (major reaction) of 97.1% the majority of the vaccinia-naïve participants exhibited an at least fourfold increase of neutralising antibody titres (32/38, 84.2%) post-vaccination. Interestingly this proportion was lower among re-vaccinees (29/46, 63.0%, p = 0.048). No significant difference was observed in the take rate or at least fourfold seroconversion rate between the threefold and sixfold diluted vaccine doses. Adverse events were reported by 98 (94.2%) participants, not accounting for itching at the vaccination site. CONCLUSION: Subjects requiring immunisation were successfully (re-) vaccinated with undiluted as well as with three- or sixfold diluted vaccinia vaccine. Our findings complement previous studies with respect to the clinical take rate and immune response. The rate of adverse events was substantial but not unexpected and no severe adverse events occurred. In conclusion, the existing smallpox vaccine stockpile might be expanded by administering three- or sixfold diluted vaccine doses combined with a careful pre-vaccination screening and extensive instructions to vaccinees.

[Botulism: prevention, clinical diagnostics, therapy and possible threat]. / Botulismus: Prävention, Diagnostik, Therapie und mögliche Bedrohungslagen.

In times of increased terrorist threat health professionals need to be prepared for bioterrorist events. The goal must be to give doctors an overview over the current state of knowledge and risk assessment of botulinum toxin. This review is based on Information gathered by a systematic analysis of the literature and by contacting experts. The toxicity of botulinum toxin exceeds any other known natural toxin. Clinical features of botulism consist of an acute, afebrile symmetrical and descending paralysis, regardless of the route of exposure, with normal mental status, sensory functions and electrolyte values. The initial diagnosis is often wrong in individual cases of botulism, but clusters with typical symptoms and two or more cases usually provide the diagnosis. Current treatment is primarily supportive care, respiratory support and antitoxin administration. Early application of antitoxin can limit the extent of the paralysis, but will not reverse it. Antitoxin for adult patients is of equine origin, while children in the USA can be treated with a recently developed human antitoxin. A pentavalent toxoid vaccine is available for persons at high risk of exposure. Botulinum toxin is easily extracted and ubiquitously available. These two features, together with the high toxicity, makes misuse easy. Misuse will continue to occur. Although a rare disease in Western Europe, botulism should be included in the differential diagnosis in patients with specific symptoms of paralysis. There is the potential threat of deliberate release of botulinum toxin. For this reason every outbreak of botulism must be assessed for any possible links to terrorism.

Real time PCR for the assessment of CD8+ T cellular immune response after prophylactic vaccinia vaccination.

BACKGROUND: The magnitude of specific CD8+ T cell reactivity responsible for vaccine-induced protection against smallpox infection has not yet been fully elucidated. Among other techniques, RT-PCR for the monitoring of cytokine release in effector T cells against tumor and viral antigens has demonstrated a novel promising method. OBJECTIVE: To determine the functional status of antigen specific CD8+ T cells in healthy participants before and 4 weeks after prophylactic vaccination (Lister strain) against smallpox using quantitative real-time PCR (qRT-PCR). STUDY DESIGN: Changes of interferon-gamma (IFNgamma) mRNA expression levels on short term ex vivo peptide antigen stimulation were measured. The corresponding specific CD8+ T cell reactivity was then displayed as CD8-normalized IFN-gamma levels (IFN-gamma/CD8 ratio). RESULTS: We found a 5-9 fold increase of CD8+ T cell reactivity in three out of four vaccinated individuals. The kinetics and strength determined in responders reveal a virus specific T cell effector repertoire pre-vaccination and a corresponding functional state after immunization comparable also to data obtained from tetramer- and ELISPOT analysis. CONCLUSIONS: Apart from protective vaccinia-specific neutralizing antibodies, the presence of antigen-specific CD8+ T-cells has been demonstrated after vaccinia vaccination. In concordance with others, results from this PCR-based study indicate that this smallpox vaccine induces strong vaccinia virus-specific CD8+ and IFN-gamma producing T cell responses.

[Knowledge, attitudes and practices among travellers to tropical and subtropical countries]. / Wissen, Einstellung und geplantes Verhalten von Reisenden in tropische und subtropische Länder.

Passengers with destinations in developing countries have been interviewed prior to departure on Zurich Airport. A total of 946 questionnaires were evaluated, 337 on travel related malaria prior to visiting an endemic country, 609 on vaccinations. This corresponds to a response rate of 72.3%. Among the respondents 550 (58.1%) had received travel health advice by a doctor. Overall, 25.5% were immunized against hepatitis A. While 70.4% of those who had obtained travel health advice carried medication against malaria, only 31.3% of those without such advice did so. Travel health advice resulted in a significantly increased appreciation of the risk of hepatitis A or malaria at the destination. Considerations on healthy travel should become a cornerstone in travel planning; special risk groups have been identified.

[Health promotion and prevention in the Lucerne canton--1995 analysis and prospects]. / Gesundheitsförderung und Prävention im Kanton Luzern--Analyse 1995 und Ausblick.

Considering the legal situation the canton of Lucerne is addressed to make his contribution to health promotion and prevention. His target groups are authorities on cantonal and community levels, specialised organisations and other health professionals, as for example physicians and pharmacists. The objectives of this study are to survey the health promotional and preventive activities, to evaluate the needs of the target groups as well as to focus on the opportunities of improved cooperation. Based on these results recommendations to the cantonal health authorities will be formulated. As far as the allocation of financial and personal resources are concerned health promotion and prevention do not figure as top priorities. Besides, the study results suggest to improve the cooperation between political representatives and health professionals. The cantonal health promotion authorities are well known among the target groups. However, cooperation could be intensified on all levels of action and is regarded as most desirable. A mutual forum focused on information and experience transfer would support these results and could stimulate joint projects. In addition, the needs of the communities have to be given special attention.