A case report of laboratory-acquired diphtheria.

In March 1996, when a 41 year old laboratory technician developed malaise, low grade fever, sore throat, hoarseness and dysphagia she was initially treated symptomatically. One day later, the patient was seen in the emergency room of an ear, nose, and thr

[The kinetics of vaccine antibodies against tetanus toxoid, diphtheria toxoid, measles virus, poliomyelitis virus and pneumococcus after allogeneic and autologous bone marrow transplantation and revaccination. 3: The kinetics of vaccine antibodies against tetanus toxoid and diphtheria toxoid after allogeneic and autologous bone marrow transplantation and combined revaccination against diphtheria and tetanus]. / Untersuchungen zur Kinetik der Impfantikörper gegen Tetanustoxoid, Diphtherietoxoid, Masern-Virus, Poliomyelitis-Virus und Pneumokokken nach allogener und autologer Knochenmarktransplantation und Wiederholungsimpfung. Teil 3: Kinetik der Impfantikörper gegen Tetanustoxoid und Diphtherietoxoid nach allogener und autologer Knochenmarktransplantation und kombinierter Wiederholungsimpfung gegen Diphtherie und Tetanus.

The 3rd part of the paper deals with the results of a combined revaccination against diphtheria and tetanus in a group of 25 children after allogeneic bone marrow transplantation (BMT) with and without graft versus host disease (GvHD) and after autologous transplantation. It can be shown that in the allogeneic transplanted groups with and without GvHD it is possible to build up a tetanus and diphtheria antitoxin titre in a safe protective cause by a 2nd basic immunisation consisting of 3 single vaccinations starting about 9 to 12 months later. For autologous transplanted children only 1 to 2 vaccinations at a later term than for the allogeneic transplanted children may possibly be sufficient.

[Kinetics of vaccination antibodies against tetanus toxoid, diphtheria toxoid, measles virus, poliomyelitis virus and pneumococcus after allogenic and autologous bone marrow transplantation and booster vaccination. 2: Kinetics of vaccination antibodies against diphtheria toxoid after allogenic and autologous bone marrow transplantation]. / Untersuchungen zur Kinetik der Impfantikörper gegen Tetanustoxoid, Diphtherietoxoid, Masern-Virus, Poliomyelitis-Virus und Pneumokokken nach allogener und autologer Knochenmarktransplantation und Wiederholungsimpfung. Teil 2: Kinetik der Impfantikörper gegen Diphtherietoxoid nach allogener und autologer Knochenmarktransplantation.

In the second part of the paper we report on the results of the diphtheria antitoxin valuation of 8 children after allogeneic bone marrow transplantation (BMT) with and without graft versus host disease (GvHD) as well as on the kinetics of the diphtheria antitoxin of 5 children after allogeneic BMT with and without GvHD and of 5 children after autologous transplantation. The antibody valuation was done by a cell-culture assay. Whereas the inspection of the isolated data gives the impression of a swift antibody decrease up to the non-protective level from the 7th month after BMT, the kinetic tests are more highly differentiated. Besides rapidly decreasing values below the accepted protection rate of 0.01 IU/ml in the allogeneic transplanted groups, there are patients with positive antibody titres within an observation period of up to 24 months after BMT in the allogeneic as well as in the autologous transplantation group.

[The expanded WHO vaccination program and the vaccination strategy in East Germany]. / Das erweiterte Impfprogramm der WHO und die Impfstrategie der DDR.

Evaluating the current stage and future trends of WHO's Expanded Programme on Immunization (EPI), conclusions for national immunization strategies have been considered. The global eradication of poliomyelitis is an important target. In 1988, an Immunization Advisory Group of the Ministry of Health has been founded. Recommendations regarding the update of immunization schedule have been elaborated. Changes are foreseen for BCG (deletion of revaccination), rubella (implementation of immunization for all girls aged 11/12 years), diphtheria (diphtheria/tetanus booster for adults), and measles (2-shot-strategy for young children and schoolchildren.

[Tetanus illnesses and mortality 1977-1983]. / Tetanuserkrankungen und -todesfälle der Jahre 1977-1983.

During the years from 1977-1983 there was an incidence of 59 diseases and 38 deaths of tetanus in the GDR. Compared with the years from 1957-1975 there was a clear decrease of morbidity and mortality, letality however, increased. This increase of letality is not only due to the patients higher age, but also to omission and delay of immediate simultaneous active and passive immunization of injured unvaccinated persons. In many cases this can be attributed to the fact that the guidelines for preventing tetanus were unknown or that the physician called for first medical treatment could not adequately cope with it.

[Preventive tetanus vaccination and recommendations for revision of the 19 October 1978 guidelines for tetanus prevention]. / Experimentelle Untersuchungen zur Tetanusschutzimpfung und Vorschläge für eine Uberarbeitung der Richtlinie zur Tetanusprophylaxe vom 19. 10. 1978.

For a long time, tetanus-toxoid has been given in relatively high quantity and relatively often in order to avoid any risk of human tetanus. It is necessary, however, to focus attention on overimmunization which includes the possibility of hypersensitivity reactions. Some recommendations gained from experiments are presented for establishing a new concept of guidelines for preventing tetanus in the GDR.

[T-cell kinetics and course of humoral immune response following subcutaneous immunization with tetanus toxoid fluid vaccine]. / T-Zellkinetik und Verlauf der Humoralen Immunantwort nach subkutaner Immunisierung mit Tetanustoxoid-Fluid-Impfstoff.

Revaccinations with tetanus toxoid fluid vaccine were performed including different groups of volunteers (aged, diabetics, rheumatics). The kinetics of T-cells were demonstrated by rosette technique in a period of 63 days after revaccination. The content of tetanus antitoxin was estimated by the mouse standard neutralization test. T-cell kinetics were different in the investigated groups, probably influenced by age, illness, therapy etc. Only those patients among the aged who were in bad health showed a relatively low humoral booster reaction.

[Modern bacterial vaccines]. / Moderne bakterielle Impfstoffe.

A well founded vaccination strategy is of crucial importance for controlling communicable diseases. The WHO Enlarged Vaccination Programme of 1976 provides to protect by vaccination all children in the world against six infection diseases - diphtheria, pertussis, tetanus, measles, poliomyelitis, and tuberculosis, a sure immunization prophylaxis being possible against them. The perspectives of further development of some classical vaccines as against cholera, typhoid fever, and pertussis are reviewed. Some recent bacterial vaccines are discussed being of special significance for controlling nosocomial infections and for protecting patients in intensive therapy and/or persons with lowered immunological defence. New ways for production of vaccine matters are shown such as capsule polysaccharides, membrane proteins, subcellular fractions, and vaccines with synthetic carrier molecules. Fundamental problems concerning the initiation of vaccination and the demands for an enlarged proof of innocence of vaccines are discussed.

[Risk of infection in instrumental and surgical urologic interventions with special reference to catheter drainage]. / Das Infektionsrisiko bei instrumentellen und operativen urologischen Eingriffen unter besonderer Berücksichtigung von Katheterableitungen.

The risk of infection in instrumental and operative urological surgery is particularly high in the use of catheter drainage. Dependent on the duration of use of a fistula catheter or a transurethral catheter, infection of the urinary tract occurs in almost 100% of cases. The pathogens of hospital infection show a clearly increasing drug resistance. The occurrence of multiple resistances is remarkable. Furthermore, fluctuations in the range of pathogens can be detected. An increase of infection by Proteus and Klebsiella and a decrease of infections of the urinary tract with Escherichia coli and staphylococci have been observed. Prophylactic administration of chemotherapeutic agents cannot prevent the recurrence of iatrogenic infections of the urinary tract.