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Background: Health Authorities recommend influenza vaccination of healthcare personnel (HCP) to decrease the transmission of influenza to vulnerable patients. Recent studies have almost exclusively used quantitative questionnaires in order to identify determinants of vaccination behaviour. Interviews enable HCP to express freely why they think they are (not) willing to get vaccinated against influenza.
Methods: By means of semi-structured one-on-one interviews with 123 Belgian, Dutch and German HCP, reasons for and against vaccination, experiences with influenza vaccination, intention to get vaccinated and possible barriers, as well as willingness to advice influenza vaccination to patients were investigated. Data were processed with QSR NVivo 8.0 and analysed using a combination of a deductive and a general inductive approach.
Results: Across countries, self-protection, patient protection, and protection of family members were reported as most important reasons to get vaccinated against influenza. Reasons to not get vaccinated against influenza were fear of side effects caused by the vaccine, a low risk-perception, the disbelief in the effectiveness of influenza vaccination, organizational barriers, misconceptions, and undefined negative emotions.
Conclusions: The social cognitive variables underlying the decision of HCP to get vaccinated against influenza (or not) seem to be similar in Belgium, Germany, and the Netherlands, even though some differences surfaced. A quantitative investigation of those social cognitive variables is needed in order to determine the importance of the social cognitive variables in explaining the intention to get vaccinated and the importance of the similarities and differences between countries that have been found in this study.
Background and Aims: Chronic infection with the hepatitis B virus (HBV) is a major health issue worldwide. Recently, single nucleotide polymorphisms (SNPs) within the human leukocyte antigen (HLA)-DP locus were identified to be associated with HBV infection in Asian populations. Most significant associations were observed for the A alleles of HLA-DPA1 rs3077 and HLA-DPB1 rs9277535, which conferred a decreased risk for HBV infection. We assessed the implications of these variants for HBV infection in Caucasians.
Methods: Two HLA-DP gene variants (rs3077 and rs9277535) were analyzed for associations with persistent HBV infection and with different clinical outcomes, i.e., inactive HBsAg carrier status versus progressive chronic HBV (CHB) infection in Caucasian patients (n = 201) and HBsAg negative controls (n = 235).
Results: The HLA-DPA1 rs3077 C allele was significantly associated with HBV infection (odds ratio, OR = 5.1, 95% confidence interval, CI: 1.9–13.7; p = 0.00093). However, no significant association was seen for rs3077 with progressive CHB infection versus inactive HBsAg carrier status (OR = 2.7, 95% CI: 0.6–11.1; p = 0.31). In contrast, HLA-DPB1 rs9277535 was not associated with HBV infection in Caucasians (OR = 0.8, 95% CI: 0.4–1.9; p = 1).
Conclusions: A highly significant association of HLA-DPA1 rs3077 with HBV infection was observed in Caucasians. However, as a differentiation between different clinical courses of HBV infection was not possible, knowledge of the HLA-DPA1 genotype cannot be translated into personalized anti-HBV therapy approaches.
With respect to nosocomial influenza infections, the welfare of patients is best served by high rates of staff immunity against influenza. However, data from the Centers of Disease Control (CDC) in the USA and the Robert Koch-Institute (RKI) in Germany indicate that most of health care workers (HCWs) choose not to be vaccinated. Under voluntary influenza immunization standards, institutional influenza outbreaks occur every flu season. The question about the legality of implementation mandatory flu vaccination for HCWs is an ongoing debate, which covers several different positions.
To characterize the attitudes of German HCWs toward mandatory influenza immunization, an anonymous questionnaire was offered to HCWs of the University Hospital in Frankfurt/Main / Germany. Our study showed that almost 70% of the respondents would accept mandatory influenza vaccination.
In our opinion an annual influenza vaccination should be required for HCWs who care for immunocompromised patients and residents in long-term care if there will be a failure of voluntary vaccination programs. An informed declination should be obtained from employees who decline vaccination and these HCWs ought to work in uncritical areas of patient care.
Medical students are exposed to infectious diseases during the course of their clinical training. Unfortunately, vaccination rates among medical students remain insufficient. However, immunizations against vaccine-preventable diseases should be carried out before the students enter clinical courses. This is vital in order to prevent nosocomial infections. We screened 366 medical students in their first clinical year for hospital-related viral diseases. Serum samples were collected between April and May 2007. Antibody testing was carried out using commercial ELISA systems against measles, mumps, rubella, varicella, hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). Overall, 63.9% (n=234) of the students were sufficiently vaccinated against HBV. In contrast, 31.7% (n=116) had not received any HBV vaccine dosage, and 4.4% (n=16) had not completed the full vaccine cycle (<3 dosage). Remarkably, two students showed serological markers of resolved HBV infection. In addition, one student was HCV-positive and one was HIV-positive, respectively. The following seronegative rates were found: measles (7.9%), mumps (17.5%), rubella (6.5%), and varicella (2.2%). Further work is needed to identify optimal strategies for improving vaccination rates among medical students. It is imperative to identify and limit possible disparities in immunity of vaccine-preventable diseases before initial patient contact. With regard to the primary diagnosis of serious virus diseases including HBV, HCV and HIV, medical students should be screened for these blood borne pathogens.
Hintergrund: Eine standardisierte Erhebung von COVID-19-Infektionen bei Gesundheitspersonal während der laufenden Pandemie war und ist nicht gegeben. Vor allem der Anteil von arbeitsbedingten Infektionen beim Gesundheitspersonal und die Frage, welche Arbeitnehmer/-innen darunter am meisten gefährdet sind, bleiben unklar.
Ziel: Ziel dieser Studie war es, die gemeldeten COVID-19-Fälle beim Gesundheitspersonal in Frankfurt/Main in den ersten 6 Monaten der Pandemie zu analysieren, die Zahl der arbeitsbedingten Infektionen zu ermitteln und somit eine bessere Interpretation der durch das Robert Koch-Institut veröffentlichten Daten zu ermöglichen.
Methoden: Die Daten des Gesundheitsamts Frankfurt/Main wurden für den Zeitraum vom 01.03. bis zum 31.08.2020 betrachtet und medizinisches Personal für eine Querschnittserhebung im Rahmen einer Umfrage rekrutiert. Drei Subgruppen wurden nach Ort des Infektionskontakts, am Arbeitsplatz, im Privaten und unbekannt, unterteilt und analysiert.
Ergebnisse: Medizinisches Personal machte 11,8 % (319/2700) aller gemeldeten COVID-19-Fälle in Frankfurt/Main im untersuchten Zeitraum aus. In der Umfrage gaben 47,2 % der Befragten an, dass ihre Infektion am Arbeitsplatz erworben wurde. Es zeigte sich eine Assoziation von Kontakt zu COVID-19-Patient/-innen sowie der Beschäftigung auf einer internistischen Station und einer arbeitsbedingten Infektion. Ersichtlich wurde außerdem ein Zusammenhang zwischen mutmaßlichen Infektionen am Arbeitsplatz und folglich gestellten Verdachtsanzeigen auf Berufskrankheit.
Diskussion und Fazit: Gesundheitsämter sind in der Lage, relevante Daten von arbeitsbedingten Transmissionen in Berufen und Arbeitsplätzen im Gesundheitswesen zu erheben, und sollten standardisierte Daten zu infiziertem Gesundheitspersonal generieren. Diese Daten sind notwendig, um gezielte Maßnahmen der Infektionsprävention zu ergreifen, die Gesundheitspersonal und ihre Patient/-innen schützen.
Einleitung: Medizinisches Personal ist dem Risiko ausgesetzt, sich an kontaminierten Instrumenten zu verletzen. Nadelstichverletzungen (NSV) können zu ernsthaften und möglicherweise schwerwiegenden Infektionen wie Hepatitis B (HBV), Hepatitis C (HCV) und HIV-Infektionen führen. Dieses Risiko betrifft auch Medizinstudenten im Verlaufe ihrer klinischen Ausbildung. Jede NSV sollte als Arbeitsunfall gemeldet werden, damit postexpositionelle Maßnahmen eingeleitet sowie etwaige Infektionen frühzeitzeitig erkannt und behandelt werden können. Im Falle einer Infektion können versicherungsrechtliche Ansprüche gegenüber den Berufsgenossenschaften geltend gemacht werden. Ziel unserer Studie war die Erhebung der Häufigkeit und Melderate von NSV bei Medizinstudenten.
Methoden: Anonyme Fragebogenerhebung bei Medizinstudenten vor Beginn des Praktischen Jahres.
Ergebnisse: Von den befragten Studenten gaben 58,8% (n=183/311) mindestens eine NSV im Rahmen des Studiums an. Insgesamt 284 NSV wurden von den befragten Studenten gemeldet. Lediglich 38,3% der Studenten hatten alle NSV gemeldet. Die häufigste Ursache für das Nichtmelden der NSV war Schamgefühl aufgrund der Verletzung (54,0%).
Schlussfolgerungen: Expositionen gegenüber Blut sind eine häufige und ernstzunehmende Gefährdung von Medizinstudenten. Es sollten Maßnahmen ergriffen werden, um die Häufigkeit von NSV zu reduzieren und das Meldeverhalten der Studenten zu optimieren. Entsprechende Schulungen sollten sowohl die technischen Fertigkeiten der Studenten als auch das Bewusstsein über die Gefährdung durch NSV vermitteln.
Dysregulation of lysophosphatidic acids in multiple sclerosis and autoimmune encephalomyelitis
(2017)
Bioactive lipids contribute to the pathophysiology of multiple sclerosis. Here, we show that lysophosphatidic acids (LPAs) are dysregulated in multiple sclerosis (MS) and are functionally relevant in this disease. LPAs and autotaxin, the major enzyme producing extracellular LPAs, were analyzed in serum and cerebrospinal fluid in a cross-sectional population of MS patients and were compared with respective data from mice in the experimental autoimmune encephalomyelitis (EAE) model, spontaneous EAE in TCR1640 mice, and EAE in Lpar2 -/- mice. Serum LPAs were reduced in MS and EAE whereas spinal cord LPAs in TCR1640 mice increased during the ‘symptom-free’ intervals, i.e. on resolution of inflammation during recovery hence possibly pointing to positive effects of brain LPAs during remyelination as suggested in previous studies. Peripheral LPAs mildly re-raised during relapses but further dropped in refractory relapses. The peripheral loss led to a redistribution of immune cells from the spleen to the spinal cord, suggesting defects of lymphocyte homing. In support, LPAR2 positive T-cells were reduced in EAE and the disease was intensified in Lpar2 deficient mice. Further, treatment with an LPAR2 agonist reduced clinical signs of relapsing-remitting EAE suggesting that the LPAR2 agonist partially compensated the endogenous loss of LPAs and implicating LPA signaling as a novel treatment approach.
Im vorliegenden Fall wird von einer Fehldiagnose auf der Grundlage eines falsch-reaktiven Anti-HCV-Tests und eines falsch-reaktiven HCV-Nukleinsäureamplifikationstests (NAT) berichtet, die bei einem 58-jährigen chirurgischen Oberarzt im Rahmen einer arbeitsmedizinischen Vorsorgeuntersuchung im krankenhauseigenen Labor gestellt wurde und zu einem knapp zweimonatigen Berufsverbot führte. Basis dieser Fehldiagnose war ein wiederholt schwach reaktiver HCV-Antikörper-ELISA, der mit einem Nukleinsäureamplifikationstest, der ebenfalls schwach positiv ausfiel, überprüft wurde. Ein Antikörperbestätigungs- bzw. Ergänzungstest (Immunoblot) wurde nicht durchgeführt. Die Fehldiagnose ist jedoch nicht durch einen Testfehler, sondern durch ein Missverständnis entstanden, indem beim Kliniker zwei Laborindizien zu einem Beweis aufsummiert wurden.
Background: Hundreds of West African healthcare workers (HCW) have become ill with Ebola virus disease (EVD) and died during the recent outbreak. The occurrence of occupational infections in laboratories could be due to the lack of use of personal protective equipment, the failure to implement specific regulations about the use of equipment and how to work with hazardous materials. Our study attempted to assess the information as well as training level of HCW of a German high level isolation unit and their concern over an occupationally acquired EVD.
Methods: During the recent Ebola virus outbreak a survey was conducted among HCWs, using an anonymous questionnaire.
Results: Although 70% of our total study population stated that they have all the information needed to care for Ebola patients, only 18.2% of laboratory workers and 29.4% of the HCW of the virology department felt sufficiently trained. The HCW rated the Internet (64.3%) and the daily press (54.3%) as the most important sources of information. Medical literature (45.7%) and official institutions (40.4%) were rated less often.
Conclusions: Formulated pointedly, the HCW turned to popular science to get the information they need to feel safe. Further in house training regarding practical skills and reference to scientific literature would be a better solution to ensure workplace safety.
Objectives: Regarding reactogenicity and immunogenicity, heterologous COVID-19 vaccination regimens are considered as an alternative to conventional immunization schemes.
Methods: Individuals receiving either heterologous (ChAdOx1-S [AstraZeneca, Cambridge, UK]/BNT162b2 [Pfizer-BioNTech, Mainz, Germany]; n = 306) or homologous (messenger RNA [mRNA]-1273 [Moderna, Cambridge, Massachusetts, USA]; n = 139) vaccination were asked to participate when receiving their second dose. Reactogenicity was assessed after 1 month, immunogenicity after 1, 3, and/or 6 months, including a third dose, through SARS-CoV-2 antispike immunoglobulin G, surrogate virus neutralization test, and a plaque reduction neutralization test against the Delta (B.1.167.2) and Omicron (B.1.1.529; BA.1) variants of concern.
Results: The overall reactogenicity was lower after heterologous vaccination. In both cohorts, SARS-CoV-2 antispike immunoglobulin G concentrations waned over time with the heterologous vaccination demonstrating higher neutralizing activity than homologous mRNA vaccination after 3 months to low neutralizing levels in the Delta plaque reduction neutralization test after 6 months. At this point, 3.2% of the heterologous and 11.4% of the homologous cohort yielded low neutralizing activity against Omicron. After a third dose of an mRNA vaccine, ≥99% of vaccinees demonstrated positive neutralizing activity against Delta. Depending on the vaccination scheme and against Omicron, 60% to 87.5% of vaccinees demonstrated positive neutralizing activity.
Conclusion: ChAdOx1-S/BNT162b2 vaccination demonstrated an acceptable reactogenicity and immunogenicity profile. A third dose of an mRNA vaccine is necessary to maintain neutralizing activity against SARS-CoV-2. However, variants of concern-adapted versions of the vaccines would be desirable.