Steep rise in notified hantavirus infections in Germany, April 2010

From January to April 2010, 396 hantavirus infections were notified in Germany, a considerable increase compared with previous years (mean: 83 for January-April 2004-2009) including the record-setting year, 2007 (n=232 January-April). Most patients are residents of known Puumala virus endemic areas in southern Germany. The recent increase in notified hantavirus infections is probably due to an increased population density of the main animal reservoir, the bank vole (Myodes glareolus).

Steep rise in notified hantavirus infections in Germany, April 2010

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Update: Multinational listeriosis outbreak due to ‘Quargel’, a sour milk curd cheese, caused by two different L. monocytogenes serotype 1/2a strains, 2009-2010

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Update: Multinational listeriosis outbreak due to 'Quargel', a sour milk curd cheese, caused by two different L. monocytogenes serotype 1/2a strains, 2009-2010

We previously reported an outbreak of listeriosis in Austria and Germany due to consumption of Quargel cheese. It comprised 14 cases (including five fatalities) infected by a serotype 1/2a Listeria monocytogenes (clone 1), with onset of illness from June 2009 to January 2010. A second strain of L. monocytogenes serotype 1/2a (clone 2) spread by this product could be linked to further 13 cases in Austria (two fatal), six in Germany (one fatal) and one case in the Czech Republic, with onset of disease from December 2009 to end of February 2010.

Abstract 2765: Cytoplasmic expression of the aryl hydrocarbon receptor elicits sensitivity and nuclear expression resistance to aminoflavone prodrug

Aminoflavone Prodrug (AFP464) is a novel anticancer agent currently in Phase I clinical trials in the US and Europe. Its target is the aryl hydrocarbon receptor (AhR). Upon binding to AhR in the cytoplasm, the receptor/AFP464 complex dimerizes with the AhR nuclear translocator and is shuttled into the nucleus where it induces xenobiotic response via the cytochrome P (CYP) system. CYP1A1 is critical to the activity of AFP464 in cells as it converts the drug into metabolites that cause DNA double strand breaks and cell death. Previous screening of AFP464 in tumor cell lines in vitro has revealed differential cytotoxicity with some lines being sensitive at nanomolar concentrations, while others were resistant even at >100μM. Here, we have investigated the cause of intrinsic resistance of tumor cells to AFP464. We used a panel of 15 breast, ovarian and pancreas cancer cell lines and compared their sensitivity to AFP464 with the cellular localization of the AhR. Five day MTT assays were used to determine in vitro antiproliferative activity and nude mouse xenografts to assess in vivo efficacy. Immunofluorescence and immunoperoxidase staining of fixed tumor cells and archival tissue were employed to analyze AhR expression. Five breast cancer cell lines (MCF-7, T47D, MDA-MB-468, MCF-7TAM1, MCF-7Her2-18), 2 ovarian (OVCAR-3, IGROV-1), and 2 pancreatic (ASPC-1 and Hs766T) lines exhibited cytoplasmic AhR; their inhibitory concentration 50% (IC50) ranged from 20nM (MDA-MB-468) to 10μM (Hs766T). The IC50s for breast (MDA-MB-231, Hs578T), ovarian (OVCAR-8) and pancreatic (PANC-1, MIAPaCa2, Capan-1) cell lines with nuclear AhR were between 13μM (OVCAR-8) and >100μM (pancreatic lines). These in vitro results translated into in vivo efficacy: MDA-MB-468 xenografts responded to single agent AFP464 at a dose of 35 mg/kg (given i.v. 4 cycles x [q2dx3]) with 62% growth inhibition compared to vehicle control, while MDA-MB-231 xenografts were resistant to AFP464, even at the maximal tolerated dose of 70mg/kg. To test whether primary human tumors would also show nuclear or cytoplasmic AhR and to assess the extent to which AhR was expressed, we analyzed 165 archival human tissues comprising breast, pancreas, ovarian and renal cell cancers. We found the 59% of all cases had detectable AhR, amongst those 78% exhibited cytoplasmic AhR and 22% nuclear AhR. Pancreatic (70%) and breast cancers (46%) showed the highest percentage of cytoplasmic AhR.

Together our data indicate that AhR has a distinct distribution pattern in tumor cells. Cytoplasmic AhR expression elicits sensitivity to the AhR ligand AFP464. If AhR is located in the nucleus, xenobiotic response is impaired and AFP464 cannot be activated. Thus, immunohistological analysis of AhR should be considered as a tool in the upcoming Phase II trials in breast and pancreatic cancer to select patients that are most likely to benefit from AFP464 treatment.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2765.

Listeriosis outbreak caused by acid curd cheese Quargel , Austria and Germany 2009

We report an outbreak of listeriosis in Austria and Germany due to the consumption of Quargel cheese produced by an Austrian manufacturer. At the time of writing this report, the outbreak was known to account for 14 outbreak cases in 2009, including four cases with lethal outcome. On 23 January 2010, the cheese product was voluntarily withdrawn from the market.

Listeriosis outbreak caused by acid curd cheese ‘Quargel’, Austria and Germany 2009

We report an outbreak of listeriosis in Austria and Germany due to the consumption of ‘Quargel’ cheese produced by an Austrian manufacturer. At the time of writing this report, the outbreak was known to account for 14 outbreak cases in 2009, including four cases with lethal outcome. On 23 January 2010, the cheese product was voluntarily withdrawn from the market.

[Climate changes and emerging diseases. What new infectious diseases and health problem can be expected?]

Increasing temperatures, but also other climatic factors, will have an impact on human health. Apart from the direct consequences of extreme weather conditions (e.g., heat-related fatalities), indirect health consequences in the long-term are also of great importance. In addition to a likely increase in allergic diseases and additional complications in the course of cardiovascular and respiratory diseases, infectious diseases are of particular interest. In Germany, endemic pathogens, such as hantavirus (with its reservoir in small rodents), tick-borne pathogens (Borrelia burgdorferi, tick-borne encephalitis virus), and certain food- and water-borne pathogens, are of concern. Mild winters favor rodent populations and may result in hantavirus epidemics in the subsequent summer period. Statistical analyses show a significant association between temperature and campylobacter incidence in Germany. An outbreak of rodent-borne leptospirosis among strawberry harvesters enhanced by heavy rainfalls illustrates how weather conditions may influence disease occurrence. Pathogens that are non-endemic in Germany but are imported by humans, vectors, and reservoir animals pose an additional risk to the population. Increasing temperatures improve the conditions for establishment of new vectors and for autochthonous transmission of some pathogens (e.g., chikungunya, dengue, West Nile virus, malaria, or leishmaniasis). Climatic and ecologic conditions in Germany currently do not favor autochthonous outbreaks for most of these pathogens. However, if temperatures increase, as expected, such outbreaks will become more likely. Germany should enhance its research in public health activities in the field of climate change and infectious diseases.

Giardiasis in kindergartens: prevalence study in Berlin, Germany, 2006

In Germany, an increase of notified giardiasis was observed between 2002 (n = 3,101) and 2007 (n = 3,651) with 62% of cases acquired in Germany. The highest incidence was reported in 1- to 5-year-olds (2001-2007, 11.5/100,000 on average) and Berlin is one of the most affected states (17.5/100,000). We performed a cross-sectional study in five Berlin kindergartens differing in socioeconomic status and migrant proportion in order to estimate the prevalence and investigate routes of transmission among children under 6 years of age. Stool samples were screened for Giardia lamblia and Cryptosporidium parvum using microscopical and antigen detection. Giardia-positive samples underwent PCR and subtyping. Two hundred two children participated (mean age 3.4 years). We found three girls (1.5%) who tested positive for G. lamblia genotype-A3, all clustering in one kindergarten (prevalence 5.5%). No common source was identified. Two children were symptomatic. Possible dog-to-child transmission was established for one of the symptomatic cases. All contact-tracing results were negative. Other microscopically detected parasites (Blastocystis hominis, Endolimax nana cysts, Entamoeba coli cysts and Iodamoeba bütschlii cysts) were found in 4% of children. In summary, a substantial level of Giardiasis may be prevalent in some of Berlin's kindergartens, despite standard hygienic measures being followed. The relatively high prevalence in one kindergarten indicates the need for further studies to identify risk factors for children, which may help to guide possible interventions and strategies. Giardiasis should be considered as a differential diagnosis in children with unclear gastrointestinal symptoms. Additional education and training on proper toilet and food hygiene may further reduce the possibility of child-to-child transmission.

Marked decrease in reporting incidence of salmonellosis driven by lower rates of Salmonella Enteritidis infections in Germany in 2008 – a continuing trend

In Germany, since the enactment of the Protection Against Infection Act (IfSG) in 2001, notification of cases of salmonellosis is based on a stable case definition [1], facilitating comparability of data. The annual incidence of notified cases of salmonellosis has declined from over 90 per 100,000 population in 2001 to 60-70 per 100,000 in 2004 through 2007. After very little change from 2005 through 2007, a marked decrease of the number of notified cases (22.6% compared to 2007) was observed in 2008. This drop, as well as the overall decline since 2001 was almost entirely due to the dwindling number of notifications of infections with Salmonella enterica subsp. enterica of serotype Enteritidis (SE) (Figure 1).

[Intersectoral collaboration of institutions in Germany and Europe in the field of food-borne zoonoses]

Prevention and control of food-borne zoonoses is given high priority in Germany and in the European Union. To implement targeted control measures, detailed data are necessary on human zoonoses and on the prevalence of zoonotic agents along the food chain. EU-wide legislations have been stipulated that allow collection and collation of relevant data across member states. The necessary structures have been established and are being constantly refined. In addition, surveillance systems and early warning systems have been improved or set up, respectively, to timely investigate and control food-borne outbreaks and to transnationally communicate food safety risks. For prevention and control to be effective, well-defined responsibilities and close collaboration of public health, veterinary public health and food safety authorities are needed. This report reviews the pertinent legislation, the established structures, and the collaboration of competent authorities in Germany and particularly in Europe. In the future, data quality and collaboration on national and EU levels will likely be further improved. Targeted control measures, particularly at primary production, are expected to lead to a sustainable reduction of the incidence of food-borne zoonoses.

Acute Effect of Blue Light Exposition on Well-being and Melatonin Secretion in Humans

Aim:

The aim of this study was to investigate the efficacy of blue light emitting diode units in suppression of melatonin secretion and to evaluate whether a single exposure can improve well being in healthy males and females (20/30) and in 15 women with premenstrual syndrome.

Methods:

All study participants were of morning-type with a regular sleep schedule. On control day 1, the subjects were kept under dim illumination (< 10 lx) from 19:00 to 22:30. On day 2, after 1.5h in dim light, the subjects were exposed for 60 min to blue light (12.15 μM/cm², TurboLite, Germany) following by 30 min dim light. Blood samples were collected every 30 min for melatonin assay. Zerssen's complaints scale was used to assess mental und physical well-being at 19:00 (pre-test) and at 22:30 (post-test) after dim illumination or blue light exposure. In addition a visual analogue scale (VAS) for sleepiness was applied.

Results:

Overall, blue light improved significantly mental and physical complaints from pre-test to post-test (reduction in sum score of the Zerssen's complaints scale by in average 30%) and reduced sleepiness, as measured by the VAS. There were gender-related differences, as well as differences related to the menstrual phase in females. Blue light reduced but not suppressed the gradual increase of melatonin in plasma with time mostly pronounced in the follicular phase.

Conclusion:

A single exposition with blue light of low radiant flux density, as applied in our study, seems to be helpful in reducing mental and physical distress.

External radiation doses from (137)Cs to frog phantoms in a wetland area: in situ measurements and dose model calculations

For assessment of external radiation doses to frogs in a wetland area contaminated with (137)Cs, frog phantoms were constructed from polymethyl methacrylate (PMMA). The frog phantoms contained thermoluminescence (TL) chips and were used in situ at two study sites to measure doses. To test if higher doses are received by the sensitive skin of frogs, extra-thin TL chips were applied close to the surface of the frog phantoms. In addition, the measured doses were compared with those calculated on the basis of soil sample data from the wetland multiplied with dose-conversion coefficients from the US Department of Energy's RESRAD-BIOTA code and from the ERICA assessment tool. Measured doses were generally lower than those calculated to ellipsoids used to model frogs. Higher doses were measured at the frog phantoms' surfaces in comparison to inner parts at one of the two sites indicating that the frogs' thin skin could receive a higher radiation dose than expected. In the efforts to assure protection of non-human biota, in situ measurements with phantoms provide valuable dose information and input to dose models in site-specific risk assessments of areas contaminated with radionuclides.

The design of an observational study of hypertension management, adherence and pressure control in Blood Pressure Success Zone Program participants

AIMS

The Blood Pressure Success Zone (BPSZ) Program, a nationwide initiative, provides education in addition to a complimentary trial of one of three antihypertensive medications. The BPSZ Longitudinal Observational Study of Success (BPSZ-BLISS) aims to evaluate blood pressure (BP) control, adherence, persistence and patient satisfaction in a representative subset of BPSZ Program participants. The BPSZ-BLISS study design is described here.

METHODS

A total of 20,000 physicians were invited to participate in the study. Using a call centre supported Interactive Voice Response System (IVRS), physicians report BP and other data at enrolment and every usual care visit up to 12 +/- 2 months; subjects self-report BPs, persistence, adherence and treatment satisfaction at 3, 6 and 12 months post-BPSZ Program enrolment. In addition to BPSZ Program enrolment medications, physicians prescribe antihypertensive medications and schedule visits as per usual care. The General Electric Healthcare database will be used as an external reference.

RESULTS

After 18 months, over 700 IRB approved physicians consented and enrolled 10,067 eligible subjects (48% male; mean age 56 years; 27% newly diagnosed); 97% of physicians and 78% of subjects successfully entered IVRS enrolment data. Automated IVRS validations have maintained data quality (< 5% error on key variables). Enrolment was closed 30 April 2007; study completion is scheduled for June 2008.

CONCLUSIONS

The evaluation of large-scale health education programmes requires innovative methodologies and data management and quality control processes. The BPSZ-BLISS design can provide insights into the conceptualisation and planning of similar studies.

Looking for tips to find icebergs - surveillance of haemolytic uraemic syndrome to detect outbreaks of Shiga toxin-producing E. coli infection

In a recent article, De Schrijver et al. described an outbreak of Verocytotoxin-producing Escherichia coli, syn. Shiga toxin-producing E. coli (STEC), linked to the consumption of ice cream produced at a farm in the province of Antwerp, Belgium. Interestingly, the outbreak was identified through the time-clustering of patients who had developed haemolytic uraemic syndrome (HUS) and from whom STEC O145 was isolated.

The Genome Austria Tissue Bank (GATiB)

In the context of the Austrian Genome Program, a tissue bank is being established (Genome Austria Tissue Bank, GATiB) which is based on a collection of diseased and corresponding normal tissues representing a great variety of diseases at their natural frequency of occurrence from a non-selected Central European population of more than 700,000 patients. Major emphasis is put on annotation of archival tissue with comprehensive clinical data, including follow-up data. A specific IT infrastructure supports sample annotation, tracking of sample usage as well as sample and data storage. Innovative data protection tools were developed which prevent sample donor re-identification, particularly if detailed medical and genetic data are combined. For quality control of old archival tissues, new techniques were established to check RNA quality and antigen stability. Since 2003, GATiB has changed from a population-based tissue bank to a disease-focused biobank comprising major cancers such as colon, breast, liver, as well as metabolic liver diseases and organs affected by the metabolic syndrome. Prospectively collected tissues are associated with blood samples and detailed data on the sample donor's disease, lifestyle and environmental exposure, following standard operating procedures. Major emphasis is also placed on ethical, legal and social issues (ELSI) related to biobanks. A specific research project and an international advisory board ensure the proper embedding of GATiB in society and facilitate international networking.