1
|
Tenenbaum T, Liese J, Welte T, Rademacher J. Respiratory Syncytial Virus–Associated Respiratory Diseases in Children and Adults. Dtsch Arztebl Int 2024:arztebl.m2024.0060. [PMID: 38652840 DOI: 10.3238/arztebl.m2024.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract infections (LRTI), particularly in neonates, infants and young children, with approximately 33 million infections worldwide each year. 1-2% of episodes lead to hospitalization. There are hardly any reliable epidemiological figures on hospitalization in adults, whose burden of disease from RSV is probably markedly underestimated. METHODS This review is based on publications retrieved by a selective search in PubMed, with particular attention to recommendations for the prevention of RSV infection. RESULTS There is no approved antiviral therapy for clinical practice, but preventive strategies are increasingly becoming available. Passive immunization in infants is well tolerated and highly effective, as is the active vaccination of pregnant women to prevent severe RSV infection in young infants. The former was found to lower the frequency of severe LRTI (5/4037 in the vaccination group vs. 19/4031 individuals in the placebo group), yielding an efficacy of 75.7%; for the latter, the corresponding findings were a reduction to 19/3682 in the vaccination group vs. 62/3676 in the placebo group, or 69.4% efficacy. For the active vaccination of older adults, both a recombinant vaccine with adjuvant and a bivalent vaccine have recently been approved. These, too, are well tolerated and highly effective: the former lowered the frequency of severe LRTI to 1/12466 in the vaccination group vs. 17/12494 in the placebo group (94.1% efficacy), while the latter lowered the frequency of LRTI with 3 or more manifestations to 2/17215 in the vaccination group vs. 14/17069 in the placebo group (85.7% efficacy). CONCLUSION The approval of new RSV-specific monoclonal antibodies and active vaccinations enables targeted prevention of RSV infection in the main population groups at risk.
Collapse
|
2
|
Ferrero F, Lin CY, Liese J, Luz K, Stoeva T, Nemeth A, Gijón M, Calvo C, Natalini S, Toh TH, Deleu S, Chen B, Rusch S, Sánchez BL, Leipoldt I, Vijgen L, Huntjens D, Baguet T, Bertzos K, Gamil M, Stevens M. CROCuS, a Phase II Study Evaluating the Antiviral Activity, Clinical Outcomes, and Safety of Rilematovir in Children Aged ≥ 28 Days and ≤ 3 Years with Acute Respiratory Tract Infection Due to Respiratory Syncytial Virus. Paediatr Drugs 2024:10.1007/s40272-024-00625-x. [PMID: 38649595 DOI: 10.1007/s40272-024-00625-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes significant morbidity and mortality in children aged ≤ 5 years and adults aged ≥ 60 years worldwide. Despite this, RSV-specific therapeutic options are limited. Rilematovir is an investigational, orally administered inhibitor of RSV fusion protein-mediated viral entry. OBJECTIVE To establish the antiviral activity, clinical outcomes, safety, and tolerability of rilematovir (low or high dose) in children aged ≥ 28 days and ≤ 3 years with RSV disease. METHODS CROCuS was a multicenter, international, double-blind, placebo-controlled, randomized, adaptive phase II study, wherein children aged ≥ 28 days and ≤ 3 years with confirmed RSV infection who were either hospitalized (Cohort 1) or treated as outpatients (Cohort 2) were randomized (1:1:1) to receive rilematovir (low or high dose) or placebo. Study treatment was administered daily as an oral suspension from days 1 to 7, with dosing based on weight and age groups. The primary objective was to establish antiviral activity of rilematovir by evaluating the area under the plasma concentration-time curve of RSV viral load in nasal secretions from baseline through day 5. Severity and duration of RSV signs and symptoms and the safety and tolerability of rilematovir were also assessed through day 28 (± 3). RESULTS In total, 246 patients were randomized, treated, and included in the safety analysis population (Cohort 1: 147; Cohort 2: 99). Of these, 231 were included in the intent-to-treat-infected analysis population (Cohort 1: 138; Cohort 2: 93). In both cohorts, demographics were generally similar across treatment groups. In both cohorts combined, the difference (95% confidence interval) in the mean area under the plasma concentration-time curve of RSV RNA viral load through day 5 was - 1.25 (- 2.672, 0.164) and - 1.23 (- 2.679, 0.227) log10 copies∙days/mL for the rilematovir low-dose group and the rilematovir high-dose group, respectively, when compared with placebo. The estimated Kaplan-Meier median (95% confidence interval) time to resolution of key RSV symptoms in the rilematovir low-dose, rilematovir high-dose, and placebo groups of Cohort 1 was 6.01 (4.24, 7.25), 5.82 (4.03, 8.18), and 7.05 (5.34, 8.97) days, respectively; in Cohort 2, estimates were 6.45 (4.81, 9.70), 6.26 (5.41, 7.84), and 5.85 (3.90, 8.27) days, respectively. A similar incidence of adverse events was reported in patients treated with rilematovir and placebo in Cohort 1 (rilematovir: 61.9%; placebo: 58.0%) and Cohort 2 (rilematovir: 50.8%; placebo: 47.1%), with most reported as grade 1 or 2 and none leading to study discontinuation. The study was terminated prematurely, as the sponsor made a non-safety-related strategic decision to discontinue rilematovir development prior to full recruitment of Cohort 2. CONCLUSIONS Data from the combined cohort suggest that rilematovir has a small but favorable antiviral effect of indeterminate clinical relevance compared with placebo, as well as a favorable safety profile. Safe and effective therapeutic options for RSV in infants and young children remain an unmet need. CLINICAL TRIAL REGISTRATION EudraCT Number: 2016-003642-93; ClinicalTrials.gov Identifier: NCT03656510. First posted date: 4 September, 2018.
Collapse
Affiliation(s)
- Fernando Ferrero
- Departamento de Medicina, Hospital General de Niños "Pedro de Elizalde", Buenos Aires, Argentina
| | - Chien-Yu Lin
- Department of Pediatrics and Infectious Disease, Hsinchu Municipal MacKay Children's Hospital, Hsinchu, Taiwan
| | - Johannes Liese
- Division of Paediatric Infectious Diseases, Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Kleber Luz
- Departamento de Infectologia, Centro de Estudos e Pesquisas em Moléstias Infecciosas-CEPCLIN, Natal, Brazil
| | - Tatyana Stoeva
- DCC 'Sv. Vrach and Sv. Sv. Kuzma and Damyan', OOD, Sofia, Bulgaria
| | - Agnes Nemeth
- Unit of Pulmonology, Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Manuel Gijón
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Calvo
- Pediatrics and Infectious Disease Unit, Hospital Universitario La Paz, Madrid, Spain
- Fundación Idipaz, CIBERINFEC ISCIII, Madrid, Spain
| | - Silvina Natalini
- Department of Pediatrics, Vaccine Unit Department, Hospital HM Puerta del Sur, Móstoles, Spain
| | - Teck-Hock Toh
- Clinical Research Centre & Department of Paediatrics, Hospital Sibu, Ministry of Health Malaysia, Sibu, Malaysia
| | - Sofie Deleu
- Janssen Research & Development, Beerse, Belgium.
| | - Bohang Chen
- Janssen Research & Development, Titusville, NJ, USA
| | - Sarah Rusch
- Janssen Research & Development, Beerse, Belgium
| | | | - Illse Leipoldt
- Janssen-Cilag Pharmaceutical South Africa, Durban North, South Africa
| | - Leen Vijgen
- Janssen Research & Development, Beerse, Belgium
| | | | | | | | - Mohamed Gamil
- Janssen Research & Development, Spring House, PA, USA
| | | |
Collapse
|
3
|
Prelog M, Jeske SD, Asam C, Fuchs A, Wieser A, Gall C, Wytopil M, Mueller-Schmucker SM, Beileke S, Goekkaya M, Kling E, Geldmacher C, Rubio-Acero R, Plank M, Christa C, Willmann A, Vu M, Einhauser S, Weps M, Lampl BMJ, Almanzar G, Kousha K, Schwägerl V, Liebl B, Weber B, Drescher J, Scheidt J, Gefeller O, Messmann H, Protzer U, Liese J, Hoelscher M, Wagner R, Überla K, Steininger P. Clinical and immunological benefits of full primary COVID-19 vaccination in individuals with SARS-CoV-2 breakthrough infections: A prospective cohort study in non-hospitalized adults. J Clin Virol 2024; 170:105622. [PMID: 38091664 DOI: 10.1016/j.jcv.2023.105622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND SARS-CoV-2 variants of concern (VOC) may result in breakthrough infections (BTIs) in vaccinated individuals. The aim of this study was to investigate the effects of full primary (two-dose) COVID-19 vaccination with wild-type-based SARS-CoV-2 vaccines on symptoms and immunogenicity of SARS-CoV-2 VOC BTIs. METHODS In a longitudinal multicenter controlled cohort study in Bavaria, Germany, COVID-19 vaccinated and unvaccinated non-hospitalized individuals were prospectively enrolled within 14 days of a PCR-confirmed SARS-CoV-2 infection. Individuals were visited weekly up to 4 times, performing a structured record of medical data and viral load assessment. SARS-CoV-2-specific antibody response was characterized by anti-spike-(S)- and anti-nucleocapsid-(N)-antibody concentrations, anti-S-IgG avidity and neutralization capacity. RESULTS A total of 300 individuals (212 BTIs, 88 non-BTIs) were included with VOC Alpha or Delta SARS-CoV-2 infections. Full primary COVID-19 vaccination provided a significant effectiveness against five symptoms (relative risk reduction): fever (33 %), cough (21 %), dysgeusia (22 %), dizziness (52 %) and nausea/vomiting (48 %). Full primary vaccinated individuals showed significantly higher 50 % inhibitory concentration (IC50) values against the infecting VOC compared to unvaccinated individuals at week 1 (269 vs. 56, respectively), and weeks 5-7 (1,917 vs. 932, respectively) with significantly higher relative anti-S-IgG avidity (78% vs. 27 % at week 4, respectively). CONCLUSIONS Full primary COVID-19 vaccination reduced symptom frequencies in non-hospitalized individuals with BTIs and elicited a more rapid and longer lasting neutralization capacity against the infecting VOC compared to unvaccinated individuals. These results support the recommendation to offer at least full primary vaccination to all adults to reduce disease severity caused by immune escape-variants.
Collapse
Affiliation(s)
- Martina Prelog
- Pediatric Rheumatology / Special Immunology, Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Samuel D Jeske
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Claudia Asam
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Andre Fuchs
- Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Monika Wytopil
- Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sandra M Mueller-Schmucker
- Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie Beileke
- Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mehmet Goekkaya
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Institute of Environmental Medicine Helmholtz Zentrum München, German Research Center for Environmental Health, Augsburg, Germany
| | - Elisabeth Kling
- Institute of Laboratory Medicine and Microbiology University Hospital Augsburg, Augsburg, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Raquel Rubio-Acero
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Michael Plank
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Catharina Christa
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Annika Willmann
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Martin Vu
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sebastian Einhauser
- Institute of Medical Microbiology and Hygiene, Molecular Microbiology (Virology), University of Regensburg, Regensburg, Germany
| | - Manuela Weps
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Benedikt M J Lampl
- Regensburg Department of Public Health, Division of Infection Control and Prevention, Regensburg, Germany; Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Giovanni Almanzar
- Pediatric Rheumatology / Special Immunology, Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Kimia Kousha
- Pediatric Rheumatology / Special Immunology, Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Valeria Schwägerl
- Pediatric Infectious Diseases, Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Bernhard Liebl
- Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - Beatrix Weber
- Institute for Information Systems, University of Applied Sciences Hof, Hof, Germany
| | | | - Jörg Scheidt
- Institute for Information Systems, University of Applied Sciences Hof, Hof, Germany
| | - Olaf Gefeller
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Helmut Messmann
- Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Ulrike Protzer
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany; Institute of Virology, Helmholtz Munich, Munich, Germany, and German Center for Infection Research, Munich partner site
| | - Johannes Liese
- Pediatric Infectious Diseases, Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Ralf Wagner
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany; Institute of Medical Microbiology and Hygiene, Molecular Microbiology (Virology), University of Regensburg, Regensburg, Germany
| | - Klaus Überla
- Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Steininger
- Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| |
Collapse
|
4
|
Lange B, Jaeger VK, Harries M, Rücker V, Streeck H, Blaschke S, Petersmann A, Toepfner N, Nauck M, Hassenstein MJ, Dreier M, von Holt I, Budde A, Bartz A, Ortmann J, Kurosinski MA, Berner R, Borsche M, Brandhorst G, Brinkmann M, Budde K, Deckena M, Engels G, Fenzlaff M, Härtel C, Hovardovska O, Katalinic A, Kehl K, Kohls M, Krüger S, Lieb W, Meyer-Schlinkmann KM, Pischon T, Rosenkranz D, Rübsamen N, Rupp J, Schäfer C, Schattschneider M, Schlegtendal A, Schlinkert S, Schmidbauer L, Schulze-Wundling K, Störk S, Tiemann C, Völzke H, Winter T, Klein C, Liese J, Brinkmann F, Ottensmeyer PF, Reese JP, Heuschmann P, Karch A. Estimates of protection levels against SARS-CoV-2 infection and severe COVID-19 in Germany before the 2022/2023 winter season: the IMMUNEBRIDGE project. Infection 2024; 52:139-153. [PMID: 37530919 PMCID: PMC10811028 DOI: 10.1007/s15010-023-02071-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/27/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Despite the need to generate valid and reliable estimates of protection levels against SARS-CoV-2 infection and severe course of COVID-19 for the German population in summer 2022, there was a lack of systematically collected population-based data allowing for the assessment of the protection level in real time. METHODS In the IMMUNEBRIDGE project, we harmonised data and biosamples for nine population-/hospital-based studies (total number of participants n = 33,637) to provide estimates for protection levels against SARS-CoV-2 infection and severe COVID-19 between June and November 2022. Based on evidence synthesis, we formed a combined endpoint of protection levels based on the number of self-reported infections/vaccinations in combination with nucleocapsid/spike antibody responses ("confirmed exposures"). Four confirmed exposures represented the highest protection level, and no exposure represented the lowest. RESULTS Most participants were seropositive against the spike antigen; 37% of the participants ≥ 79 years had less than four confirmed exposures (highest level of protection) and 5% less than three. In the subgroup of participants with comorbidities, 46-56% had less than four confirmed exposures. We found major heterogeneity across federal states, with 4-28% of participants having less than three confirmed exposures. CONCLUSION Using serological analyses, literature synthesis and infection dynamics during the survey period, we observed moderate to high levels of protection against severe COVID-19, whereas the protection against SARS-CoV-2 infection was low across all age groups. We found relevant protection gaps in the oldest age group and amongst individuals with comorbidities, indicating a need for additional protective measures in these groups.
Collapse
Affiliation(s)
- Berit Lange
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany.
- German Center for Infection Research (DZIF), TI BBD, Brunswick, Germany.
| | - Veronika K Jaeger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Manuela Harries
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Hendrik Streeck
- Institute of Virology, Medical Faculty, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Brunswick, Germany
| | - Sabine Blaschke
- Emergency Department, University Medical Center Göttingen, Göttingen, Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Max J Hassenstein
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Isabell von Holt
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Axel Budde
- Institute of Virology, Medical Faculty, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Brunswick, Germany
| | - Antonia Bartz
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Julia Ortmann
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Marc-André Kurosinski
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Reinhard Berner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Max Borsche
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Gunnar Brandhorst
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
| | - Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Kathrin Budde
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Geraldine Engels
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Marc Fenzlaff
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christoph Härtel
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Olga Hovardovska
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Alexander Katalinic
- Institute of Social Medicine and Epidemiology, University of Luebeck, Luebeck, Germany
| | - Katja Kehl
- Institute of Virology, Medical Faculty, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Brunswick, Germany
| | - Mirjam Kohls
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Stefan Krüger
- Dimap, das Institut Für Markt- Und Politikforschung GmbH, Bonn, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Tobias Pischon
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Biobank Technology Platform, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Rosenkranz
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
| | - Nicole Rübsamen
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
| | - Christian Schäfer
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Mario Schattschneider
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Anne Schlegtendal
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Simon Schlinkert
- Dimap, das Institut Für Markt- Und Politikforschung GmbH, Bonn, Germany
| | - Lena Schmidbauer
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Kai Schulze-Wundling
- Institute of Virology, Medical Faculty, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Brunswick, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center (CHFC), and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Theresa Winter
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Folke Brinkmann
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Patrick F Ottensmeyer
- Institute of Virology, Medical Faculty, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Brunswick, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
| |
Collapse
|
5
|
Knies K, Wagenhäuser I, Hofmann D, Rauschenberger V, Eisenmann M, Reusch J, Flemming S, Andres O, Petri N, Topp MS, Papsdorf M, McDonogh M, Verma-Führing R, Scherzad A, Zeller D, Böhm H, Gesierich A, Seitz AK, Kiderlen M, Gawlik M, Taurines R, Wurmb T, Ernestus RI, Forster J, Weismann D, Weißbrich B, Liese J, Vogel† U, Kurzai O, Dölken L, Gabel A, Krone M. The Sensitivity of Rapid Tests for SARS-CoV-2 Antigen. Dtsch Arztebl Int 2023; 120:763-764. [PMID: 38051563 PMCID: PMC10745559 DOI: 10.3238/arztebl.m2023.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Kerstin Knies
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
- * The authors share first authorship
| | - Isabell Wagenhäuser
- University Hospital Würzburg, Würzburg, Germany,
- * The authors share first authorship
| | - Daniela Hofmann
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Vera Rauschenberger
- University Hospital Würzburg, Würzburg, Germany,
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | | | - Julia Reusch
- University Hospital Würzburg, Würzburg, Germany,
| | | | | | - Nils Petri
- University Hospital Würzburg, Würzburg, Germany,
| | - Max S. Topp
- University Hospital Würzburg, Würzburg, Germany,
| | | | | | | | | | | | - Hartmut Böhm
- University Hospital Würzburg, Würzburg, Germany,
| | | | | | | | - Micha Gawlik
- University Hospital Würzburg, Würzburg, Germany,
| | | | - Thomas Wurmb
- University Hospital Würzburg, Würzburg, Germany,
| | | | - Johannes Forster
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | | | - Benedikt Weißbrich
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | | | - Ulrich Vogel†
- University Hospital Würzburg, Würzburg, Germany,
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Lars Dölken
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Alexander Gabel
- University Hospital Würzburg, Würzburg, Germany,
- *The authors share last authorship
| | - Manuel Krone
- University Hospital Würzburg, Würzburg, Germany,
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- *The authors share last authorship
| |
Collapse
|
6
|
Forster J, Paul P, Liese J. Current Management of Pediatric Parapneumonic Pleural Effusions and Pleural Empyema. Pediatr Infect Dis J 2023; 42:e407-e410. [PMID: 37566896 DOI: 10.1097/inf.0000000000004061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Affiliation(s)
- Johannes Forster
- From the Institute for Hygiene and Microbiology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Pia Paul
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| |
Collapse
|
7
|
Eichel VM, Last K, Brühwasser C, von Baum H, Dettenkofer M, Götting T, Grundmann H, Güldenhöven H, Liese J, Martin M, Papan C, Sadaghiani C, Wendt C, Werner G, Mutters NT. Epidemiology and outcomes of vancomycin-resistant enterococcus infections: a systematic review and meta-analysis. J Hosp Infect 2023; 141:119-128. [PMID: 37734679 DOI: 10.1016/j.jhin.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
Vancomycin-resistant enterococci (VRE) cause many infections in the healthcare context. Knowledge regarding the epidemiology and burden of VRE infections, however, remains fragmented. We aimed to summarize recent studies on VRE epidemiology and outcomes in hospitals, long-term-care facilities (LTCFs) and nursing homes worldwide based on current epidemiological reports. We searched MEDLINE/PubMed, the Cochrane Library, and Web of Science for observational studies, which reported on VRE faecium and faecalis infections in in-patients published between January 2014 and December 2020. Outcomes were incidence, infection rate, mortality, length of stay (LOS), and healthcare costs. We conducted a meta-analysis on mortality (PROSPERO registration number: CRD42020146389). Of 681 identified publications, 57 studies were included in the analysis. Overall quality of evidence was moderate to low. VRE incidence was rarely and heterogeneously reported. VRE infection rate differed highly (1-55%). The meta-analysis showed a higher mortality for VRE faecium bloodstream infections (BSIs) compared with VSE faecium BSIs (risk ratio, RR 1.46; 95% confidence interval (CI) 1.17-1.82). No difference was observed when comparing VRE faecium vs VRE faecalis BSI (RR 1.00, 95% CI 0.52-1.93). LOS was higher in BSIs caused by E. faecium vs E. faecalis. Only three studies reported healthcare costs. In contrast to previous findings, our meta-analysis of included studies indicates that vancomycin resistance independent of VRE species may be associated with a higher mortality. We identified a lack of standardization in reporting outcomes, information regarding healthcare costs, and state-of-the-art microbiological species identification methodology, which may inform the set-up and reporting of future studies.
Collapse
Affiliation(s)
- V M Eichel
- Heidelberg University Hospital, Center for Infectious Diseases, Section of Hospital and Environmental Hygiene, Heidelberg, Germany
| | - K Last
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany.
| | - C Brühwasser
- Heidelberg University Hospital, Center for Infectious Diseases, Section of Hospital and Environmental Hygiene, Heidelberg, Germany; Infection Prevention and Hospital Hygiene, University Hospital Innsbruck, Innsbruck, Austria
| | - H von Baum
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany
| | | | - T Götting
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - H Grundmann
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - H Güldenhöven
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - J Liese
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - M Martin
- Institute for Infection Prevention and Hospital Hygiene, SLK-Kliniken Heilbronn GmbH, Germany
| | - C Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - C Sadaghiani
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - C Wendt
- MVZ Labor Dr. Limbach, Department of Hygiene, Heidelberg, Germany
| | - G Werner
- Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, National Reference Centre for Staphylococci and Enterococci (NRC), Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - N T Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
8
|
Engels G, Oechsle AL, Schlegtendal A, Maier C, Holzwarth S, Streng A, Lange B, Karch A, Petersmann A, Streeck H, Blaschke-Steinbrecher S, Härtel C, Schroten H, von Kries R, Berner R, Liese J, Brinkmann F, Toepfner N. SARS-CoV-2 sero-immunity and quality of life in children and adolescents in relation to infections and vaccinations: the IMMUNEBRIDGE KIDS cross-sectional study, 2022. Infection 2023; 51:1531-1539. [PMID: 37280412 PMCID: PMC10243264 DOI: 10.1007/s15010-023-02052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/13/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The study evaluates the effects on sero-immunity, health status and quality of life of children and adolescents after the upsurge of the Omicron variant in Germany. METHODS This multicenter cross-sectional study (IMMUNEBRIDGE Kids) was conducted within the German Network University Medicine (NUM) from July to October 2022. SARS-CoV-2- antibodies were measured and data on SARS-CoV-2 infections, vaccinations, health and socioeconomic factors as well as caregiver-reported evaluation on their children's health and psychological status were assessed. RESULTS 497 children aged 2-17 years were included. Three groups were analyzed: 183 pre-schoolchildren aged 2-4 years, 176 schoolchildren aged 5-11 years and 138 adolescents aged 12-18 years. Positive antibodies against the S- or N-antigen of SARS-CoV-2 were detected in 86.5% of all participants (70.0% [128/183] of pre-schoolchildren, 94.3% of schoolchildren [166/176] and 98.6% of adolescents [136/138]). Among all children, 40.4% (201/497) were vaccinated against COVID-19 (pre-schoolchildren 4.4% [8/183], schoolchildren 44.3% [78/176] and adolescents 83.3% [115/138]). SARS-CoV-2 seroprevalence was lowest in pre-school. Health status and quality of life reported by the parents were very positive at the time of the survey (Summer 2022). CONCLUSION Age-related differences on SARS-CoV-2 sero-immunity could mainly be explained by differences in vaccination rates based on the official German vaccination recommendations as well as differences in SARS-CoV-2 infection rates in the different age groups. Health status and quality of life of almost all children were very good independent of SARS-CoV-2 infection and/or vaccination. TRIAL REGISTRATION German Registry for Clinical Trials Identifier Würzburg: DRKS00025546 (registration: 11.09.2021), Bochum: DRKS00022434 (registration:07.08.2020), Dresden: DRKS 00022455 (registration: 23.07.2020).
Collapse
Affiliation(s)
- Geraldine Engels
- Department of Pediatrics, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Anna-Lisa Oechsle
- Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, LMU Munich, Haydnstraße 5, 80336, Munich, Germany
| | - Anne Schlegtendal
- Children's Hospital, Ruhr University of Bochum, Alexandrinenstrasse 5, 44791, Bochum, Germany
| | - Christoph Maier
- Children's Hospital, Ruhr University of Bochum, Alexandrinenstrasse 5, 44791, Bochum, Germany
| | - Sarah Holzwarth
- Department of Pediatrics, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Fetscherstr. 74, 01307, Dresden, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Berit Lange
- Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Brunswick, Germany
- German Centre for Infection Research (DZIF), TI BBD, Brunswick, Germany
| | - Andre Karch
- Institute for Epidemiology and Social Medicine, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Astrid Petersmann
- Institute for Clinical Chemistry and Laboratory Medicine, University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University of Greifswald, Ferdinand-Sauerbruchstrasse, 17475, Greifwald, Germany
| | - Hendrik Streeck
- Institute of Virology, University Hospital, University of Bonn, Venusberg-Campus 1, Gebäude 63, 53127, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Brunswick, Germany
| | | | - Christoph Härtel
- Department of Pediatrics, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Horst Schroten
- Pediatric Infectious Diseases, Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Rüdiger von Kries
- Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, LMU Munich, Haydnstraße 5, 80336, Munich, Germany
| | - Reinhard Berner
- Department of Pediatrics, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Fetscherstr. 74, 01307, Dresden, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Folke Brinkmann
- Children's Hospital, Ruhr University of Bochum, Alexandrinenstrasse 5, 44791, Bochum, Germany
- Department of Pediatrics, University of Lübeck, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Fetscherstr. 74, 01307, Dresden, Germany.
| |
Collapse
|
9
|
Wagenhäuser I, Mees J, Reusch J, Lâm TT, Schubert-Unkmeir A, Krone LB, Frey A, Kurzai O, Frantz S, Dölken L, Liese J, Gabel A, Petri N, Krone M. Determinants of Influenza A infection rate in post-COVID-19 era. J Infect 2023; 87:361-364. [PMID: 37567511 DOI: 10.1016/j.jinf.2023.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Isabell Wagenhäuser
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Juliane Mees
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - Julia Reusch
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Thiên-Trí Lâm
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | | | - Lukas B Krone
- Department of Physiology, Anatomy and Genetics, Sir Jules Thorn Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK; Department of Neurology, Centre for Experimental Neurology, University of Bern, Bern, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anna Frey
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knoell-Institute, Jena, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Lars Dölken
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Johannes Liese
- Department of Paediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Gabel
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - Nils Petri
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Manuel Krone
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany; Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany.
| |
Collapse
|
10
|
Schillok H, Coenen M, Rehfuess EA, Kuhlmann PH, Matl S, Kindermann H, Maison N, Eckert J, von Both U, Behrends U, Frühwald MC, Neubert A, Woelfle J, Melter M, Liese J, Hübner J, Klein C, Kern A, Jung-Sievers C. Changes in behavior and quality of life in German young children during the COVID-19 pandemic-results from the COVID kids bavaria study. Front Pediatr 2023; 11:1135415. [PMID: 37228432 PMCID: PMC10204608 DOI: 10.3389/fped.2023.1135415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/29/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction The COVID-19 pandemic with its containment measures such as closures of schools and daycare facilities led to numerous restrictions in daily life, putting developmental opportunities and health-related quality of life in children at risk. However, studies show that not every family was impacted equally by the pandemic and that this exceptional health and societal situation reinforced pre-existing health inequalities among the vulnerable. Our study aimed at analyzing changes in behavior and health-related quality of life of children attending elementary schools and daycare facilities in Bavaria, Germany in spring 2021. We also sought to identify associated factors contributing to inequalities in quality of life. Methods Data from a multi-center, open cohort study ("COVID Kids Bavaria") conducted in 101 childcare facilities and 69 elementary schools across all electoral districts of Bavaria were analyzed. Children attending these educational settings (aged 3-10 years) were eligible for participation in a survey on changes in behavior and health-related quality of life. The KINDLR questionnaire (based on children's self-report and parental report) was administered about one year after the onset of the pandemic (spring 2021). Descriptive and logistic regression analyses and comparisons to pre-pandemic KiGGS (German Health Interview and Examination Survey for Children and Adolescents) data were undertaken. Results Among respondents, a high percentage of parents reported changes in their children's eating and sleeping behavior, sports and outdoor activities as well as altered screen time. Health-related quality of life in KINDLR analyses compared to pre-pandemic population averages were lower in all age groups (for 3-6-year-old KINDLR-total score: COVID Kids Bavaria MD 74.78 ± 10.57 vs KiGGS data 80.0 ± 8.1; 7-10 years-old KINDLR-total score: COVID Kids Bavaria MD 73.88 ± 12.03 vs KiGGS data 79.30 ± 9.0). No significant differences were detected with regard to associated factors, namely type of institution, sex of the child, migration background, household size and parental education. Conclusion These findings suggest a relevant impact of the COVID-19 pandemic on children's behavior and health-related quality of life one year after the onset of the pandemic. Further analyses in large-scale longitudinal studies are needed to determine the effects of specific pandemic or crisis associated factors contributing to health inequalities.
Collapse
Affiliation(s)
- Hannah Schillok
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva A. Rehfuess
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Pia H. Kuhlmann
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Stefan Matl
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Hannah Kindermann
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Nicole Maison
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
- German Center for Lung Research (DZL), Munich, Germany
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Jana Eckert
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Ulrich von Both
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Uta Behrends
- Department of Pediatrics, Kinderklinik München Schwabing, StKM GmbH und Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael C. Frühwald
- Paediatric and Adolescent Medicine University Hospital Augsburg, Augsburg, Germany
| | - Antje Neubert
- Department of Paediatric and Adolescent Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Joachim Woelfle
- Department of Paediatric and Adolescent Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Michael Melter
- University Children’s Hospital Regensburg (KUNO), Regensburg, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Hübner
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Anna Kern
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Caroline Jung-Sievers
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| |
Collapse
|
11
|
Bender F, Tarasconi A, Catena F, Sartelli M, Coccolini F, Liese J, Padberg W, Reichert M, Hecker A. [Current WSES-AAST guidelines on anorectal emergencies-Summary and comments]. Chirurgie (Heidelb) 2023; 94:333-341. [PMID: 36808498 DOI: 10.1007/s00104-023-01826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
In 2019, the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) generated consensus recommendations for the treatment of anorectal emergencies in Parma, Italy, and published a guideline in 2021. This is the first global guideline dealing with this important topic for surgeons' everyday work. Seven anorectal emergencies were discussed and the guideline recommendations were given according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.
Collapse
Affiliation(s)
- F Bender
- Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - A Tarasconi
- Emergency Surgery Department, Parma University Hospital, Parma, Italien
| | - F Catena
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italien
| | - M Sartelli
- Department of Surgery, Macerata Hospital, Macerata, Italien
| | - F Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italien
| | - J Liese
- Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - W Padberg
- Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - M Reichert
- Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - A Hecker
- Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland.
| |
Collapse
|
12
|
Sieg AL, Liese J. 1,5/m mit Husten und Tachydyspnoe. Monatsschr Kinderheilkd 2023. [PMCID: PMC10029772 DOI: 10.1007/s00112-023-01729-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
- Anna-Lena Sieg
- Universitäts-Klinikum Würzburg, Kinderklinik und Poliklinik, Josef-Schneider-Str. 2, 97080 Würzburg, Deutschland
| | - Johannes Liese
- Universitäts-Klinikum Würzburg, Kinderklinik und Poliklinik, Josef-Schneider-Str. 2, 97080 Würzburg, Deutschland
| |
Collapse
|
13
|
Krone M, Wagenhäuser I, Knies K, Hofmann D, Engels G, Taurines R, McDonogh M, Flemming S, Meyer T, Böhm H, Scherzad A, Eisenmann M, Rauschenberger V, Gabel A, Petri N, Reusch J, Forster J, Weißbrich B, Dölken L, Kurzai O, Vogel U, Härtel C, Liese J, Andres O. Clinical accuracy of SARS-CoV-2 rapid antigen testing in screening children and adolescents. J Infect 2023; 86:256-308. [PMID: 36565725 PMCID: PMC9767879 DOI: 10.1016/j.jinf.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Manuel Krone
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany; Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany.
| | - Isabell Wagenhäuser
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany; Department of Internal Medicine I, University Hospital Wuerzburg, Oberdürrbacher Str. 6, Wuerzburg 97080, Germany
| | - Kerstin Knies
- Institute for Virology and Immunobiology, University of Wuerzburg, Versbacher Str. 7, Würzburg 97078, Germany
| | - Daniela Hofmann
- Institute for Virology and Immunobiology, University of Wuerzburg, Versbacher Str. 7, Würzburg 97078, Germany
| | - Geraldine Engels
- Department of Paediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Regina Taurines
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Margarete-Höppel-Platz 1, Würzburg 97080, Germany
| | - Miriam McDonogh
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Oberdürrbacher Str. 6, Wuerzburg 97080, Germany
| | - Sven Flemming
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Wuerzburg, Oberdürrbacher Str. 6, Wuerzburg 97080, Germany
| | - Thomas Meyer
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Wuerzburg, Oberdürrbacher Str. 6, Wuerzburg 97080, Germany
| | - Hartmut Böhm
- Department of Oral and Maxillofacial Surgery, University Hospital Wuerzburg, Pleicherwall 2, Wuerzburg 97070, Germany
| | - Agmal Scherzad
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg 97080, Germany
| | - Michael Eisenmann
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany
| | - Vera Rauschenberger
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany; Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany
| | - Alexander Gabel
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany
| | - Nils Petri
- Department of Internal Medicine I, University Hospital Wuerzburg, Oberdürrbacher Str. 6, Wuerzburg 97080, Germany
| | - Julia Reusch
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany; Department of Internal Medicine I, University Hospital Wuerzburg, Oberdürrbacher Str. 6, Wuerzburg 97080, Germany
| | - Johannes Forster
- Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany
| | - Benedikt Weißbrich
- Institute for Virology and Immunobiology, University of Wuerzburg, Versbacher Str. 7, Würzburg 97078, Germany
| | - Lars Dölken
- Institute for Virology and Immunobiology, University of Wuerzburg, Versbacher Str. 7, Würzburg 97078, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany; Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knoell-Institute, Beutenbergstraße 13, Jena 07745, Germany
| | - Ulrich Vogel
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany; Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg 97080, Germany
| | - Christoph Härtel
- Department of Paediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Johannes Liese
- Department of Paediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Oliver Andres
- Department of Paediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
14
|
Karakizlis H, Trudel N, Brose A, Reinisch A, Reichert M, Hecker A, Bender F, Askevold I, Rainer L, Weimer R, Krombach GA, Padberg W, Liese J. Sarcopenia of kidney transplant recipients as a predictive marker for reduced graft function and graft survival after kidney transplantation. Langenbecks Arch Surg 2023; 408:103. [PMID: 36826595 PMCID: PMC9958183 DOI: 10.1007/s00423-023-02836-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE The association between sarcopenia of kidney transplant recipients and outcome after kidney transplantation (KT) has not yet been fully understood and is still considered controversial. The aim of our study was to analyze the impact of pre-transplant sarcopenia on graft function, postoperative complication rates, and survival of the patients after renal transplantation. METHODS In this retrospective single-center study, all patients who underwent KT (01/2013-12/2017) were included. Demographic data, rejection rates, delayed graft function, and graft and patient survival rates were analyzed. Sarcopenia was measured in computed tomography images by the sex-adjusted Hounsfield unit average calculation (HUAC). RESULTS During the study period, 111 single KTs (38 women and 73 men) were performed. Living donor kidney transplants were performed in 48.6%. In total, 32.4% patients had sarcopenia. Sarcopenic patients were significantly older (59.6 years vs. 49.8 years; p < 0.001), had a higher body mass index (BMI = 27.6 kg/m2 vs. 25.0 kg/m2; p = 0.002), and were more likely to receive deceased donor kidneys (72.2% vs. 41.3%; p = 0.002). Interestingly, 3 years after KT, the creatinine serum levels were significantly higher (2.0 mg/dl vs. 1.5 mg/dl; p = 0.001), whereas eGFR (39.9 ml/min vs. 53.4 ml/min; p = 0.001) and graft survival were significantly lower (p = 0.004) in sarcopenic transplant recipients. Sarcopenic patients stayed in hospital significantly longer postoperatively than those who were non-sarcopenic. CONCLUSIONS At the time of kidney transplantation, sarcopenia was found to predict reduced long-term graft function and diminished graft survival after KT. The early identification of sarcopenic patients can not only enable an optimized selection of recipients, but also the initiation of pre-habilitation programs during the waiting period.
Collapse
Affiliation(s)
- H Karakizlis
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
| | - N Trudel
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
- Department of Diagnostic and Interventional Radiology, Marienhospital Stuttgart, Stuttgart, Germany
| | - A Brose
- Department of Radiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - A Reinisch
- Department of General, Visceral and Oncologic Surgery, Hospital and Clinics Wetzlar, Teaching Hospital of the Justus-Liebig-University Giessen, Wetzlar, Germany
| | - M Reichert
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - A Hecker
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - F Bender
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - I Askevold
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - L Rainer
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
| | - R Weimer
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
| | - G A Krombach
- Department of Radiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - W Padberg
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - J Liese
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany.
| |
Collapse
|
15
|
Wagenhäuser I, Knies K, Hofmann D, Rauschenberger V, Eisenmann M, Reusch J, Gabel A, Flemming S, Andres O, Petri N, Topp MS, Papsdorf M, McDonogh M, Verma-Führing R, Scherzad A, Zeller D, Böhm H, Gesierich A, Seitz AK, Kiderlen M, Gawlik M, Taurines R, Wurmb T, Ernestus RI, Forster J, Weismann D, Weißbrich B, Dölken L, Liese J, Kaderali L, Kurzai O, Vogel U, Krone M. Virus variant-specific clinical performance of SARS coronavirus two rapid antigen tests in point-of-care use, from November 2020 to January 2022. Clin Microbiol Infect 2023; 29:225-232. [PMID: 36028089 PMCID: PMC9398563 DOI: 10.1016/j.cmi.2022.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Antigen rapid diagnostic tests (RDTs) for SARS coronavirus 2 (SARS-CoV-2) are quick, widely available, and inexpensive. Consequently, RDTs have been established as an alternative and additional diagnostic strategy to quantitative reverse transcription polymerase chain reaction (RT-qPCR). However, reliable clinical and large-scale performance data specific to a SARS-CoV-2 virus variant of concern (VOC) are limited, especially for the Omicron VOC. The aim of this study was to compare RDT performance among different VOCs. METHODS This single-centre prospective performance assessment compared RDTs from three manufacturers (NADAL, Panbio, MEDsan) with RT-qPCR including deduced standardized viral load from oropharyngeal swabs for detection of SARS-CoV-2 in a clinical point-of-care setting from November 2020 to January 2022. RESULTS Among 35 479 RDT/RT-qPCR tandems taken from 26 940 individuals, 164 of the 426 SARS-CoV-2 positive samples tested true positive with an RDT corresponding to an RDT sensitivity of 38.50% (95% CI, 34.00-43.20%), with an overall specificity of 99.67% (95% CI, 99.60-99.72%). RDT sensitivity depended on viral load, with decreasing sensitivity accompanied by descending viral load. VOC-dependent sensitivity assessment showed a sensitivity of 42.86% (95% CI, 32.82-53.52%) for the wild-type SARS-CoV-2, 43.42% (95% CI, 32.86-54.61%) for the Alpha VOC, 37.67% (95% CI, 30.22-45.75%) for the Delta VOC, and 33.67% (95% CI, 25.09-43.49%) for the Omicron VOC. Sensitivity in samples with high viral loads of ≥106 SARS-CoV-2 RNA copies per mL was significantly lower in the Omicron VOC (50.00%; 95% CI, 36.12-63.88%) than in the wild-type SARS-CoV-2 (79.31%; 95% CI, 61.61-90.15%; p 0.015). DISCUSSION RDT sensitivity for detection of the Omicron VOC is reduced in individuals infected with a high viral load, which curtails the effectiveness of RDTs. This aspect furthert: limits the use of RDTs, although RDTs are still an irreplaceable diagnostic tool for rapid, economic point-of-care and extensive SARS-CoV-2 screening.
Collapse
Affiliation(s)
- Isabell Wagenhäuser
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Kerstin Knies
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Daniela Hofmann
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Vera Rauschenberger
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Wuerzburg, Germany,Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Michael Eisenmann
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Julia Reusch
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Alexander Gabel
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Sven Flemming
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Oliver Andres
- Department of Paediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Nils Petri
- Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Max S. Topp
- Department of Internal Medicine II, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Papsdorf
- Department of Obstetrics and Gynaecology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Miriam McDonogh
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Raoul Verma-Führing
- Department of Ophthalmology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Agmal Scherzad
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Daniel Zeller
- Department of Neurology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Hartmut Böhm
- Department of Oral and Maxillofacial Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Anja Gesierich
- Department of Dermatology, Venerology and Allergology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Anna K. Seitz
- Department of Urology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Kiderlen
- Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Micha Gawlik
- Department of Psychiatry and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Regina Taurines
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Thomas Wurmb
- Department of Anaesthesia and Critical Care, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Johannes Forster
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Dirk Weismann
- Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Benedikt Weißbrich
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Lars Dölken
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Johannes Liese
- Department of Paediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Lars Kaderali
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany,Leibniz Institute for Natural Product Research and Infection Biology—Hans-Knoell-Institute, Jena, Germany
| | - Ulrich Vogel
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Wuerzburg, Germany,Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Manuel Krone
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Wuerzburg, Wuerzburg, Germany; Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany.
| |
Collapse
|
16
|
Engels G, Hecker K, Forster J, Toepfner N, Hick E, Pietsch F, Heuschmann P, Berner R, Härtel C, Kurzai O, Petersmann A, Streng A, Liese J. High Seroprevalence of SARS-CoV-2 in Preschool Children in July 2022. Dtsch Arztebl Int 2022; 119:771-772. [PMID: 36700368 PMCID: PMC9884839 DOI: 10.3238/arztebl.m2022.0345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 08/17/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Nicole Toepfner
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden
| | - Elena Hick
- Department of Pediatrics, University Hospital Würzburg
| | | | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg,Clinical Trial Center Würzburg (CTC/ZKS), University Hospital Würzburg
| | - Reinhard Berner
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden
| | | | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Würzburg
| | - Astrid Petersmann
- Institute for Clinical Chemistry and Laboratory Medicine, University Oldenburg, Oldenburg,Institute for Clinical Chemistry and Laboratory Medicine,University Medicine Greifswald, University of Greifswald
| | - Andrea Streng
- Department of Pediatrics, University Hospital Würzburg
| | | |
Collapse
|
17
|
Engels G, Forster J, Streng A, Rücker V, Rudolph P, Pietsch F, Wallstabe J, Wallstabe L, Krauthausen M, Schmidt J, Ludwig T, Bauer C, Gierszewski D, Bendig J, Timme S, Jans T, Weißbrich B, Romanos M, Dölken L, Heuschmann P, Härtel C, Gágyor I, Figge MT, Liese J, Kurzai O. Acceptance of Different Self-sampling Methods for Semiweekly SARS-CoV-2 Testing in Asymptomatic Children and Childcare Workers at German Day Care Centers: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e2231798. [PMID: 36107424 PMCID: PMC9478779 DOI: 10.1001/jamanetworkopen.2022.31798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Closure of day care centers (DCCs) to contain the COVID-19 pandemic has been associated with negative effects on children's health and well-being. OBJECTIVE To investigate the acceptance of self-sampling methods for continuous SARS-CoV-2 surveillance among asymptomatic children and childcare workers (CCWs) in DCCs. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized pilot study included children and CCWs at 9 DCCs in Wuerzburg, Germany, from May to July 2021. INTERVENTIONS Twice weekly testing for SARS-CoV-2 was conducted by self-sampled mouth-rinsing fluid (saliva sampling [SAL], with subsequent pooled polymerase chain reaction test) plus nasal rapid antigen self-test (RAgT) (group 1), SAL only (group 2), or RAgT only (group 3) in children and CCWs. MAIN OUTCOMES AND MEASURES Main outcomes were rates for initial acceptance and successful (≥60% of scheduled samples) long-term participation. The probability of SARS-CoV-2 introduction into DCCs was modeled as a function of age-adjusted background incidence and DCC size. RESULTS Of 836 eligible children, 452 (54.1%; 95% CI, 50.7%-57.4%) participated (median [IQR] age: 4 [3-5] years; 213 [47.1%] girls), including 215 (47.6%) in group 1, 172 (38.1%) in group 2, and 65 (14.4%) in group 3. Of 190 CCWs, 139 (73.2%; 95% CI, 66.4%-79.0%) participated (median [IQR] age: 30 [25-46] years; 128 [92.1%] women), including 96 (69.1%) in group 1, 29 (20.9%) in group 2, and 14 (10.1%) in group 3. Overall, SARS-CoV-2 PCR tests on 5306 SAL samples and 2896 RAgTs were performed in children, with 1 asymptomatic child detected by PCR from SAL. Successful long-term participation was highest in group 2 (SAL only; children: 111 of 172 [64.5%]; CCWs: 18 of 29 [62.1%]). Weekly participation rates in children ranged from 54.0% to 83.8% for SAL and from 44.6% to 61.4% for RAgT. Participation rates decreased during the study course (P < .001). The probability of SARS-CoV-2 introduction into a DCC with 50 children was estimated to reach at most 5% for an age-adjusted SARS-CoV-2 incidence below 143. CONCLUSIONS AND RELEVANCE Self-sampling for continuous SARS-CoV-2 testing was well accepted, with SAL being the preferred method. Given the high number of negative tests, thresholds for initiating continuous testing should be established based on age-adjusted SARS-CoV-2 incidence rates. TRIAL REGISTRATION German Registry for Clinical Trials Identifier: DRKS00025546.
Collapse
Affiliation(s)
- Geraldine Engels
- Department of Pediatrics, University Hospital Wuerzburg, Würzburg, Germany
| | - Johannes Forster
- Institute for Hygiene and Microbiology, University of Wuerzburg, Würzburg, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital Wuerzburg, Würzburg, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - Paul Rudolph
- Leibniz Institute for Natural Product Research and Infection Biology–Hans-Knoell-Institute, Jena, Germany
| | - Franziska Pietsch
- Institute for Hygiene and Microbiology, University of Wuerzburg, Würzburg, Germany
| | - Julia Wallstabe
- Institute for Hygiene and Microbiology, University of Wuerzburg, Würzburg, Germany
| | - Lars Wallstabe
- Institute for Hygiene and Microbiology, University of Wuerzburg, Würzburg, Germany
| | - Maike Krauthausen
- Department of General Practice, University Hospital Wuerzburg, Würzburg, Germany
| | - Julia Schmidt
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - Timo Ludwig
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - Carsten Bauer
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - David Gierszewski
- Department of General Practice, University Hospital Wuerzburg, Würzburg, Germany
| | - Jesper Bendig
- Department of Pediatrics, University Hospital Wuerzburg, Würzburg, Germany
| | - Sandra Timme
- Leibniz Institute for Natural Product Research and Infection Biology–Hans-Knoell-Institute, Jena, Germany
| | - Thomas Jans
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Würzburg, Germany
| | - Benedikt Weißbrich
- Institute for Virology and Immunobiology, University of Wuerzburg, Würzburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Würzburg, Germany
| | - Lars Dölken
- Institute for Virology and Immunobiology, University of Wuerzburg, Würzburg, Germany
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
- Clinical Trial Center Wuerzburg, University Hospital Wuerzburg, Würzburg, Germany
| | - Christoph Härtel
- Department of Pediatrics, University Hospital Wuerzburg, Würzburg, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Wuerzburg, Würzburg, Germany
| | - Marc Thilo Figge
- Leibniz Institute for Natural Product Research and Infection Biology–Hans-Knoell-Institute, Jena, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Wuerzburg, Würzburg, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Wuerzburg, Würzburg, Germany
- Leibniz Institute for Natural Product Research and Infection Biology–Hans-Knoell-Institute, Jena, Germany
| |
Collapse
|
18
|
Roberts K, Streng A, Göttler D, Hartmann K, Peter-Kern M, Roggendorf H, Bogdan C, Jilg W, Plentz A, Hübner J, Schober T, Liese J. Medical Student Self-Assessment of Knowledge About Vaccinations and the Quality of Vaccination Training. Dtsch Arztebl Int 2022; 119:562-563. [PMID: 36422871 PMCID: PMC9743225 DOI: 10.3238/arztebl.m2022.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/07/2022] [Accepted: 06/07/2022] [Indexed: 12/15/2022]
|
19
|
Gierszewski D, Kurotschka PK, Krauthausen M, Fröhlich W, Forster J, Pietsch F, Streng A, Rücker V, Wallstabe J, Hartmann K, Jans T, Engels G, Romanos M, Heuschmann P, Härtel C, Kurzai O, Liese J, Gágyor I. Corrigendum: Parents' and childcare workers' perspectives toward SARS-CoV-2 test and surveillance protocols in pre-school children day care centers: A qualitative study within the german Wü-KiTa-CoV project. Front Med (Lausanne) 2022; 9:973518. [PMID: 35935757 PMCID: PMC9351591 DOI: 10.3389/fmed.2022.973518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Gierszewski
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Peter Konstantin Kurotschka
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
- *Correspondence: Peter Konstantin Kurotschka
| | - Maike Krauthausen
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Willi Fröhlich
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Johannes Forster
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Franziska Pietsch
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Julia Wallstabe
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Katrin Hartmann
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Thomas Jans
- Clinic and Policlinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Geraldine Engels
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Marcel Romanos
- Clinic and Policlinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- Clinical Trial Center Wuerzburg, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christoph Härtel
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
- Leibniz Institute for Natural Product Research and Infection Biology—Hans-Knoell- Institute, Jena, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
20
|
Papan C, Reifenrath K, Last K, Attarbaschi A, Graf N, Groll AH, Huebner J, Laws HJ, Lehrnbecher T, Liese J, Martin L, Tenenbaum T, Weichert S, Vieth S, von Both U, Hufnagel M, Simon A. Antimicrobial Use in Pediatric Oncology and Hematology: Protocol for a Multicenter Point-Prevalence Study With Qualitative Expert Panel Assessment. JMIR Res Protoc 2022; 11:e35774. [PMID: 35723906 PMCID: PMC9253971 DOI: 10.2196/35774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Because infections are a major driver of morbidity and mortality in children with hematologic or oncologic diseases, antimicrobials are frequently prescribed in pediatric oncology practice. However, excess or inappropriate use of antimicrobials is directly linked to the emergence of antimicrobial resistance. Although point-prevalence studies have examined the extent of antimicrobial use, a comprehensive qualitative evaluation of individual antimicrobial prescriptions remains lacking. Objective The aim of this study is to identify appropriate versus inappropriate antimicrobial use among pediatric cancer patients in a point-prevalence study, followed by an expert panel adjudication process and a subsequent report of these findings to participating centers. This study also aims to improve the quality of patient care by informing centers about discrepancies between internal standards of care and national guidelines. Methods Our point-prevalence study is performed at pediatric cancer centers in Germany and Austria. All patients under 18 years old who are hospitalized at the time of the study are included. As a supplement to the point-prevalence study, an expert panel is qualitatively assessing each of the antimicrobial prescriptions at the participating centers to review local guidelines and compare them with national guidelines. Results As of December 2021, the point-prevalence survey has been conducted at 30 sites and expert panel adjudication for qualitative assessment of each antimicrobial use is ongoing. Results of the study are expected in 2022. Conclusions This is the first point-prevalence study conducted among pediatric cancer centers with an integrated, multistep, qualitative approach that assesses each antimicrobial prescription. The results of this study will inform possible interventions for internal guidelines and antimicrobial stewardship programs implemented at pediatric cancer centers. In addition, local guidelines will be compared with national guidelines. Furthermore, this study will contribute to the overall integration of antimicrobial stewardship principles and initiatives in pediatric oncology and hematology, thereby improving safety and quality of care for children and adolescents with cancer and blood disorders. International Registered Report Identifier (IRRID) DERR1-10.2196/35774
Collapse
Affiliation(s)
- Cihan Papan
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Katharina Reifenrath
- Pediatric Hematology and Oncology, University Children's Hospital, Saarland University, Homburg, Germany
| | - Katharina Last
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Norbert Graf
- Pediatric Hematology and Oncology, University Children's Hospital, Saarland University, Homburg, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Department of Pediatric Hematology/Oncology and Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany
| | - Johannes Huebner
- Division of Pediatric Infectious Disease, Dr v Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Hans-Jürgen Laws
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University of Duesseldorf, Düsseldorf, Germany
| | - Thomas Lehrnbecher
- Division for Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Johannes Liese
- Pediatric Infectious Diseases and Immunology, University Children's Hospital, University of Würzburg, Würzburg, Germany
| | - Luise Martin
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Tenenbaum
- Pediatric Infectious Diseases, Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Weichert
- Pediatric Infectious Diseases, Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Simon Vieth
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrich von Both
- Division of Pediatric Infectious Disease, Dr v Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Markus Hufnagel
- Division of Pediatric Infectious Diseases and Rheumatology, Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Arne Simon
- Pediatric Hematology and Oncology, University Children's Hospital, Saarland University, Homburg, Germany
| |
Collapse
|
21
|
Pfeil J, Bialek R, Heininger U, Liese J, Simon A, Stich A, Assaad K, von Both U, Janda A, Kitz C, Kobbe R, Kunze M, Lindert J, Ritz N, Trapp S, Fressle R, Hufnagel M. Aktualisierte Empfehlungen zur infektiologischen Versorgung von Flüchtlingen im Kindes- und Jugendalter in Deutschland (Stand 30. März 2022), angemeldet als S1-Leitlinie (AWMF-Register Nr. 048-017). Monatsschr Kinderheilkd 2022; 170:632-647. [PMID: 35645410 PMCID: PMC9130691 DOI: 10.1007/s00112-022-01499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/08/2022]
Abstract
Hintergrund Mit etwa 190.000 Asylanträgen im Jahr 2021 ist Deutschland das wichtigste Aufnahmeland von Asylsuchenden in Europa. Die vorliegenden Handlungsempfehlungen sollen eine Grundlage für eine evidenzbasierte und zielgerichtete infektiologische Versorgung minderjähriger Flüchtlinge schaffen. Ziele Die Handlungsempfehlungen sollen medizinisches Personal in der Versorgung minderjähriger Flüchtlinge unterstützen, um 1. einen unvollständigen Impfschutz frühzeitig zu erkennen und zu vervollständigen; 2. übliche Infektionskrankheiten zu diagnostizieren und zu behandeln; 3. in Deutschland seltene Infektionskrankheiten frühzeitig zu erkennen und zu therapieren. Material und Methoden Die Handlungsempfehlungen wurden als AWMF-Leitlinie Stufe 1 verfasst. Entsprechend wurden die Empfehlungen durch eine repräsentativ zusammengesetzte Expertengruppe der beteiligten Fachgesellschaften im informellen Konsens erarbeitet und final von den Vorständen der Fachgesellschaften offiziell verabschiedet. Ergebnisse Es werden Empfehlungen ausgesprochen, für den Umfang der Anamnese und der körperlichen Untersuchung minderjähriger Flüchtlinge. Für alle minderjährigen Flüchtlinge werden die Bestimmung eines Differenzialblutbildes sowie Untersuchungen auf Tuberkulose und Hepatitis B empfohlen. Je nach Herkunft und Alter werden weitere gezielte Untersuchungen z. B. auf Hepatitis C, HIV oder Schistosomiasis empfohlen. Zur raschen Vervollständigung des Impfstatus wird eine alters- und indikationsbezogene Priorisierung einzelner Impfungen vorgenommen. Diskussion Angesichts anhaltend hoher Flüchtlingszahlen ist eine weitere Professionalisierung der medizinischen Versorgung minderjähriger Flüchtlinge notwendig. Hierzu sollten die notwendigen strukturellen und personellen Rahmenbedingungen geschaffen werden.
Collapse
|
22
|
Gierszewski D, Kurotschka PK, Krauthausen M, Fröhlich W, Forster J, Pietsch F, Streng A, Rücker V, Wallstabe J, Hartmann K, Jans T, Engels G, Romanos M, Heuschmann P, Härtel C, Kurzai O, Liese J, Gágyor I. Parents’ and Childcare Workers’ Perspectives Toward SARS-CoV-2 Test and Surveillance Protocols in Pre-school Children Day Care Centers: A Qualitative Study Within the German Wü-KiTa-CoV Project. Front Med (Lausanne) 2022; 9:897726. [PMID: 35572986 PMCID: PMC9102144 DOI: 10.3389/fmed.2022.897726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/11/2022] [Indexed: 12/17/2022] Open
Abstract
Background Feasibility of surveillance through continuous SARS-CoV-2 testing in pre-school children and childcare workers (CCWs) to prevent closure of day care centers (DCCs) was proven in the Wü-KiTa-CoV study. The purpose of this study was to describe the factors that facilitate or hinder the implementation of continuous SARS-CoV-2 testing from the perspective of parents and CCWs involved in the study. Methods A total of 148 semi–structured telephone interviews, repeated before and after the implementation of the surveillance protocols, were conducted with parents and CCWs belonging to the DCCs involved in Wü-KiTa-CoV and analyzed using qualitative content analysis. Results Five main topical categories that influences implementation of surveillance protocols for SARS-CoV-2 in DCCs emerged: Generating valuable knowledge, Impact on daily life, Communication and information, Children’s wellbeing and the Sense of security. Smooth integration in daily routines, quickly delivered test results, and efficient communication and information between the study team and the participants were identified as factors that had a positive impact on implementation. To ensure children’s wellbeing, the introduction of non-invasive testing procedures such as saliva testing, parental involvement to motivate, and prepare children for the procedure, the creation of a child-friendly environment for testing, and use of child-friendly explanations were considered critical. The surveillance was found to increase the sense of security during the pandemic. Conversely, reliability of tests in the surveillance protocols, low participation rates, non-transparent communication, the need to travel to testing sites, fear of quarantine in case of positive test results, concerns about higher workloads, the fear of unpleasant feelings for children, their young age, and changing test teams were considered as hindering factors. Conclusion This qualitative study of parents of children in day care and DCC staff under surveillance through continuous testing for SARS-CoV-2 in nine German DCCs identified several factors that facilitate or hinder its implementation. These should be considered when planning screening interventions to prevent the spread of SARS-CoV-2 or other infectious diseases in pre-school children DCCs.
Collapse
Affiliation(s)
- David Gierszewski
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Peter Konstantin Kurotschka
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
- *Correspondence: Peter Konstantin Kurotschka,
| | - Maike Krauthausen
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Willi Fröhlich
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Johannes Forster
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Franziska Pietsch
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Julia Wallstabe
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Katrin Hartmann
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Thomas Jans
- Clinic and Policlinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Geraldine Engels
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Marcel Romanos
- Clinic and Policlinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- Clinical Trial Center Wuerzburg, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christoph Härtel
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
- Leibniz Institute for Natural Product Research and Infection Biology—Hans-Knoell-Institute, Jena, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
23
|
Forster J, Streng A, Rudolph P, Rücker V, Wallstabe J, Timme S, Pietsch F, Hartmann K, Krauthausen M, Schmidt J, Ludwig T, Gierszewski D, Jans T, Engels G, Weißbrich B, Romanos M, Dölken L, Heuschmann P, Härtel C, Gágyor I, Figge MT, Kurzai O, Liese J. Feasibility of SARS-CoV-2 Surveillance Testing Among Children and Childcare Workers at German Day Care Centers: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e2142057. [PMID: 34982157 PMCID: PMC8728621 DOI: 10.1001/jamanetworkopen.2021.42057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Closure of day care centers has been implemented globally to contain the COVID-19 pandemic but has negative effects on children's health and psychosocial well-being. OBJECTIVE To investigate the feasibility of surveillance among children and childcare workers and to model the efficacy of surveillance on viral spread prevention. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled trial was conducted at 9 day care centers in Wuerzburg, Germany, from October 2020 to March 2021. Participants included children attending day care, childcare workers, and household members. Participating day care centers were assigned to different surveillance modules in a nonrandomized feasibility study. A mathematical model for SARS-CoV-2 spread in day care centers was developed to identify optimal surveillance. INTERVENTIONS Modules 1, 2, and 3 involved continuous surveillance of asymptomatic children and childcare workers by SARS-CoV-2 polymerase chain reaction testing of either midturbinate nasal swabs twice weekly (module 1) or once weekly (module 2) or self-sampled saliva samples twice weekly (module 3). Module 4 involved symptom-based, on-demand testing of children, childcare workers, and their household members by oropharyngeal swabs. All participants underwent SARS-CoV-2 antibody status testing before and after the sampling period. Questionnaires on attitudes and perception of the pandemic were administered in weeks 1, 6, and 12. Mathematical modeling was used to estimate SARS-CoV-2 spread in day care centers. MAIN OUTCOMES AND MEASURES The primary outcomes were acceptance of the respective surveillance protocols (feasibility study) and the estimated number of secondary infections (mathematical modeling). RESULTS Of 954 eligible individuals (772 children and 182 childcare workers), 592 (62%), including 442 children (median [IQR] age, 3 [2-4] years; 214 [48.6%] female) and 150 childcare workers (median [IQR] age, 29 [25-44] years; 129 [90.8%] female) participated in the surveillance. In total, 4755 tests for SARS-CoV-2 detected 2 infections (1 childcare worker and 1 adult household member). Acceptance for continuous surveillance was highest for biweekly saliva testing (150 of 221 eligible individuals [67.9%; 95% CI, 61.5%-73.7%]) compared with biweekly (51 of 117 individuals [43.6%; 95% CI, 35.0%-52.6%]) and weekly (44 of 128 individuals [34.4%; 95% CI, 26.7%-43.0%]) midturbinate swabbing (P < .001). Dropout rates were higher for midturbinate swabbing (biweekly, 11 of 62 participants [18%]; once weekly, 11 of 55 participants [20%]) than for saliva testing (6 of 156 participants [4%]). Mathematical modeling based on study and literature data identified biweekly testing of at least 50% of children and childcare workers as minimal requirements to limit secondary infections. CONCLUSIONS AND RELEVANCE In this nonrandomized controlled trial, surveillance for SARS-CoV-2 in 9 German day care centers was feasible and well accepted. Mathematical modeling estimated that testing can minimize the spread of SARS-CoV-2 in day care centers. These findings enable setup of surveillance programs to maintain institutional childcare. TRIAL REGISTRATION German Registry for Clinical Trials Identifier: DRKS00023721.
Collapse
Affiliation(s)
- Johannes Forster
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Paul Rudolph
- Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knoell-Institute, Jena, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Julia Wallstabe
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Sandra Timme
- Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knoell-Institute, Jena, Germany
| | - Franziska Pietsch
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Katrin Hartmann
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Maike Krauthausen
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Julia Schmidt
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Timo Ludwig
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - David Gierszewski
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Thomas Jans
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Geraldine Engels
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Benedikt Weißbrich
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Lars Dölken
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- Clinical Trial Center Wuerzburg, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christoph Härtel
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Marc Thilo Figge
- Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knoell-Institute, Jena, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
- Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knoell-Institute, Jena, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
24
|
Kern A, Kuhlmann PH, Matl S, Ege M, Maison N, Eckert J, von Both U, Behrends U, Anger M, Frühwald MC, Gerstlauer M, Woelfle J, Neubert A, Melter M, Liese J, Goettler D, Sing A, Liebl B, Hübner J, Klein C. Surveillance of Acute SARS-CoV-2 Infections in Elementary Schools and Daycare Facilities in Bavaria, Germany (09/2020-03/2021). Front Pediatr 2022; 10:888498. [PMID: 35874561 PMCID: PMC9298551 DOI: 10.3389/fped.2022.888498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Here we report our results of a multi-center, open cohort study ("COVID-Kids-Bavaria") investigating the distribution of acute SARS-CoV-2 infections among children and staff in 99 daycare facilities and 48 elementary schools in Bavaria, Germany. MATERIALS AND METHODS Overall, 2,568 children (1,337 school children, 1,231 preschool children) and 1,288 adults (466 teachers, 822 daycare staff) consented to participate in the study and were randomly tested in three consecutive phases (September/October 2020, November/December 2020, March 2021). In total, 7,062 throat swabs were analyzed for SARS-CoV-2 by commercial RT-PCR kits. RESULTS In phase I, only one daycare worker tested positive. In phase II, SARS-CoV-2 was detected in three daycare workers, two preschool children, and seven school children. In phase III, no sample tested positive. This corresponds to a positive test rate of 0.05% in phase I, 0.4% in phase II and 0% in phase III. Correlation of a positive PCR test result with the local-7-day incidence values showed a strong association of a 7-day-incidence of more than 100/100,000 as compared to <100/100,000 (OR = 10.3 [1.5-438], p < 0.005). After phase III, antibody testing was offered to 713 study participants in elementary schools. A seroprevalence rate of 7.7% (students) and 4.5% (teachers) was determined. DISCUSSION During the initial waves of the SARS-CoV-2 pandemic, the risk of a positive SARS-CoV-2 result correlated positively with the local 7-day incidence. Hence, the occurrence of SARS-CoV-2 infections were reflected in schools and daycare facilities. An increased risk of SARS-CoV-2 transmission in the setting of daycare and elementary schooling was unlikely.
Collapse
Affiliation(s)
- Anna Kern
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
| | - Pia H Kuhlmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
| | - Stefan Matl
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
| | - Markus Ege
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Nicole Maison
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany.,Helmholtz Center Munich, Institute for Asthma- and Allergy Prevention (IAP), German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Jana Eckert
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
| | - Ulrich von Both
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Uta Behrends
- Department of Pediatrics, Kinderklinik München Schwabing, StKM GmbH und Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Melanie Anger
- Department of Pediatrics, Kinderklinik München Schwabing, StKM GmbH und Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael C Frühwald
- Paediatric and Adolescent Medicine University Hospital Augsburg, Augsburg, Germany
| | - Michael Gerstlauer
- Paediatric and Adolescent Medicine University Hospital Augsburg, Augsburg, Germany
| | - Joachim Woelfle
- Department of Paediatric and Adolescent Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Antje Neubert
- Department of Paediatric and Adolescent Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Michael Melter
- University Children's Hospital Regensburg (KUNO), Regensburg, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Sing
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Bernhard Liebl
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Johannes Hübner
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
| | | |
Collapse
|
25
|
Hufnagel M, Simon A, Trapp S, Liese J, Reinke S, Klein W, Parlowsky T, Pfeil J, Renk H, Berner R, Hübner J, Kummer S, Tillmann R. Erratum zu: Antibiotische Standardtherapie häufiger Infektionskrankheiten in der ambulanten Pädiatrie. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
26
|
Wagenhäuser I, Knies K, Rauschenberger V, Eisenmann M, McDonogh M, Petri N, Andres O, Flemming S, Gawlik M, Papsdorf M, Taurines R, Böhm H, Forster J, Weismann D, Weißbrich B, Dölken L, Liese J, Kurzai O, Vogel U, Krone M. Clinical performance evaluation of SARS-CoV-2 rapid antigen testing in point of care usage in comparison to RT-qPCR. EBioMedicine 2021; 69:103455. [PMID: 34186490 PMCID: PMC8234263 DOI: 10.1016/j.ebiom.2021.103455] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Antigen rapid diagnostic tests (RDT) for SARS-CoV-2 are fast, broadly available, and inexpensive. Despite this, reliable clinical performance data from large field studies is sparse. METHODS In a prospective performance evaluation study, RDT from three manufacturers (NADAL®, Panbio™, MEDsan®, conducted on different samples) were compared to quantitative reverse transcription polymerase chain reaction (RT-qPCR) in 5 068 oropharyngeal swabs for detection of SARS-CoV-2 in a hospital setting. Viral load was derived from standardised RT-qPCR Cycle threshold (Ct) values. The data collection period ranged from November 12, 2020 to February 28, 2021. FINDINGS The sensitivity of RDT compared to RT-qPCR was 42·57% (95% CI 33·38%-52·31%). The specificity was 99·68% (95% CI 99·48%-99·80%). Sensitivity declined with decreasing viral load from 100% in samples with a deduced viral load of ≥108 SARS-CoV-2 RNA copies per ml to 8·82% in samples with a viral load lower than 104 SARS-CoV-2 RNA copies per ml. No significant differences in sensitivity or specificity could be observed between samples with and without spike protein variant B.1.1.7. The NPV in the study cohort was 98·84%; the PPV in persons with typical COVID-19 symptoms was 97·37%, and 28·57% in persons without or with atypical symptoms. INTERPRETATION RDT are a reliable method to diagnose SARS-CoV-2 infection in persons with high viral load. RDT are a valuable addition to RT-qPCR testing, as they reliably detect infectious persons with high viral loads before RT-qPCR results are available. FUNDING German Federal Ministry for Education and Science (BMBF), Free State of Bavaria.
Collapse
Affiliation(s)
- Isabell Wagenhäuser
- Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Str. 2 / E1, Wuerzburg 97080, Germany
| | - Kerstin Knies
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | | | - Michael Eisenmann
- Infection Control Unit, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Miriam McDonogh
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Nils Petri
- Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Oliver Andres
- Department of Paediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Sven Flemming
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Micha Gawlik
- Department of Psychiatry and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Papsdorf
- Department of Obstetrics and Gynaecology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Regina Taurines
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Hartmut Böhm
- Department of Oral and Maxillofacial Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Johannes Forster
- Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Str. 2 / E1, Wuerzburg 97080, Germany
| | - Dirk Weismann
- Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Benedikt Weißbrich
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Lars Dölken
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Johannes Liese
- Department of Paediatrics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Str. 2 / E1, Wuerzburg 97080, Germany; Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knoell-Institute, Jena, Germany
| | - Ulrich Vogel
- Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Str. 2 / E1, Wuerzburg 97080, Germany; Infection Control Unit, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Manuel Krone
- Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Str. 2 / E1, Wuerzburg 97080, Germany; Infection Control Unit, University Hospital Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany.
| |
Collapse
|
27
|
Röbl-Mathieu M, Kunstein A, Liese J, Mertens T, Wojcinski M. Vaccination in Pregnancy. Dtsch Arztebl Int 2021; 118:262-268. [PMID: 34114547 PMCID: PMC8287076 DOI: 10.3238/arztebl.m2021.0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 06/24/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vaccination during pregnancy can protect both the expecting mother and the unborn and newborn child from infectious diseases. METHODS This review is based on publications retrieved by a selective literature search on the immunological particularities of infectious diseases affecting pregnant women, unborn children, and neonates, with particular attention to the guidelines of the German Standing Committee on Vaccinations (Ständige Impfkommission, STIKO) and the pertinent guidelines. RESULTS Vaccination during pregnancy protects the expecting mother from a severe course of a number of different infectious diseases. Vaccination with inactivated vaccines against influenza, tetanus, and pertussis is effective, safe, and well tolerated. Women who are pregnant or of child-bearing age should be immunized against tetanus according to the STIKO recommendations. All pregnant women from the second trimester onward should receive an inactivated quadrivalent influenza vaccine. The immunity acquired after vaccination with an acellular pertussis vaccine is present only for a limited time. In a cohort study involving 72,781 pregnant women, pertussis vaccination during pregnancy was found to yield 91% protection against pertussis for their subsequently born children in the first three months of life. Further types of vaccine can also be given during pregnancy if indicated. 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 women of child-bearing age. Treating physicians play a crucial role in encouraging vaccine acceptance by their patients. CONCLUSION Maternal immunization is a safe and effective strategy for giving neo - nates passive immune protection against life-threatening infections by the vertical transmission of maternal antibodies until they are able to build up their own adaptive immunity.
Collapse
Affiliation(s)
- Marianne Röbl-Mathieu
- Gynecologist's office, Munich; Member of STIKOGynecologist's office, MunichDepartment of Pediatrics, University Hospital WürzburgInstitute of Virology, Ulm University Hospital, Ulm; Member of STIKOWorking Group Vaccination in Pregnancy, German Professional Association of Gynecologists, Munich
| | | | | | | | | |
Collapse
|
28
|
Kuntz M, Kohlfürst DS, Feiterna-Sperling C, Krüger R, Baumann U, Buchtala L, Elling R, Grote V, Hübner J, Hufnagel M, Kaiser-Labusch P, Liese J, Otto EM, Rose MA, Schneider C, Schuster V, Seidl M, Sommerburg O, Vogel M, von Bernuth H, Weiß M, Zimmermann T, Nieters A, Zenz W, Henneke P. Risk Factors for Complicated Lymphadenitis Caused by Nontuberculous Mycobacteria in Children. Emerg Infect Dis 2021; 26:579-586. [PMID: 32091372 PMCID: PMC7045849 DOI: 10.3201/eid2603.191388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) are an emerging cause of infections, including chronic lymphadenitis in children. To identify risk factors for NTM lymphadenitis, particularly complicated disease, we collected epidemiologic, clinical, and microbiological data on 138 cases of NTM lymphadenitis in children across 13 centers in Germany and Austria. We assessed lifestyle factors but did not identify specific risk behaviors. We noted that more cases of NTM lymphadenitis occurred during cold months than during warm months. Moreover, we noted female sex and age <5.5 years as potential risk factors. Complete extirpation of the affected lymph node appeared to be the best therapeutic measure. We integrated the study data to develop a simple risk score to predict unfavorable clinical outcomes for NTM lymphadenitis.
Collapse
|
29
|
Hecker A, Hecker M, Liese J, Kauffels-Sprenger A, Weigand MA, Coccolini F, Catena F, Sartelli M, Padberg W, Reichert M, Askevold I. [Summary and comments on the WSES guidelines on open abdomen in trauma and non-trauma patients]. Chirurg 2021; 92:344-349. [PMID: 33666667 DOI: 10.1007/s00104-021-01373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
The first edition of the World Society of Emergency Surgeons (WSES) guidelines on the indications and treatment of open abdomen in trauma as well as in non-trauma patients was published at the end of 2018. Publications from 1980 to 2017 were included in the evaluation. Based on the GRADE system each publication was checked for its evidence and evaluated in a Delphi process. In this article the aspects of the guidelines are presented and commented on.
Collapse
Affiliation(s)
- A Hecker
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland.
| | - M Hecker
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Gießen, Deutschland
| | - J Liese
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - A Kauffels-Sprenger
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - F Coccolini
- Klinik für Notfall- und Traumachirurgie, Bufalini Hospital, Cesena, Italien
| | - F Catena
- Klinik für Notfall- und Traumachirurgie, Parma Maggiore Hospital, Parma, Italien
| | | | - W Padberg
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - M Reichert
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - I Askevold
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| |
Collapse
|
30
|
Hanitsch L, Baumann U, Boztug K, Burkhard-Meier U, Fasshauer M, Habermehl P, Hauck F, Klock G, Liese J, Meyer O, Müller R, Pachlopnik-Schmid J, Pfeiffer-Kascha D, Warnatz K, Wehr C, Wittke K, Niehues T, von Bernuth H. Treatment and management of primary antibody deficiency: German interdisciplinary evidence-based consensus guideline. Eur J Immunol 2020; 50:1432-1446. [PMID: 32845010 DOI: 10.1002/eji.202048713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/25/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022]
Abstract
This evidence-based clinical guideline provides consensus-recommendations for the treatment and care of patients with primary antibody deficiencies (PADs). The guideline group comprised 20 clinical and scientific expert associations of the German, Swiss, and Austrian healthcare system and representatives of patients. Recommendations were based on results of a systematic literature search, data extraction, and evaluation of methodology and study quality in combination with the clinical expertise of the respective representatives. Consensus-based recommendations were determined via nominal group technique. PADs are the largest clinically relevant group of primary immunodeficiencies. Most patients with PADs present with increased susceptibility to infections, however immune dysregulation, autoimmunity, and cancer affect a significant number of patients and may precede infections. This guideline therefore covers interdisciplinary clinical and therapeutic aspects of infectious (e.g., antibiotic prophylaxis, management of bronchiectasis) and non-infectious manifestations (e.g., management of granulomatous disease, immune cytopenia). PADs are grouped into disease entities with definitive, probable, possible, or unlikely benefit of IgG-replacement therapy. Summary and consensus-recommendations are provided for treatment indication, dosing, routes of administration, and adverse events of IgG-replacement therapy. Special aspects of concomitant impaired T-cell function are highlighted as well as clinical data on selected monogenetic inborn errors of immunity formerly classified into PADs (APDS, CTLA-4-, and LRBA-deficiency).
Collapse
Affiliation(s)
- Leif Hanitsch
- Institute for Medical Immunology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Ulrich Baumann
- Department of Paediatric Pulmonology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Kaan Boztug
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Department of Pediatrics and Adolescent Medicine and St. Anna Kinderspital and Children's Cancer Research Institute, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Maria Fasshauer
- ImmunoDeficiencyCenter Leipzig (IDCL), Hospital St. Georg gGmbH Leipzig, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
| | | | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gerd Klock
- Technische Universität Darmstadt, Clemens-Schöpf-Institut für Organische Chemie & Biochemie, Darmstadt, Germany
| | - Johannes Liese
- Pediatric Immunology, Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Oliver Meyer
- Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rainer Müller
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Jana Pachlopnik-Schmid
- Division of Immunology, University Children's Hospital Zurich and University of Zurich, Switzerland
| | | | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claudia Wehr
- Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kirsten Wittke
- Institute for Medical Immunology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Tim Niehues
- Department of Pediatrics, Helios Klinikum Krefeld, Krefeld, Germany
| | - Horst von Bernuth
- Department of Immunology, Labor Berlin Charité - Vivantes GmbH, Berlin, Germany.,Berlin Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
31
|
Rose MA, Barker M, Liese J, Adams O, Ankermann T, Baumann U, Brinkmann F, Bruns R, Dahlheim M, Ewig S, Forster J, Hofmann G, Kemen C, Lück C, Nadal D, Nüßlein T, Regamey N, Riedler J, Schmidt S, Schwerk N, Seidenberg J, Tenenbaum T, Trapp S, van der Linden M. [Guidelines for the Management of Community Acquired Pneumonia in Children and Adolescents (Pediatric Community Acquired Pneumonia, pCAP) - Issued under the Responsibility of the German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Pulmonology (GPP)]. Pneumologie 2020; 74:515-544. [PMID: 32823360 DOI: 10.1055/a-1139-5132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The present guideline aims to improve the evidence-based management of children and adolescents with pediatric community-acquired pneumonia (pCAP). Despite a prevalence of approx. 300 cases per 100 000 children per year in Central Europe, mortality is very low. Prevention includes infection control measures and comprehensive immunization. The diagnosis can and should be established clinically by history, physical examination and pulse oximetry, with fever and tachypnea as cardinal features. Additional signs or symptoms such as severely compromised general condition, poor feeding, dehydration, altered consciousness or seizures discriminate subjects with severe pCAP from those with non-severe pCAP. Within an age-dependent spectrum of infectious agents, bacterial etiology cannot be reliably differentiated from viral or mixed infections by currently available biomarkers. Most children and adolescents with non-severe pCAP and oxygen saturation > 92 % can be managed as outpatients without laboratory/microbiology workup or imaging. Anti-infective agents are not generally indicated and can be safely withheld especially in children of young age, with wheeze or other indices suggesting a viral origin. For calculated antibiotic therapy, aminopenicillins are the preferred drug class with comparable efficacy of oral (amoxicillin) and intravenous administration (ampicillin). Follow-up evaluation after 48 - 72 hours is mandatory for the assessment of clinical course, treatment success and potential complications such as parapneumonic pleural effusion or empyema, which may necessitate alternative or add-on therapy.
Collapse
Affiliation(s)
- M A Rose
- Fachbereich Medizin, Johann-Wolfgang-Goethe-Universität Frankfurt/Main und Zentrum für Kinder- und Jugendmedizin, Klinikum St. Georg Leipzig
| | - M Barker
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Emil von Behring, Berlin
| | - J Liese
- Kinderklinik und Poliklinik, Universitätsklinikum an der Julius-Maximilians-Universität Würzburg, Würzburg
| | - O Adams
- Institut für Virologie, Universitätsklinikum Düsseldorf
| | - T Ankermann
- Klinik für Kinder- und Jugendmedizin 1, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - U Baumann
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - F Brinkmann
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ruhr-Universität Bochum
| | - R Bruns
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - M Dahlheim
- Praxis für Kinderpneumologie und Allergologie, Mannheim
| | - S Ewig
- Kliniken für Pneumologie und Infektiologie, Thoraxzentrum Ruhrgebiet, Bochum/Herne
| | - J Forster
- Kinderabteilung St. Hedwig, St. Josefskrankenhaus , Freiburg und Merzhausen
| | | | - C Kemen
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg
| | - C Lück
- Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden
| | - D Nadal
- Kinderspital Zürich, Schweiz
| | - T Nüßlein
- Klinik für Kinder- und Jugendmedizin, Gemeinschaftsklinikum Mittelrhein, Koblenz
| | - N Regamey
- Pädiatrische Pneumologie, Kinderspital Luzern, Schweiz
| | - J Riedler
- Kinder- und Jugendmedizin, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Österreich
| | - S Schmidt
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - N Schwerk
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - J Seidenberg
- Klinik für pädiatrische Pneumologie und Allergologie, Neonatologie, Intensivmedizin und Kinderkardiologie, Klinikum Oldenburg
| | - T Tenenbaum
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim
| | | | - M van der Linden
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Aachen
| |
Collapse
|
32
|
Schlag S, Liese J, Veldhoen S. [Acute abdomen with Bilious Vomiting - A Linseed Bezoar as a Rare Cause of an Obstructive Ileus in an Anorexic Adolescent]. Klin Padiatr 2020; 233:72-74. [PMID: 32455437 DOI: 10.1055/a-1170-7435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Akute Bauchschmerzen im Kindes- und Jugendalter sind ein häufiger Grund ärztlicher
Konsultation. Die Ätiologien der Beschwerden sind vielfältig und oft eine
diagnostische Herausforderung für den Kliniker. Komplizierend führen auch
extraabdominelle Erkrankungen zum Leitsymptom „Bauchschmerzen“. Wichtig ist die
Unterscheidung zwischen akuten Krankheitsbildern, die einer sofortigen
diagnostischen oder therapeutischen, ggf. auch chirurgischen Intervention bedürfen
und denen, die zunächst beobachtet werden können. Auch müssen lebensbedrohliche
Zustände erkannt und rasch behandelt werden. Die Schmerzursachen unterscheiden sich
je nach Alter und Vorgeschichte der Patienten erheblich, so kann bspw. ein
mechanischer Ileus auf dem Boden unterschiedlichster Erkrankungen entstehen (Yang
WC, Chen CY, Wu HP. Etiology of non-traumatic acute abdomen in pediatric emergency
departments. World J Clin Cases 2013; 1(9): 276–284). Im vorgestellten Fall soll die
Schwierigkeit der ätiologischen Zuordnung eines mechanischen Ileus aufgezeigt
werden.
Collapse
|
33
|
Oppelt PU, Askevold I, Bender F, Liese J, Padberg W, Hecker A, Reichert M. Morgagni-Larrey diaphragmatic hernia repair in adult patients: a retrospective single-center experience. Hernia 2020; 25:479-489. [PMID: 32112200 PMCID: PMC8055631 DOI: 10.1007/s10029-020-02147-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 02/06/2020] [Indexed: 01/13/2023]
Abstract
Purpose Morgagni−Larrey congenital diaphragmatic hernia (MLH) is rare in adult patients and surgery is performed infrequently. The evidence regarding the most beneficial treatment modality is low. Nevertheless, with increasing experience in minimally-invasive surgery, the literature proves the laparoscopic approach as being safely feasible. However, knowledge on the disease as well as treatment options are based on single surgeon’s experiences and small case series in the literature. Methods Retrospective single-center analysis on adult patients (≥ 18 years) with MLH from 01/2003 to 06/2019 regarding symptoms, hernia sac contents, surgical technique and perioperative outcome. Results 4.0% of diaphragmatic hernia repair procedures were performed for MLH (n = 11 patients). 27.3% of these patients were asymptomatic. Dyspnea or gastrointestinal symptoms were frequently observed (both in 45.5% of the patients). Colon transversum (63.6%), omentum majus (45.5%) and/or stomach (27.3%) were the most common hernia sac contents. Correct diagnosis was achieved preoperatively in 10/11 patients by cross-sectional imaging. All procedures were performed by trans-abdominal surgery (laparotomy in four and laparoscopy in seven patients). All hernias were reinforced by mesh after primary closure. No differences were observed in the perioperative outcome between patients who underwent hernia repair by laparotomy versus laparoscopy. Pleural complications requiring drainage were the most common postoperative complications. Conclusion MLH repair seems to be safely feasible by laparoscopic surgery. The benefit of mesh augmentation in MLH repair is not clear yet. In contrast to the current literature, all patients in this study received mesh augmentation after primary closure of the hernia. This should be evaluated in larger patient cohorts with long-term follow-up.
Collapse
Affiliation(s)
- P U Oppelt
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - I Askevold
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - F Bender
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - J Liese
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - W Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - A Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - M Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany.
| |
Collapse
|
34
|
Hofmann CE, Harmatz P, Vockley J, Högler W, Nakayama H, Bishop N, Martos-Moreno GÁ, Moseley S, Fujita KP, Liese J, Rockman-Greenberg C. Efficacy and Safety of Asfotase Alfa in Infants and Young Children With Hypophosphatasia: A Phase 2 Open-Label Study. J Clin Endocrinol Metab 2019; 104:2735-2747. [PMID: 30811537 PMCID: PMC6530655 DOI: 10.1210/jc.2018-02335] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/22/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Long-term data on enzyme replacement treatment of hypophosphatasia (HPP) are limited. OBJECTIVE To evaluate efficacy and safety of asfotase alfa in patients aged ≤5 years with HPP followed for up to 6 years. DESIGN Phase 2 open-label study (July 2010 to September 2016). SETTING Twenty-two sites; 12 countries. PARTICIPANTS Sixty-nine patients [median (range) age: 16.0 (0.02 to 72) months] with severe HPP and sign/symptom onset before age 6 months. INTERVENTION Asfotase alfa 2 mg/kg three times/week or 1 mg/kg six times/week subcutaneously. MAIN OUTCOME MEASURES Primary efficacy measure: Radiographic Global Impression of Change (RGI-C) score [-3 (severe worsening) to +3 (complete/near-complete healing)]. Additional outcome measures: respiratory status, growth, and safety. Post hoc analysis: characteristics of radiographic responders vs nonresponders at Year 1 (RGI-C: ≥+2 vs <+2). RESULTS During median (minimum, maximum) 2.3 (0.02, 5.8) years of treatment, RGI-C scores improved significantly at Month 6 [+2.0 (-1.7, +3.0)], Year 1 [+2.0 (-2.3, +3.0)], and Last Assessment [+2.3 (-2.7, +3.0); P < 0.0001 all]. Of 24 patients requiring respiratory support at Baseline, 11 (46%) no longer needed support. Height/weight z scores generally increased. Nine patients died (13%). All patients experienced at least one adverse event; pyrexia was most common. Compared with responders [n = 50 (72%)], nonresponders [n = 19 (28%)] had more severe disease at Baseline and a higher rate of neutralizing antibodies (NAbs) at Last Assessment. CONCLUSIONS Most infants/young children given asfotase alfa showed early radiographic and clinical improvement sustained up to 6 years; radiographic nonresponders had more severe disease and more frequent NAbs at Last Assessment.
Collapse
Affiliation(s)
- Christine E Hofmann
- University Children’s Hospital, University of Würzburg, Würzburg, Germany
- Correspondence and Reprint Requests: Christine E. Hofmann, MD, University Children’s Hospital, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany. E-mail:
| | - Paul Harmatz
- University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, California
| | - Jerry Vockley
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Wolfgang Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University, Linz, Austria
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Nick Bishop
- Sheffield Children’s Hospital, Sheffield, United Kingdom
- University of Sheffield, Sheffield, United Kingdom
| | - Gabriel Á Martos-Moreno
- Hospital Infantil Universitario Niño Jesús, IIS La Princesa, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Scott Moseley
- Alexion Pharmaceuticals, Inc., Boston, Massachusetts
| | | | - Johannes Liese
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Cheryl Rockman-Greenberg
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | |
Collapse
|
35
|
Whyte MP, Leung E, Wilcox WR, Liese J, Argente J, Martos-Moreno GÁ, Reeves A, Fujita KP, Moseley S, Hofmann C. Natural History of Perinatal and Infantile Hypophosphatasia: A Retrospective Study. J Pediatr 2019; 209:116-124.e4. [PMID: 30979546 DOI: 10.1016/j.jpeds.2019.01.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To report clinical characteristics and medical history data obtained retrospectively for a large cohort of pediatric patients with perinatal and infantile hypophosphatasia. STUDY DESIGN Medical records from academic medical centers known to diagnose and/or treat hypophosphatasia were reviewed. Patients born between 1970 and 2011 with hypophosphatasia and any of the following signs/symptoms at age <6 months were eligible: vitamin B6-dependent seizures, respiratory compromise, or rachitic chest deformity (NCT01419028). Patient demographics and characteristics, respiratory support requirements, invasive ventilator-free survival, and further complications of hypophosphatasia were followed for up to the first 5 years of life. RESULTS Forty-eight patients represented 12 study sites in 7 countries; 13 patients were alive, and 35 were dead (including 1 stillborn). Chest deformity, respiratory distress, respiratory failure (as conditioned by the eligibility criteria), failure to thrive, and elevated calcium levels were present in >70% of patients between birth and age 5 years. Vitamin B6-dependent seizures and respiratory distress and failure were associated significantly (P < .05) with the risk of early death. Serum alkaline phosphatase activity in all 41 patients tested (mean [SD]: 18.1 [15.4] U/L) was below the mean lower limit of normal of the reference ranges of the various laboratories (88.2 U/L). Among the 45 patients with relevant data, 29 had received respiratory support, of whom 26 had died at the time of data collection. The likelihood of invasive ventilator-free survival for this cohort decreased to 63% at 3 months, 54% at 6 months, 31% at 12 months, and 25% at 5 years. CONCLUSIONS Patients with perinatal or infantile hypophosphatasia and vitamin B6-dependent seizures, with or without significant respiratory distress or chest deformities, have high morbidity and mortality in the first 5 years of life. TRIAL REGISTRATION ClinicalTrials.gov: NCT01419028.
Collapse
Affiliation(s)
- Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St Louis, MO; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO.
| | - Edward Leung
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William R Wilcox
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA
| | - Johannes Liese
- University Children's Hospital, University of Würzburg, Würzburg, Germany
| | - Jesús Argente
- Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, CIBERobn, ISCIII, IMDEA Food Institute, CEIUAM+CSIC, Madrid, Spain
| | - Gabriel Á Martos-Moreno
- Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, CIBERobn, ISCIII, IMDEA Food Institute, CEIUAM+CSIC, Madrid, Spain
| | - Amy Reeves
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St Louis, MO
| | - Kenji P Fujita
- Clinical Research, Alexion Pharmaceuticals, Inc, Boston, MA
| | - Scott Moseley
- Biostatistics, Alexion Pharmaceuticals, Inc, Boston, MA
| | - Christine Hofmann
- University Children's Hospital, University of Würzburg, Würzburg, Germany
| | | |
Collapse
|
36
|
Tenenbaum T, Papan C, Porwoll M, Hakim U, Argentiero A, Testa I, Pasticci MB, Mezzetti D, Perruccio K, Etshtein L, Mastboim N, Cohen A, Simon E, Boico O, Shani L, Gottlieb T, Navon R, Oved K, Eden E, Simon A, Liese J, Knuf M, Schneider S, Farinelli E, Esposito S. 1962. TRAIL Level and ImmunoXpert™ Score Complement Molecular Viral Detection in the Classification of Febrile Children: An Interim Analysis From the AutoPilotDx-Study. Open Forum Infect Dis 2018. [PMCID: PMC6252596 DOI: 10.1093/ofid/ofy210.1618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Differentiating between viral and bacterial etiology is essential in order to enable the adequate use of antibiotics. Previous studies showed that TNF-related apoptosis induced ligand (TRAIL) can serve as a useful biomarker for distinguishing between bacterial and viral infections when combined with IP-10 and CRP (ImmunoXpert™). Here we evaluate the potential of a new proteomic fingerprints in children with suspected viral and bacterial infections that had a confirmed viral detection. Methods In the prospective multinational multicenter study “AutoPilot-Dx” (NCT03052088) we aim to validate the diagnostic accuracy of the ImmunoXpert™ test. Infection etiology was assigned by majority adjudication of three experts based on comprehensive clinical and laboratory investigation. Viruses were detected using multiplex-PCR applied to nasopharyngeal swabs (Allplex™, Seegene). We performed an interim analysis of the first 134 febrile children recruited that had both PCR viral detection and etiology determination. TRAIL, IP-10, CRP and ImmunoXpert™ values were measured via a Tecan EVO75 ELISA platform. Results Bacterial diagnoses were assigned by the experts to 29%, 29% and 25% of patients with adenovirus (ADV), rhinovirus (RV), and respiratory syncytial virus (RSV) detection, respectively. Children with a viral infection including ADV, RSV, and RV had significantly lower ImmunoXpert™ scores as compared with children with a bacterial infection. Notably, TRAIL levels were markedly increased in viral infections as compared with bacterial infection, irrespective of the detected virus. Conclusion Classification of viral infections correlated significantly with elevated TRAIL levels and low ImmunoXpert™ scores. The differential expression of TRAIL in response to viral vs. bacterial infections can complement molecular viral detection, appears useful in the diagnostic workup for febrile children and may reduce antibiotic misuse. Disclosures L. Etshtein, MeMed Diagnostics: Employee, Salary. N. Mastboim, MeMed Diagnostics: Employee, Salary. A. Cohen, MeMed Diagnostics: Employee, Salary. E. Simon, MeMed: Employee, Salary. O. Boico, MeMed Diagnostics: Employee, Salary. L. Shani, MeMed Diagnostics: Employee, Salary. T. Gottlieb, MeMed Diagnostics: Employee, Salary. R. Navon, MeMed Diagnostics: Employee, Salary. K. Oved, MeMed Diagnostics: Board Member, Employee and Shareholder, Salary. E. Eden, MeMed Diagnostics: Board Member, Employee and Shareholder, Salary.
Collapse
Affiliation(s)
- Tobias Tenenbaum
- Pediatric Infectious Diseases and Pulmonology, University Children`s Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Cihan Papan
- University Children’s Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Marian Porwoll
- University Children’s Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Ummaya Hakim
- University Children’s Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Alberto Argentiero
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Ilaria Testa
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Maria Bruna Pasticci
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Daniele Mezzetti
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Katia Perruccio
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | | | | | - Asi Cohen
- MeMed Diagnostics, Tirat Carmel, Israel
| | | | | | | | | | - Roy Navon
- MeMed Diagnostics, Tirat Carmel, Israel
| | - Kfir Oved
- MeMed Diagnostics, Tirat Carmel, Israel
| | - Eran Eden
- MeMed Diagnostics, Tirat Carmel, Israel
| | - Arne Simon
- Pediatric Oncology and Haematology, Saarland University Hospital, Homburg, Germany
| | - Johannes Liese
- Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Markus Knuf
- Children’s Hospital, Dr. Horst Schmidt Klinik, Wiesbaden, Germany
| | - Sven Schneider
- Institute for Clinical Chemistry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Edoardo Farinelli
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| |
Collapse
|
37
|
Liese J, Lippmann J, Fulda S. PO-433 The modulation of redox homeostasis and induction of ferroptotic cell death in hepatocellular carcinoma as an anticancer strategy. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
38
|
Peter S, Bezdan D, Oberhettinger P, Vogel W, Dörfel D, Dick J, Marschal M, Liese J, Weidenmaier C, Autenrieth I, Ossowski S, Willmann M. Whole-genome sequencing enabling the detection of a colistin-resistant hypermutating Citrobacter werkmanii strain harbouring a novel metallo-β-lactamase VIM-48. Int J Antimicrob Agents 2018; 51:867-874. [DOI: 10.1016/j.ijantimicag.2018.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 11/27/2022]
|
39
|
Abstract
ZusammenfassungHereditäre Störungen der Granulozyten betreffen das angeborene Immunsystem („innate immunity“). Sie lassen sich in Erkrankungen mit quantitativer Reduktion und funktionellen Störungen der Granulozyten/Phagozyten einteilen. Sie können ferner isoliert oder als Begleitsymptom weiterer Störungen auftreten. Pathogenetisch sind Mutationen in so unterschiedlichen Molekülen wie Enzymen, Transkriptionsfaktoren, Adhäsionsproteinen und Strukturproteinen ursächlich beteiligt. Der folgende Übersichtsartikel stellt die Krankheitsbilder schwere kongenitale Neutropenie, zyklische Neutropenie, Shwachman-Diamond-Syndrom, Glykogenose Ib, Chediak-Higashi-Syndrom, Dyskeratosis congenita, Knorpel-Haar-Hypoplasie, Leukozytenadhäsionsdefekte I-III, ß-Actin-Defizienz, RAC-2-Defizienz, spezifischer Granula-Defekt, Glukose-6-Phosphat-Dehydrogenase sowie chronische Granulomatose vor.
Collapse
|
40
|
Omeñaca F, Vázquez L, Garcia-Corbeira P, Mesaros N, Hanssens L, Dolhain J, Gómez IP, Liese J, Knuf M. Immunization of preterm infants with GSK's hexavalent combined diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine: A review of safety and immunogenicity. Vaccine 2018; 36:986-996. [PMID: 29336924 DOI: 10.1016/j.vaccine.2018.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/20/2017] [Accepted: 01/04/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Infants with history of prematurity (<37 weeks gestation) and low birth weight (LBW, <2500 g) are at high risk of infection due to functional immaturity of normal physical and immunological defense mechanisms. Despite current recommendations that infants with history of prematurity/LBW should receive routine immunization according to the same schedule and chronological age as full-term infants, immunization is often delayed. METHODS Here we summarize 10 clinical studies and 15 years of post-marketing safety surveillance of GSK's hexavalent vaccine (DTPa-HBV-IPV/Hib), a combined diphtheria-tetanus-acellular-pertussis-hepatitis-B-inactivated-poliovirus-Haemophilus influenzae-type-b (Hib) conjugate vaccine, when administered alone, or co-administered with pneumococcal conjugate, rotavirus, and meningococcal vaccines and respiratory syncytial virus IgG to infants with history of prematurity/LBW in clinical trials. RESULTS At least 92.5% of infants with history of prematurity/LBW as young as 24 weeks gestation in clinical studies were seropositive to all vaccine antigens after 3-dose primary vaccination with GSK's hexavalent DTPa-HBV-IPV/Hib vaccine, with robust immune responses to booster vaccination. Seropositivity rates and antibody concentrations to hepatitis B and Hib appeared lower in infants with history of prematurity/LBW than term infants. Between 13-30% of medically stable infants with history of prematurity developed apnea after vaccination with GSK's hexavalent DTPa-HBV-IPV/Hib vaccine; usually after dose 1. The occurrence of post-immunization cardiorespiratory events appears to be influenced by the severity of any underlying neonatal condition. Most cardiorespiratory events resolve spontaneously or require minimal intervention. GSK's hexavalent DTPa-HBV-IPV/Hib vaccine was well tolerated in co-administration regimens. CONCLUSION GSK's hexavalent DTPa-HBV-IPV/Hib vaccine alone or co-administered with other pediatric vaccines has a clinically acceptable safety and immunogenicity profile when used in infants with history of prematurity/LBW for primary and booster vaccination. Additional studies are needed in very premature and very LBW infants. However, currently available data support using GSK's hexavalent DTPa-HBV-IPV/Hib vaccine to immunize infants with history of prematurity/LBW according to chronological age.
Collapse
Affiliation(s)
- Felix Omeñaca
- Hospital Infantil La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Liliana Vázquez
- Fundación Centro de Estudios Infectológicos, C1425AWK Buenos Aires, Argentina.
| | - Pilar Garcia-Corbeira
- GSK, Parque Tecnológico de Madrid, Calle de Severo Ochoa, 2, 28760 Tres Cantos, Madrid, Spain.
| | | | | | | | | | - Johannes Liese
- Department of Paediatrics, Paediatric Infectious Diseases and Immunology, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany.
| | - Markus Knuf
- HELIOS Dr. Horst Schmidt Kliniken, Children's Hospital, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany.
| |
Collapse
|
41
|
Almanzar G, Schmalzing M, Trippen R, Höfner K, Weißbrich B, Geissinger E, Meyer T, Liese J, Tony HP, Prelog M. Significant IFNγ responses of CD8+ T cells in CMV-seropositive individuals with autoimmune arthritis. J Clin Virol 2016; 77:77-84. [PMID: 26921739 DOI: 10.1016/j.jcv.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/27/2016] [Accepted: 02/16/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Latent Cytomegalovirus (CMV) infection accelerates immunosenescence in elderly with reactivations reported in Rheumatoid Arthritis (RA) and abnormal responses towards CMV in Juvenile Idiopathic Arthritis (JIA). OBJECTIVES Considering the signs of premature T-cell immunosenescence in arthritis patients, the known effect of CMV latency on speeding up many of these signs in an age-dependent manner and the role of CMV on IFNγ-mediated inflammation in healthy elderly and RA, we hypothesized that latent CMV infection accelerates TCR repertoire restriction, loss of CD28, peripheral T-cell proliferation and aberrant IFNγ responses in arthritis patients. STUDY DESIGN Unspecific and CMVpp65-specific IFNγ responses were investigated in peripheral CD8+ T-cells in RA or JIA patients and healthy, age-matched controls. RESULTS Despite higher prevalence and concentrations of IgG-anti-CMV, arthritis patients showed lower unspecific IFNγ production, lower CD69-mediated activation and lower CD8+ T-cell proliferation. CMV-seropositive RA patients showed higher intracellular IFNγ production and increased proportions of CD28-CD8+ T-cells after specific CMVpp65 long-term stimulation which was not altered by in vitro blockade of TNFα or IL-6. A skewed TCR repertoire towards oligoclonality and less polyclonality was found in JIA. DISCUSSION CMVpp65-specific IFNγ production with expansion of CD28-CD8+ T-cells suggests an efficient control of latent CMV regardless of immunosuppressive therapy or in vitro blockade of TNFα or IL-6 in CMV-seropositive arthritis patients. Increased IgG-anti-CMV antibody concentrations and increased proportions of intracellular IFNγ-producing CMVpp65-specific CD8+ T-cells in long-term cultures propose a possibly role of endogenous CMV reactivations boosting antibody levels and a higher possibly CMV-driven IFNγ-mediated inflammatory potential of CD8+ T-cells in arthritis patients.
Collapse
Affiliation(s)
- Giovanni Almanzar
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany.
| | - Marc Schmalzing
- Department of Internal Medicine II, Rheumatology and Immunology, University Hospital Würzburg, Würzburg, Germany
| | - Raimund Trippen
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Kerstin Höfner
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Benedikt Weißbrich
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Eva Geissinger
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Thomas Meyer
- Pediatric Surgery Unit, Department of Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Hans-Peter Tony
- Department of Internal Medicine II, Rheumatology and Immunology, University Hospital Würzburg, Würzburg, Germany
| | - Martina Prelog
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| |
Collapse
|
42
|
Herbst M, Gazendam R, Reimnitz D, Sawalle-Belohradsky J, Groll A, Schlegel PG, Belohradsky B, Renner E, Klepper J, Grimbacher B, Kuijpers T, Liese J. Chronic Candida albicans Meningitis in a 4-Year-Old Girl with a Homozygous Mutation in the CARD9 Gene (Q295X). Pediatr Infect Dis J 2015; 34:999-1002. [PMID: 25933095 DOI: 10.1097/inf.0000000000000736] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A 4-year-old Turkish girl of consanguineous parents was hospitalized for the evaluation of headaches and recurrent febrile episodes of unknown origin. Her medical history was unremarkable except for a few episodes of uncomplicated oral thrush. Meningitis was diagnosed, and Candida albicans was the only pathogen identified by polymerase chain reaction and culture. Despite systemic antifungal multidrug therapy, a prolonged course of 16 months of therapy was necessary to clear C. albicans from the cerebrospinal fluid. Molecular genetic analysis revealed a homozygous caspase recruitment domain 9 (CARD9) mutation (Q295X), which was reported to predispose to chronic mucocutaneous candidiasis. Immunologic workup excluded predisposing B-cell and T-cell defects. In addition, T cells producing interleukin-17 were repeatedly measured within the normal range. Analyses of neutrophils demonstrated normal nicotinamide adenine dinucleotide phosphate oxidase activity in response to various stimuli including Staphylococcus aureus and C. albicans. Additional neutrophilic functional testing, however, showed a decreased cytotoxicity to nonopsonized C. albicans, indicating an impaired killing mechanism against Candida spp. independent from the production of reactive oxygen species by the nicotinamide adenine dinucleotide phosphate oxidase system. Because this defect was only demonstrated in the absence of opsonins, it might especially predispose to chronic C. albicans infections in the central nervous system where opsonin concentrations are usually low. We, therefore, suggest that due to an additional neutrophil dependent defect CARD9 deficiency predisposes not only to chronic mucocutaneous candidiasis, but also to invasive chronic Candida infections, especially of the central nervous system.
Collapse
Affiliation(s)
- Martin Herbst
- From the *Department of Pediatrics, Pediatric Infectious Diseases and Immunology, University of Wuerzburg, Germany; †Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, The Netherlands; ‡Department of Pediatrics, Hospital Aschaffenburg, Germany; §University Children's Hospital at Dr. von Haunersches Kinderspital, Ludwig Maximilians University, Munich, Germany; ¶Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster, Germany; ‖Center for Chronic Immunodeficiency, University of Freiburg, Germany; and **Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Hofmann C, Rockman-Greenberg C, Harmatz P, Moseley S, Odrljin T, Liese J. Improvement in bone manifestations and respiratory status in infants and young children with HPP treated with asfotase alfa: an update on the ENB-010-10 trial. ACTA ACUST UNITED AC 2015. [DOI: 10.1530/boneabs.4.oc18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
44
|
Rieber N, Singh A, Öz H, Carevic M, Bouzani M, Amich J, Ost M, Ye Z, Ballbach M, Schäfer I, Mezger M, Klimosch SN, Weber ANR, Handgretinger R, Krappmann S, Liese J, Engeholm M, Schüle R, Salih HR, Marodi L, Speckmann C, Grimbacher B, Ruland J, Brown GD, Beilhack A, Loeffler J, Hartl D. Pathogenic fungi regulate immunity by inducing neutrophilic myeloid-derived suppressor cells. Cell Host Microbe 2015; 17:507-14. [PMID: 25771792 PMCID: PMC4400268 DOI: 10.1016/j.chom.2015.02.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/17/2014] [Accepted: 01/26/2015] [Indexed: 01/19/2023]
Abstract
Despite continuous contact with fungi, immunocompetent individuals rarely develop pro-inflammatory antifungal immune responses. The underlying tolerogenic mechanisms are incompletely understood. Using both mouse models and human patients, we show that infection with the human pathogenic fungi Aspergillus fumigatus and Candida albicans induces a distinct subset of neutrophilic myeloid-derived suppressor cells (MDSCs), which functionally suppress T and NK cell responses. Mechanistically, pathogenic fungi induce neutrophilic MDSCs through the pattern recognition receptor Dectin-1 and its downstream adaptor protein CARD9. Fungal MDSC induction is further dependent on pathways downstream of Dectin-1 signaling, notably reactive oxygen species (ROS) generation as well as caspase-8 activity and interleukin-1 (IL-1) production. Additionally, exogenous IL-1β induces MDSCs to comparable levels observed during C. albicans infection. Adoptive transfer and survival experiments show that MDSCs are protective during invasive C. albicans infection, but not A. fumigatus infection. These studies define an innate immune mechanism by which pathogenic fungi regulate host defense. Pathogenic fungi induce myeloid-derived suppressor cells (MDSCs) MDSC induction involves Dectin-1/CARD9, ROS, caspase-8, and IL-1 MDSCs dampen T and NK cell immune responses Adoptive transfer of MDSCs improves survival in Candida infection in vivo
Collapse
Affiliation(s)
- Nikolaus Rieber
- Department of Pediatrics I, University of Tübingen, 72076 Tübingen, Germany.
| | - Anurag Singh
- Department of Pediatrics I, University of Tübingen, 72076 Tübingen, Germany
| | - Hasan Öz
- Department of Pediatrics I, University of Tübingen, 72076 Tübingen, Germany
| | - Melanie Carevic
- Department of Pediatrics I, University of Tübingen, 72076 Tübingen, Germany
| | - Maria Bouzani
- Department of Medicine II, University of Würzburg, 97080 Würzburg, Germany
| | - Jorge Amich
- IZKF Research Group for Experimental Stem Cell Transplantation, Department of Medicine II, 97080 Würzburg, Germany
| | - Michael Ost
- Department of Pediatrics I, University of Tübingen, 72076 Tübingen, Germany
| | - Zhiyong Ye
- Department of Pediatrics I, University of Tübingen, 72076 Tübingen, Germany; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Marlene Ballbach
- Department of Pediatrics I, University of Tübingen, 72076 Tübingen, Germany
| | - Iris Schäfer
- Department of Pediatrics I, University of Tübingen, 72076 Tübingen, Germany
| | - Markus Mezger
- Department of Pediatrics I, University of Tübingen, 72076 Tübingen, Germany
| | - Sascha N Klimosch
- Institute of Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
| | - Alexander N R Weber
- Institute of Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
| | | | - Sven Krappmann
- Microbiology Institute - Clinical Microbiology, Immunology and Hygiene, University Hospital of Erlangen and Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Johannes Liese
- Department of Pediatrics, University of Würzburg, 97080 Würzburg, Germany
| | - Maik Engeholm
- Department of Neurology, University of Tübingen, 72076 Tübingen, Germany
| | - Rebecca Schüle
- Department of Neurology, University of Tübingen, 72076 Tübingen, Germany
| | | | - Laszlo Marodi
- Department of Infectious and Pediatric Immunology, Medical and Health Science Center, University of Debrecen, 4032 Debrecen, Hungary
| | - Carsten Speckmann
- Centre of Chronic Immunodeficiency (CCI), University Medical Center Freiburg and University of Freiburg, 79106 Freiburg, Germany
| | - Bodo Grimbacher
- Centre of Chronic Immunodeficiency (CCI), University Medical Center Freiburg and University of Freiburg, 79106 Freiburg, Germany
| | - Jürgen Ruland
- Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Gordon D Brown
- Aberdeen Fungal Group, Section of Immunology and Infection, University of Aberdeen, AB24 3FX Aberdeen, UK
| | - Andreas Beilhack
- IZKF Research Group for Experimental Stem Cell Transplantation, Department of Medicine II, 97080 Würzburg, Germany
| | - Juergen Loeffler
- Department of Medicine II, University of Würzburg, 97080 Würzburg, Germany
| | - Dominik Hartl
- Department of Pediatrics I, University of Tübingen, 72076 Tübingen, Germany.
| |
Collapse
|
45
|
Guiso N, Liese J, Plotkin S. The Global Pertussis Initiative: Meeting report from the fourth regional roundtable meeting, France, April 14-15, 2010. Human Vaccines 2014; 7:481-8. [DOI: 10.4161/hv.7.4.14528] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
46
|
Almanzar G, Bienenstein E, Höfner K, Schmalzing M, Tony HP, Liese J, Prelog M. AB0034 IFN-Gamma-Producing VZV-Specific CD4 T-Cells in Patients with Rheumatoid Arthritis (RA). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
47
|
Whyte M, Leung E, Wilcox W, Liese J, Reeves A, Melian A, Odrljin T, Zhang H, Hofmann C. Hypophosphatasia: a retrospective natural history study of the severe perinatal and infantile forms. ACTA ACUST UNITED AC 2014. [DOI: 10.1530/boneabs.3.pp364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
48
|
Sauerbrei A, Langenhan T, Brandstadt A, Schmidt-Ott R, Krumbholz A, Girschick H, Huppertz H, Kaiser P, Liese J, Streng A, Niehues T, Peters J, Sauerbrey A, Schroten H, Tenenbaum T, Wirth S, Wutzler P. Prevalence of antibodies against influenza A and B viruses in children in Germany, 2008 to 2010. ACTA ACUST UNITED AC 2014; 19. [PMID: 24524235 DOI: 10.2807/1560-7917.es2014.19.5.20687] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prevalence of influenza A and B virus-specific IgG was determined in sera taken between 2008 and 2010 from 1,665 children aged 0-17 years and 400 blood donors in Germany. ELISA on the basis of whole virus antigens was applied. Nearly all children aged nine years and older had antibodies against influenza A. In contrast, 40% of children aged 0-4 years did not have any influenza A virus-specific IgG antibodies. Eightysix percent of 0-6 year-olds, 47% of 7-12 year-olds and 20% of 13-17 year-olds were serologically naïve to influenza B viruses. By the age of 18 years, influenza B seroprevalence reached approximately 90%. There were obvious regional differences in the seroprevalence of influenza B in Germany. In conclusion, seroprevalences of influenza A and influenza B increase gradually during childhood. The majority of children older than eight years have basal immunity to influenza A, while comparable immunity against influenza B is only acquired at the age of 18 years. Children aged 0-6 years, showing an overall seroprevalence of 67% for influenza A and of 14% for influenza B, are especially at risk for primary infections during influenza B seasons.
Collapse
Affiliation(s)
- A Sauerbrei
- Institute of Virology and Antiviral Therapy, Jena University Clinic, Friedrich Schiller University of Jena, Jena, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Plotkin SA, Liese J, Madhi SA, Ortiz E. A DTaP–IPV//PRP∼T vaccine (Pentaxim™): a review of 16 years’ clinical experience. Expert Rev Vaccines 2014; 10:981-1005. [DOI: 10.1586/erv.11.72] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
50
|
|