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Background and Objective: The elimination of measles is a goal of the WHO which has not been achieved in Europe yet. As measles is a vaccine-preventable disease and can be eliminated by immunization the Standing Committee on Vaccination (STIKO) has updated the recommendation of measles vaccination. The goal of this study was to evaluate the immune status by serological testing and by raising immunisation status., Methods: Antibody-testing from the routine diagnostic of the Institute of Medical Virology (Frankfurt/Main) for patients, health care workers and medical students was investigated retrospectively., Results: Overall all significant increase in seropositivity was shown from 64.8 to 86.2 %. Nevertheless immunity gaps still exist in population, especially in persons under 19 years of age. In 1999 80.7 % of the 5-9 year age group and 75.3 % of the 10-19 year age group were seropositive. In 2009 the percentage in these age groups has decreased to 68.2 % and 71.1 % respectively. By obtaining the immunity status of 230 travellers at our vaccination centre immunity gaps have been recognised as well. Only 29.6 % were completely immunized (at least two vaccination). 54.4 % have been vaccinated incomplete and in 16.1 % vaccination status was unknown., Conclusion: Our results indicated that measles immunization status and seroprevalence are still not sufficient to achieve the elimination of measles., (© Georg Thieme Verlag KG Stuttgart · New York.)

The influenza virus isolation in embryonated chicken eggs was possible early in 1930er years and allowed the influenza vaccine production. Most influenza vaccines were derived from this, but actually new virus cell culture methods are established. For better tolerability, influenza vaccines include only antigen proportions (split- and subunit vaccines) but with the disadvantage of minor vaccine efficacy. This was compared with the addition of adjuvants. Aluminium salts are used for many decades and still in use to enhance the effect of vaccines. New formulations are MF59, AS03, AS04 or toll- like receptor-agonists. Also virosomal formulations and "ISCOMs"(Immune Stimulating Complexes) are newly designed and compromises enhanced immune reactions. Actually a broad range of various influenza vaccines exist and are available for a very different group of patients (which depends on physical conditions, age, immune status or allergies)., (© Georg Thieme Verlag KG Stuttgart · New York.)

History and Admission Findings: A 27-year-old female presented with fever (40 C) and infection of the upper respiratory tract in an emergency room (ER) department of our university hospital. Within the last days, she worked as a nurse in that ER, responsible for taking care of patients with novel influenza and also executing screening-examinations of suspicious cases., Investigations: Patient in a reduced condition of health. C-reactive protein was significantly elevated (6.6 mg/dl - norm < 0.5). A PCR carried out on the admission day revealed a highly positive reaction (CT:19.29)., Diagnosis, Treatment and Course: Due to positive PCR laboratory report for H1N1/2009 and multiple occupational contacts with H1N1/2009 patients, therapy with neuraminidase inhibitor was started. After a five-day antiviral therapy and clinical signs of recovery, PCR was negative on the sixth treatment day., Conclusion: Health care workers (HCWs) are at risk of occupational exposure to influenza. Against the backdrop of the spread of H1N1 (2009) appropriate protective measures should be implemented to reduce the risk for transmission in health-care settings. The acquisition of epidemiologic data of occupational infections in Germany ought to be optimized. Required protective measures should be evaluated with regard to practicability and effectiveness., (Georg Thieme Verlag KG Stuttgart, New York.)

Background and Objective: Since 1988 the recommendations of the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute has explicitly designated healthcare workers (HCW) as persons that should be vaccinated against influenza. However, the acceptance rate of influenza vaccination within medical personnel is low. This account describes reasons why the vaccination rate remains inadequate and how it could be improved., Methods: At the University Hospital Frankfurt an anonymized questionnaire regarding the attitude towards influenza vaccination was distributed in the course of a vaccination campaign in 2006/2007. 1,052 healthcare workers among 4,080 healthcare workers (2,715 females/ [66.5%]; 1,365 males [ 33.5%] were vaccinated against influenza (35.8%), 628 females and 419 males, while gender was not recorded for five. Most of the participants (76.2%) were between 20 and 49 years old., Results: An extensive information campaign achieved an increase in the influenza vaccination rate. Nevertheless significant vaccination gaps still exist. A mere 25.8% of personnel participated in the influenza vaccination campaign., Conclusion: In spite of an extensive vaccination campaign and a significantly increased vaccination rate of the personnel (3.5% in 2001/2002; 25.8% in 2006/2007), the acceptance of influenza vaccination remains low. Long-term measures are required to obtain better rates for preventive vaccine protection against influenza.

Avian influenza is an infectious disease of birds, caused by type A strains of the influenza virus. The disease, which was first identified in Italy more than 100 years ago, occurs worldwide. Avian influenza viruses are mainly distributed by migratory birds. Different mammals like swine, horse and finally humans are susceptible for avian influenza viruses. The high possibility of genomic changes like gene shift and drift is caused by the segmented RNA genome. During the avian flu outbreak in East Asia at the end of 2003 the virus also killed several humans in Vietnam and Thailand. That avian influenza could also infect humans has been known since 1997. The H5N1 flu outbreak seemed successfully controlled, but currently new cases in poultry and humans in Vietnam, Thailand, China and Indonesia are recognized. Also another avian influenza A strain type H9N2 was prevalent in chickens of local markets in Hong Kong. Because of the natural virus reservoir like wild and/ or domesticated ducks and others, actually there is little chance of eradicating avian influenza. Furthermore the virus could mutate and jump to humans with the threat of a global influenza pandemic.

Despite remarkable progress made in the fields of antiviral therapy and virological laboratory diagnosis, infections with the human cytomegalovirus (CMV) still pose considerable problems in certain patient groups. The variety of available test methods - mostly not standardised - with their different test characteristics, sample types etc. is often confusing for the clinician. There is often great uncertainty as to whether a given laboratory result is pathognomonic. In addition, not only is the diagnostic repertoire growing constantly - for instance through genome quantification and measurement of virus-specific T lymphocytes - but also the available antiviral therapeutic options with the need for adequate surveillance. This paper gives an up-to-date overview about the available diagnostic means with their specific advantages and disadvantages. Concrete recommendations regarding a rational and comprehensive, yet economic approach to CMV diagnosis have to be targeted at the individual patient group and specific diagnostic problem; this is beyond the scope of this paper and the reader is referred to the pertinent expert groups' publications. This review article deals with general and fundamental aspects.

Background and Objective: Measles, mumps, rubella and varicella zoster virus (VZV) infections are regarded as typical diseases of childhood: They are normally clinically mild and result in lifelong immunity. Severe clinical disease is known in immunocompromised patients; rubella virus infections during pregnancy often result in congenital rubella syndrome. All these diseases are preventable by vaccination which is recommended in Germany, recently vaccination against VZV for teenager without immunity since July 2001. In the following study we screened for immunity against the four viruses., Patients and Methods: Serum samples were obtained at the Institute of Medical Virology Frankfurt/Main from January 1999 until December 2000. We tested for specific antibodies against measles (n = 915), against mumps (n = 857), against rubella (n = 1886) and against VZV (n = 2291). Seroprevalences were determined in different age groups., Results: Altogether the highest rate of seronegatives is detected in younger children. VZV-seronegativity rates decrease from 74 % to 32 % in younger children. Against rubella also in this age group rate of seronegatives is found in 40 % and less than 10 % by teenagers. From this age group also immunity against rubella is found approximately in 80 % of seropositives., Conclusions: The following study shows that high seronegative rates are detectable, and here specially against VZV-specific antibodies. For seronegative teenagers, vaccination against VZV is now recommended in Germany. Immunization rates of at least 95 % in childhood would be effective in avoiding severe courses of disease and giving protection in pregnancy.

Neutralizing antibodies against poliovirus types 1, 2 and 3 were determined in the serum samples, supplied by 11 virological institutes, from 3,341 subjects of different ages living in the western part of the Federal Republic of Germany. The 3 poliovirus types were found in all age groups, with a seroprevalence of at least 80%. Although antibodies against the 3 types of poliovirus in the age-groups up to 30 years were demonstrated more frequently than in the previous years in which samples had been examined (1969, 1972, 1978 and 1983), 33% of subjects over 40 years (this age-group had not previously been tested) did not have complete immunity against all 3 poliovirus types. For this reason immunization against poliomyelitis should continue to be recommended when indicated, especially before travels to regions where the disease is endemic.

Comparative analysis of two Q fever epidemics in Baden-Württemberg demonstrated the following characteristics of this zoo-anthroponosis endemic in southern Germany: 1. affected areas are situated along sheep tracks and natural concentrations of the Dermacentor marginatus. 2. The disease spreads in waves. 3. It causes typical symptoms, particular an intense tension headache, and typical radiographic findings. Men are more commonly and more severely affected than women. Children are not affected despite proven exposure. 4. The CBR antibody titre is a reliable laboratory diagnostic parameter. 5. Epidemiological measures (search for the source of infection, elimination of seropositive sheep, use of disinfectants) reduce the reservoir of the infective agent. 6. The therapeutic drug of choice is doxycyclin.

Over a period of 16 months acute mycoplasma pneumonia was diagnosed in 20 patients. All were rapidly and completely cured by ampicillin and cephalosporins, which are ineffective against mycoplasma, indicating that acute mycoplasma infection in children does not require selective treatment, the pneumonia probably being caused by other micro-organisms. There is no prove that mycoplasma pneumonia heals spontaneously, without any therapy.

The immunity of the populations of several countries of the GFR against poliovirus 1, 2 and 3 was investigated in 11 laboratories. Sera of 4707 persons aged 0 to 30 years were assessed for neutralising antibodies (serum dilution 1:4) against the 3 types of poliovirus. 34.5% of the 4707 investigated sera had no neutralising antibodies at least against one type of the poliovirus, 4.7% showed no antibodies against all 3 types of the virus. Especially children aged 0 to 4 years were protected incompletely against the 3 types of poliovirus. In comparison with similar investigations of 1969 and 1972 no decisive change of immunity of the population of the GFR against poliomyelitis has occurred.

Neutralizing antibodies against poliovirus types 1, 2 and 3 were determined in serum of 4,039 persons of different ages and of 879 persons at the beginning of their training (male recruits at their initial examination; female teaching trainees and student nurses). The sera were supplied by eleven institutions. Compared with similar studies in 1969, 1972 and 1978, the immunity against individual poliovirus types as well as that against the three types in the different age groups has improved. About three quarters of those older than seven years have antibodies against types 1, 2 and 3. The present study, which for the first time used a more sensitive neutralization test, revealed that about 85% of probands had antibodies against all three types. The trivalent immunity of those aged from 0 to six years has improved by 11 percent points since 1978. There was no decrease in immunity among those older than 20 years.

Six virus laboratories from various parts of the German Federal Republic and West Berlin undertook investigations into polio-myelitis immunity in 1972. A total of 267 persons aged up to 20 years were investigated for neutralizing antibodies against the three types of polio virus. The study showed that from the fourth year of life approximately 70% of the persons investigated had antibodies against all three types of polio virus. In some younger children the equivalent values were considerably lower. After the fourth year of life there were only slight differences in the humoral immunity against the three polio virus types. There was no evidence that the immunity level had deteriorated up to the 20th year of life and thus there is no indication of the necessity for a repeat immunisation at a certain time. The investigation confirmed that three oral administrations of trivalent vaccine, as are now generally recommended as basic immunization in the German Federal Republic, result in a conversion rate of over 90% against each of the three virus types.