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From December 2008 to June 2009 a measles outbreak occurred in the Federal State of Hamburg, Germany. The outbreak affected 216 persons and was caused by a new measles strain termed D4-Hamburg which led to consecutive outbreaks between 2009 and 2011 in at least 12 European countries. Here, we describe epidemiological characteristics of the outbreak and evaluate the control measures taken in Hamburg. In one of the seven boroughs of Hamburg a local Roma community comprised more than 50% of the notified cases.We compared in a stratified analysis the age distribution of these cases with cases of fellow citizens who did not belong to the Roma community. The age group of infants (0-11 months) comprised 33% among the non-Roma measles cases, while in the Roma community only 4% belonged to this stratum. In the stratum of 5-17 year-olds only 8% were affected among the non-Roma cases, whereas in the Roma community 50% belonged to this age group. We discuss the influencing factors that might have led to this difference in age distribution between the two groups.

From December 2008 to June 2009 a measles outbreak occurred in the Federal State of Hamburg, Germany. The outbreak affected 216 persons and was caused by a new measles strain termed D4-Hamburg which led to consecutive outbreaks between 2009 and 2011 in at least 12 European countries. Here, we describe epidemiological characteristics of the outbreak and evaluate the control measures taken in Hamburg. In one of the seven boroughs of Hamburg a local Roma community comprised more than 50% of the notified cases. We compared in a stratified analysis the age distribution of these cases with cases of fellow citizens who did not belong to the Roma community. The age group of infants (0-11 months) comprised 33% among the non-Roma measles cases, while in the Roma community only 4% belonged to this stratum. In the stratum of 5-17 year-olds only 8% were affected among the non-Roma cases, whereas in the Roma community 50% belonged to this age group. We discuss the influencing factors that might have led to this difference in age distribution between the two groups.

Die Umgebungsuntersuchung eines akut an Hepatitis B erkrankten 33jahrigen Vaters ergab, das der vierjahrige Adoptivsohn ein HBV-Dauertrager mit massiver Viramie war. Die Infektion trat erst nach dreieinhalb Jahre langem Kontakt auf. Bei der Ehefrau und der Tochter, ebenso bei einem Spielkameraden der Kinder wurde der serologische Befund einer zuruckliegenden, mit Immunschutz ausgeheilten Hepatitis B erhoben. Mit hoher Wahrscheinlichkeit war der Adoptivsohn Ausloser dieser Infektionen. Die Anamnese des Kindes mit persistierender Infektion sowie deren klinischer Verlauf deuten auf eine perinatal erworbene Hepatitis B hin. Um die weitere Ausbreitung der Infektion zu verhindern, wurden sieben Spielkameraden mit einem durchschnittlichen Alter von funf Jahren aktiv gegen Hepatitis B geimpft. Die Impfergebnisse bei den Kindern wurden mit denen einer Kontrollgruppe von Erwachsenen verglichen. Bei den Kindern war nach dreimaliger Applikation des Impfstoffes im Abstand von jeweils vier Wochen die Serokonversion zu anti-HBs fruher zu beobachten, und die Antikorpertiter waren hoher. 71% der Kinder hatten bereits nach der ersten Immunisierung anti-HBs gebildet, wahrend es bei den Erwachsenen nur 13% waren (Durchschnittsalter 33 Jahre). Die Serokonversionsrate war bei den Kindern bereits nach zweiter Immunisierung 100%, bei den Erwachsenen vier bis sechs Wochen nach dritter Impfung aber nur 93%.

The periods of persisting immunoglobulin M class antibodies to hepatitis B core antigen in 28 patients with acute hepatitis B infections and in 134 patients with chronic hepatitis B infections were studied by using an enzyme-linked immunosorbent assay and an indirect immunofluorescence technique. We showed that the clearance of antibodies to hepatitis B core antigen is independent of the degree of viremia in both forms of hepatitis.

Screening the contacts of a 33-year-old father with acute hepatitis B virus (HBV) infection revealed that this four-year-old adopted son was a persistent HBV carrier with massive viremia. The infection did not occur until they had been in contact for three and a half years. Serological findings from the wife, daughter and one of the children's playmates indicated previous hepatitis B infections which had been healed with a positive immune response. It is highly probable that the son induced these infections. The history of the child with persistent HBV infection as well as the clinical course indicate a perinatally acquired HBV infection. To prevent this infection from spreading further, seven playmates with an average age of five years were actively vaccinated against hepatitis B. The success of this vaccination was compared to a control group of adults. After applying the vaccine three times at four-week intervals, the seroconversion to anti-HBs occurred earlier and the antibody titres were higher in the children. 71% of the children had produced anti-HBs after the first vaccination compared to only 13% of the adults (mean age: 33 years). The rate of seroconversion was 100% for the children after the second vaccination, compared to only 93% for the adults four to six weeks after the third vaccination.

53 persons at high risk for hepatitis B infection have been vaccinated with a hepatitis B vaccine produced in the Hygiene Institute of the University of Göttingen. The vaccine proved to be without side effects in all vaccinees. Only minor complaints at the site of inoculation were registered. Three vaccinations are necessary. Protective antibodies were present in 96% of the vaccinees after the third inoculation. The female vaccinees developed anti HBs earlier than the males, moreover they showed significantly higher antibody titers. A simultaneous active and passive immunization is possible. To minimize the risk of contracting a hepatitis B or a non A- non B hepatitis as a result of the vaccination only such vaccines should be used which have been prepared from sera containing anti-HBe and which have been inactivated with a high dose of formaldehyde.

Perinatal transmission of hepatitis B virus does not occur before the beginning of labor. Therefore, neither an embryopathy nor a fetopathy appears to be caused by an acute or chronic HBV infection during pregnancy. There is no necessity to interrupt pregnancy for the reason of a HBV infection. Transmission of HBV infection, however, may take place during delivery. By simultaneous administration of hepatitis B immunoglobulin and the HBV vaccine to the newborn infant directly after birth, perinatal infection with HBV can be prevented. This immunization procedure leads to a rapid and efficient anti-HBs response in the newborn comparable to that of adults. Protection against HBV infection by passive immunization is sufficient until active anti-HBs antibody formation is starting. The hepatitis B vaccine consists of the purified non-infectious surface of the HB virus. Due to the physical purification and chemical inactivation of the hepatitis B surface antigen (HBsAg) from human sera, the vaccine is considered to be safe. It is not harmful and exhibits an excellent compatibility in newborn infants.