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BACKGROUND: Travelers are often advised to receive both the typhoid fever and hepatitis A virus (HAV) vaccines, particularly when going to areas where the 2 diseases are endemic. Thus, combined administration of these vaccines could make immunization more acceptable by reducing the number of injections needed. OBJECTIVE: This study compared the safety profiles and immunogenicity of 3 batches of a combined typhoid fever/HAV vaccine administered using a dual-chamber bypass syringe. METHODS: This randomized, open-label study was conducted at 2 university-based travel clinics in Germany and Austria. Subjects received a single IM injection from 1 of 3 batches of the combined vaccine. Blood samples were drawn immediately before and 28 days after vaccination to evaluate the response to the 2 antigens by assessing geometric mean titers (GMTs) and rates of seroconversion and seroprotection. Subjects recorded all adverse events (AEs) occurring during the study period in a diary. RESULTS: Six hundred ten healthy adults were enrolled in the study. Twenty-eight days after vaccination, 90.6% of the study population had protective typhoid Vi antibody titers (> or = 1 microg/mL) and 100% had protective HAV antibody titers (> or = 20 mIU/mL). Seroconversion rates and GMTs were not significantly different between the 3 batches. There were no differences with regard to local or systemic AEs between the 3 batches of vaccine. There were no immediate adverse reactions (within 30 minutes of vaccination) and no serious AEs related to vaccination. Of 609 evaluable subjects (1 was lost to follow-up after the first visit), 555 (91.1%) experienced > or = 1 local reaction within the first 7 days after vaccination, mainly pain at the injection site (550 [90.3%]), but only 26 (4.3%) described this pain as severe. Vaccine-related headache and mild to moderate asthenia were each reported by 54 subjects (8.9%). Symptoms resolved spontaneously in all cases. CONCLUSIONS: The 3 batches of the combined typhoid fever/HAV vaccine administered by dual-chamber bypass syringe were equally well tolerated and effective in healthy adults, and did not differ significantly in terms of GMTs or seroconversion rates. [ABSTRACT FROM AUTHOR]

Background: Patients suffering from chronic hepatitis C (CHC) may exhibit impaired liver functions such as disturbances of fatty acid storage, synthesis and degradation., Objective: Possible associations between serum fatty acid (SFA) profiles, antioxidant status and treatment response were investigated in a trans-sectional study of untreated and treated CHC patients in comparison to a healthy control group., Methods: SFA composition and antioxidant status were examined in female patients with CHC: 9 were naïve to Interferon-α and ribavirin treatment (IFR), 21 sustained treatment responders, 21 were nonresponders, and 21 were healthy control group members. Additionally, in all CHC patients gammaglutamyl transferase (GGT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured., Results: Responders and healthy control group members had significantly higher antioxidant (P < .001), eicosapentaenoic (P < .001) and arachidonic acid (P < .004) levels, but lower stearic acid (P < .001) concentrations than non-responders and untreated patients. ALT was higher in untreated CHC patients than in treated ones (P < .028). GGT and AST did not differ significantly between patient groups, however GGT levels were associated with serum Gamma-Linolenic-Acid concentration (P = .009)., Conclusion: SFA profiles and antioxidant status in female CHC patients differ markedly from those of healthy controls, a phenomenon which is possibly related with their effect of HCV replication., (Copyright © 2011 National Lipid Association. Published by Elsevier Inc. All rights reserved.)

The new prevalence data regarding the estimated global number of human immunodeficiency virus positive (HIV+) cases, i.e., including people who are either aware or unaware of their HIV infection in 2010, lead many to wonder why the increase in incidence has reached today's unprecedented level and escalated within such a short time. This, in spite of prevention campaigns in countries affected by HIV/acquired immune deficiency syndrome (AIDS) with their urgent messages aimed at preventing HIV transmission by promoting changes in individual's behavior. This article analyzes the background of the prevention strategies, in particular their political, social and legal concepts in terms of human rights, and reveals traits of human behavior not considered thus far. A radical reappraisal is necessary, at social and legislative levels, as well as options additional to current concepts. When ethical issues come up, they become blamed for outmoded moralistic positions. However, ignoring the reality has led to dire consequences from prioritizing individual human rights over society's collective need to prevent the spread of HIV.

Aim of the Study: The increasing numbers of new HIV diagnoses in Germany generate a need to measure the level of knowledge of the young generation about the issue of HIV/AIDS., Methodology: A survey was conducted of 769 pupils of different age groups and from different schools in Mecklenburg-Western Pomerania. Data analysis was performed using SPSS; statistically significant differences (p<0.05) were tested between the groups using the chi-square test., Results: The level of knowledge within the sample differs: more precise knowledge is demonstrated by pupils following an awareness event (60%) and by pupils interested in HIV (69%) than by those who have attended no awareness event (40%) and those who have little interest in the issue (31%). Moreover, it was noted that grammar school pupils generally achieve better results than pupils from comprehensive and intermediate secondary schools. Furthermore, there are significant differences between the genders: girls give correct answers more frequently than boys and more often show an interest in the HIV/AIDS issue. In addition, age-specific differences are also identifiable: from the age of 14, there is a considerable increase in knowledge, which then remains static at the age of 16. AIDS education in biology lessons is common among pupils and 93% are familiar with this. Over 70% of pupils are unfamiliar with local AIDS awareness teams., Conclusions: There are significant gaps in the level of knowledge about methods of infection, particularly with respect to questions about the no risk areas, which should thus be particularly dealt with in awareness events. As to knowledge transfer, the pupils' interest should be aroused while taking the type of school, gender and age of the pupils into consideration. In the course of the school career, every pupil should take part in at least one awareness event since our survey showed that only 60% attended such an event. Local AIDS awareness teams should be more frequently active in the schools since 73% stated to be unfamiliar with them in our survey., (© Georg Thieme Verlag KG Stuttgart · New York.)

This article reports a study of the public perception of large wood in rivers and streams in the United States. Large wood is an element of freshwater aquatic ecosystems that has attracted much scientific interest in recent years because of its value in biological and geomorphological processes. At the heart of the issue is the nature of the relationship between scientific recognition of the ecological and geomorphological benefits of wood in rivers, management practices utilizing wood for river remediation progress, and public perceptions of in-channel wood. Surveys of students' perceptions of riverscapes with and without large wood in the states of Colorado, Connecticut, Georgia, Illinois, Iowa, Missouri, Oregon, and Texas suggest that many individuals in the United States adhere to traditionally negative views of wood. Except for students in Oregon, most respondents considered photographs of riverscapes with wood to be less aesthetically pleasing and needing more improvement than rivers without wood. Analysis of reasons given for improvement needs suggest that Oregon students are concerned with improving channels without wood for fauna habitat, whereas respondents elsewhere focused on the need for cleaning wood-rich channels for flood risk management. These results underscore the importance of public education to increase awareness of the geomorphological and ecological significance of wood in stream systems. This awareness should foster more positive attitudes toward wood. An integrated program of research, education, and policy is advocated to bridge the gap between scientific knowledge and public perception for effective management and restoration of river systems with wood.

History: A 61-year-old man was bitten by a tick at Lake Woblitz, near the town of Neustrelitz in former East Germany. Nine days later he saw his general practitioner because of fever and headache. Three weeks after the tick bite he was hospitalized with fever (39.2 degrees C) and mental confusion. Because he had taken a Nile cruise six months earlier, malaria was considered and he was transferred to the department of tropical medicine and infectious diseases of the University of Rostock., Investigations: The patient was somnolent, his speech was slurred, and he had amnesic aphasia, as well as impaired fine motor control, but no meningism, focal signs, pyramidal tract or sensory impairment. Cerebrospinal fluid (CSF) showed mild lymphocytosis (9,400 leukocytes per microL; 89% lymphocytes) and elevated protein concentration (1322 mg/L) with blood brain barrier impairment and intrathecal IgM synthesis. Anti-tick-bite encephalitis (TBE) antibodies (ELISA: IgG and IgM) were present in serum and CSF, and serum immunofluorescence showed an eight-fold titer increase within two weeks. These findings confirm the diagnosis of TBE. Other infections (including those with cross-reacting flaviviruses) were excluded by appropriate antibody testing., Therapy and Clinical Course: There is no specific antiviral treatment for TBE, but on symptomatic therapy the patient recovered fully within four weeks., Conclusion: The site of the patient's infection is located 10 km to the west of an old TBE focus, but no TBE virus had been detected there after 1975. The case demonstrates that TBE should be included in the differential diagnosis of meningoencephalitis, even if the patient has not been in an acknowledged TBE endemic area.

Background/aims: The natural course of the hepatitis C virus genotype 1b (HCV-1b) infection is still unclear but important for therapeutic decisions. There are few unbiased long-term follow-up studies with known dates of infection., Methods: Between August 1978 and March 1979, 14 HCV-1b contaminated batches of anti-D immunoglobulin had been administered to 2867 women for prophylaxis of rhesus isoimmunization throughout East Germany. We reexamined 1980 women, representing 70% of the total cohort of 15 centers., Results: After application of the contaminated anti-D, 93% of the recipients developed an acute hepatitis C. After 25 years, 86% of the 1833 affected women still tested positive for hepatitis C virus antibodies and 46% for HCV RNA. Only nine (0.5%) had overt liver cirrhosis, 30 women (1.5%) developed pre-cirrhotic stages and one HCC was diagnosed. Ten (0.5%) died of HCV related complications, half of these related to additional comorbidity. In the last 5 years, a continuous, but low increase of fibrotic scores was observed., Conclusions: Young women without comorbidity may clear HCV (1b) infection in more than half of the cases, or develop mild chronic hepatitis C. We confirmed the low risk of progression to cirrhosis in this cohort within 25 years.

Neurologic complications in the course of Plasmodium falciparum infections are commonly diagnosed as cerebral malaria, but bacterial or viral meningitis may exhibit similar symptoms. One to three weeks after P. falciparum malaria, acute disseminated encephalomyelitis (ADEM) can also mimick the symptoms of cerebral malaria. We describe a 31-year-old woman with life-threatening ADEM five days after successful treatment of P. falciparum malaria. The detection of IgG and IgM antibodies in serum and cerebrospinal fluid (CSF) against multiple viruses and bacteria reflected a non-specific polyclonal B cell activation and was more confusing than helpful for diagnostic decisions. Varicella zoster virus was identified with a reverse transcriptase multiplex polymerase chain reaction in the initially obtained and frozen CSF. This case and findings from the literature indicate that P. falciparum-associated ADEM might not be immune mediated, but of infectious origin. With unclear cerebral complications during or after P. falciparum malaria, prompt initiation of empirical antiviral and antibacterial treatment in addition to antimalarials may reduce mortality.

Introduction: Chronic hepatitis C-therapy is limited to the combined use of PEG-ylated interferons and ribavirin. Side effects of this therapy include retinal changes that manifest with bleeding, cotton wool spots and/or thrombosis., Patient: A 51-year-old man presented with a sudden decrease of visual acuity. Chronic hepatitis C was known for the duration of 6 months and treated for 3 months with a combined therapy of PEG-interferon alpha2B and ribavirin. A sudden visual loss occurred in the right eye and bilateral visual field defects were detected. Ophthalmoscopic examination revealed bilateral papilloedema. After withdrawal of PEG-interferon alpha2B and ribavirin, a standard haemodilution therapy was started without functional improvement. After papilloedema regression, a beginning secondary atrophy of the optic nerve was diagnosed bilaterally. Vision did not improve., Conclusion: The ocular side effects of combined hepatitis C therapy with PEG-interferon alpha2B and ribavirin range from mild retinal changes to severely impaired vision. Treatment should be carried out in co-operation with an ophthalmologist. With respect to the uncertain effectiveness of hepatitis C therapy with interferon alpha2B and ribavirin, therapy should be stopped as soon as severe ophthalmological complications occur.

Case History: Four males (age 25 to 40 years) and one female (age 25) were admitted to our hospital almost simultaneously with symptoms of fever up to 38 degrees C, dry cough, thoracodynia, dyspnoea, myalgia and arthralgia. All patients belonged to a team of eight German bat researchers who had returned from Cuba 10 days before, where they had investigated bats in caves. Another member of the team had only mild histoplasmosis and was followed in our outpatient clinic. Two scientists who wore their breathing masks continuously during their work in the caves did not fall ill., Examinations: Chest X-rays of all in-patients showed pulmonary infiltrates correlating with the severity of their illness. In all patients specific IgG antibodies against Histoplasma capsulatum-antigen were found in the Western Blot assay, confirming the diagnosis of histoplasmosis., Treatment: Treatment with oral itraconazole 200 mg b.d was given to four inpatients for 6 weeks, in the fifth patient itraconazole was discontinued because of an increase of liver transaminases., Conclusion: Antimycotic treatment of advancing histoplasmosis seems appropriate also in immunocompetent patients. The high number of patients within this group suggests high numbers of Histoplasma capsulatum in the caves. Wearing breathing masks throughout the work in the caves may prevent histoplasmosis even in case of high infectious doses. Pre-travel recommendations for cave researchers have to emphasize the continuous use of breathing masks and vaccination against tetanus and rabies.

Background: Combination therapy with interferon alpha (IFNalpha) plus ribavirin has been shown to improve the sustained response rate in patients with chronic hepatitis C but there is little information regarding the lengths of time for this therapeutic regimen. In this study we therefore tried to evaluate whether the analysis of different virological parameters could provide new clues with respect to the early determination of the efficacy of this form of combination therapy. Furthermore, we also examined whether short-term induction combination therapy followed by IFNalpha alone is more effective than monotherapy in mounting an initial as well as a sustained virological response., Methods: 185 patients with histologically proven chronic hepatitis C (mean age 42 years (range 19-65 years); 110 males, 75 females) were enrolled in the study. The patients were randomly assigned to receive, over the first 12 weeks, either interferon alpha 2a 6 million units (MU) three times weekly plus ribavirin 14 mg/kg per day (n=93) or the same dose of IFNalpha alone (n=92). Patients with a virological response (serum HCV RNA undetectable) after 12 weeks were subsequently treated with 3 MU IFNalpha alone thrice weekly for a further 40 weeks. Otherwise, treatment was discontinued. After the end of treatment, patients were followed up for 24 weeks., Results: Patient characteristics at baseline were not significantly different in the two treatment groups. An initial virological response at week 12 was seen in 61 (66%) patients receiving IFNalpha plus ribavirin and in 44 (48%) being treated with IFNalpha alone (p=0.015) and this improvement in the response rate was mainly restricted to HCV genotype 1-infected patients (58% vs. 38%). In contrast, end-of-treatment (week 52) and sustained virological response rates were similar in both groups (37% vs. 29% and 26% vs. 17% [p=0.1], respectively). Interestingly, patients with HCV genotype 3, however, clearly benefited from short-term combination therapy. Thus, sustained virological response rates in these patients significantly increased from 25% (IFNalpha monotherapy) to 59% (combination therapy) (p=0.05)., Conclusions: Short-term combined therapy for 12 weeks is more effective than the monotherapy with respect to the induction of an initial virological response but this effect applies only to genotype 1-infected patients. However, there is no significant difference between both therapeutic schedules with regard to the induction of sustained response. Although HCV genotype 3-infected patients seem to benefit from this short-term combined therapy, prolonged combined therapy may be necessary in HCV genotype 1-infected patients.

From August 1978 until March 1979, 14 batches of anti-D immune globulin contaminated with hepatitis C virus (HCV) genotype 1b (20, 000-480,000 copies/dose) from a single erythrocyte donor had been administered for prophylaxis of rhesus isoimmunization throughout East Germany. All 2,867 women involved had been recalled after January 12, 1979 for repeated screening of alanine transaminase (ALT). They were prospectively followed in regional centers. We have reexamined a cohort of 1,018 women (median age 24, range 16-38 years at infection) on follow-up for 20 years in 9 representative centers. Within 6 months after anti-D administration, 10% of these women had no evidence of disease and 90% had acute hepatitis C (n = 917) including 49% with symptomatic and 22% with icteric course. After 20 years, 85% of the 917 affected women still tested positive for HCV antibodies (among them 3% responded to interferon treatment) and 55% were positive for HCV RNA (among them 7% were nonresponders to interferon and 3% were apparent HCV carriers). Only 4 (0.4%) had overt cirrhosis. Two (0.2%) died of superinfected fulminant hepatitis B or alcoholism and cirrhosis, respectively. Histology obtained in 44% of the viremic women showed hepatitis of minimal to moderate grade in 96%, portal fibrosis in 47%, and septal fibrosis in 3% of the cases. In conclusion, formerly healthy young women, without hepatic comorbidity, may clear HCV (1b) infection in half of the cases or develop mild chronic hepatitis C with low risk of progression to cirrhosis within 20 years.

Background/aims: Combination therapy with interferon-alpha (IFN-alpha) plus ribavirin is more efficacious than IFN-alpha monotherapy in previously untreated patients with chronic hepatitis C and patients with IFN-alpha relapse. Only limited data are available in IFN-alpha non-responders. In a multicenter trial we therefore evaluated the efficacy of combination therapy in IFN-alpha-resistant chronic hepatitis C., Methods: Eighty-two patients (mean age 46.8 years, 54 males, 28 females) with chronic hepatitis C were treated with IFN-alpha-2a (3 x 6 MIU/week) and ribavirin (14 mg/kg daily) for 12 weeks. Thereafter, treatment was continued only in virological responders (undetectable serum HCV RNA at week 12) with an IFN-alpha dose of 3 x 3 MIU/week and without ribavirin for a further 9 months. The primary study endpoint was an undetectable HCV RNA by RT-PCR at the end of the 24-week follow-up period., Results: After 12 weeks of combination therapy, an initial virological response was observed in 29 of 82 (35.4%) patients. Due to a high breakthrough rate after IFN-alpha dose reduction and ribavirin discontinuation, an end-of-treatment response was only achieved in 12 of 82 (14.6%) patients. After the follow-up period, a sustained virological response was observed in 8 of 82 (9.8%) patients. Infection with HCV genotype 3 was the only pretreatment parameter, which could predict a sustained response (HCV-1, 5%; HCV-3, 57.1%; p < 0.001)., Conclusions: Despite a high initial response rate of 35.4%, sustained viral clearance was achieved only in 9.8% of the retreated primary IFN-alpha non-responders. Higher IFN-alpha induction and maintenance dose, as well as prolonged ribavirin treatment may possibly increase the virological response rates in non-responders, particularly in those infected by HCV-1., (Copyright 2000 S. Karger AG, Basel)

A 22 year old male with infectious mononucleosis, who stated a history of trauma to his left thoracic wall, developed an acute abdomen with symptoms of shock. A ruptured spleen was suspected. This working diagnosis, which was supported by ultrasound led to a splenectomy the initial diagnosis. The case report of this rare complication--due to the increased vulnerability of the spleen capsula in infectious mononucleosis--is highlighting the possible danger of splenic rupture. As of today, emergency splenectomy without any compromise ist still the safest state of the art therapy.

A multicentre, controlled, randomised, open, comparative trial including 839 healthy adult volunteers was carried out in order to compare the immunogenicity and reactogenicity of two vaccines against hepatitis A virus (HAV) during primary immunization and after booster injection. The first vaccine was produced by Pasteur Mérieux (PM), and the second vaccine by Smith-Kline Beecham (SKB). The vaccination schedule consisted of 2 doses (months 0, 6) for PM and 3 doses (months 0, 1, and 6) for SKB. Two weeks after the first dose, the seroconversion rates among initially HAV seronegative subjects (n = 608) were 93.4% and 76.1% for the PM and SKB vaccines, respectively, the corresponding geometric mean titres (GMTs) were 59.0 mIU/ml versus 30.8 mlU/ml (modified RIA HAVAB assay, Abbott Laboratories). Two months after the beginning of immunization (one dose versus two doses) the GMTs were 138.4 and 161.6 mlU/ml, respectively. At month 7, the seroconversion rates were 100% for both vaccines, and the GMTs were 4,189 and 3,163 mlU/ml, respectively. After the first dose of vaccine, 24.6% and 19.6% of the PM and SKB vaccines reported local reactions. The rates for systemic reactions were 27.2% and 25.0%, respectively. Lower rates for local and systemic reactions were seen after booster injections and statistical differences were not observed between the two vaccines. The study also demonstrated that vaccination was as well tolerated in subjects with anti-HAV antibodies as in HAV seronegative subjects. Logistic regression analysis revealed a significant vaccine effect on seroconversion rates only at week 2 (P < 10(-4). The same conclusions were drawn from the analysis of GMT by multivariate regression.(ABSTRACT TRUNCATED AT 250 WORDS)

The medical advice for travellers into tropical and subtropical climatic zones is essentially a task of the physician. Thereby the medical advice and the prophylactic measures should restrict themselves not only to risks of infection, but they must--as far as possible--comprise all health risks. The travellers who bear with themselves a health risk deserve particular attention on the side of the physician. Precarious from the medical point of view are travels with infants and babies as well as travels of pregnant women. The personal, age- and sex-specific health situation, the subjective behaviour as well as style of travelling and lifestyle play an essential role. The personal situation of the traveller is to be taken into consideration concerning the risk of the travel, so that the advice regarding the travel can in every case be only an individual medical action. According recommendations in the field of tropical medicine the performance of protective inoculations the prescription of a suitable chemoprophylactic drug against malaria as well as if the occasion arises of a medicine cabinet for travelling is necessary. The postexpositional after-care after the return, the so-called returners' examination should not be neglected.

To maintain the hatchability of miracidia, pure worm eggs of S. mansoni were collected in great quantities from liver and spleen of experimentally infected mice. For this purpose, the tissue was digested with papain, hyaluronidase and trypsin. Worm eggs in the residue were separated from remaining host cells, tissue materials and dead eggs by using the sieving chamber (sieves 200 microns x 200 microns and 28 microns x 28 microns) and by density gradient centrifugation.

A report is given on experiences with complications after antirabic treatment with hempt-vaccine gathered during 15 years (1960 to 1974). Among 4,315 inoculated persons local reactions appeared in 1.9%, a phenol shock in 0.11%, general reactions in 0.21% and neurological complications in 0.069%. In casuistic form is reported on postvaccinal neuritis, dorsolumbal myelitis and meningoencephalitis.

Casuistic reports supplement parasitological and epidemiological references to the affection of man with Fasciola hepatica, Clonorchis sinensis and Opisthorchis felineus. Due to the increase of the tourist traffic must be reckoned with a more frequent appearance of these parasitoses little known in Middle Europe.

A report is given on four patients with spontaneous mediastinal and skin emphysema. In three cases younger patients from 14 to 21 years were concerned, in the fourth case a 63-year-old patient was concerned. Two of the younger patients revealed a long lasting malnutrition. As favouring or triggering factor, respectively, for the pathogenesis of the mediastinal emphysema in accordance with Macklin an increase of the intrathoracic pressure by retching, pressing or vomiting is regarded. Apart from this a vasoconstriction of the alveolar vessels (due to decrease of the plasma volume) and nutritional disease might be of importance. In all patients the mediastinal and skin emphysema receded under symptomatic therapeutic measures within some days.

In 100 patients before and after a percutaneous blind puncture of the liver after Menghini biliary juice was received with the help of a duodenal sound and this was investigated for blood admixtures microscopically and chemically. In 21 out of 100 punctures patients blood was proved in the duodenal juice: In 11 cases the proof of blood was positive before and after the puncture and in 10 patients only after the puncture blood was found in the duodenal juice. A macrohaemobilia was never observed. The influence of thromboplastin time, number of thrombocytes, time of haemorrhage, age and basic disease on the development and support of microhaemobilia was examined. In about 10% of the patients is to be reckoned with a microhaemobilia taking into consideration the indication and contraindication, also in exact performance of the blind puncture of the liver. However, the clinical importance is little in general.

The human parasitoses, in which a diarrhoea can appear or is the obligatory symptom, occurring in warm countries are discussed in a survey.