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Background Acute gastroenteritis (AGE) is a major medical condition for travellers worldwide, particularly travellers to low- and middle-income countries. Norovirus (NoV) is the most common cause of viral AGE in older children and adults, but data on prevalence and impact amongst travellers is limited. Methods Prospective, multi-site, observational cohort study conducted 2015–2017, amongst adult international travellers from the US and Europe to areas of moderate to high risk of travel-acquired AGE. Participants provided self-collected pre-travel stool samples and self-reported AGE symptoms whilst travelling. Post-travel stool samples were requested from symptomatic subjects and a sample of asymptomatic travellers within 14 days of return. Samples were tested for NoV by RT-qPCR, genotyped if positive and tested for other common enteric pathogens by Luminex xTAG GPP. Results Of the 1109 participants included, 437 (39.4%) developed AGE symptoms resulting in an overall AGE incidence of 24.7 per 100 person-weeks [95% confidence interval (CI): 22.4; 27.1]. In total, 20 NoV-positive AGE cases (5.2% of those tested) were identified at an incidence of 1.1 per 100 person-weeks (95% CI: 0.7; 1.7). NoV-positive samples belonged mostly to genogroup GII (18, 85.7%); None of the 13 samples sequenced belonged to genotype GII.4. Clinical severity of AGE was higher for NoV-positive than for NoV-negative cases (mean modified Vesikari Score 6.8 vs 4.9) with more cases classified as severe or moderate (25% vs 6.8%). In total, 80% of NoV-positive participants (vs 38.9% in NoV-negative) reported at least moderate impact on travel plans. Conclusions AGE is a prevalent disease amongst travellers with a small proportion associated with NoV. Post-travel stool sample collection timing might have influenced the low number of NoV cases detected; however, NoV infections resulted in high clinical severity and impact on travel plans. These results may contribute to targeted vaccine development and the design of future studies on NoV epidemiology.

BACKGROUND Some children and adolescents suffer from late effects of a SARS-CoV-2 infection despite a frequently mild course of the disease. Nevertheless, extensive care for post–COVID-19 condition, also known as post–COVID-19 syndrome, in children and young people is not yet available. A comprehensive care network, Post-COVID Kids Bavaria (PoCo), for children and adolescents with post–COVID-19 condition has been set up as a model project in Bavaria, Germany. OBJECTIVE The aim of this study is to evaluate the health care services provided within this network structure of care for children and adolescents with post–COVID-19 condition in a pre-post study design. METHODS We have already recruited 117 children and adolescents aged up to 17 years with post–COVID-19 condition who were diagnosed and treated in 16 participating outpatient clinics. Health care use, treatment satisfaction, patient-reported outcomes related to health-related quality of life (the primary endpoint), fatigue, postexertional malaise, and mental health are being assessed at different time points (at baseline and after 4 weeks, 3 months, and 6 months) using routine data, interviews, and self-report questionnaires. RESULTS The study recruitment process ran from April 2022 until December 2022. Interim analyses will be carried out. A full analysis of the data will be conducted after follow-up assessment is completed, and the results will be published. CONCLUSIONS The results will contribute to the evaluation of therapeutic services provided for post–COVID-19 condition in children and adolescents, and avenues for optimizing care may be identified. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/41010

This current consensus paper for long COVID complements the existing AWMF S1 guidelines for long COVID with a detailed overview on the various clinical aspects of long COVID in children and adolescents. Members of 19 different pediatric societies of the DGKJ convent and collaborating societies together provide expert-based recommendations for the clinical management of long COVID based on the currently available but limited academic evidence for long COVID in children and adolescents. It contains screening questions for long COVID and suggestions for a structured, standardized pediatric medical history and diagnostic evaluation for patients with suspected long COVID. A time and resource-saving questionnaire, which takes the clinical complexity of long COVID into account, is offered via the DGKJ and DGPI websites as well as additional questionnaires suggested for an advanced screening of specific neurocognitive and/or psychiatric symptoms including post-exertional malaise (PEM) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). According to the individual medical history as well as clinical signs and symptoms a step by step diagnostic procedure and a multidisciplinary therapeutic approach are recommended.

Feline infectious peritonitis (FIP) caused by feline coronavirus (FCoV) is a common dis-ease in cats, fatal if untreated, and no effective treatment is currently legally available. The aim of this study was to evaluate efficacy and toxicity of the multi-component drug Xraphconn® in vitro and as oral treatment in cats with spontaneous FIP by examining survival rate, development of clinical and laboratory parameters, viral loads, anti-FCoV antibodies, and adverse effects. Mass spectrometry and nuclear magnetic resonance identified GS-441524 as an active component of Xraphconn®. Eighteen cats with FIP were prospectively followed up while being treated orally for 84 days. Values of key parameters on each examination day were compared to values before treatment initiation using linear mixed-effect models. Xraphconn® displayed high virucidal activity in cell culture. All cats recovered with dramatic improvement of clinical and laboratory parameters and massive reduction in viral loads within the first few days of treatment without serious adverse effects. Oral treatment with Xraphconn® containing GS-441524 was highly effective for FIP without causing serious adverse effects. This drug is an excellent option for the oral treatment of FIP and should be trialed as potential effective treatment option for other severe coronavirus-associated diseases across species. ispartof: VIRUSES-BASEL vol:13 issue:11 ispartof: location:Switzerland status: published

Background Intravenous artesunate (ivA) is the standard treatment for severe malaria. Data systematically evaluating the use of ivA in pediatric patients outside malaria-endemic regions are limited. The aim of this case series was to summarize efficacy and safety of ivA for imported severe malaria in children in Germany. Methods Our retrospective case series included pediatric patients with imported severe malaria treated with at least 1 dose of ivA (Artesun, Guilin Pharmaceutical; Shanghai, China) at 4 German tertiary care centers. Severe malaria was defined according to World Health Organization criteria. Results Between 2010 and 2018, 14 children with a median [interquartile range (IQR)] age of 6 (1;9.5) years were included. All children were of African descent. All but 2 patients had Plasmodium falciparum malaria; 1 child had P. vivax malaria and 1 child had P. falciparum and P. vivax co-infection. Median (IQR) parasitemia at admission in patients with P. falciparum was 9.5% (3;16.5). Patients were treated with 1-10 [median (IQR) 3 (3;4)] doses ivA. All but one patient received a full course of oral antimalarial treatment. Parasite clearance was achieved within 2-4 days, with the exception of 1 patient with prolonged clearance of peripheral parasitemia. Three patients experienced posttreatment hemolysis but none needed blood transfusion. Otherwise ivA was safe and well tolerated. Conclusions ivA was highly efficacious in this pediatric cohort. We observed episodes of mild to moderate posttreatment hemolysis in approximately one-third of patients. The legal status and usage of potentially lifesaving ivA should be evaluated in Europe.

Bei Fieber nach Tropenaufenthalt kommen eine Vielzahl moglicher Erkrankungen in Frage. Anhand der Anamnese und einfacher Basisuntersuchungen konnen Sie rasch die Schwere und Bedeutung (lebensbedrohlich? ansteckend?) der Erkrankung feststellen.

Deutschland verzeichnete 2015 einen Zuwachs des Fluchtlingsstroms auf etwa 1 Mio. Menschen. Die medizinische Versorgung dieser Patientengruppe birgt einige Besonderheiten, die sich von der medizinischen Versorgung der einheimischen Bevolkerung grundlegend unterscheiden. Katastrophale hygienische Bedingungen wahrend der Flucht sowie Mangel- und Fehlernahrung fuhren zu einer erhohten Krankheitsmorbiditat, insbesondere hinsichtlich Infektionserkrankungen. Ziel dieser Ubersichtsarbeit ist es, anhand eigener Daten sowie der bisher verfugbaren Literatur (nach Pubmed-Recherche) diese Spezifika in der medizinischen Versorgung von Fluchtlingen herauszuarbeiten. Ergebnisse Die Fluchtlinge sind uberwiegend mannlich (65 %), der Altersmedian betragt

The aim of this controlled cross-sectional study was to assess the clinical validity of elevated values of three clinically relevant transferase enzymes (aspartate transaminase [AST], alanine transaminase [ALT], and gamma-glutamyl transferase [GGT]) induced by imported infectious diseases (IDs) seen among patients consulting the Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (from 1999 to 2014) after being in the sub-/tropics. Data sets of 14,559 diseased German travelers returning from Latin America (2,715), Africa (4,574), or Asia (7,270) and of 1,536 healthy controls of German origin without recent travels were analyzed. Among the cases, the proportions of those with elevated values of AST (7.8%) and of ALT (13.4%) were significantly larger than among controls (4.0% and 10.6%, respectively), whereas for GGT, no significant difference was found (cases: 10.0%; controls: 11.4%). The study identified IDs with significantly larger proportions of both AST and ALT (hepatitis A [100%/100%], cytomegalovirus [CMV] infection [77%/81%], chronic hepatitis C [67%/67%], infectious mononucleosis [65%/77%], typhoid fever [50%/50%], cyclosporiasis [45%/66%], dengue fever [43%/35%], malaria [20%/27%], and rickettsiosis [20%/24%]), of AST alone (paratyphoid fever [42%]), of ALT alone (giardiasis [20%]), and of GGT (hepatitis A [100%], infectious mononucleosis [71%], CMV infection [58%], rickettsiosis (20%], and dengue fever [19%]). The study demonstrates that the determination of AST and ALT among travelers returning from the sub-/tropics has a high clinical validity, as their elevated values are typically caused by several imported viral, bacterial, and protozoan IDs, whereas no additional clinical validity was found by the determination of GGT.

The continuing trend of German citizens to travel internationally and the steep rise in the number of migrants and refugees from malaria-endemic countries have led to an increase in the number of malaria cases in Germany in recent years. The unspecific symptoms can lead to misdiagnoses, possibly resulting in severe and life-threatening courses of the disease. Knowledge concerning the signs and symptoms, diagnostics and therapy of malaria is therefore important for pediatricians, especially those caring for refugees or for travelers and migrants visiting friends and relatives in malaria-endemic countries.

The aim of this study was to assess the spectrum of imported infectious diseases (IDs) among patients consulting the University of Munich, Germany, between 1999 and 2014 after being in the sub-/tropics. The analysis investigated complete data sets of 16,817 diseased German travelers (2,318 business travelers, 4,029 all-inclusive travelers, and 10,470 backpackers) returning from Latin America (3,225), Africa (4,865), or Asia (8,727), and 977 diseased immigrants, originating from the same regions (112, 654 and 211 respectively). The most frequent symptoms assessed were diarrhea (38%), fever (29%), and skin disorder (22%). The most frequent IDs detected were intestinal infections with species of Blastocystis (900), Giardia (730), Campylobacter (556), Shigella (209), and Salmonella (183). Also frequently observed were cutaneous larva migrans (379), dengue (257), and malaria (160). The number of IDs with significantly elevated proportions was higher among backpackers (18) and immigrants (17), especially among those from Africa (18) and Asia (17), whereas it was lower for business travelers (5), all-inclusive travelers (1), and those from Latin America (5). This study demonstrates a large spectrum of imported IDs among returning German travelers and immigrants, which varies greatly based not only on travel destination and origin of immigrants, but also on type of travel.

Background Acute gastroenteritis (AGE) is the leading cause of illness among returning travelers seeking medical care. Multiple types of enteric pathogens can cause travel-acquired AGE and, while bacterial pathogens have a predominant role, the importance of viruses, such as norovirus, is increasingly recognized. There is a lack of information on travel-acquired norovirus incidence among symptomatic and asymptomatic individuals irrespective of healthcare-seeking behavior. Our aim is to estimate the incidence of travel-acquired AGE due to norovirus and to characterize the burden of disease among international travelers from the United States and Europe. Methods We describe a prospective cohort study implemented in five US and European sites to estimate the role of AGE due to norovirus among adult international travelers. We enrolled individuals aged 18 years and older who are traveling to regions of moderate-high risk of AGE, or via cruise ship with an international port stop, with a trip duration of 3–15 days. The study will generate a wide range of health and travel-related data for pre-, during, and up to 6-months post-travel. We will identify laboratory-confirmed travel-acquired norovirus infections among both symptomatic and asymptomatic individuals from self-collected whole stool samples tested via quantitative RT-PCR. Coinfections will be identified in a subset of travelers with AGE using a multiplex molecular-based assay. Discussion This study is unique in design and breadth of data collected. The prospective collection of health and behavioral data, as well as biologic samples from travelers irrespective of symptoms, will provide useful data to better understand the importance of norovirus AGE among international travelers. This study will provide data to estimate the incidence of norovirus infections and AGE and the risk of post-infectious sequelae in the 6-month post-travel period serving as a baseline for future norovirus AGE vaccination studies. This study will contribute valuable information to better understand the role of norovirus in travel-acquired AGE risk and the impact of these infections on a broad set of outcomes.

Zusammenfassung Bei Fieber nach Tropenaufenthalt kommen eine Vielzahl möglicher Erkrankungen in Frage. Anhand der Anamnese und einfacher Basisuntersuchungen können Sie rasch die Schwere und Bedeutung (lebensbedrohlich? ansteckend?) der Erkrankung feststellen.

Die Beratung zu Reiseimpfungen und Malariaprophylaxe ist eine wesentliche praventive Aufgabe der Reisemedizin. Neben den fur die Einreise in bestimmte Lander vorgeschriebenen Impfungen konnen verschiedene Indikationsimpfungen empfehlenswert sein, die einerseits von Ziel und Art der Reise und andererseits von individuellen Risiken des Reisenden abhangen. Zudem sollte jede Beratung zum Anlass genommen werden generell empfohlene Standardimpfungen zu uberprufen. Basis der Malariaprophylaxe ist ein konsequenter Muckenschutz. Eine zusatzliche Chemoprophylaxe ist vor allem bei Reisen in Gebiete mit hohem Malariarisiko angezeigt. Wenn keine regelmasige Chemoprophylaxe durchgefuhrt wird, sollte in Gebieten ohne adaquate medizinische Versorgung ein fur die notfallmasige Selbsttherapie geeignetes Medikament mitgefuhrt werden, das bei malariaverdachtigen Symptomen und nicht innerhalb von 24 Stunden erreichbarer arztlicher Hilfe eingenommen wird. Dies ist jedoch nur eine Notfallmasnahme bis zum Erreichen medizinischer Versorgung.

Background This phase 3b randomized, open‐label study evaluated the immunogenicity and safety of coadministration of a hepatitis A and/or B vaccine with a quadrivalent oligosaccharide meningococcal CRM197‐conjugate vaccine (MenACWY‐CRM), in the context of an accelerated hepatitis A and/or B immunization schedule. Methods A total of 252 healthy adult subjects were randomized to three groups to receive hepatitis A/B only (HepA/B), hepatitis A/B coadministered with MenACWY‐CRM (HepA/B+MenACWY‐CRM), or MenACWY‐CRM only (MenACWY‐CRM). Hepatitis A and/or B vaccination was administered in the form of a single booster dose or a primary three‐dose series, depending on the hepatitis A and/or B vaccination history of subjects. Antibody responses to hepatitis A/B vaccination were assessed 1 month following the last hepatitis A and/or B dose. Serum bactericidal activity with human complement (hSBA) against meningococcal serogroups A, C, W‐135, and Y was assessed 1 month post‐MenACWY‐CRM vaccination. Safety was monitored throughout the study. Results At 1 month following the final hepatitis A and/or B vaccination, concomitant administration of hepatitis A/B and MenACWY‐CRM was non‐inferior to administration of hepatitis A/B alone in terms of geometric mean concentrations of antibodies against the hepatitis A and B antigens. One month post‐MenACWY‐CRM vaccination, the percentages of subjects achieving hSBA titers ≥8 for serogroups A, C, W‐135, and Y in the HepA/B+MenACWY‐CRM group (76, 87, 99, and 94%, respectively) were comparable to those in the MenACWY‐CRM group (67, 82, 96, and 88%, respectively). The percentages of subjects reporting adverse events (AEs) were similar across study groups and a majority of the reported AEs were mild to moderate in nature. There were no study vaccine‐related serious AEs. Conclusions MenACWY‐CRM can be administered concomitantly with a hepatitis A and/or B vaccine in the context of an accelerated hepatitis A and/or B immunization schedule without increasing safety concerns or compromising the immune responses to any of the vaccine antigens. [[NCT01453348][1]] [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01453348&atom=%2Fjtm%2F22%2F2%2F105.atom

There are several clinical reports about the co-occurrence of autosomal dominant polycystic kidney disease (ADPKD) and connective tissue disorders. A simultaneous occurrence of osteogenesis imperfecta (OI) type I and ADPKD has not been observed so far.This report presents the first patient with OI type I and ADPKD.Mutational analysis of PKD1 and COL1A1 in the index patient revealed a heterozygous mutation in each of the two genes. Mutational analysis of the parents indicated the mother as a carrier of the PKD1 mutation and the father as a carrier of the COL1A1 mutation. The simultaneous occurrence of both disorders has an estimated frequency of 3.5:100 000 000.In singular cases, ADPKD can occur in combination with other rare disorders, e.g. connective tissue disorders.

Background This study aimed to investigate the morbidity profile and the sociodemographic characteristics of unaccompanied refugee minors (URM) arriving in the region of Bavaria, Germany, between October 2014 and February 2016. Methods The retrospective cross sectional study included 154 unaccompanied refugee minors between 10 and 18 years of age. The data was derived from medical data records of their routine first medical examination in two paediatric practices and one collective housing for refugees in the region of Bavaria, Germany. Results Only 12.3% of all participants had no clinical finding at arrival. Main health findings were skin diseases (31.8%) and mental disorders (25%). In this cohort the hepatitis A immunity was 92.8%, but only 34.5% showed a constellation of immunity against hepatitis B. Suspect cases for tuberculosis were found in 5.8% of the URM. There were no HIV positive individuals in the cohort. Notably, 2 females were found to have undergone genital mutilations. Conclusions The majority of arriving URM appear to have immediate health care needs, whereas the pathologies involved are mostly common entities that are generally known to the primary health care system in Germany. Outbreaks due to hepatitis A virus are unlikely since herd immunity can be assumed, while this population would benefit from hepatitis B vaccination due to low immunity and high risk of infection in crowded housing conditions. One key finding is the absence of common algorithms and guidelines in health care provision to URM.

Background Compact and short pre‐travel immunization schedules, which include several vaccinations in a single visit, are desirable for many travelers. However, concomitant vaccination could potentially compromise immunogenicity and/or safety of the individual vaccines and, therefore, possible vaccine interferences should be carefully assessed. This article discusses the immunogenicity and safety of travel vaccines for typhoid fever (TF) and yellow fever (YF), when administered with or without a quadrivalent meningococcal glycoconjugate ACWY‐CRM vaccine (MenACWY‐CRM). Methods Healthy adults (18–≤60 years) were randomized to one of three vaccine regimens: TF + YF + MenACWY‐CRM (group I; n = 100), TF + YF (group II; n = 101), or MenACWY‐CRM (group III; n = 100). Immunogenicity at baseline and 4 weeks post‐vaccination (day 29) was assessed by serum bactericidal assay using human complement (hSBA), enzyme‐linked immunosorbent assay (ELISA), or a neutralization test. Adverse events (AEs) and serious adverse events (SAEs) were collected throughout the study period. Results Non‐inferiority of post‐vaccination geometric mean concentrations (GMCs) and geometric mean titers (GMTs) was established for TF and YF vaccines, respectively, when given concomitantly with MenACWY‐CRM vaccine versus when given alone. The percentages of subjects with seroprotective neutralizing titers against YF on day 29 were similar in groups I and II. The antibody responses to meningococcal serogroups A, C, W‐135, and Y were within the same range when MenACWY‐CRM was given separately or together with TF and YF vaccines. The percentage of subjects reporting AEs was the same for TF and YF vaccines with or without MenACWY‐CRM vaccine. There were no reports of SAEs or AEs leading to study withdrawals. Conclusions These data provide evidence that MenACWY‐CRM can be administered with typhoid Vi polysaccharide vaccine and live attenuated YF vaccine without compromising antibody responses stimulated by the individual vaccines. MenACWY‐CRM can, therefore, be incorporated into travelers' vaccination programs without necessitating an additional clinic visit ([NCT01466387][1]). [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01466387&atom=%2Fjtm%2F22%2F1%2F48.atom

In 2016, the number of refugees worldwide reached 65.6 million. So far, only limited data are available on the health status of refugees and asylum seekers (RAs). Especially, notifiable infectious diseases (NIDs) carry the risk of outbreaks in communal accommodations hosting RAs. We conducted a monocentric retrolective cross-sectional study including 15,137 RAs treated in a special health care unit for RAs located in the major reception center in Munich from November 2014 to October 2016. Altogether 811 RAs with NIDs according to sections 6 and 7 of the German Infection Protection Act or with other infections relevant in the setting of a communal accommodation (RIDs) could be identified. The gender and age distribution was generally comparable to that of refugees in Germany. However, patients from East Africa and Nigeria were significantly overrepresented. NIDs/RIDs were dominated by cases of tuberculosis, hepatitis B, and vaccine-preventable and parasitic diseases. Significant risk factors included country of origin (COI) and age for hepatitis B, age for hepatitis C, gender and age for HIV, and COI, gender and age for tuberculosis and ectoparasitosis. Calculated prevalences of hepatitis B, hepatitis C, and HIV were mostly below those of the COI. Incidences of tuberculosis were mostly strongly elevated. COI, gender, and age have an impact on the occurrence of NIDs/RIDs. Early vaccinations and improved hygiene could be effective in preventing NIDs/RIDs in communal accommodations. Screening, prompt therapy, and infection protection measures are necessary to prevent the transmission of diseases.

Summary Background Potential interactions between vaccines may compromise the immunogenicity and/or safety of individual vaccines so must be assessed before concomitant administration is recommended. In this study, the immunogenicity and safety of travel vaccines against Japanese encephalitis (JEV) and rabies (PCECV) administered together with or without a quadrivalent meningococcal glycoconjugate ACWY-CRM vaccine were evaluated (NCT01466387). Method Healthy adults aged 18 to ≤60 years were randomized to one of four vaccine regimens: JEV + PCECV + MenACWY-CRM, JEV + PCECV, PCECV or MenACWY-CRM. Immunogenicity at baseline and 28 days post-complete vaccination was assessed by serum bactericidal assay using human complement or neutralization tests. Adverse events (AEs) were collected throughout the study period. Results JEV + PCECV + MenACWY-CRM was non-inferior to JEV + PCECV. Post-vaccination seroprotective neutralizing titers or concentrations were achieved in 98–99% (JE) and 100% (rabies) of subjects across the vaccine groups. Antibody responses to vaccine meningococcal serogroups were in the same range for MenACWY-CRM and JEV + PCECV + MenACWY-CRM. Rates of reporting of AEs were similar for JEV + PCECV and JEV + PCECV + MenACWY-CRM. Conclusions MenACWY-CRM was administered with an inactivated adjuvanted JE and a purified chick embryo cell-culture rabies vaccine without compromising immunogenicity or safety of the individual vaccines. These data provide evidence that MenACWY-CRM could be effectively incorporated into travel vaccination programs. Trial number: NCT01466387 .

Bei der reisemedizinischen Beratung spielen Impfungen eine wichtige Rolle. Sie konnen das Risiko zahlreicher Infektionskrankheiten aufheben oder zumindest drastisch reduzieren. Unterschieden werden kann zwischen vorgeschriebenen Impfungen sowie Standard- und Indikationsimpfungen. Die Gelbfieberimpfung war lange Zeit die einzige Impfung, die nach den Internationalen Gesundheitsvorschriften (IGV) vorgeschrieben werden konnte. Die neuen IGV sehen vor, dass ggf. auch weitere Impfungen und andere Prophylaxemasnahmen bei der Einreise verlangt werden konnen. Die auch in Deutschland empfohlenen Standardimpfungen sind bei fehlendem Impfschutz vor Reisen aufzufrischen oder nachzuholen, zumal in vielen Landern ein hoheres Infektionsrisiko besteht. Bei den reisemedizinischen Indikationsimpfungen muss im Einzelfall anhand von Reiseziel, Reisestil, Aufenthaltsdauer, besonderen Expositionsrisiken, Alter und Gesundheitszustand des Reisenden entschieden werden, inwieweit ein Impfschutz zu empfehlen ist. Von Interesse fur die Reisemedizin sind einige in Entwicklung befindliche Impfstoffe, z. B. gegen Malaria und Denguefieber.

Background: Measurement of inulin clearance is considered to be the gold standard for determining kidney function in children, but this method is time consuming and expensive. The Glomerular filtration rate (GFR) is on the other hand easier to calculate by using various creatinine- and/or cystatin C-based formulas. However, for the determination of serum creatinine and cystatin C, different and non-interchangeable analytical methods exist. Given the fact that different analytical methods for the determination of creatinine and cystatin C were used in order to validate existing GFR formulas, clinicians should be aware of the type used in their local laboratory. In this study, we compared GFR results calculated on the basis of different GFR formulas and either used serum creatinine and cystatin C values as determined by the analytical method originally employed for validation or values obtained by an alternative analytical method to evaluate any possible effects on the performance. Methods: Cystatin C values determined by means of an immunoturbidimetric assay were used for calculating the GFR using equations in which this analytical method had originally been used for validation. Additionally, these same values were then used in other GFR formulas that had originally been validated using a nephelometric immunoassay for determining cystatin C. The effect of using either the compatible or the possibly incompatible analytical method for determining cystatin C in the calculation of GFR was assessed in comparison with the GFR measured by creatinine clearance. Results: Unexpectedly, using GFR equations that employed cystatin C values derived from a possibly incompatible analytical method did not result in a significant difference concerning the classification of patients as having normal or reduced GFR compared to the classification obtained on the basis of creatinine clearance. Sensitivity and specificity were adequate. On the other hand, formulas using cystatin C values derived from a compatible analytical method partly showed insufficient performance when compared to creatinine clearance. Conclusion: Although clinicians should be aware of applying a GFR formula that is compatible with the locally used analytical method for determining cystatin C and creatinine, other factors might be more crucial for the calculation of correct GFR values.

Purpose. Up to 30% of international travelers are affected by travelers’ diarrhea (TD). Reliable data on the etiology of TD is lacking. Sufficient laboratory capacity at travel destinations is often unavailable and transporting conventional stool samples to the home country is inconvenient. We evaluated the use of Hemoccult cards for stool sampling combined with a multiplex PCR for the detection of model viral, bacterial, and protozoal TD pathogens.Methods. Following the creation of serial dilutions for each model pathogen, last positive dilution steps (LPDs) and thereof calculated last positive sample concentrations (LPCs) were compared between conventional stool samples and card samples. Furthermore, card samples were tested after a prolonged time interval simulating storage during a travel duration of up to 6 weeks.Results. The LPDs/LPCs were comparable to testing of conventional stool samples. After storage on Hemoccult cards, the recovery rate was 97.6% forC. jejuni, 100% forE.histolytica, 97.6% for norovirus GI, and 100% for GII. Detection of expected pathogens was possible at weekly intervals up to 42 days.Conclusion. Stool samples on Hemoccult cards stored at room temperature can be used in combination with a multiplex PCR as a reliable tool for testing of TD pathogens.

Background and Aims: Exclusive enteral nutrition (EEN) induces remission in patients with Crohn's disease (CD). We investigated the short-term impact of EEN on bone quality and muscle mass in children with CD. Methods: Ten newly diagnosed CD patients (7 male, 10.6-17.7 years of age) were assessed by peripheral quantitative computed tomography (pQCT) at the forearm before starting an 8-weeks treatment with EEN, and after 12 and 52 weeks. No steroids or biologicals were applied. Trabecular and cortical bone mineral density, total bone, and muscle cross-sectional area (CSA) were measured by pQCT and expressed as age- and sex-specific z-scores; size-dependent CSAs were corrected for low height for age. Wilcoxon rank sum test was applied. Results: Remission at week 12 was achieved in 8 patients; 2 still had mild disease. Initially low trabecular density z-scores improved (+0.3; p = 0.006) at week 12; simultaneously, the increased cortical density z-scores normalized (-0.4; p = 0.027). The low z-score for muscle CSA corrected for height (median -2.5, range -3.49 to -0.97) increased within 12 weeks (+1.0; p = 0.002) with no further improvement thereafter. Conclusions: The results indicate disturbed bone remodeling and severely impaired muscle mass in newly diagnosed CD children. Bone metabolism and muscle mass improved within 3 months after starting EEN with no further normalization thereafter.

Conventional rabies pre-exposure prophylaxis (PrEP) and Japanese encephalitis (JE) primary series vaccination regimens each require up to 4 weeks to complete and, thus, may not be feasible for individuals who need these immunizations on short notice. This Phase 3b, randomized, controlled, observer-blind study evaluated the immunogenicity and safety of concomitant administration of a purified chick embryo cell culture rabies vaccine and an inactivated, adsorbed JE vaccine according to an accelerated (1 week) regimen when compared with the conventional regimens (4 weeks). This report describes the kinetics of immune responses up to 1 year after vaccination.A total of 661 healthy adults (18 to ≤65 years) were randomized into the following accelerated or conventional vaccine regimens: Rabies + JE-Conventional, Rabies + JE-Accelerated, Rabies-Conventional and JE-Conventional. Immunogenicity was assessed by virus neutralization tests. Safety and tolerability were also evaluated.Irrespective of rabies vaccination regimen, ≥97% of subjects had adequate levels of rabies virus neutralizing antibody (RVNA) concentrations (≥0.5 IU/ml) up to Day 57, with percentages of subjects with RVNA concentrations ≥0.5 IU/ml at Day 366 ranging between 68% in the Rabies + JE-Accelerated group and 80% of subjects in the Rabies-Conventional group. The Rabies + JE-Accelerated group revealed high JE neutralizing antibody titers at all-time points. At Day 366, the percentage of subjects with antibody titers indicative of seroprotection (PRNT50 titers ≥1:10) remained high across JE vaccine groups (86-94%).The accelerated PrEP rabies and JE vaccination regimens, once licensed, could represent a valid alternative in the short-term to currently recommended conventional regimens. The concomitant administration of these two vaccines does not compromise immune responses to any of the vaccine antigens particularly when aiming for short-term protection. Further evidence will clarify the need for and timing to administration of rabies vaccine booster doses in subjects primed with an accelerated PrEP regimen. (NCT01662440).