TY - JOUR A1 - Fortmann, Mats Ingmar A1 - Dirks, Johannes A1 - Goedicke-Fritz, Sybelle A1 - Liese, Johannes A1 - Zemlin, Michael A1 - Morbach, Henner A1 - Härtel, Christoph T1 - Immunization of preterm infants: current evidence and future strategies to individualized approaches JF - Seminars in Immunopathology N2 - Preterm infants are at particularly high risk for infectious diseases. As this vulnerability extends beyond the neonatal period into childhood and adolescence, preterm infants benefit greatly from infection-preventive measures such as immunizations. However, there is an ongoing discussion about vaccine safety and efficacy due to preterm infants’ distinct immunological features. A significant proportion of infants remains un- or under-immunized when discharged from primary hospital stay. Educating health care professionals and parents, promoting maternal immunization and evaluating the potential of new vaccination tools are important means to reduce the overall burden from infectious diseases in preterm infants. In this narrative review, we summarize the current knowledge about vaccinations in premature infants. We discuss the specificities of early life immunity and memory function, including the role of polyreactive B cells, restricted B cell receptor diversity and heterologous immunity mediated by a cross-reactive T cell repertoire. Recently, mechanistic studies indicated that tissue-resident memory (Trm) cell populations including T cells, B cells and macrophages are already established in the fetus. Their role in human early life immunity, however, is not yet understood. Tissue-resident memory T cells, for example, are diminished in airway tissues in neonates as compared to older children or adults. Hence, the ability to make specific recall responses after secondary infectious stimulus is hampered, a phenomenon that is transcriptionally regulated by enhanced expression of T-bet. Furthermore, the microbiome establishment is a dominant factor to shape resident immunity at mucosal surfaces, but it is often disturbed in the context of preterm birth. The proposed function of Trm T cells to remember benign interactions with the microbiome might therefore be reduced which would contribute to an increased risk for sustained inflammation. An improved understanding of Trm interactions may determine novel targets of vaccination, e.g., modulation of T-bet responses and facilitate more individualized approaches to protect preterm babies in the future. KW - preterm infants KW - immunization KW - vaccination KW - safety KW - mechanisms KW - resident memory T cells Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324261 VL - 44 IS - 6 ER - TY - JOUR A1 - Prelog, Martina T1 - Differential Approaches for Vaccination from Childhood to Old Age JF - Gerontology N2 - Primary prevention strategies, such as vaccinations at the age extremes, in neonates and elderly individuals, demonstrate a challenge to health professionals and public health specialists. The aspects of the differentiation and maturation of the adaptive immune system, the functional implications of immunological immaturity or immunosenescence and its impact on vaccine immunogenicity and efficacy will be highlighted in this review. Several approaches have been undertaken to promote Th1 responses in neonates and to enhance immune functions in elderly, such as conjugation to carrier proteins, addition of adjuvants, concomitant vaccination with other vaccines, change in antigen concentrations or dose intervals or use of different administration routes. Also, early protection by maternal vaccination seems to be beneficial in neonates. However, it also appears necessary to think of other end points than antibody concentrations to assess vaccine efficacy in neonates or elderly, as also the cellular immune response may be impaired by the mechanisms of immaturity, underlying health conditions, immunosuppressive treatments or immunosenescence. Thus, lifespan vaccine programs should be implemented to all individuals on a population level not only to improve herd protection and to maintain protective antibody levels and immune memory, but also to cover all age groups, to protect unvaccinated elderly persons and to provide indirect protection for neonates and small infants. KW - immunosenescence KW - aging KW - T cells KW - B cells KW - immunization KW - vaccination KW - thymus KW - influenza KW - neonates KW - antibody Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-196602 SN - 0304-324X SN - 1423-0003 N1 - This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively. VL - 59 IS - 3 ER - TY - THES A1 - Loeff, Rebekka Magdalena T1 - Screening auf multiresistente Erreger, Erhebung von Tuberkulose- und Impfstatus sowie sonstiger meldepflichtiger Infektionskrankheiten bei Geflüchteten am Universitätsklinikum Würzburg im Zeitraum vom 1.11.2015 bis 30.04.2016 T1 - Screening for Multidrug-Resistant Organisms, status of tuberculosis, vaccination and other infectious diseases in refugees at the University Hospital Würzburg from November 1, 2015 to April 30, 2016 N2 - Hintergrund: Geflüchtete haben ein hohes Risiko, Multiresistente Erreger (MRE) zu tragen. Infektionen mit MRE (Multiresistente Gram-negative Bakterien [MRGN] und Methicillin-resistenter Staphylococcus aureus [MRSA]) sind mit einer erhöhten Mortalität, Krankenhausaufenthaltsdauer und Krankenhauskosten assoziiert. Der Einfluss von prädisponierenden Faktoren für eine Besiedlung mit MRE ist für Geflüchtete noch unzureichend erforscht. Kenntnisse über prädisponierende Faktoren können helfen, Infektionsschutzmaßnahmen für Geflüchtete in Krankenhäusern anzupassen. Methodik: Von November 2015 bis April 2016 wurden 134 Geflüchtete am Universitätsklinikum Würzburg auf MRE im Nasen-/Rachen- (MRSA), Rektal- (MDRGN-Enterobacteriaceae, MDRGN-Pseudomonas aeruginosa) und Haut-/Rachenabstrich (MDRGN-Acinetobacter baumannii) gescreent. Ergebnisse: 62,7% von 134 gescreenten Flüchtlingen waren männlichen Geschlechts und das Durchschnittsalter lag bei 19 Jahren [IQR: 7–31]. 23,9% (n=32) zeigten einen positiven MRE-Befund (MRSA: 3,4 % von 118, 2MDRGN-Neopäd: 19,3 % von 57, 3MDRGN: 13,6 % von 125, 4MDRGN: 0 % von 125). Es wurden 25 Escherichia coli (98,3%), 3 Klebsiella pneumoniae (10,7%) und keine positiven Befunde auf Pseudomonas aeruginosa oder Acinetobacter baumannii gefunden. 3 Geflüchtete (9,6%) zeigten eine Mehrfachbesiedlung und 2 Geflüchtete (6,2%) wiesen eine durch MRE bedingte Infektionserkrankung auf (submandibulärer Abszess, Pyelonephritis). Bei 94 Geflüchteten mit vollständigem Screening waren Geflüchtete mit positivem MRE-Befund im Vergleich zu Geflüchteten mit negativem MRE-Befund jüngeren Alters (Medianalter: 8 Jahre [IQR: 3–36] vs. 24 Jahre [IQR: 14–33]) und vermehrt weiblichen Geschlechts (61,1%). Geflüchtete mit positivem MRE-Befund wiesen zudem im Vergleich vermehrt prädisponierende Faktoren auf, bspw. einen vorherigen Krankenhausaufenthalt (61,1 % vs. 35,5%), chronische Pflegebedürftigkeit (16,7 % vs. 1,3 %) oder eine Fluchtanamnese ≤ 3 Monate (80,0 % vs. 29,4 %). Schlussfolgerung: Prädisponierende Faktoren spielen eine große Rolle für eine Besiedlung mit MRE. Prospektive Studien sollten folgen, um prädisponierende Faktoren für eine Besiedlung mit MRE bei Geflüchteten besser charakterisieren zu können. N2 - Background: Refugees are at high risk to carry multidrug-resistant organisms (MDRO). Infections with MDRO (multidrug-resistant gram-negative organisms [MDRGN] and methicillin-resistant Staphylococcus aureus [MRSA]) are associated with increased mortality, duration of hospital stay and hospital costs. The influence of risk factors for MDRO is still insufficient for refugees. Knowledge about risk factors of refugees can help to adapt infection control measures for refugees at hospitals. Methods From November 2015 to April 2016, 134 refugees were screened at the University Hospital of Würzburg for MDRO with naso/pharyngeal (MRSA), rectal swab (MDRGN-Enterobacteriaceae, MDRGN-Pseudomonas aeruginosa) and skin/pharyngeal swab (MDRGN-Acinetobacter baumannii). Results 62.7% of 134 screened refugees were masculine and the median age was 19 years [IQR: 7-31]. 23.9% (n=32) were positive for at least one MDRO (MRSA: 3.4% of 118, 2MDRGN-Neopäd: 19.3% of 57, 3MDRGN: 13.6% of 125, 4MDRGN: 0% of 125). 25 Escherichia coli (98.3%), 3 Klebsiella pneumoniae (10.7%) and neither Pseudomonas aeruginosa nor Acinetobacter baumannii were found. We detected co-colonization with 2 pathogens in 3 refugees (9.6%) and an infection of MRDO (submandibular abscess, pyelonephritis) in 2 refugees (6.2%). In a subsample of 94 refugees screened simultaneously with all swabs abovementioned, refugees with MDRO were younger (median age: 8 years [IQR: 3-36] vs. 24 years [IQR: 14-33]) and more feminine (61.1%) in comparison to MDRO-negative refugees. Refugees screened positive for MDRO had more risk factors than refuges screened negative, e.g. previous hospital stay (61.1% vs. 35.5%), presence of care level (16.7% vs. 1.3%) or duration of stay in Germany ≤3 months (80.0% vs. 29.4%). Conclusion Risk factors are associated with higher prevalence of MDRO. Prospective studies need to follow to better understand the risk factors in refugees. KW - Geflüchtete KW - Multiresistente Erreger KW - Screening KW - Tuberkulose KW - Impfungen KW - refugee KW - multidrug-resistant organisms KW - screening KW - tuberculosis KW - vaccination Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239424 ER - TY - JOUR A1 - Hagemann, Christine A1 - Streng, Andrea A1 - Kraemer, Alexander A1 - Liese, Johannes G. T1 - Heterogeneity in coverage for measles and varicella vaccination in toddlers – analysis of factors influencing parental acceptance JF - BMC Public Health N2 - Background: In 2004, routine varicella vaccination was introduced in Germany for children aged 11–14 months. Routine measles vaccination had already been introduced in 1973 for the same age group, but coverage is still too low (<95%) in some areas to eliminate measles. The present study assessed varicella and measles vaccination coverage and determinants of parental acceptance in two study regions, situated in Northern and Southern Bavaria (Germany). Methods: From 2009 to 2011, annual cross-sectional parent surveys were performed on random samples of 600 children aged 18–36 months in the Bavarian regions of both Munich and Würzburg. Logistic regression models were used to identify factors associated with varicella and measles vaccination. Results: In 2009, 2010 and 2011, vaccination coverage was lower in Munich than in Würzburg, for both varicella (Munich 53%, 67%, 69% vs. Würzburg 72%, 81%, 83%) and for measles (Munich 88%, 89%, 91% vs. Würzburg 92%, 93%, 95%). Recommendation by the physician was the main independent factor associated with varicella vaccination in both regions (adjusted odd ratios (OR) with 95% confidence interval (CI): Munich OR 19.7, CI 13.6–28.6; Würzburg OR 34.7, CI 22.6–53.2). Attendance at a childcare unit was positively associated with a higher acceptance of varicella vaccination in Munich (OR 1.5, CI 1.1–2.2). Regarding measles vaccination, attendance at a childcare unit was positively associated in both regions (Munich OR 2.0; CI 1.3–3.0; Würzburg OR 1.8; CI 1.1–3.1), and a higher level of parental school education was negatively associated in Würzburg (OR 0.5, CI 0.3–0.9). Conclusions: Vaccination rates differed between regions, with rates constantly higher in Würzburg. Within each region, vaccination rates were lower for varicella than for measles. Measles vaccination status was mainly dependent upon socio-demographic factors (attendance at a childcare unit, parental school education), whereas for the more recently introduced varicella vaccination recommendation by the physician had the strongest impact. Hence, different strategies are needed to further improve vaccination rates for both diseases. KW - varicella KW - measles KW - vaccination KW - coverage KW - surveillance KW - pediatric Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157827 VL - 17 IS - 724 ER - TY - JOUR A1 - Rose, Markus A. A1 - Damm, Oliver A1 - Greiner, Wolfgang A1 - Knuf, Markus A1 - Wutzler, Peter A1 - Liese, Johannes G. A1 - Krüger, Hagen A1 - Wahn, Ulrich A1 - Schaberg, Tom A1 - Schwehm, Markus A1 - Kochmann, Thomas F. A1 - Eichner, Martin T1 - The epidemiological impact of childhood influenza vaccination using live-attenuated influenza vaccine (LAIV) in Germany: predictions of a simulation study JF - BMC Infectious Diseases N2 - Background: Routine annual influenza vaccination is primarily recommended for all persons aged 60 and above and for people with underlying chronic conditions in Germany. Other countries have already adopted additional childhood influenza immunisation programmes. The objective of this study is to determine the potential epidemiological impact of implementing paediatric influenza vaccination using intranasally administered live-attenuated influenza vaccine (LAIV) in Germany. Methods: A deterministic age-structured model is used to simulate the population-level impact of different vaccination strategies on the transmission dynamics of seasonal influenza in Germany. In our base-case analysis, we estimate the effects of adding a LAIV-based immunisation programme targeting children 2 to 17 years of age to the existing influenza vaccination policy. The data used in the model is based on published evidence complemented by expert opinion. Results: In our model, additional vaccination of children 2 to 17 years of age with LAIV leads to the prevention of 23.9 million influenza infections and nearly 16 million symptomatic influenza cases within 10 years. This reduction in burden of disease is not restricted to children. About one third of all adult cases can indirectly be prevented by LAIV immunisation of children. Conclusions: Our results demonstrate that vaccinating children 2-17 years of age is likely associated with a significant reduction in the burden of paediatric influenza. Furthermore, annual routine childhood vaccination against seasonal influenza is expected to decrease the incidence of influenza among adults and older people due to indirect effects of herd protection. In summary, our model provides data supporting the introduction of a paediatric influenza immunisation programme in Germany. KW - vaccination KW - live-attenuated influenza vaccine KW - children KW - transmission model KW - metanalysis KW - recommendations KW - hospitalizations KW - burden KW - infection KW - young children KW - seasonal influenza KW - United States KW - disease KW - efficacy KW - Germany KW - influenza Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-117563 SN - 1471-2334 VL - 14 IS - 40 ER - TY - THES A1 - Schubert, Christoph T1 - Die Masernepidemie in Ansbach 1992/93 : epidemiologische Untersuchungen und Berechnungen zur Impfwirksamkeit T1 - The measles epidemic of Ansbach/Germany 1992/93 N2 - In der vorliegenden Studie wurde die Ansbacher Masernepidemie der Jahre 1992/93 retrospektiv epidemiologisch ausgewertet und Berechnungen zur Impfwirksamkeit erstellt. Daten über Komplikationen, die Alters- und Geschlechtsverteilung sowie den Impfstatus von 530 an Masern erkrankten Personen wurden über ein Fragebogenverfahren oder durch direkte Befragung von 85 kontaktierten Allgemein- und Kinderärzte anonym gewonnen. Es waren hauptsächlich Kinder und Jugendliche bis 17 Jahren erkrankt, mit einem kontinuierlichen Ansteigen der Inzidenz bis 14 Jahren. Die Epidemie war deutlich mädchenwendig. 18,7% der Patienten waren mit einem Masernlebendimpfstoff geimpft worden. In 16,7% aller Fälle traten Komplikationen auf, am häufigsten waren Otitis media (10,3%) und Pneumonie (5,0%). Ein ungeimpfter 17jähriger Patient verstarb an einer Masernenzephalitis. Sieben Patienten mussten hospitalisiert werden (1,4%). Bis auf die Konstellation „geimpft+männlich+Pneumonie“, die signifikant häufiger auftrat, fanden sich keine Zusammenhänge zwischen Alter, Geschlecht, Impfstatus und Komplikationen. Bei der Berechnung der Impfeffektivität zeigte sich, dass die Impfwirksamkeit bei älteren Patienten deutlich geringer war als bei jüngeren. Über ein weiterentwickeltes mathematisches Modell wurde das Impfversagen in Abhängigkeit von der Zeit seit der Impfung analysiert. Daraus ergab sich ein primäres Impfversagen von ca. 6%. Außerdem ist anzunehmen, dass es bei einem Drittel der Geimpften innerhalb von 14 Jahren zu einem sekundären Impfversagen kam. Letztere Aussage ist jedoch nur zulässig, wenn man annimmt, dass das primäre Impfversagen seit Impfbeginn konstant blieb. Die Ursachen für die Epidemie in Ansbach sind eindeutig die zu geringen Immuni-sierungsraten. N2 - The study examines the measles epidemic of Ansbach/Germany of winter 1992/93 by an retrospective study design. Data like complication, age, sex and vaccination state of 530 sick persons were recorded. Only a few sick persons were older than 17 years. The incidence rises from age 1 to 14 continuously. There were more sick girls than boys. 18,7% of the sick persons were vaccinated by a live attenuated vaccine. Complications were found by 16,7% (otitis media 10,3%, pneumonia 5%). One 17year old unvaccinated boy died of measles encephalitis. The vaccination efficacy of young persons was higher than of older ones. Calculations using a further developed mathematic model showed a primary vaccination failure of 6%. It seems that one third of all vaccinated people lose the protection of measles vaccination within 14 years. The cause of the measles epidemic was found in the low vaccination rate. KW - Masern KW - Epidemiologie KW - Impfung KW - Impfversagen KW - Komplikationen KW - measles KW - epidemiologie KW - vaccination KW - vaccination failure KW - complications Y1 - 2002 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-7901 ER -