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  • 1
    In: Medical Education, July 2008, Vol.42(7), pp.742-745
    Description: Medical students are at risk of occupational exposure to blood‐borne viruses following needlestick injuries (NSIs) during medical school. The reporting of NSIs is an important step in the prevention of further injuries and in the initiation of early prophylaxis or treatment. The objective of this study was to describe the mechanisms whereby medical students experience occupational percutaneous blood exposure through NSIs and to discuss rational strategies for prevention. Incidents of exposure to blood‐borne pathogens among medical students at a large German university were analysed. Year 6 medical students completed a written survey immediately before the clinical part of their training began, describing incidents that had occurred during the previous 5 years. In our study, 58.8% (183/311) of participating medical students recalled at least one NSI that had occurred during their studies. Overall, 284 NSIs were reported via an anonymous questionnaire. Occupational exposure to blood is a common problem among medical students. Efforts are required to ensure greater awareness of the risks associated with blood‐borne pathogens among German medical students. Proper training in percutaneous procedures and how to act in the event of injury should be given in order to reduce the number of injuries.
    Keywords: Needlestick Injuries/*Prevention‐&‐Control/Aetiology ; Humans ; *Education ; Medical ; Undergraduate ; Occupational Diseases/*Prevention‐&‐Control/Aetiology ; Virus Diseases/*Prevention‐&‐Control/Aetiology ; Germany ; Risk Factors ; Prevalence ; Risk Assessment ; Male ; Female ; Adult
    ISSN: 0308-0110
    E-ISSN: 1365-2923
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  • 2
    In: Acta Pædiatrica, February 2009, Vol.98(2), pp.270-276
    Description: Aim: To evaluate incidence, timing and clinical relevance of acquired human cytomegalovirus (HCMV) infection in preterm infants. Methods: The prospective longitudinal study included preterm infants ≤31 weeks. Congenital HCMV infection was excluded by negative HCMV culture from urine or by HCMV‐PCR‐negative umbilical cord blood. Infants from HCMV‐IgG‐positive mothers received thawed frozen breast milk until 33 weeks. Urine samples were obtained weekly for HCMV culture. Data were collected regarding clinical course and milk‐intake. Results: Twenty‐nine mothers (29/48, 60%) of 35 infants were HCMV‐IgG‐positive. Five of 35 infants (14%) excreted HCMV in urine. Three of five children remained asymptomatic. One child developed a respirator‐dependent HCMV pneumonia, the other child an upper airway infection and a transient thrombocytopenia. HCMV infected children had a significant longer hospital stay (median 96 vs. 73 days, p = 0.025) and received more formula milk (89 vs. 44 mL/kg/day, p = 0.04). Mothers of infected children had significantly higher HCMV‐IgG levels than those of non‐infected children (mean 1557 vs. 921 AU/mL, p = 0.048). Nineteen of 48 mothers (40%) with 23 infants were HCMV‐IgG‐negative. These children remained HCMV negative. Conclusion: Feeding preterm infants ≤31 weeks of HCMV‐IgG‐positive mothers with thawed frozen breast milk until 33 completed weeks does not prevent symptomatic HCMV infection in all cases. These infections can be associated with a prolonged hospital stay.
    Keywords: Breast Milk ; Cytomegalovirus ; Postnatal Cytomegalovirus Infection ; Preterm Infants
    ISSN: 0803-5253
    E-ISSN: 1651-2227
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  • 3
    In: Clinical Transplantation, June 2003, Vol.17(3), pp.254-258
    Description: Hepatitis B (HBV)‐infected patients receive an anti‐HBs immunoprophylaxis [hepatitis B immunoglobulin (HBIG) titre of more than 100 IU/L] in combination with lamivudine to prevent reinfection after orthotopic liver transplantation (OLT). In comparison with intramuscular (i.m.) HBIG, costs for intravenous (i.v.) HBIG are found to be extremely high. We therefore studied patients' outcome (i) after a switch from i.v. to i.m. HBIG and (ii) the outcome after the patients were initially treated with i.m. HBIG after discharge from the hospital. (i) Six outpatients were switched from 2000 IU i.v. HBIG (Hepatect) administered every 2 wk to 2000 IU i.m. HBIG (Hepatitis‐B‐Immunglobulin Behring) given once a month. (ii) Six other outpatients were directly treated with i.m. HBIG every 4 wk after OLT. All patients also received 100 mg lamivudine/d. Patients switched from i.v. to i.m. HBIG had stable anti‐HBs titres (i.v. HBIG: 180 ± 37 IU/L vs. i.m. HBIG: 173 ± 23 IU/L). Patients directly treated with i.m. HBIG also had sufficient anti‐HBs titres (176 ± 31 IU/L). Intramuscular application of HBIG was well tolerated by all patients and no side‐effects were observed in patients receiving i.m. HBIG. In comparison with the protocol using i.v. HBIG, the costs of i.m. treatment were 60% lower. Long‐term administration of i.m. HBIG saves up to 60% of the usual costs for i.v. prophylaxis of HBV reinfection in patients after OLT. In combination with lamivudine, long‐term i.m. HBIG therapy is as efficient as i.v. HBIG treatment, but its lower costs clearly favour its use in preventing HBV reinfection after OLT.
    Keywords: Hepatitis B ; Hepatitis B Immunoglobulin ; Immunoprophylaxis ; Liver Transplantation ; Recurrence
    ISSN: 0902-0063
    E-ISSN: 1399-0012
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  • 4
    In: Transfusion, September 2009, Vol.49(9), pp.1836-1844
    Description: In February 2007, a 63‐year‐old man underwent surgery. Retrospective testing with nucleic acid testing (NAT) showed that the patient was human immunodeficiency virus Type 1 (HIV‐1) positive 10 days after transfusion. The transfusion‐transmitted infection had been identified by a donor‐related lookback started in April 2007 after anti‐HIV seroconversion. Sequence analysis was performed in the gag‐pol region as well as in the V3 loop env region. Archived plasma from the transmitting donation was investigated for the individual‐donation NAT with the Roche COBAS AmpliPrep/COBAS TaqMan HIV‐1 test (Roche CAP/CTM HIV‐1 test) and for HIV antigen/antibody combination testing (Abbott Architect). Additional testing was done on the donor's follow‐up sample and on the recipient's sample. The Roche CAP/CTM HIV‐1 test failed to detect viral RNA by minipool NAT in the index donation (April 2007) as well as in the donation that caused the infection (January 2007). Phylogenetic analysis showed a very high genetic similarity among viral sequences from both donor and recipient, proving the HIV‐1 transmission by sequence data. This case represents the first documented HIV‐1 transmission by transfusion of red blood cells after mandatory introduction of HIV‐1 NAT for blood screening in Germany. Low viral load and mismatches in the primer/probe region might explain the detection failure of the NAT screening assay. A certain risk remains that new virus variants contain mutations at positions critical for amplification or detection of viral genomes. An option to reduce the risk of a detection failure by NAT is the simultaneous use of several conserved regions as amplification targets.
    Keywords: Disease Transmission -- Health Aspects ; Hiv Infections -- Health Aspects ; Biological Products -- Health Aspects ; Hiv Tests -- Health Aspects ; Rna -- Health Aspects ; Hiv -- Health Aspects;
    ISSN: 0041-1132
    E-ISSN: 1537-2995
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  • 5
    Language: English
    In: Journal of Medical Virology, June 2000, Vol.61(2), pp.201-207
    Description: This study was carried out to determine the prevalence of antibodies to herpes simplex virus types 1 (HSV‐1) and 2 (HSV‐2) in selected German populations, such as blood donors, hospital patients, and human immunodeficiency virus (HIV)‐seropositive individuals. Serum samples collected between 1996 and 1998 were tested by enzyme immunoassays using monoclonal antibody‐selected native gG1 and gG2 as antigens and an immunoblot using type‐specific recombinant glycoproteins. Equivocal results were resolved by an “in‐house” Western blot assay. The prevalence of HSV‐1 antibodies increased steadily with age and reached high levels of ≥88% among subjects 40 years of age or older. In the sample of patients and blood donors, the HSV‐2 seroprevalence was 12.8% (95% CI = 11.9–13.8%). About 81% of the HSV‐2 seropositive subjects were coinfected with HSV‐1. When adjusted for age, there was no difference in the HSV‐2 seroprevalence between hospital patients and blood donors. The HSV‐2 seroprevalence was significantly higher among women (15%) than among men (10.5%), yielding a female : male odds ratio of 1.5 for hospital patients and of 1.67 for blood donors. Among the HIV‐infected population, 91.1% were seropositive for HSV‐1 and 47.9% for HSV‐2. HIV‐infected women have a significantly higher risk of HSV‐2 infection than men (odds ratio [OR] = 3.22; 95% confidence ratio [CI] 1.99–5.20). In conclusion, although the rate of infections with HSV‐2 is relatively low in the German population, attention should be given to the further development in adolescents, especially in view of a possible decrease of HSV‐1 seroprevalence in childhood. J. Med. Virol. 61:201–207, 2000. © 2000 Wiley‐Liss, Inc.
    Keywords: Epidemiology ; Sexually Transmitted Disease ; Type‐Specific Antibodies ; Hiv ; Hsv
    ISSN: 0146-6615
    E-ISSN: 1096-9071
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