RESUMEN
The coronavirus disease 2019 (COVID19) mostly occurs in children and adolescents as an asymptomatic infection. The course of the disease is usually mild or moderate. The estimated seroprevalence in Germany before the start of the vaccination program in children and adolescents was >â¯10%. Individual risk factors for a severe course are known. The COVID19-associated pediatric inflammatory multisystem syndrome (PIMS) is a very rare and severe disease with a favorable prognosis if diagnosed early and treated appropriately. The data situation on long-COVID syndrome in children and adolescents is still insufficiently defined and the incidence is not known. The primary source of infections in children and adolescents are household contacts. Transmission in school settings and other day care facilities play a subordinate role, at least in Germany.Two mRNA vaccines are currently approved in Europe for the prevention of COVID19 in children and adolescents above the age of 12 years. Except for the very rare occurrence of pericarditis/myocarditis in temporal association with the vaccination, especially in young men, the COVID19 vaccines are considered effective and safe in the age group 12-17 years. The Standing Vaccination Commission (STIKO) issued a vaccination recommendation for all 12-17-year-olds on 19 August 2021.
RESUMEN
The number of patients suffering from immunodeficiency is increasing; however, the vaccination rate of these patients is below average. Administration of inactivated vaccines is harmless but does not reliably trigger a persistent immune response. Live vaccines provide a reliable protection but can cause severe disease in immunocompromised patients. Live vaccines can be administered under defined levels of immunosuppression, e.g. against measles, mumps, rubella and varicella (MMRV). In addition, the immunization of the domestic environment plays an important role in preventing infectious diseases.
Asunto(s)
Huésped Inmunocomprometido , Vacunación , Humanos , Esquemas de Inmunización , Vacunas CombinadasRESUMEN
BACKGROUND: In early childhood, the allergen-specific IgG repertoire is mainly directed to animal and vegetable food molecules and infrequently to airborne molecules. It is unknown whether this early pattern is maintained throughout childhood. OBJECTIVE: To investigate the evolution of IgG and IgE responses to a broad panel of allergenic molecules from birth to age 10 years. METHODS: We examined the sera collected between birth and age 10 years from participants in the German Multicentre Allergy Study, a birth cohort born in 1990. The IgE (cutoff ≥0.30 ISU) and IgG (cutoff ≥0.10 ISU) responses to 35 genuine allergenic molecules were measured with a multiplex microarray approach (ImmunoCAP ISAC™). RESULTS: IgE responses were mostly directed against a restricted group of airborne molecules, with a sequence and prevalence hierarchy (Phl p 1> Bet v 1> Fel d 1> Phl p 5> Der p 2> Der p 1) largely maintained over time. Conversely, the IgG repertoire was much broader, starting with animal foodborne, then spreading to vegetable foodborne and finally to airborne molecules. A strong and persistent IgG response to a given airborne molecule almost invariably preceded or accompanied an IgE response to that molecule. CONCLUSIONS: The evolution of IgG and IgE responses throughout childhood differs widely at population level. IgG responses are mostly directed to animal food allergens, while IgE responses are dominated by airborne allergens. However, a strong IgG response almost invariably precedes or accompanies the appearance of IgE to the same molecule in specifically sensitized subjects.
Asunto(s)
Alérgenos/sangre , Alérgenos/inmunología , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Factores de Edad , Niño , Preescolar , Estudios de Cohortes , Femenino , Alemania , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Estudios ProspectivosRESUMEN
The German Standing Committee on Vaccination (STIKO) recommends seasonal influenza vaccination for children and adolescents with chronic medical conditions that put them at risk for severe influenza illness. In addition to trivalent inactivated influenza vaccines (TIV), a trivalent live-attenuated influenza vaccine (LAIV) was licensed for children and adolescents aged 2-17 years in the European Union in 2011. Employing the methodology of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group, we examined the evidence for efficacy and safety of LAIV relative to TIV to guide STIKO's decision on whether LAIV should be preferentially recommended for at-risk children. In our meta-analysis of data from two randomized trials directly comparing LAIV and TIV in children aged ≤ 6 years, the protective efficacy of LAIV against laboratory-confirmed influenza was 53 % [95 % confidence interval (CI): 45-61 %] higher than that of TIV. A similar study in individuals aged 6-17 years showed a 32 % (95 % CI: 3-52 %) higher efficacy of LAIV. The quality of the evidence for a superior protective efficacy of LAIV against all relevant clinical outcomes was rated 'moderate' for children aged 2-6 years and 'low' for the age group 7-17 years. Regarding safety outcomes, the available data suggest no significant differences between LAIV and TIV. Based on these results, STIKO recommends that LAIV should be used preferentially for influenza vaccination of at-risk children aged 2-6 years. In children and adolescents aged 7-17 years, either LAIV or TIV may be used without specific preference. Possible contraindications and the vaccinee's and his/her guardians' preferences should be taken into account.
Asunto(s)
Medicina Basada en la Evidencia , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Guías de Práctica Clínica como Asunto , Vacunación/estadística & datos numéricos , Vacunación/normas , Niño , Preescolar , Femenino , Alemania/epidemiología , Humanos , Masculino , Prevalencia , Factores de Riesgo , Resultado del Tratamiento , Vacunas Atenuadas/normas , Vacunas Atenuadas/uso terapéuticoRESUMEN
The vaccination programme for adults in Germany is based on the comprehensive immunization acquired during childhood and adolescence. The goal of these vaccinations given at regular intervals is to achieve effective immunization coverage lasting into old age. The public health authorities in Germany recommend, according to the Standing Vaccination Commission (STIKO) standards, that adults should receive at least a decennial booster vaccination against diphtheria and tetanus as well as a pertussis booster if the last pertussis vaccine was administered more than 10 years earlier. Individuals above the age of 60 additionally benefit from vaccinations against pneumococcal diseases and annual vaccinations against seasonal influenza. In special life situations, e.g. during pregnancy, vaccination against influenza is also recommended for younger people. The current amendments to the recommendations of the STIKO are aimed at definitive control of measles and eradication of rubella embryopathy. A periodic check-up of the individual vaccination status, and if appropriate completion of missing vaccinations is an important duty of every practising physician. Supporting the creation of herd immunity contributes to the protection of individuals as well as the whole population.
Asunto(s)
Vacunación/normas , Adulto , Factores de Edad , Anciano , Niño , Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Femenino , Alemania , Adhesión a Directriz , Humanos , Inmunidad Colectiva , Esquemas de Inmunización , Inmunización Secundaria/normas , Vacunas contra la Influenza/administración & dosificación , Masculino , Vacuna Antisarampión/administración & dosificación , Persona de Mediana Edad , Vacunas Neumococicas/administración & dosificación , Embarazo , Vacuna contra la Rubéola/administración & dosificaciónRESUMEN
BACKGROUND: PID-ARI.net was one of three infectious disease epidemiological research networks funded by the German Ministry of Education and Research (BMBF). Its objectives were to strengthen the national initiative on infectious diseases epidemiology and to focus on a health care problem of high relevance. PATIENTS AND METHODS: A research network on the epidemiology of ARI in children was formed to generate data on several levels. Key structure was a centrally organized active surveillance system in three areas of Germany from north to south. RESULTS: In the 6 years of funding by the BMBF, an integrated research network with a known population denominator was formed. In the laboratory-based surveillance of up to 19 respiratory pathogens, 18,899 samples were analyzed. The added value is utilization of data on time, place, person and pathogen of a disease episode at several levels - from surveillance and online publication via a website to descriptive, analytical and molecular epidemiology and further specialized projects. Its wide age range including children up to 16 years of age, an extensive panel of pathogens, a known population denominator and the diversity of 3 distant geographical areas should considerably reduce vulnerability due to bias. CONCLUSIONS: Active surveillance systems for ARI are superior to passive systems. If a surveillance system such as the one used in PID-ARI.net is part of a research network which can utilize the data on several levels, the expenditure for such a system should be worthwhile and such a system would be an asset to any health care system.
Asunto(s)
Investigación Biomédica , Vigilancia de la Población , Infecciones del Sistema Respiratorio/epidemiología , Enfermedad Aguda , Adolescente , Niño , Preescolar , Bases de Datos como Asunto , Alemania , Humanos , Lactante , Recién Nacido , Sistemas en Línea , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/microbiología , Encuestas y CuestionariosRESUMEN
UNLABELLED: Fatal infantile cardioencephalomyopathy (OMIM No. 604377) is a disorder of the mitochondrial respiratory chain and is characterised by neonatal progressive muscular hypotonia and cardiomyopathy because of severe Cytochrome c oxidase deficiency. Here we report a novel mutation in the Cytochrome c oxidase assembly gene SCO2 in an infant with fatal infantile cardioencephalomyopathy despite normal initial metabolic screening. CONCLUSION: In newborns with unexplained muscular hypotonia and cardiomyopathy genetic testing of mitochondrial respiratory chain disorders might be helpful to establish a final diagnosis and guide treatment decisions.
Asunto(s)
Cardiomiopatías/genética , Proteínas Portadoras/genética , Deficiencia de Citocromo-c Oxidasa/genética , Encefalomiopatías Mitocondriales/genética , Proteínas Mitocondriales/genética , Mutación , Deficiencia de Citocromo-c Oxidasa/complicaciones , Resultado Fatal , Femenino , Heterocigoto , Humanos , Lactante , Chaperonas MolecularesRESUMEN
Humoral and cell-mediated immune responses (CMI) were evaluated in subjects 3 and 6 years after primary and booster vaccination with either three-component acellular (Pa) or whole-cell (Pw) vaccines. Low anti-pertussis toxin (PT) antibody levels confirmed the absence of pertussis disease, consistent with ongoing protection. Anti-pertactin (PRN) antibodies, remained at higher levels in Pa-vaccinated subjects. At year 6, CMI responses continued to be present and were higher in Pa-vaccinated than Pw-vaccinated subjects. Long-term protection with Pa vaccines can be expected to be at least as good as that provided by efficacious Pw vaccines.
Asunto(s)
Bordetella pertussis/inmunología , Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Vacuna contra Difteria, Tétanos y Tos Ferina/inmunología , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/inmunología , Inmunización Secundaria/métodos , Formación de Anticuerpos/inmunología , Cápsulas Bacterianas , Proteínas de la Membrana Bacteriana Externa/inmunología , Niño , Preescolar , Vacunas contra Haemophilus/administración & dosificación , Vacunas contra Haemophilus/inmunología , Humanos , Inmunidad Celular/inmunología , Lactante , Activación de Linfocitos/inmunología , Linfocinas/inmunología , Toxina del Pertussis/inmunología , Polisacáridos Bacterianos/administración & dosificación , Polisacáridos Bacterianos/inmunología , Factores de Virulencia de Bordetella/inmunologíaRESUMEN
BACKGROUND: Drug poisonings in childhood account with about one fourth for the most important group of poisonings in this age group. METHOD: From 1995 to 2004 the inquiries to a poison centre regarding drug poisonings of children < or = 6 years of age were analyzed. Additionally, a standardized questionnaire was sent for follow-up information. RESULTS: During the study period a total number of 17 553 cases of drug poisonings in childhood was determined and follow-up information was obtained for 8 590 cases (48.9 %). Boys were more likely to be affected (53.4 %) and most children were between 2 and 4 years of age (57.5 %). Mostly oral contraceptives, homeopathic drugs, nonsteroidal anti-inflammatory drugs, sodium fluoride and paracetamol were ingested. In 97.8 % of the reported cases none or minor symptoms and in 1.5 % medium or major symptoms (1 death) were observed. In the latter group of patients mostly neuroleptics, antihistaminics, nonsteroidal anti-inflammatory drugs, beta2-sympathomimetics and paracetamol were ingested. In most cases the application of fluids (47.3 %) or activated charcoal (32.0 %) was sufficient. CONCLUSIONS: Severe symptoms have rarely been observed in drug poisonings and in most children a treatment by non-professionals was sufficient. Most frequently activated charcoal was currently used for primary poison elimination. We suggest an early involvement of a poison centre in drug intoxications.
Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Centros de Control de Intoxicaciones/estadística & datos numéricos , Intoxicación/epidemiología , Niño , Preescolar , Estudios Transversales , Femenino , Alemania , Encuestas Epidemiológicas , Humanos , Incidencia , Lactante , Masculino , Intoxicación/prevención & control , Factores de RiesgoRESUMEN
The humoral and cellular immune response to inactivated hepatitis A vaccine was investigated dynamically in a time elapse study over 1 year. Fourty-five healthy volunteers, seronegative for anti-HAV, were vaccinated with 1440 enzyme-linked immunosorbent assay units (EU) of formalin-inactivated hepatitis A virus following a 0--6-month schedule. Serum anti-HAV levels and HAV-specific proliferation of peripheral blood mononuclear cells were measured at several time points over a 26- and 28-week period after the first and second injection, respectively. Distinct B and T cell responses were determined within 14 days after primary vaccination. The booster vaccination-induced immediate peak levels for the humoral (anti-HAV GMC=5376mIU/ml) as well as the cellular (median Deltacpm=14173cpm) response.
Asunto(s)
Anticuerpos de Hepatitis A/sangre , Vacunas contra la Hepatitis A/inmunología , Virus de la Hepatitis A Humana/inmunología , Inmunidad Celular/efectos de los fármacos , Activación de Linfocitos/efectos de los fármacos , Vacunas contra Hepatitis Viral/administración & dosificación , Adulto , Femenino , Hepatitis A/prevención & control , Vacunas contra la Hepatitis A/administración & dosificación , Humanos , Inmunización Secundaria , Masculino , Vacunas de Productos Inactivados/administración & dosificación , Vacunas de Productos Inactivados/inmunologíaRESUMEN
BACKGROUND: Passive immunization with palivizumab is expensive and requires considerable logistic effort. So far 5 monthly injections from November to March are recommended. The RSV season onset and its duration, however, shows considerable variation. In many countries on the northern hemisphere a dual rhythm is described. METHOD: A web-based early warning system within the research network PID-ARI.net is in place since 2002. The surveillance data are published online weekly via www.pid-ari.net. This enables physicians to carry out interventions, like passive immunization for RSV, synchronously with the epidemiology of a given pathogen instead of a rigid schedule. The surveillance of PID-ARI.net is based on a 19 valent multiplex RT-PCR on naso-pharyngeal aspirates. The samples are provided by hospitals and offices in Freiburg, Mainz and Schleswig-Holstein (north, middle, south of Germany). Children with lower airway infections are prospectively enrolled. RESULTS: In the time period from July 1999 to June 2003 with 20 months of recommended palivizumab application, 5 months (25 %) would have been not on target. In two seasons the start of the vaccine campaign would have been too early (waste of two months). In one season the application would have started one month too late and in two seasons the vaccine campaign would have been stopped two months too early leaving the vaccinees on risk for acquiring RSV. CONCLUSIONS: The web-based early warning system of PID-ARI.net is the first, pathogen-specific, comprehensive and fast surveillance-system for airway pathogens in Europe. It facilitates the epidemic-synchronous use of the passive immunization with palivizumab and by this increases its efficiency and should safe costs.
Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Antivirales/administración & dosificación , Control de Enfermedades Transmisibles/métodos , Inmunización Pasiva , Internet , Vigilancia de la Población , Infecciones por Virus Sincitial Respiratorio/prevención & control , Anticuerpos Monoclonales Humanizados , Niño , Alemania , Humanos , Esquemas de Inmunización , Estudios Longitudinales , Palivizumab , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/epidemiología , Factores de Riesgo , Estaciones del Año , Resultado del TratamientoRESUMEN
The safety and reactogenicity of a booster dose of GSK Biologicals' hexavalent DTPa-HBV-IPV/Hib vaccine (N=4725) was compared with the separate administration of GSK Biologicals' DTPa-IPV/Hib and HBV vaccines (N=4474) in two open, randomized multicenter studies (A and B). Solicited symptoms occurring within 4 days of vaccination were recorded on diary cards and serious adverse events (SAEs) were collected throughout the study period. In Study A (N=1149), incidences of solicited symptoms were similar in both groups; there were no SAEs either reported within 4 days of vaccination or considered to be causally related to vaccination. In study B (N=8050), where fever was the only solicited symptom, rectal temperature > or =39.5 degrees C was observed in 2.5% and 2.8% of the subjects, respectively. Fever > or =40.0 degrees C was rare (0.6%), and only two cases of febrile convulsions were recorded during the 4 days following vaccination both in the control group. Large swelling reactions (defined as local injection site swelling with diameter >50 mm, noticeable diffuse injection site swelling or noticeable increased circumference of the injected limb) were reported following 2.3% of the booster vaccine doses, regardless of the vaccine used. Extensive swelling reactions involving an adjacent joint were reported in 0.1% of the subjects. Two SAEs, both reported after booster doses of DTPa-IPV/Hib and HBV vaccines administered separately, were considered by the investigators to be related to vaccination. Both resolved completely without sequelae. The hexavalent DTPa-HBV-IPV/Hib vaccine and the DTPa-IPV/Hib and HBV vaccines administered separately have similar good reactogenicity and safety profiles when given as booster doses in the second year of life.
Asunto(s)
Esquemas de Inmunización , Inmunización Secundaria/métodos , Estudios Multicéntricos como Asunto/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Vacunas Combinadas/administración & dosificación , Intervalos de Confianza , Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Vacuna contra Difteria, Tétanos y Tos Ferina/efectos adversos , Femenino , Fiebre/inducido químicamente , Vacunas contra Haemophilus , Vacunas contra Hepatitis B/administración & dosificación , Vacunas contra Hepatitis B/efectos adversos , Humanos , Inmunización Secundaria/efectos adversos , Lactante , Masculino , Estudios Multicéntricos como Asunto/estadística & datos numéricos , Vacuna Antipolio de Virus Inactivados , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Vacunas Combinadas/efectos adversosRESUMEN
A live attenuated human rotavirus (HRV) vaccine, strain RIX4414, was tested sequentially in adults, previously infected toddlers, and previously uninfected infants. A single dose was given to adults and toddlers and found well tolerated. Next, a dose ranging (three different viral concentrations) safety and immunogenicity study was conducted in rotavirus IgA antibody negative infants (N= 192), who received two doses of RIX4414 vaccine or placebo at 2 and 4 months of age. No side effects were seen after vaccination. Specifically, administration of RIX4414 vaccine was not temporally associated with fever, diarrhea, or increase in liver transaminases. Rotavirus IgA seroconversion ranged from 50 to 88% after one dose and from 73 to 96% after two doses, depending on vaccine titer. After the first dose, on days 7-9 post vaccination, between 38 and 60% of the infants shed the vaccine virus, whereas after the second dose only 0 to 13% of the vaccinees shed the vaccine virus. It is concluded that RIX4414 strain HRV vaccine is virtually non-reactogenic and, at high titer, highly immunogenic in susceptible infants.
Asunto(s)
Vacunas contra Rotavirus/efectos adversos , Vacunas contra Rotavirus/inmunología , Vacunas Atenuadas/inmunología , Adolescente , Adulto , Preescolar , Clonación Molecular , Diarrea/virología , Relación Dosis-Respuesta Inmunológica , Método Doble Ciego , Heces/virología , Femenino , Humanos , Inmunoglobulina A/biosíntesis , Inmunoglobulina A/inmunología , Lactante , Pruebas de Función Hepática , Masculino , Infecciones por Rotavirus/inmunología , Infecciones por Rotavirus/prevención & control , Vacunas Atenuadas/efectos adversosRESUMEN
Safety, reactogenicity and immunogenicity of GSK Biologicals' hexavalent DTPa-HBV-IPV/Hib vaccine (Infanrix)hexa) was assessed when used for primary vaccination at 3, 4 and 5 months of age (N = 2163), compared to the separate administration of DTPa-IPV/Hib and HBV vaccines (N = 720). A similar safety and reactogenicity profile was demonstrated for both vaccine regimens, as well as a good immune response for all antigen components. By offering protection against six diseases in a series of single injections, the hexavalent DTPa-HBV-IPV/Hib vaccine was shown to be a safe, well tolerated and immunogenic alternative to primary immunization with licensed separately administered vaccines.
Asunto(s)
Vacunas Combinadas/efectos adversos , Vacunas Combinadas/inmunología , Cápsulas Bacterianas , Difteria/prevención & control , Toxoide Diftérico/administración & dosificación , Toxoide Diftérico/efectos adversos , Toxoide Diftérico/inmunología , Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Vacuna contra Difteria, Tétanos y Tos Ferina/efectos adversos , Vacuna contra Difteria, Tétanos y Tos Ferina/inmunología , Femenino , Infecciones por Haemophilus/prevención & control , Vacunas contra Haemophilus/administración & dosificación , Vacunas contra Haemophilus/efectos adversos , Vacunas contra Haemophilus/inmunología , Hepatitis B/prevención & control , Vacunas contra Hepatitis B/administración & dosificación , Vacunas contra Hepatitis B/efectos adversos , Vacunas contra Hepatitis B/inmunología , Humanos , Lactante , Masculino , Vacuna contra la Tos Ferina/administración & dosificación , Vacuna contra la Tos Ferina/efectos adversos , Vacuna contra la Tos Ferina/inmunología , Poliomielitis/prevención & control , Vacuna Antipolio de Virus Inactivados/administración & dosificación , Vacuna Antipolio de Virus Inactivados/efectos adversos , Vacuna Antipolio de Virus Inactivados/inmunología , Polisacáridos Bacterianos/administración & dosificación , Polisacáridos Bacterianos/efectos adversos , Polisacáridos Bacterianos/inmunología , Tétanos/prevención & control , Toxoide Tetánico/administración & dosificación , Toxoide Tetánico/efectos adversos , Toxoide Tetánico/inmunología , Vacunación , Vacunas Combinadas/administración & dosificación , Tos Ferina/prevención & controlRESUMEN
OBJECTIVE: Lymphadenitis colli due to NTM should always be considered in children with cervical Lymphadenitis. For Germany there is a lack of data concerning the incidence, the epidemiology, the diversity and frequency of the different bacteria, the diagnosis, the clinical manifestation and the medical treatment. METHODS: By means of a questionnaire, which was retrospective for 1985 to 1994 and was sent to 277 children's hospitals in Germany, we collected data on Lymphadenitis colli in Germany. In our study we also incorporated cases from the "National Laboratory for Mycobacteria" in Borstel as well as six cases from our hospital in Mainz. Therefore our data includes both clinical (28) and laboratory (30) cases. Additionally we screened the literature on "Lymphadenitis colli in children due to NTM". RESULTS: A total of 51 cases of Lymphadenitis due to NTM could be identified. The illness occurs typically in young children up to six years of age. The most frequent cause were species of the Mycobacterium avium-intracellulare-scrofulaceum complex. Except for the local diagnosis of a cervical Lymphadenitis other clinical symptoms are missing, just as specific laboratory parameters with a subacute or chronic course. The tuberculin skin test can be false positive. The diagnosis is confirmed by biopsy and histology as well as through microbiological tests. CONCLUSIONS: The best treatment is complete surgical excision, whereas the importance of additional or exclusive treatment with Clarithromycin, Rifabutin and other antibiotics could not be clarified completely. But in patients with AIDS Rifabutin and other drugs could perhaps be useful, even for prophylaxis. Also if complete excision is impossible, treatment with certain drugs (Clarithromycin or Azithromycin in combination with Rifampicin) will be recommended. It still remains in question if NTM infections in children are really increasing.