German Standing Research Articles

Immunizations in immunocompromised patients: a guide for dermatologists.

The increasingly frequent use of immunomodulatory agents in dermatology requires the observance of specific recommendations for immunization. These recommendations are developed and regularly updated by the German Standing Committee on Vaccination (STIKO), an independent advisory group at the Robert Koch Institute. Dermatological patients on immunosuppressive treatment should ideally receive all vaccinations included in the standard immunization schedule. Additionally, it is recommended that they also undergo vaccination against the seasonal flu, pneumococci, and herpes zoster (inactivated herpes zoster subunit vaccine for patients ≥ 50 years). Additional immunizations against Haemophilus influenzae type B, hepatitis B and meningococci may be indicated depending on individual comorbidities and exposure risk. Limitations of use, specific contraindications and intervals to be observed between vaccination and immunosuppression depend on the immunosuppressive agent used and its dosing. Only under certain conditions may live-attenuated vaccines be administered in patients on immunosuppressive therapy. Given its strong suppressive effect on the humoral immune response, no vaccines -except for flu shots - should be given within six months after rituximab therapy. This CME article presents current recommendations on immunization in immunocompromised individuals, with a special focus on dermatological patients. Its goal is to enable readers to provide competent counseling and to initiate necessary immunizations in this vulnerable patient group.

Genetic variation of introduced red oak (Quercus rubra) stands in Germany compared to North American populations

Although Northern red oak (Quercus rubra L.) is the most important introduced deciduous tree species in Germany, only little is known about its genetic variation. For the first time, we describe patterns of neutral and potentially adaptive nuclear genetic variation in Northern red oak stands across Germany. For this purpose, 792 trees were genotyped including 611 trees from 12 stands in Germany of unknown origin and 181 trees from four populations within the natural distribution area in North America. Our marker set included 12 potentially adaptive (expressed sequence tag-derived simple sequence repeat = EST SSR) and 8 putatively selectively neutral nuclear microsatellite (nSSR) markers. Our results showed that German stands retain comparatively high levels of genetic variation at both EST-SSRs and nSSRs, but are more similar to each other than to North American populations. These findings are in agreement with earlier chloroplast DNA analyses which suggested that German populations originated from a limited geographic area in North America. The comparison between potentially adaptive and neutral microsatellite markers did not reveal differences in the analyzed diversity and differentiation measures for most markers. However, locus FIR013 was identified as a potential outlier locus. Due to the absence of signatures of selection in German stands, we suggest that introduced populations were established with material from provenances that were adapted to environmental conditions similar to those in Germany. However, we analyzed only a limited number of loci which are unlikely to be representative of adaptive genetic differences among German stands. Our results suggest that the apparent introduction from a limited geographic range in North America may go along with a reduced adaptive potential.

Genetic diversity and differentiation of introduced red oak (Quercus rubra) in Germany in comparison with reference native North American populations

Northern red oak (Quercus rubra) was introduced to Europe in the late seventeenth century and has since become the most important deciduous non-native tree species in Germany. Despite its importance, little is known about the origin and patterns of genetic variation in German red oak stands. To be able to make recommendations regarding the adaptive potential of red oak stands, which might be related to their origin and the selection of provenances, with respect to climate change, a better understanding of the genetic diversity and structure of German red oak stands is needed. Individuals from 62 populations in Germany and North America were genotyped at five chloroplast microsatellite loci to characterize chloroplast haplotype diversity and geographic structure. Compared to reference populations from the natural distribution range, German red oak stands demonstrated a relatively low genetic differentiation among populations and represented only a fraction of the haplotype diversity found in North America. For several stands located in southern Germany, considerably higher haplotype diversity than in other German stands was found. While most German stands showed signatures of founder effects, the diversity of stands in southern Germany might have been increased due to admixture and multiple introductions of different North American provenances. Overall, we conclude that German stands originated from a limited geographic area, possibly located in the northern part of the native distribution range.

Sexually Transmitted Infections - What's New, What's Different?

The incidence of sexually transmitted infections like syphilis or gonorrhea is still rising, particularly in the high-risk population of men having sex with men (MSM). Neisseria gonorrhoeae is capable to develop resistance to all antibiotics previously or currently used for treatment. Dual antimicrobial therapy with ceftriaxone and azithromycin is considered the current empirical first-line therapy. Since 2011 ceftriaxone-resistant strains have emerged in many countries and in 2018 the first case with high-level resistance to azithromycin and resistance to ceftriaxone was documented in the UK, making the development of new antimicrobials against gonorrhea a public health priority. HIV-pre-exposure-prophylaxis (HIV-PrEP) has recently been approved in Germany and may become an important complementary approach to reduce HIV transmission. However, appropriate counselling and STI testing has to be secured in PrEP users. The German Standing Committee on Vaccination (STIKO) now recommends human papillomavirus (HPV) vaccination for boys aged 9 - 14 years. The Centers for Disease Control and Prevention (CDC) shortens the recommended interval from leaving a zika virus-endemic country until conception to 3 months.

Influenzaimpfquoten von Patienten mit vertrags\xe4rztlicher Versorgung in besch\xfctzenden Einrichtungen, Pflege- und Altenheimen

ZusammenfassungHintergrundEine der wichtigsten und wirksamsten Präventionsmaßnahmen zum Schutz vor saisonaler Influenza sind Impfungen. Die ständige Impfkommission (STIKO) empfiehlt die Influenzaimpfung für besondere Personengruppen, wie Patienten in beschützenden Einrichtungen sowie in Pflege- und Altenheimen (bPA-Einrichtungen). Die Europäische Kommission (EK) fordert eine Influenzaimpfquote von 75 % in der älteren Bevölkerung. In Deutschland liegen bisher nur vereinzelte Ergebnisse aus Befragungen zu Influenzaimpfquoten für Patienten in bPA-Einrichtungen vor.FragestellungZiel der Studie war es, auf Basis ambulanter Abrechnungsdaten erstmals einen bundesweiten Überblick über die Influenzaimpfquoten bei in bPA-Einrichtungen versorgten Patienten zu geben.Material und MethodenEs erfolgte die deskriptive Auswertung der ambulanten vertragsärztlichen Abrechnungsdaten für 6 Studienkohorten in den Jahren 2010 bis 2016.ErgebnisseDie Impfquote der Studienkohorten variiert über die Saisons hinweg zwischen 56,6 % und 60,3 %. Über den Gesamtzeitraum wurde ein Durchschnitt von 58,5 % erreicht. Es zeigten sich deutliche regionale Unterschiede in den Influenzaimpfquoten von bis zu 20 Prozentpunkten (PP) sowie wenn zuvor ein Hausarzt konsultiert wurde (bis zu 35 PP).DiskussionDie Ergebnisse geben erste Einblicke zu Impfquoten in bPA-Einrichtungen und enthalten Hinweise auf Zusammenhänge zwischen strukturellen Versorgungsunterschieden und der Inanspruchnahme von Influenzaimpfungen. Die Ergebnisse können dazu beitragen, Gruppen mit besonders niedrigen Influenzaimpfquoten zu identifizieren. Sie ergänzen die Datenbasis für gesundheitspolitische Maßnahmen zur Erhöhung der Impfquoten. Für die untersuchte Gruppe wurden die Empfehlungen der EK zu einer Influenzaimpfquote von 75 % bisher nicht erreicht.

Secular trends in vaccination rates among school beginners in Baden-Wuerttemberg, 1987–2014

Introduction Mandatory health investigations of children before school entrance in Germany allow the surveillance of vaccination rates in subsequent age cohorts of school beginners at the age of school entrance (about six years). The aim of the study presented here was an overview of secular trends in vaccination rates among children before school entrance in the State of Baden-Wuerttemberg. Methods Since 1987 data on vaccination rates were collected in school entrance investigations by the health offices in the whole country of Baden-Wuerttemberg, which is located in the Southwest of Germany. Analyses of secular trends in vaccination rates by the Baden-Wuerttemberg State Health Office included data on vaccinations against diphtheria, poliomyelitis, tetanus, measles, mumps, rubella, Haemophilus influenzae, hepatitis B, pertussis and varicella. The annual vaccination rates were determined for about 100,000 per year in the country of Baden-Wuerttemberg and visualized in time series in order to describe secular trends of the different vaccinations. Results The percentage of children with a written documentation of the vaccinations they received was 90% > 92% compared to all children investigated. The highest vaccination rates during the whole observation period were observed for the vaccinations against diphtheria, tetanus and poliomyelitis. Vaccination rates against pertussis covered 10–20% of the children until 1996 and increased since then to 93% in 2014 after the introduction of acellular pertussis vaccines and recommendation of the vaccination for all children. The vaccination rates against measles, rubella, hepatitis B and varicella mainly reflect the development of recommendations of the German Standing Committee on Vaccination (STIKO). So the second vaccination against measles was recommended until 2000 at the age of 4 to 5 years. This recommendation was changed 2001 to the age of 1 to 2 years, which led to an increase in the corresponding vaccination rates to almost 95% in 2014. The general recommendation of the vaccination against varicella for children was introduced in 2004 and subsequently the vaccination rates among school beginners increased and reached 77% in 2014. This is still below the rates of other vaccinations introduced decades before. Conclusions The regular collection of data on vaccinations in school entrance health investigations allows a continuous surveillance of vaccination rates based on 90–92% of all school beginners. The interpretation of secular trends has to take into account changes in the recommendations of the German Standing Committee on Vaccination as well as potential changes in the age of the children at time of investigation. The time series can indicate infections risks due to missing vaccinations among adolescents and adults, in case these age groups did not receive missing vaccinations after school entrance. Therefore the regular collection of these data from vaccination documents of school beginners should be continued for a long-term surveillance by public health offices.

Temporal development of collar necroses and butt rot in association with ash dieback

Abstract: In recent years collar necroses and butt rot associated with the ash dieback disease occurred with alarming frequency in Fraxinus excelsior. We analysed tree ring structures to identify the year of necrosis initiation on a set of 507 necroses on 155 stem discs from nine severely diseased south-western German stands. The number of first-time infections of trees was highest from 2010 to 2012 and slightly decreased in 2013 and 2014, whereas the total number of newly emerging individual necroses remained high. Logistic modelling of disease progression suggests that collar rot infection has almost reached its maximum incidence and that a fraction of trees will remain healthy at the root collar. On average, Hymenoscyphus fraxineus was isolated more frequently from younger collar necroses, whereas older necroses were more often colonized by Armillaria spp. Advanced stages of rot that may pose a risk to forest workers, visitors and traffic were observed already in two years-old necroses infected by Armillaria spp.

Risk of Intussusception After Rotavirus Vaccination.

In 2013, the German Standing Committee on Vaccination (Ständige Impfkommission, STIKO) recommended rotavirus (RV) vaccination for all infants while stating that this mildly increased the risk of intussusception, a potentially life-threatening event. Since this recommendation was issued, multiple observational studies on this topic designed as self-controlled case series (SCCS) have been published. The SCCS design is particularly suitable for the study of rare adverse effects of medications. We systematically searched the literature for SCCS studies on the risk of intussusception after RV vaccination. Relative risks (RR) corresponding to different doses of vaccine were summarized in a meta-analysis, and attributable risks (AR) were calculated. Of the 16 initially identified studies, 10 with a predominantly low risk of bias were considered in the analysis. The RR for intussusception was 5.71 (95% confidence interval [4.50; 7.25]) 1-7 days after the first dose, 1.69 [1.33; 2.14] after the second, and 1.14 [0.75; 1.74] after the third. The AR for children of the age at which RV vaccination is recommended was 1.7 [1.1; 2.7] additional intussusceptions per 100 000 vaccinated children after the first dose and 0.25 [0.16; 0.40] after the second. If >3-month-old infants are vaccinated, the AR is higher: 5.6 [4.3; 7.2] per 100 000 after the first dose and 0.81 [0.63; 1.06] per 100 000 after the second. RV vaccination is associated with a markedly elevated RR and a mildly elevated AR for intussusception 1-7 days after the first dose. Physicians should begin the series of vaccinations at age 6-12 weeks, as recommended by the STIKO, because the risk of intussusception is higher afterward. Current health insurance company claim data indicate that 11.2% of infants are still receiving the first dose of the vaccine at ages above 3 months. The parents of vaccinated children should be informed about the possible signs of intussusception (colicky pain, bilious vomiting, and red "currant jelly" stool).

P486 Immunization status of children and adolescents with inflammatory bowel disease or autoimmune hepatitis in Germany

Background: Long-term immunosuppressed patients with inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH) are at risk of severe infections with vaccination preventable diseases. Several recent studies demonstrated insufficient immunization coverage in children and adolescents with IBD. Therefore, we evaluated the vaccination rate of children and adolescents with IBD and AIH in Germany. Methods: As part of the German multicentre clinical trial called “VARICED”, the immunization rate of patients with IBD and AIH below 18 years of age was assessed from the certificate of vaccination, medical history of chicken pox and by analysing varicella zoster virus (VZV) IgG and measles virus IgG antibody titres by ELISA. Results: To date 229 patients (51% female, mean age at diagnosis 9.9 years) are registered: 137 have Crohn's disease (CD), 53 ulcerative colitis (UC), 19 IBD-unclassified (IBD-U) and 20 AIH. The majority of the patients (n=190, 83%) are on immunosuppressive therapy (AIH 100%, CD 89%, UC 68%). A complete basic immunisation consisting of 4 doses of a hexavalent vaccine were given to 89% of the total cohort. A combined inoculation for measles, mumps, and rubella (MMR) was documented in 225 (98%) patients, 208 (92%) received two doses. VZV vaccination was introduced in 2004 to the vaccination schedule from the German Standing Committee on Vaccination (STIKO). A good implementation with 90% was found in the birth cohorts from 2005 onwards. In children born before 2005 (n=190) only 22% received VZV vaccination catch up. VZV vaccination was documented in only 77 (34%) patients, but 17 patients (22%) did not display sufficient VZV IgG titres. Already 144 (63%) patients had a medical history of chicken pox. However, three of them did not have verifiable VZV IgG antibodies. In addition, 37 patients had neither a history of a chicken pox infection nor VZV inoculation, but 11 out of them were found to have sufficient VZV IgG titres. Conclusions: There is a good implementation of the vaccination schedule from the German Standing Committee on Vaccination (STIKO) in the group of children and adolescents with IBD and AIH. Our data suggests a gap in VZV immunity in birth cohorts before 2005 in Germany. Moreover, neither the certificate of vaccination nor the medical history of chicken pox infection is reliable for assessing VZV immunity. Serologic investigations demonstrated that some non-immunized patients may undergo occult immunization, and immunized patients did not present sufficient VZV-IgG titres. Thus, we recommend VZV IgG serology within the check-up in newly diagnosed IBD or AIH and VZV vaccination before initiating immunosuppressive therapy, if applicable.

An estimate of the public health impact and cost-effectiveness of universal vaccination with a 9-valent HPV vaccine in Germany

ABSTRACTIntroduction: Since 2007, the German Standing Vaccination Committee recommends HPV vaccination for girls aged 12–17 with a 2- (Cervarix®) or 4-valent (Gardasil®) vaccine. A 9-valent vaccine (Gardasil 9®) recently received a European market authorization in 2015.Methods: A dynamic transmission model was calibrated to the German setting and used to estimate costs and QALYs associated with vaccination strategies.Results: Compared to the current vaccination program, the 9-valent vaccine extended to boys shows further reductions of 24% in the incidence of cervical cancer, 30% and 14% in anal cancer for males and females, as well as over a million cases of genital warts avoided after 100 years. The new strategy is associated with an ICER of 22,987€ per QALY gained, decreasing to 329€ when considering the vaccine switch for girls-only.Conclusion: Universal vaccination with the 9-valent vaccine can yield significant health benefits when compared to the current program.

Influences on immunization rates: Vaccination coverage of mumps, measles, rubella and varicella before and after the STIKO intervention 2011 – A retrospective study

BackgroundIn September 2011, the German Standing Committee on Vaccinations (STIKO) changed their recommendation regarding the mumps–measles–rubella–varicella vaccination (MMRV). We compared the immunization rates against MMRV in Germany before and after the STIKO intervention. MethodsWe recorded the immunization status of children born between 09/2008 and 08/2012 in 35 selected doctor’s surgeries in Germany. ResultsAfter the STIKO intervention, the ratio of the combined MMRV vaccine as the first dose immunization was reduced to approximately 25% of the initial value. A slight increase in the number of children not sufficiently vaccinated against varicella (1.2%) was observed, but the immunization rates against measles, mumps, rubella and varicella did not significantly decrease. ConclusionsThe STIKO intervention led to a significant change in physicians’ vaccination procedures. The separate administration MMR+V vaccination may be a helpful option to improve the immunization rates in general.

Cologne Statement for Medical Care of Refugees

The Cologne statement resulted from both regional and nationwide controversial discussions about meaning and purpose of an initial examination for infectious diseases of refugees with respect to limited time, personnel and financial resources. Refugees per se are no increased infection risk factors for the general population as well as aiders, when the aiders comply with general hygiene rules and are vaccinated according to the recommendations of the German Standing Committee on Vaccination (STIKO). This is supported by our own data. Based on individual medical history, refugees need medical care, which is offered purposeful, economic, humanitarian and ethical. In addition to medical confidentiality, the reporting obligation according § 34 Infection Protection Act (IPA) and the examination concerning infectious pulmonary tuberculosis according to § 36 (4) IPA must be considered.

Background Paper for the update of meningococcal vaccination recommendations in Germany: use of the serogroup B vaccine in persons at increased risk for meningococcal disease.

In December 2013 Bexsero® became available in Germany for vaccination against serogroup B meningococci (MenB). In August 2015 the German Standing Committee on Vaccination (STIKO) endorsed a recommendation for use of this vaccine in persons at increased risk of invasive meningococcal disease (IMD). This background paper summarizes the evidence underlying the recommendation. Bexsero® is based on surface protein antigens expressed by about 80% of circulating serogroup B meningococci in Germany. The paper reviews available data on immunogenicity and safety of Bexsero® in healthy children and adolescents; data in persons with underlying illness and on the effectiveness in preventing clinical outcomes are thus far unavailable.STIKO recommends MenB vaccination for the following persons based on an individual risk assessment: (1) Persons with congenital or acquired immune deficiency or suppression. Among these, persons with terminal complement defects and properdin deficiency, including those under eculizumab therapy, are at highest risk with reported invasive meningococcal disease (IMD) incidences up 10,000-fold higher than in the general population. Persons with asplenia were estimated to have a ~ 20-30-fold increased risk of IMD, while the risk in individuals with other immune defects such as HIV infection or hypogammaglobulinaemia was estimated at no more than 5-10-fold higher than the background risk. (2) Laboratory staff with a risk of exposure to N. meningitidis aerosols, for whom an up to 271-fold increased risk for IMD has been reported. (3) Unvaccinated household (-like) contacts of a MenB IMD index case, who have a roughly 100-200-fold increased IMD risk in the year after the contact despite chemoprophylaxis. Because the risk is highest in the first 3 months and full protective immunity requires more than one dose (particularly in infants and toddlers), MenB vaccine should be administered as soon as possible following identification of the serogroup of the index case.

Analysis of vaccination data of patients aged 60 years and older from Bavaria and Thuringia

Despite annual updates of vaccination recommendations by the German Standing Committee on Vaccination (STIKO) at the Robert Koch Institute, diseases preventable by vaccination still cause a relevant burden of disease in the elderly. A comparison of the vaccination status of the elderly in Bavaria and Thuringia was carried out. Medical settlement data from the first quarter of 2007 to the second quarter of 2008 from the association of panel doctors in Bavaria and Thuringia for insured persons aged 60 years and above were analyzed concerning vaccinations, age, gender and multimorbidity. The vaccination rates for influenza were calculated. The use of all recommended vaccinations in this age group was greater in Thuringia (eastern federal state) than in Bavaria (western federal state). In both states the administration rates of tetanus and diphtheria vaccines were lower in individuals with higher comorbidity and age. Protection rates against diphtheria were incomplete as a result of inadequate use of combination vaccines. In both states the administration of pneumococcal vaccine was higher in subjects with more comorbidities. In Bavaria administration rates increased with age. Influenza vaccination rates increased in association with age and comorbidity in both states. In elderly individuals influenza vaccination was used more often in the third quarter of 2007. Old age and multimorbidity are often insufficiently taken into consideration in studies on vaccination rates. The data from this study confirmed the relevant findings from other studies and emphasize the deficient implementation of standard vaccinations in primary prevention. In this study very old patients were differentiated and considered according to age groups for the first time.

Are the immunization services offered to students at university hospitals in Germany sufficient?

Healthcare professionals have an increased risk of acquiring infectious diseases and can also serve as a source of infection to their patients. The German Standing Committee on Vaccination (STIKO) recommends that healthcare professionals should be sufficiently vaccinated against vaccine-preventable infections. Also medical students belong to this target group. For this reason their vaccination status should be checked and -if necessary- completed before working with patients. Anonymous questionnaire-based survey among occupational physicians at university hospitals in Germany provided information about immunization services and the acceptance of vaccination. In total 34 of 37 university hospitals (response 91.9%) participated in this survey. Except one university hospital, all offered occupation-related vaccinations to their medical students. While hepatitis B vaccination was offered in all 33 university hospitals with immunization services, more than 44% did not offer at all or only to restricted groups (e. g. students with an internship in Pediatrics) vaccinations against measles-mumps-rubella (MMR). In 50% of the university hospitals this also applied to the pertussis vaccinations. Only 33% of university hospitals reported to collect data for a precise vaccination coverage assessment. A seasonal influenza vaccination program for medical staff was established at 30 (88%) university hospitals, but of these only 56% included medical students. The forceful implementation of evidence-based vaccination recommendations supports the reduction of nosocomial infections and outbreaks. In view of the WHO goal of eliminating measles and a documented increased risk of acquiring measles, it is alarming that university hospitals do not offer MMR-vaccines to their medical students at all or only to restricted groups. There is also a need to improve health services in respect to offering influenza and pertussis vaccinations to medical students and collecting data to better assess vaccination coverage.

Vaccination prevents allergic disorders in children

Methods 2187 study participants of different birth years (1988/89, 94/95, 98/99) but same age group (5-6 years old) were involved in 3 epidemiological studies using questionnaires, clinical examinations and determination of vaccination titer: a cross sectional study (S1) supplemented by the Leipzig part of a multicenter birth cohort study (S2) and a birth cohort study with children at risk for allergy (S3). Based on questionnaires, vaccination certificates and vaccination titer respectively it was distinguished between no, incomplete and full vaccination. All vaccinations recommended by the German Standing Committee on vaccination have been considered, such as vaccinations against tetanus, haemophilus influenca type B, measles etc. Targets were physician diagnosed atopic eczema and any other allergic symptoms.

Vaccination of children with a live-attenuated, intranasal influenza vaccine - analysis and evaluation through a Health Technology Assessment.

The present HTA provides an extensive basis for further scientific approaches and pending decisions relating to health policy.

S3-Guideline on allergy prevention: 2014 update

The continued high prevalence of allergic diseases in Western industrialized nations combined with the limited options for causal therapy make evidence-based primary prevention necessary. The recommendations last published in the S3-guideline on allergy prevention in 2009 have been revised and a consensus reached on the basis of an up-to-date systematic literature search.Evidence was sought for the period between May 2008 and May 2013 in the Cochrane and MEDLINE electronic databases, as well as in the reference lists of recent review articles. In addition, experts were surveyed for their opinions. The relevance of retrieved literature was checked by means of two filter processes: firstly according to title and abstract, and secondly based on the full text of the articles. Included studies were given an evidence grade, and a bias potential (low/high) was specified for study quality. A formal consensus on the revised recommendations was reached by representatives of the relevant specialist societies and (self-help) organizations (nominal group process).Of 3,284 hits, 165 studies (one meta-analysis, 15 systematic reviews, 31 randomized controlled trials, 65 cohort studies, 12 case-control studies and 41 cross-sectional studies) were included and evaluated. Recommendations on the following remain largely unaltered: full breastfeeding for 4 months as a means of allergy prevention (hypoallergenic infant formula in the case of infants at risk); avoidance of overweight; fish consumption (during pregnancy/lactation and in the introduction of solid foods for infants); vaccination according to the recommendations of the German Standing Committee on Vaccination (Ständige Impfkommission, STIKO); avoidance of air pollutants and tobacco exposure and avoidance of indoor conditions conducive to the development of mold. The assertion that a reduction in house-dust mite allergen content as a primary preventive measure is not recommended also remains unchanged. The introduction of solid foods into infant diet should not be delayed. In the case of children at risk cats should not be acquired as domestic pets. Keeping dogs is not associated with an increased risk of allergy. The updated guideline includes a new recommendation to consider the increased risk of asthma following delivery by cesarean section. Additional statements have been formulated on pre- and probiotic agents, psychosocial factors, medications, and various nutritional components.Revising the guideline by using an extensive evidence base has resulted not only in an endorsement of the existing recommendations, but also in modifications and in the addition of new recommendations. The updated guideline enables evidence-based and up-to-date recommendations to be made on allergy prevention.Electronic Supplementary MaterialSupplementary material is available for this article at 10.1007/s40629-014-0022-4 and is accessible for authorized users.

Incidence of herpes zoster and its complications in Germany, 2005–2009

After introduction of a herpes zoster (HZ) vaccine in Germany in 2013, a potential recommendation by the German Standing Vaccination Committee is still pending. This study estimated data on the disease burden of HZ in Germany to extend the data basis for the decision process. A retrospective cohort study on data from 7 million statutory health insurance members from 2005 to 2009 was conducted. HZ cases were identified using ICD-10-codes. IRs of HZ and complications were estimated overall, by age, sex and immune status. The proportion of postherpetic neuralgia (PHN), hospitalizations, the diagnosing physician specialty and systemic antiviral therapy were assessed. Annual standardized IRs ranged between 5.3 and 5.5 per 1000 person-years (PY) between 2006 and 2009 with higher IRs in females. In 2009, 72.4% of HZ patients were without complications, while 15.5% suffered from nervous system involvement. The age-related increase was higher for HZ complications than for uncomplicated HZ. Immunocompromised patients suffered slightly more complications than immunocompetent patients. The PHN proportion increased to 15% in 2009 with a steady age-related increase. About 3% of HZ cases were hospitalized. Age-related increases of HZ complications and PHN suggest that particularly older patients might benefit from HZ vaccination.

The efficacy and duration of vaccine protection against human papillomavirus: a systematic review and meta-analysis.

The German Standing Committee on Vaccination (STIKO) recommends vaccination against human papillomaviruses (HPV) of the high-risk types 16 and 18. The duration of protection afforded by HPV vaccines has been reported in multiple studies to date but has not been systematically evaluated. Systematic literature review and meta-analysis on the efficacy of vaccination, with assessment of evidence by the GRADE criteria (Grading of Recommendations Assessment, Development and Evaluation). 15 studies were identified: 10 randomized controlled trials (RCTs) and 5 observational studies. The RCTs included a total of 46 436 participants. The duration of follow-up was short (median, 3 years) in 8 RCTs and long (median, 6 years) in 2 RCTs. During the period of short-term follow up, the pooled efficacy of vaccination for the study endpoint of incident HPV infection (percentage of infections prevented) was 83% (95% confidence interval [CI]: 70-90% ), while the pooled efficacy against persistent HPV infection was 90% (95% CI: 79-95% ). In this period, CIN 2+ lesions were prevented with 84% efficacy (95% CI: 50-95% ), and CIN 3+ lesions with 94% efficacy (95% CI: 83-98% ). During the period of long-term follow-up, incident infections were prevented with 94% efficacy (95% CI: 80-98% ) and persistent infections with 95% efficacy (95% CI: 84-99% ). The long-term efficacy against CIN 2+ lesions was 86% (95% CI: -166-99% ). No data are available on the long-term efficacy of vaccination against CIN 3+ lesions. Long-term observation does not indicate any loss of antiviral protection after vaccination against HPV 16 and 18, although the evidence for long-term protection is of lesser quality than that for short-term protection.