Publications by authors named "Sabine Wicker"

74 Publications

Monitoring influenza vaccination coverage and acceptance among health-care workers in German hospitals - results from three seasons.

Hum Vaccin Immunother 2020 Oct 30:1-9. Epub 2020 Oct 30.

Immunization Unit, Robert Koch Institute , Berlin, Germany.

Health-care workers are an important vaccination target group, they are more frequently exposed to infectious diseases and can contribute to nosocomial infections. We established a country-wide online monitoring system to estimate influenza vaccine uptake and its determinants among German hospital staff (OKaPII). The online questionnaire included items on vaccination behavior and reasons for and against influenza vaccination. After a pilot phase in 2016, a country-wide roll-out was performed in 2017. Questions on measles (2018) and hepatitis B (2019) vaccination status were added in subsequent years. In 2017, 2018 and 2019 in total 52, 125 and 171 hospitals with 5 808, 17 891 and 27 163 employees participated, respectively. Influenza vaccination coverage in season 2016/17 and 2017/18 was similar (39.5% and 39.3%) while it increased by 12% in 2018/19 (52.3%). Uptake was higher for physicians than for nurses. Self-protection was the most common reason for influenza vaccination. While physicians mainly identified constraints as reasons for being unvaccinated, nurses mainly referred to a lack of vaccine confidence. Of the hospital staff, 87.0% were vaccinated against measles, 6.3% claimed to be protected due to natural infection; 97.7% were vaccinated against hepatitis B. OKaPII shows that influenza vaccination coverage among German hospital staff is low. Occupational group-specific differences should be considered: physicians might benefit from easier access; information campaigns might increase nurses' vaccine confidence. OKaPII serves as a platform to monitor the uptake of influenza and other vaccines; it also contributes to a better understanding of vaccination behavior and planning of targeted interventions.
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http://dx.doi.org/10.1080/21645515.2020.1801072DOI Listing
October 2020

Evaluation of a vaccination seminar in regard to medical students' attitudes and their theoretical and practical vaccination-specific competencies.

GMS J Med Educ 2020 15;37(4):Doc38. Epub 2020 Jun 15.

Universitätsklinikum Frankfurt, Betriebsärztlicher Dienst, Frankfurt a. M., Germany.

Despite having a generally positive attitude toward vaccinations, medical students show gaps in their own immunization histories and knowledge about vaccinations. Future practicing physicians will be confronted with the need to evaluate protective immunity and make vaccination recommendations. This study aims to investigate the extent to which a seminar on the topic of vaccination can improve students' attitudes, knowledge and practical skills in interpreting vaccination certificates. Two different one-hour seminars were developed and integrated into the required clinical curriculum. A third of the students attended a theory-based seminar; the other two-thirds completed a predominantly practice-based seminar. The theoretical seminar consisted of a lecture on the principles and theoretical aspects of immunization. In the practical seminar, the curricular content was case-based and taught using fictive examples of vaccination certificates. Before the seminar was held, a voluntary and anonymous survey of the students was conducted regarding their attitudes toward and knowledge of immunization. At the conclusion of the seminar, the students' ability to understand vaccination certificates was tested. After completing the seminar, all of the participants received a link to participate in a voluntary online survey to evaluate the seminar. Of the 149 seminar attendees in the 2017/18 winter semester, 148 participated in the study. Students have a positive attitude toward vaccinations. Regardless of the type of seminar attended, the agreement with statements on vaccination could be significantly increased primarily among students who already at the start of the seminar expressed a high degree of agreement. Students vaccinated against influenza showed significantly stronger agreement than unvaccinated students. Regardless of teaching format, students' knowledge about vaccination topics could be increased. For those vaccinated against influenza, the mean value for agreement with the statement, saw an increase on a five-point Likert scale from 3.97 to 4.4 (p<0.001; R=0.67). For the unvaccinated students, the mean value rose from 4.04 to 4.19 (p=0.06; R=0.29). The students who attended the theory-based seminar tended to score higher on interpreting vaccination certificates than those who attended the practical seminar; however, this difference was not statistically significant. The online evaluation was completed by 18% of the participants. The theoretical seminar received the grade of 2.9 based on the conventional German academic grading scale; the practical seminar received 1.9. This difference is statistically significant (p=0.02). Precisely for skeptical students it was only possible to minimally change existing views with a seminar that offers very brief instruction. Attendees of the theoretical seminar tended to score somewhat higher on interpreting vaccination certificates than those who took the practical seminar. The practical seminar was rated significantly better on the course evaluation than the theoretical one. The advantage that the students attending the theoretical seminar had can be explained best by the structured review of the current vaccination recommendations as part of the seminar, which should, as a consequence, be integrated into the practical seminar.
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http://dx.doi.org/10.3205/zma001331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346291PMC
June 2020

High Glucosylceramides and Low Anandamide Contribute to Sensory Loss and Pain in Parkinson's Disease.

Mov Disord 2020 10 11;35(10):1822-1833. Epub 2020 Jul 11.

Institute of Clinical Pharmacology, Goethe-University, Medical Faculty, Frankfurt, Germany.

Background: Parkinson's disease (PD) causes chronic pain in two-thirds of patients, in part originating from sensory neuropathies. The aim of the present study was to describe the phenotype of PD-associated sensory neuropathy and to evaluate its associations with lipid allostasis, the latter motivated by recent genetic studies associating mutations of glucocerebrosidase with PD onset and severity. Glucocerebrosidase catalyzes the metabolism of glucosylceramides.

Methods: We used quantitative sensory tests, pain ratings, and questionnaires and analyzed plasma levels of multiple bioactive lipid species using targeted lipidomic analyses. The study comprised 2 sets of patients and healthy controls: the first 128 Israeli PD patients and 224 young German healthy controls for exploration, the second 50/50 German PD patients and matched healthy controls for deeper analyses.

Results: The data showed a 70% prevalence of PD pain and sensory neuropathies with a predominant phenotype of thermal sensory loss plus mechanical hypersensitivity. Multivariate analyses of lipids revealed major differences between PD patients and healthy controls, mainly originating from glucosylceramides and endocannabinoids. Glucosylceramides were increased, whereas anandamide and lysophosphatidic acid 20:4 were reduced, stronger in patients with ongoing pain and with a linear relationship with pain intensity and sensory losses, particularly for glucosylceramide 18:1 and glucosylceramide 24:1.

Conclusions: Our data suggest that PD-associated sensory neuropathies and PD pain are in part caused by accumulations of glucosylceramides, raising the intriguing possibility of reducing PD pain and sensory loss by glucocerebrosidase substituting or refolding approaches. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.28186DOI Listing
October 2020

[Development and implementation of an operational concept in a university eye hospital in the SARS-CoV-2 pandemic].

Ophthalmologe 2020 Jul;117(7):595-601

Universitätsklinkum, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.

The SARS-CoV‑2 pandemic poses major challenges for the entire medical care system. Especially in maximum care clinical facilities, a higher exposure to potentially infectious patients or positively tested COVID-19 patients is to be expected. A hospital facility concept was developed in the Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany with the aim of achieving maximum patient safety with maximum employee protection. The current infection control hygiene recommendations of the Robert Koch Institute (RKI), the leading specialist association, were taken into consideration along with the existing hospital hygiene plan of the University Hospital Frankfurt am Main. Incorporated into the developmental process were the Institute for Medical Microbiology and Hospital Hygiene, the occupational medical service department and the board of the University Hospital Frankfurt am Main. The operational concept with individualized measures ensures that (i) the care of outpatients; (ii) the performance of outpatient operations; (iii) and the care of admitted patients and patients undergoing surgery are also guaranteed during the COVID-19 pandemic. All measures have been documented in writing in the clinic's internal quality manual and are thus accessible to all employees. The concept is regularly checked for functionality, so-called stress tests and hygiene inspections are carried out and improvements are made as necessary.
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http://dx.doi.org/10.1007/s00347-020-01156-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327855PMC
July 2020

[SARS-CoV-2/COVID-19: systematic review of requirements for personal protective equipment in primary patient contact and organization of the operating area].

Chirurg 2020 Jul;91(7):576-585

Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.

Background: The SARS-CoV-2/COVID-19 pandemic necessitates a rapid reorganization of the hospital procedures. The establishment of centers dedicated to COVID-19 treatment and care also necessitates preparation of the surgical departments for the forthcoming emergency interventions for infected patients and patients with an unclear infection status. This article summarizes the evidence on standards for personal protective equipment for personnel in the central emergency admission department and in the operations area as well as restructuring measures for the procedures in the operations area in a COVID-plus area.

Method: A systematic literature search was carried out.

Results: The grey area of unknown infected and potential transmitters of SARS-CoV-2/COVID-19 is high. Patients with an unclear infection status or who are highly suspected of having an infection should be classified as infectious until the contrary can be proven. The protection of personnel in healthcare professions against infections is of particular importance. The supply of adequate personal protective equipment in a risk-stratified form can substantially influence the success of combating the pandemic. Most operations must be assessed as aerosol-forming procedures and necessitate the maximum protection of personnel working directly on the patient. Particular attention should be paid to obligatory hygiene regulatory measures for protection against contamination during the reorganization in the operations area and on the transport routes between the wards.

Conclusion: The correct personal protective equipment considering the occupational safety helps to sustainably protect personnel from infections. Reorganizational measures in the operating room are urgently indicated for potential aerosol-forming procedures in infected patients or patients with an unclear infection status. The current dynamic situation necessitates a high level of flexibility as well as reassessment and adaptation of the measures at short intervals.
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http://dx.doi.org/10.1007/s00104-020-01229-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315115PMC
July 2020

Vitamin D in Type 2 Diabetes: Genetic Susceptibility and the Response to Supplementation.

Horm Metab Res 2020 Jul 15;52(7):492-499. Epub 2020 Jun 15.

Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, Goethe-University Hospital, Frankfurt/Main, Germany.

Variants of vitamin D metabolism-genes may predispose to type 2 diabetes (T2D). This study investigated the impact of these variants on disease susceptibility, Vitamin D, parathyroid hormone, C-peptide and HbA1c levels before and after cholecalciferol supplementation in patients with T2D.Twelve polymorphisms within CYP2R1, CYP27B1, DBP, VDR and CYP24A1 were genotyped in 553 T2D patients and 916 controls. In addition 65 patients receiving either cholecalciferol or placebo were analyzed during 6 months intervention and 6 months follow-up.T2D risk alleles are VDR rs7975232 "G" (p=0.031), rs1544410 "G" (p=0.027) and CYP2R1 rs10741657 "A" (p=0.016). Patients with genotypes CYP27B1 rs10877012 "CC" (p=4x10), DBP rs7041 "GG" (p=0.003), rs4588 "CC" (p = 3x10), CYP24A1 rs2585426 "CG" (p=0.006) and rs2248137 "CG" (p=0.001) showed lower 25(OH)D3 and DBP rs4588 "CC" lower 1,25(OH)2D3 levels (p=0.005). Whereas DBP rs4588 "CC" (p=0.009), CYP27B1 rs10877012 "AC" (p=0.059), VDR rs7975323 "AG" (p=0.033) and rs1544410 "GG" (p=0.013) are associated with higher 25(OH)D3 levels at 6 months' follow-up. Significant PTH suppression was detected for CYP2R1 "AG" (p=0.002), DBP rs4588 "CC" (p<0.001), VDR rs110735810 "CT" (p<0.001) and CYP24A1 rs2248137 "GG" (p=0.021).Genetic variants of the vitamin D system predispose to type 2 diabetes and regulate - partially - vitamin D metabolism, concentrations and the vitamin D status. Vitamin D insufficiency is a T2D risk factor. The response to cholecalciferol supplementation can be measured as 25(OH)D3 increment and PTH suppression. This process is regulated by genes of the vitamin D system conferring modest T2D risk.
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http://dx.doi.org/10.1055/a-1157-0026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746514PMC
July 2020

[Implementation of an operational concept in an ENT clinic in the context of the SARS-CoV-2 pandemic].

Laryngorhinootologie 2020 08 28;99(8):552-560. Epub 2020 May 28.

Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany.

The SARS-CoV-2 pandemic poses major challenges for the entire medical care system. Especially in university institutions as maximum care providers, a higher exposure to potentially infectious patients or actual COVID-19 patients is to be expected. In a short period of time, an operational concept had to be developed regarding the current hygiene recommendations of the Robert Koch Institute (RKI), the leading medical societies and the internal hospital hygiene plan. Here, patient safety and employee protection are equally important.In cooperation with the Institute for Medical Microbiology and Hospital Hygiene and the occupational medical service, interventions were defined to develop solutions to minimize the COVID-19 transmission risk for examiners and patients despite limited diagnostic and equipment resources. For this purpose, an operational concept was developed, consisting of various individual actions, e. g. the reduction of outpatient treatment to emergencies, life-threatening diseases and urgent aftercare, a double triage of patients and the introduction of treatment teams.The newly developed operational concept was successfully implemented within a few days. After the initial rollout and several "hygiene inspections" only minor improvements to the concept were necessary. All measures were documented in the internal quality handbook and are accessible to all employees. Since the SARS-CoV-2 pandemic is a dynamic process with regular changes in the development and information status, the operational concept is regularly reviewed for validity and adjusted as necessary.
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http://dx.doi.org/10.1055/a-1174-0234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417936PMC
August 2020

Manufacturing and supply of face shields in hospital operation in case of unclear and confirmed COVID-19 infection status of patients.

Eur J Trauma Emerg Surg 2020 Aug 27;46(4):743-745. Epub 2020 May 27.

Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.

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http://dx.doi.org/10.1007/s00068-020-01392-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252420PMC
August 2020

Vaccination of healthcare personnel in Europe: Update to current policies.

Vaccine 2019 12 14;37(52):7576-7584. Epub 2019 Oct 14.

Director, Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN, United States.

We investigated and compared current national vaccination policies for health-care personnel (HCP) in Europe with results from our previous survey. Data from 36 European countries were collected using the same methodology as in 2011. National policies for HCP immunization were in place in all countries. There were significant differences in terms of number of vaccinations, target HCP and healthcare settings, and implementation regulations (recommended or mandatory vaccinations). Vaccination policies against hepatitis B and seasonal influenza were present in 35 countries each. Policies for vaccination of HCP against measles, mumps, rubella and varicella existed in 28, 24, 25 and 19 countries, respectively; and against tetanus, diphtheria, pertussis and poliomyelitis in 21, 20, 19, and 18 countries, respectively. Recommendations for hepatitis A immunization existed in 17 countries, and against meningococcus B, meningococcus C, meningococcus A, C, W, Y, and tuberculosis in 10, 8, 17, and 7 countries, respectively. Mandatory vaccination policies were found in 13 countries and were a pre-requisite for employment in ten. Comparing the vaccination programs of the 30 European countries that participated in the 2011 survey, we found that more countries had national vaccination policies against measles, mumps, rubella, hepatitis A, diphtheria, tetanus, poliomyelitis, pertussis, meningococcus C and/or meningococcus A, C, W, Y; and more of these implemented mandatory vaccination policies for HCP. In conclusion, European countries now have more comprehensive national vaccination programs for HCP, however there are still gaps. Given the recent large outbreaks of vaccine-preventable diseases in Europe and the occupational risk for HCP, vaccination policies need to be expanded and strengthened in several European countries. Overall, vaccination policies for HCP in Europe should be periodically re-evaluated in order to provide optimal protection against vaccine-preventable diseases and infection control within healthcare facilities for HCP and patients.
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http://dx.doi.org/10.1016/j.vaccine.2019.09.061DOI Listing
December 2019

Targeted lipidomics reveal derangement of ceramides in major depression and bipolar disorder.

Metabolism 2019 06 5;95:65-76. Epub 2019 Apr 5.

Institute of Clinical Pharmacology, Goethe-University Hospital Frankfurt, Germany. Electronic address:

Changes of sphingolipid metabolism were suggested to contribute to the patho-etiology of major depression (MD) and bipolar disorder (BD). In a pilot study we assessed if lipid allostasis manifested in pathological plasma concentrations of bioactive lipids i.e. endocannabinoids, sphingolipids, ceramides, and lysophosphatidic acids.

Methods: Targeted and untargeted lipidomic analyses were performed according to GLP guidelines in 67 patients with unipolar or bipolar disorders (20-67 years, 36 male, 31 female) and 405 healthy controls (18-79 years, 142 m, 263 f), who were matched according to gender, age and body mass index. Multivariate analyses were used to identify major components, which accounted for the variance between groups and were able to predict group membership.

Results: Differences between MD and BP patients versus controls mainly originated from ceramides and their hexosyl-metabolites (C16Cer, C18Cer, C20Cer, C22Cer, C24Cer and C24:1Cer; C24:1GluCer, C24LacCer), which were strongly increased, particularly in male patients. Ceramide levels were neither associated with the current episode, nor with the therapeutic improvement of the Montgomery Åsberg Depression Rating Scale (MARDS). However, long-chain ceramides were linearly associated with age, stronger in patients than controls, and with high plasma levels of diacyl- and triacylglycerols. Patients receiving antidepressants had higher ceramide levels than patients not taking these drugs. There was no such association with lithium or antipsychotics except for olanzapine.

Conclusion: Our data suggest that high plasma ceramides in patients with major depression and bipolar disorder are indicative of a high metabolic burden, likely aggravated by certain medications.
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http://dx.doi.org/10.1016/j.metabol.2019.04.002DOI Listing
June 2019

Hospital outbreak of measles - Evaluation and costs of 10 occupational cases among healthcare worker in Germany, February to March 2017.

Vaccine 2019 03 5;37(14):1905-1909. Epub 2019 Mar 5.

Occupational Health Service, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Electronic address:

After treatment of an inpatient with measles, an outbreak occurred within the unprotected healthcare workers (HCW) of a regional hospital in Hesse, Germany in February and March 2017. Overall, 10 HCW contracted measles. Remarkably, none of the affected HCW had direct contact to the index patient. One nosocomial transmission to a patient occurred. The economic impact of the outbreak is estimated to approximately 700,000€. Medical institutions play a major role in the management of measles outbreaks, since the risk of exposure as well as nosocomial transmission to vulnerable patients and HCW is very high. To avoid outbreaks it is essential to have an easily accessible documentation of the immune-status of all HCW. The role of occupational medicine in identifying and closing vaccination gaps is of particular importance.
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http://dx.doi.org/10.1016/j.vaccine.2019.02.068DOI Listing
March 2019

Post-exposure prophylaxis for measles with immunoglobulins revised recommendations of the standing committee on vaccination in Germany.

Vaccine 2018 12 23;36(52):7916-7922. Epub 2018 Nov 23.

University of Basel Children's Hospital, Spitalstrasse 33, CH-4056 Basel, Switzerland.

Passive immunisation with immunoglobulins as post-exposure prophylaxis after contact with measles is recommended by the German Standing Committee on Vaccination (STIKO) particularly for unprotected individuals at high risk of complications for whom active immunization is contraindicated, such as infants <6 months of age, immunocompromised patients and pregnant women. The efficacy of passive immunisation in preventing measles depends on how soon after exposure it is administered, the concentration of measles antibodies in the immunoglobulin products and dosage. Since the global introduction of standard active immunisation against measles and the concomitant reduction in virus circulation, the levels of measles virus (MV)-specific IgG antibodies in the population have dropped. Thus, the concentration of MV-specific antibodies in immunoglobulin products derived from human plasma donors has declined as the proportion of vaccinated donors has increased. The MV-neutralizing capacity of immunoglobulin products is not routinely tested in Germany. No official data exist on the concentrations of MV-specific IgG antibodies in individual batches of immunoglobulins available in Germany and the required minimum level for MV-specific IgG is not stipulated. The STIKO re-evaluated available data and measurements of MV-neutralizing capacities of available immunoglobulin (IgG) products in Germany at the National Reference Centre Measles, Mumps, Rubella at the Robert Koch Institute. Based on the findings, STIKO modified its previous recommendations on the post-exposure use of immunoglobulins (2001), especially with respect to risk groups, application and dosage. STIKO now recommends a single intravenous administration of immunoglobulins (400 mg/kg body weight) as soon as possible, preferably within six days, after exposure to measles, specifically for infants aged <6 months, susceptible pregnant women and immunocompromised patients.
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http://dx.doi.org/10.1016/j.vaccine.2018.10.070DOI Listing
December 2018

Machine-learning based lipid mediator serum concentration patterns allow identification of multiple sclerosis patients with high accuracy.

Sci Rep 2018 10 5;8(1):14884. Epub 2018 Oct 5.

DataBionics Research Group, University of Marburg, Hans - Meerwein - Straße 22, 35032, Marburg, Germany.

Based on increasing evidence suggesting that MS pathology involves alterations in bioactive lipid metabolism, the present analysis was aimed at generating a complex serum lipid-biomarker. Using unsupervised machine-learning, implemented as emergent self-organizing maps of neuronal networks, swarm intelligence and Minimum Curvilinear Embedding, a cluster structure was found in the input data space comprising serum concentrations of d = 43 different lipid-markers of various classes. The structure coincided largely with the clinical diagnosis, indicating that the data provide a basis for the creation of a biomarker (classifier). This was subsequently assessed using supervised machine-learning, implemented as random forests and computed ABC analysis-based feature selection. Bayesian statistics-based biomarker creation was used to map the diagnostic classes of either MS patients (n = 102) or healthy subjects (n = 301). Eight lipid-markers passed the feature selection and comprised GluCerC16, LPA20:4, HETE15S, LacCerC24:1, C16Sphinganine, biopterin and the endocannabinoids PEA and OEA. A complex classifier or biomarker was developed that predicted MS at a sensitivity, specificity and accuracy of approximately 95% in training and test data sets, respectively. The present successful application of serum lipid marker concentrations to MS data is encouraging for further efforts to establish an MS biomarker based on serum lipidomics.
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http://dx.doi.org/10.1038/s41598-018-33077-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173715PMC
October 2018

Visual Vaccinology: Changing public perception.

Vaccine 2018 08 11;36(33):5104-5105. Epub 2018 Jul 11.

Occupational Health Service, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Electronic address:

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http://dx.doi.org/10.1016/j.vaccine.2018.07.014DOI Listing
August 2018

Local thermal reaction after influenza vaccination: Quantification by infrared imaging and biometric considerations.

Vaccine 2018 05 10;36(20):2783-2787. Epub 2018 Apr 10.

University Hospital Frankfurt, Goethe University, Occupational Health Service, 60590 Frankfurt am Main, Germany.

Background: Extensive clinical investigations are mandatory to evaluate the safety and reactogenicity of vaccines. The recording of common adverse events like injection site soreness or general discomfort derives from individual subjective perceptions. Thermal imaging at the injection site possibly provides a non-subjective and a non-invasive approach to supplement this evaluation.

Results: A protocol for quantified injection-site infrared imaging included 86 participants during a flu vaccine campaign, 40% of whom had a thermal reaction of 1 °C; 25-30% had no thermal response. There was little subjective pain reporting and no clinical correlations were observed except with post-vaccination erythema. Higher responses were linked with advanced age and multiple previous vaccinations.

Conclusion: Evan if influenza vaccine was only moderately reactogenic, a thermal response was detectable in about 70% of vaccinees, though no relationship to reactogenicity was seen. Infrared imaging might however be a prospective tool for individual studies of vaccine-induced vascular responses.
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http://dx.doi.org/10.1016/j.vaccine.2018.04.001DOI Listing
May 2018

Influenza Vaccination Rates Among Parents and Health Care Personnel in a German Neonatology Department.

Vaccines (Basel) 2018 Jan 5;6(1). Epub 2018 Jan 5.

Department for Children and Adolescents, Division for Neonatology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.

The influenza vaccination is recommended for all German pregnant women and health care personnel (HCP). We are the first to publish vaccination rates of mothers of hospitalized newborns and HCP in neonatal units. Between September 2016 and March 2017, data were collected in our level-III neonatology department in this descriptive multidisciplinary study, using an anonymous questionnaire. As a result, 513 persons were asked to participate, including 330 parents and 183 HCP. We received an 80.3% (412/513) response rate, 87.3% (288/330), and 67.8% (124/183) from parents and HCP, respectively. Ten percent (16/160) of mothers and 4.7% (6/127) of fathers had been vaccinated in 2016-2017 and 54.4% (87/160) mothers and 52.2% (66/127) fathers ever in their lifetime. In 2016-2017, 51.2% (21/41) of physicians had been vaccinated, 25.5% (14/55) of nurses, and 50.0% (14/28) of other staff members. When comparing those who had more than five influenza vaccinations in their life time, physicians were at 43.9% (18/41) versus nurses at 10.9% (6/55) ( < 0.01), and other HCP at 7.4% (2/27) ( < 0.01). The influenza vaccine uptake rate of 10% in mothers of hospitalized neonates is disappointingly low, resulting in 90% of hospitalized neonates being potentially vulnerable to influenza infection at a time where the risk for influenza-related complication can be severe.
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http://dx.doi.org/10.3390/vaccines6010003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874644PMC
January 2018

[Measles in Germany: An Epidemiological Analysis and First Measures for Containment].

Dtsch Med Wochenschr 2017 Nov 16;142(23):1767-1772. Epub 2017 Nov 16.

Measles are one of the most contagious diseases of mankind. Measles incidence has declined worldwide since the introduction of vaccinations. Due to low numbers of measles cases in countries with high vaccination rates the population is not aware of possible complications of measles any more. Measles elimination is an important goal set by all regions of the World Health Organization. However, it remains a challenge for Germany and other European countries. Because of a high proportion of susceptibles in specific population and age groups outbreaks take place in Germany every year after importation of the virus. More than 50 % of measles cases are 20 years and older. However, the highest incidences have been seen in two-year-olds since several years. In addition to epidemiological findings such as case numbers and risk groups, genotyping permits e. g. an assessment of the endemic circulation of viruses. Suspicion of a measles case should result in immediate and consistent measures.
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http://dx.doi.org/10.1055/s-0043-117973DOI Listing
November 2017

[What you always wanted and ought to know about measles].

MMW Fortschr Med 2017 Apr;159(6):54-58

Robert Koch-Institut, Fachgebiet Impfprävention, Berlin, Deutschland.

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http://dx.doi.org/10.1007/s15006-017-9484-xDOI Listing
April 2017

Work-related infections in dentistry: risk perception and preventive measures.

Clin Oral Investig 2017 Nov 18;21(8):2473-2479. Epub 2017 Jan 18.

Occupational Health Service, University Hospital Frankfurt, Johann Wolfgang Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.

Objectives: Evaluation of (1) the risk perception of work-related infections in dentistry, (2) the vaccination status, (3) knowledge of the blood-borne pathogens and HIV post-exposure prophylaxis (PEP) as well as (4) use of personal protective equipment (PPE) (gloves, goggles, mask) among the staff and students of the Center of Dentistry and Oral Medicine (ZZMK [Carolinum]) of the Goethe University Frankfurt/Main.

Material And Methods: All staff (dentists, dental assistants) and students of the ZZMK with direct contact to patients were asked to anonymously complete a questionnaire. The results of this survey were compared with respect to gender, age and occupational group.

Results: Of 178 employees working and 234 students studying at the ZZMK with direct contact to patients, 108 (61%) and 167 (71%) participated (1 person did not reveal his/her status). Thirty-three per cent of the participants assessed the risk of transmission of blood-borne diseases in dental practice as high. Whereas 94% of the participants were fully vaccinated against hepatitis B, only 21% knew their anti-HBs titer. Fifty per cent of students, 13% of dentists and 45% of the assistants did not know the standardised procedure of HIV-PEP. Ninety-four per cent of the study participants always wore protective gloves, 87% always wore a surgical mask and 67% always wore protective goggles.

Conclusions: The fear of HIV is still the largest, followed by hepatitis C. The participants assessed the risk of transmission in spite of all protective measures from the patient to the dentist significantly higher than the transmission from the dentist to the patient. The use of protective measures, especially goggles, requires further optimizing.

Clinical Relevance: In general, the use of protective measures, especially goggles, requires further optimizing.
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http://dx.doi.org/10.1007/s00784-017-2046-xDOI Listing
November 2017

Hintergrundpapier der STIKO: Evaluation der bestehenden Influenzaimpfempfehlung für Indikationsgruppen und für Senioren (Standardimpfung ab 60 Jahren).

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016 Dec;59(12):1606-1622

Institut für Virologie, Universitätsklinikum Ulm, Ulm, Deutschland.

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http://dx.doi.org/10.1007/s00103-016-2467-8DOI Listing
December 2016

The virologist and the flu.

J Clin Virol 2015 Aug 26;69:200-2. Epub 2015 Jun 26.

Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Paul-Ehrlich-Str. 40, 60596 Frankfurt am Main, Germany. Electronic address:

We report a case of a virologist - who is in age-appropriate medical condition with no relevant chronic diseases - who shed influenza A H3N2 virus RNA for 70 days while infectious virus could be detected by cell culture only up to 5 days after onset of symptoms despite a 5-day course of oseltamivir. The case might have implications for infection control in hospital settings and the weighting of the predictive value of PCR results.
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http://dx.doi.org/10.1016/j.jcv.2015.06.099DOI Listing
August 2015

Management of Microbiological Samples in a Confirmed Case of Ebola Virus Disease: Constraints and Limitations.

J Clin Microbiol 2015 Nov 24;53(11):3396-400. Epub 2015 Jun 24.

Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany

In light of the recent Ebola virus outbreak, it has to be realized that besides medical treatment, precise algorithms for the management of complicating microbial infections are mandatory for Ebola virus disease (EVD) patients. While the necessity of such diagnostics is apparent, practical details are much less clear. Our approach, established during the treatment of an EVD patient at the University Hospital in Frankfurt am Main, Germany, provides a roadmap for reliable and safe on-site microbiological testing.
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http://dx.doi.org/10.1128/JCM.01142-15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609678PMC
November 2015

[Recommended adult immunization schedule].

MMW Fortschr Med 2015 Mar;157 Suppl 1:43-8

Betriebsärztlicher Dienst, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt am Main, Deutschland,

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http://dx.doi.org/10.1007/s15006-015-2721-2DOI Listing
March 2015

Medical students' attitude towards influenza vaccination.

BMC Infect Dis 2015 Apr 15;15:185. Epub 2015 Apr 15.

Department of Work & Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.

Background: Influenza vaccination is recommended for all healthcare personnel (HCP) and most institutions offer vaccination for free and on site. However, medical students do not always have such easy access, and the predictors that might guide the motivation of medical students to get vaccinated are largely unknown.

Methods: We conducted a cross-sectional survey study among pre-clinical medical students in a German University hospital to assess the social cognitive predictors of influenza vaccination, as well as reasons for refusal and acceptance of the vaccine.

Results: Findings show that pre-clinical medical students have comparable knowledge gaps and negative attitudes towards influenza vaccination that have previously been reported among HCP. Lower injunctive norms and higher feelings of autonomy contribute to no intention to get vaccinated against influenza, while a positive instrumental attitude and higher feelings of autonomy contribute to a high intention to get vaccinated. The variables in the regression model explained 20% of the variance in intention to get vaccinated.

Conclusions: The identified factors should be addressed early in medical education, and hospitals might benefit from a more inclusive vaccination program and accessibility of free vaccines for their medical students.
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http://dx.doi.org/10.1186/s12879-015-0929-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419496PMC
April 2015

Regulation of circulating endocannabinoids associated with cancer and metastases in mice and humans.

Oncoscience 2014 30;1(4):272-282. Epub 2014 Apr 30.

pharmazentrum frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Hospital, Frankfurt am Main, Germany.

Background And Aims: Endocannabinoids may modify cancer development, progression and associated pain. We determined whether cancer-evoked dysregulations in this system become manifest in altered tissue and plasma endocannabinoids.

Methods: Endocannabinoid changes due to cancer were explored in a local and metastatic syngeneic mouse melanoma model. Endocannabinoid stratification in human cancer was cross-sectionally assessed in the plasma of 304 patients (147 men, 157 women, aged 32 - 87 years) suffering from several types of cancer at Roman Numeral Staging between I and IVc, mostly IV (n = 220), and compared with endocannabinoids of healthy controls.

Results: In mice with local tumor growth, ethanolamide endocannabinoids, i.e., anandamide (AEA), palmitoylethanolamide (PEA) and oleoylethanolamide (OEA) were downregulated, whereas 2-arachidonoylglycerol (2-AG) was increased. Upon spreading of the cancer cells particularly 2-AG steadily increased in parallel to disease progression while OEA modulated cell migration. Results translated into humans, in whom cancer was associated with a decreased AEA, increased 2-AG and increased OEA correlating with the number of metastases.

Conclusions: The endocannabinoid system was subject to cancer-associated regulations to an extent that led to measurable changes in circulating endocannabinoid levels, emphasizing the importance of the endocannabinoid system in the pathophysiology of cancer.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278301PMC
http://dx.doi.org/10.18632/oncoscience.33DOI Listing
January 2015

Influenza vaccination of healthcare personnel.

Hum Vaccin Immunother 2014 1;10(9):2627-8. Epub 2014 Nov 1.

a Occupational Health Service ; University hospital Frankfurt; Goethe University ; Frankfurt am Main , Germany.

The thought is terrifying--you are admitted to the hospital and you die of a nosocomial infection. What sounds like a horror scenario, happens every day in hospitals all over the world. Nosocomial influenza is associated with considerable morbidity and mortality among patients with underlying diseases (especially immunocompromised patients), the elderly, and neonates. Although vaccination of healthcare personnel (HCP) is the main measure for preventing nosocomial influenza and is consistently recommended by public-health authorities, vaccine uptake among HCP remains low. (1.)
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http://dx.doi.org/10.4161/hv.28154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975055PMC
May 2016

[Immunity against measles among healthcare personnel at the University Hospital Frankfurt, 2003-2013].

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015 Feb;58(2):182-9

Betriebsärztlicher Dienst, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.

Background: Despite aiming for the elimination of measles by 2015, the current epidemiological situation in Germany shows that there is still insufficient vaccination coverage among the population. During the present pre-elimination period, nosocomial measles are gaining in importance.

Aim: The purpose of our study was to determine the immune status of measles among healthcare personnel and medical students at the University Hospital Frankfurt. Moreover, the knowledge of study participants regarding the WHO's goal of the elimination of measles and the general attitude towards vaccination recommendations were investigated.

Methods: A retrospective study of measles seroprevalence was conducted among healthcare personnel and students at the University Hospital Frankfurt with an observation period of 11 years. In spring 2014, medical students were asked to complete an anonymous questionnaire regarding vaccination status, knowledge of measles and acceptance of measles vaccination recommendations.

Results: In total, 9,933 serologies were evaluated and 85.7% of the participants had sufficient immunity against measles. Significant changes in immunity to measles over time were not observed. However, a significant difference in the immunity rate of participants born before 1970 and those born after1970 was found. Participants born before 1970 significantly more often showed sufficient immunity against measles compared to those born later (96.4 vs. 83.3 %, p < 0.0001). Almost 20 % of the medical students were not aware of their measles vaccination status and merely 70.7 % indicated that they had received two measles vaccinations. Furthermore, only 45.4 % of the medical students were familiar with the WHO's goal of eliminating measles by 2015; however 95 % could be classified as vaccination-supporters on the basis of the questionnaire.

Conclusions: Overall, the immunity rate of measles determined by serology within the study population did not reach the WHO goal of ≥ 95 %, and this gap was even greater in group of medical students. Despite the medical students' positive attitude towards vaccination guidelines, the awareness in this field awaits improvement.
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http://dx.doi.org/10.1007/s00103-014-2098-xDOI Listing
February 2015

Personal attitudes and misconceptions, not official recommendations guide occupational physicians' vaccination decisions.

Vaccine 2014 Jul 21;32(35):4478-4484. Epub 2014 Jun 21.

Occupational Health Service, University Hospital Frankfurt, Goethe-University Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Electronic address:

Introduction: Healthcare personnel (HCP) are often under-vaccinated. The aim of this study was to evaluate occupational physicians' potential role by assessing relations between their knowledge and attitudes regarding HCP vaccination and the extent to which official vaccination recommendations are communicated.

Methods: Cross-sectional survey, n=135 occupational physicians.

Results: Occupational physicians who treat HCP recommend vaccinations more often to HCP when they have better knowledge of official vaccination recommendations and a more positive attitude towards vaccination compared to physicians with less such knowledge or a more negative attitude. The attitude towards vaccination most strongly affects whether occupational physicians recommend the measles, mumps, and rubella (MMR) vaccination: physicians with less positive attitudes recommend MMR to HCP in a more restricted way. A more positive attitude towards vaccination also relates to fewer misconceptions. Occupational physicians' knowledge and attitude further influence the extent to which pregnant HCP receive vaccinations against influenza. Knowledge about official recommendations does not influence the recommendation of influenza vaccination for pregnant women.

Conclusions: Reasons for vaccination gaps in HCP might have their roots in occupational physicians' incomplete knowledge of vaccination recommendations. Attitudes, which are related to misperceptions, also influence which vaccinations are recommended to HCP. Official recommendations, and not personal attitudes and misconceptions, should guide occupational vaccination behavior.
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http://dx.doi.org/10.1016/j.vaccine.2014.06.046DOI Listing
July 2014

Vaccine-preventable diseases in Europe: where do we stand?

Expert Rev Vaccines 2014 Aug 24;13(8):979-87. Epub 2014 Jun 24.

Occupational Health Service, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.

During the second half of the 20th century, vaccinations led to the control or even eradication of several vaccine-preventable diseases (VPDs) in Europe. However, outbreaks of VPDs continue to occur even in countries with well-established vaccination programs. Reasons include the existence of under-vaccinated populations, the increasing anti-vaccination movement and the increasing movement of populations across borders. Ensuring adequate levels of herd immunity is the only reliable method for preventing epidemics and a re-emergence of VPDs. In order to achieve this, more flexible vaccine delivery platforms are needed targeting the less-privileged people, especially in the context of the current economic crisis. Healthcare personnel and healthcare systems should be prepared to address these challenges in the following years.
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http://dx.doi.org/10.1586/14760584.2014.933077DOI Listing
August 2014

Vaccination of healthcare personnel: spotlight on groups with underlying conditions.

Vaccine 2014 Jul 6;32(32):4025-31. Epub 2014 Jun 6.

Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, 3-5 Agrafon Street, 15123 Athens, Greece.

Healthcare personnel (HCP) are at increased risk of acquiring vaccine-preventable diseases (VPDs). Vaccination protects HCP and their patients from nosocomial transmission of VPDs. HCP who have underlying diseases (e.g., immunocompromised, HIV-infected, or those with chronic diseases) and HCP in particular phases of life (e.g., pregnant, elderly) require special consideration in regards the provision of vaccines. On the one hand, live virus vaccines may be contraindicated (e.g., pregnant HCP, immunocompromised HCP), while on the other hand, vaccines not routinely recommended (e.g., pneumococcal) may be indicated (e.g., elderly or immunocompromised HCP). It is not known how many HCP with underlying conditions require special consideration in the healthcare setting. This is an important issue, because the risk for serious morbidity, complications and mortality for HCP with underlying conditions will only increase. The prevention of nosocomial infections requires comprehensive occupational safety programs. The healthcare system must engage HCP and occupational physicians to ensure sufficient vaccination rates as part of an effective nosocomial infection prevention and HCP safety strategy.
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http://dx.doi.org/10.1016/j.vaccine.2014.05.070DOI Listing
July 2014