Christof David Vinnemeier

Malaria is a mosquito-borne parasitic disease that causes severe mortality and morbidity, particularly in Sub-Saharan Africa. As the vectors predominantly bite between dusk and dawn, risk of infection is determined by the abundance of P. falciparum infected mosquitoes in the surroundings of the households. Remote sensing is commonly employed to detect associations between land use/land cover (LULC) and mosquito-borne diseases. Due to challenges in LULC identification and the fact that LULC merely functions as a proxy for mosquito abundance, assuming spatially homogenous relationships may lead to overgeneralized conclusions. Data on incidence of P. falciparum parasitaemia were recorded by active and passive follow-up over two years. Nine LULC types were identified through remote sensing and ground-truthing. Spatial associations of LULC and P. falciparum parasitaemia rate were described in a semi-parametric geographically weighted Poisson regression model. Complete data were available for 878 individuals, with an annual P. falciparum rate of 3.2 infections per person-year at risk. The influences of built-up areas (median incidence rate ratio (IRR): 0.94, IQR: 0.46), forest (median IRR: 0.9, IQR: 0.51), swampy areas (median IRR: 1.15, IQR: 0.88), as well as banana (median IRR: 1.02, IQR: 0.25), cacao (median IRR: 1.33, IQR: 0.97) and orange plantations (median IRR: 1.11, IQR: 0.68) on P. falciparum rate show strong spatial variations within the study area. Incorporating spatial variability of LULC variables increased model performance compared to the spatially homogenous model. The observed spatial variability of LULC influence in parasitaemia would have been masked by traditional Poisson regression analysis assuming a spatially constant influence of all variables. We conclude that the spatially varying effects of LULC on P. falciparum parasitaemia may in fact be associated with co-factors not captured by remote sensing, and suggest that future studies assess small-scale spatial variation of vegetation to circumvent generalised assumptions on ecological associations that may in fact be artificial.

Background: The present study aimed to evaluate immunogenicity and safety of the 2012/2013 seasonal influenza vaccine (Optaflu®) after the World Health Organization recommended two new strains for the composition. Results: Twenty-one days post-vaccination geometric mean titers (GMTs) against A(H1N1), A(H3N2) and the B strain were 528, 935, and 201 for adults and 272, 681, and 101 for elderly subjects, respectively. The proportion of subjects with a HI titer of ≥ 40 against the three strains A(H1N1), A(H3N2) and B was 98%, 100%, and 98% in adults and 100%, 100%, and 85% in elderly subjects, respectively. Optaflu® met the CHMP criteria of the Committee for Medicinal Products for Human Use (CPMP/BWP/214/96). Pre-vaccination titers indicated seroprotection against the A(H1N1), the A(H3N2) and the B strain in 56%, 86%, and 54% of the adults and in 61%, 85%, and 40% of the elderly with highest titers against the A(H3N2) strain. In the safety analysis injection site pain (37%) and myalgia (31%) were the most common local and systemic reactions. No serious adverse events were recorded. Conclusion: The 2012/2013 seasonal influenza vaccine Optaflu® showed good immunogenicity and an acceptable safety profile in both adults and elderly. Methods: In this trial, 126 subjects (63 adults ≥18 to ≤60 y, 63 elderly ≥61 y) were vaccinated with a single dose Optaflu® containing each of the three virus strains recommended for the 2012/2013 season (A/California/7/2009(H1N1)-like strain, A/Victoria/361/2011(H3N2)-like strain, and B/Wisconsin/1/2010-like strain). Immunogenicity was assessed by hemagglutinin inhibition (HI) and single radial hemolysis (SRH) assays on day 22, the safety profile was investigated throughout the whole study period.

Die Inzidenz invasiver Meningokokkenerkrankungen lag in Deutschland im Jahr 2011 bei 0,45/100 000 Einwohner und damit etwa auf dem Niveau der Vorjahre. In anderen Regionen, insbesondere auf dem afrikanischen Kontinent, hat Neisseria meningitidis einen deutlich größeren Einfluss auf Morbidität und Mortalität. Invasive Meningokokkenerkrankungen sind bei Reisenden insgesamt selten, sie verlaufen aber häufig kompliziert und mit einer hohen Letalität. Bezüglich der Impfstoffe haben sich in den letzten 2,5 Jahren einige Neuentwicklungen ergeben. Zusätzlich zu den im Jahr 2006 auch in Deutschland als Standardimpfung bei Kindern eingeführten monovalenten Impfstoffen gegen Meningokokken der Gruppe C sind seit 2011 beziehungsweise 2012 auch 2 tetravalente Konjugatimpfstoffe gegen die Gruppen A, C, W₁₃₅ und Y ab einem Alter von 12 beziehungsweise 24 Monaten zugelassen. Ferner hat im Frühjahr 2013 erstmals ein Multikomponentenimpfstoff gegen Gruppe-B-Meningokokken, der in gemäßigten Klimazonen überwiegend vorkommenden Gruppe, die Zulassung ab dem 2. Lebensmonat erhalten. Dieser Impfstoff wird voraussichtlich Anfang 2014 verfügbar sein. Bei Reisenden kommt eine Impfung insbesondere für Reisen in den Meningitisgürtel Afrikas in Frage. Das Infektionsrisiko ist aber auch zum Beispiel bei Schülern in Neuseeland oder bei Bewohnern von Studentenwohnheimen in den USA höher als im heimischen Umfeld. Für Hadsch-Pilgerreisende besteht eine Impfpflicht. According to latest figures the incidence of invasive meningococcal disease in Germany is stable over the last 2 years. In other countries, in particular on the African continent, invasive disease related to Neisseria meningitidis has much higher morbidity and mortality. Several new vaccines against meningococcal infections have been licensed within the last 2,5 years. Beside the conjugated monovalent vaccines against group-C-meningococci, 2 conjugated tetravalent vaccines against groups A,C,W135 and Y have become available in 2011 and 2012. Furthermore, a first multicomponent group-B-vaccine has been licensed in spring 2013. In Germany, this vaccine will be available in 2014. Although surveillance data of the last decade show that very few travelers have been affected by meningococcal disease, persons traveling to the so-called meningitis belt in Africa are at comparatively high risk for meningococcal disease. Increased incidences have also been observed in college or military dormitories in the U.S. as well as among students in Australia and New Zealand. Vaccination with a tetravalent vaccine is a prerequisite for Hadjj-pilgrims.

Although the incidence of Plasmodium falciparum malaria in some parts of sub-Saharan Africa is reported to decline and other conditions, causing similar symptoms as clinical malaria are gaining in relevance, presumptive anti-malarial treatment is still common. This study traced for age-dependent signs and symptoms predictive for P. falciparum parasitaemia. In total, 5447 visits of 3641 patients between 2–60 months of age who attended an outpatient department (OPD) of a rural hospital in the Ashanti Region, Ghana, were analysed. All Children were examined by a paediatrician and a full blood count and thick smear were done. A Classification and Regression Tree (CART) model was used to generate a clinical decision tree to predict malarial parasitaemia a7nd predictive values of all symptoms were calculated. Malarial parasitaemia was detected in children between 2–12 months and between 12–60 months of age with a prevalence of 13.8% and 30.6%, respectively. The CART-model revealed age-dependent differences in the ability of the variables to predict parasitaemia. While palmar pallor was the most important symptom in children between 2–12 months, a report of fever and an elevated body temperature of ≥37.5°C gained in relevance in children between 12–60 months. The variable palmar pallor was significantly (pP. falciparum parasitaemia. The predictive value of palmar pallor should be underlined in health worker training. Due to a lack of sensitivity neither the best algorithm nor palmar pallor as a single sign are eligible for decision-making and cannot replace presumptive treatment or laboratory diagnosis.