This study sought to assess the risk of secondary transmission after import of Lassa fever into Europe. A total of 232 persons exposed to a case of Lassa fever imported into Germany were identified. The level of exposure was determined for 157 persons (68%), and 149 (64%) were tested serologically. High-risk or close contact was reported by 30 (19%) of 157 persons. No symptomatic secondary infections were observed. However, Lassa virus-specific immunoglobulin G antibodies were detected in a serum sample obtained from a physician who examined the index patient on day 9 of illness. The physician received ribavirin prophylaxis and did not develop symptoms of Lassa fever. On the basis of these data, the contact was classified as having a probable secondary infection. The study indicates a low risk of transmission during the initial phase of symptomatic Lassa fever, even with high-risk exposures. The risk may increase with progression of disease and increasing virus load.

The influence of food on the pharmacokinetics of the triazole antimycotics fluconazole and itraconazole was investigated in a randomised, parallel group, single dose study in 24 healthy subjects. Each group took either a 100 mg capsule of fluconazole or a 100 mg capsule of itraconazole, pre-prandially or after a light meal or a full meal, in a three-way crossover design. Gastric and intestinal pH were measured with a co-administered radiotelemetric pH capsule, and gastric emptying time of the capsule (GET) was taken as the maximum gastric residence time of drug and food. The plasma AUC and Cmax of itraconazole were significantly different under the various conditions and the mean AUC was greatest after the full meal. The bioavailability (90% confidence intervals) of itraconazole relative to that after the full meal, was 54% (41-77%) on an empty stomach and 86% (65-102%) after a light meal. The criteria for bioequivalence were not attained. In contrast, the bioavailability (90% CI) of fluconazole relative to the full meal was 110% pre-prandially (100-115%) and 102% after the light meal (88-103%), and the criteria for bioequivalence were attained. Itraconazole absorption was promoted by low stomach pH, long gastric retention time and a high fat content of the coadministered meal, whereas the pharmacokinetics of fluconazole was relatively insensitive to physiological changes in the gastrointestinal tract.

To the Editor-Children are the invisible victims of the COVID-19 pandemic. Although they have a low risk of severe COVID-19 disease and death, they are suffering disproportionate harm from non-pharmaceutical public-health measures, including deleterious educational effects of school closures, and decreased social care,

To assess influenza vaccination coverage in Germany, we conducted a nationwide telephone survey in November 1999 in adults (>18 yrs) using random-digit dialing. Overall, 23% of 1,190 survey participants reported having been vaccinated (adjusted 18%) with 16% (adjusted 15%) in former West Germany versus 35% (adjusted 32%) in former East Germany. Immunization rates for vaccination target groups were lower in West Germany (21%) than in East Germany (40%). Seven percent of health-care workers were immunized. Previous influenza vaccination, positive attitudes towards immunization, and having a family physician increased the rate of vaccination; fear of adverse effects lowered the rate. Family physicians performed 93% of the vaccinations, which suggests their key role in improving low vaccination coverage in Germany. The fact that >71% (850/1,190) of participants belonged to at least one of the vaccination target groups recommended by the German Standing Commission on Immunization emphasizes the need to focus the definition of target groups.

Human hantavirus (serotype Puumala) infections are prevalent throughout Europe. The bank vole is the main reservoir of the Puumala virus (PUUV). Between 2001 and 2006, the annual incidences in Germany ranged from 0.1 to 0.5 per 100,000 inhabitants. About half of the cases were reported from the state of Baden-Württemberg (BW) in southwest Germany. In 2007, 1,089 PUUV infections were reported from BW. This reflects an incidence of 10.1:100,000, which is more than 11 times higher than the mean incidence of the previous 6 years. Spatial analysis highlights incidences up to 90:100,000 in the most affected district. The winter season 2006/2007 showed an all time high in reported mean temperature. The previous summer and autumn led to a beech mast year, resulting in favourable feed conditions for bank voles in the winter season 2006/2007. The causes of the observed increase in PUUV infections in 2007 cannot be restricted to known cycles in the bank vole population. Favourable feed conditions, a mild winter and an early onset of spring may have influenced bank vole population size as well as human exposure to infectious rodent excretions. Further epidemiologic studies are necessary to better understand the interaction between environmental factors, occurrence of Puumala virus in bank voles and the risk for human disease.