BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) may cause prolonged outbreaks of infections in neonatal intensive care units (NICUs). While the specific factors favouring MRSA spread on neonatal wards are not well understood, colonized infants, their relatives, or health-care workers may all be sources for MRSA transmission. Whole-genome sequencing may provide a new tool for elucidating transmission pathways of MRSA at a local scale.Methods and FindingsWe applied whole-genome sequencing to trace MRSA spread in a NICU and performed a case-control study to identify risk factors for MRSA transmission. MRSA genomes had accumulated sequence variation sufficiently fast to reflect epidemiological linkage among individual patients, between infants and their mothers, and between infants and staff members, such that the relevance of individual nurses’ nasal MRSA colonization for prolonged transmission could be evaluated. In addition to confirming previously reported risk factors, we identified an increased risk of transmission from infants with as yet unknown MRSA colonisation, in contrast to known MRSA-positive infants.ConclusionsThe integration of epidemiological (temporal, spatial) and genomic data enabled the phylogenetic testing of several hypotheses on specific MRSA transmission routes within a neonatal intensive-care unit. The pronounced risk of transmission emanating from undetected MRSA carriers suggested that increasing the frequency or speed of microbiological diagnostics could help to reduce transmission of MRSA.

IntroductionPersisting human papillomavirus (HPV) infections, especially with HPV high-risk types 16 or 18, are prerequisites for cervical precancer and cancer. At the end of 2006 a quadrivalent HPV-vaccine became available in Germany providing protection against the HPV-types 6, 11, 16, and 18. The primary vaccination series consists of 3 separate doses administered at 0, 2, and 6 mo. If an alternate vaccination schedule is necessary, the second dose should be administered at least one month after the first and the third at least 3 mo after the second dose. The primary vaccination series should be completed within a 1-y period, according to the German summary of product characteristics (SPC). In 2007, a bivalent vaccine was approved for immunisation against HPV-types 16 and 18. For this vaccine, the German SPC recommends a vaccination schedule of 0, 1, 6 mo. HPV vaccination is free of charge in Germany. In clinical trials, the HPV-vaccines demonstrated > 90% efficacy against HPV 16-and 18-related Purpose: since March 2007, the standing committee on Vaccination (sTIKO) recommends HpV vaccination for all 12-17 y-old females in Germany. In the absence of an immunization register, we aimed at assessing HpV-vaccination coverage and knowledge among students in Berlin, the largest city in Germany, to identify factors influencing HpV-vaccine uptake.Results: Between september and December 2010, 442 students completed the questionnaire (mean age 15.1; range 14-19). In total 281/442 (63.6%) students specified HpV correctly as a sexually transmitted infection. Of 238 participating girls, 161 (67.6%) provided their vaccination records. among these, 66 (41.0%) had received the recommended three HpVvaccine doses. Reasons for being HpV-unvaccinated were reported by 65 girls: Dissuasion from parents (40.2%), dissuasion from their physician (18.5%), and concerns about side-effects (30.8%) (multiple choices possible). The odds of being vaccinated increased with age [Odds Ratio (OR) 2.19, 95% confidence Interval (cI) 1.16, 4.15] and decreased with negative attitude toward vaccinations (OR = 0.33, 95% cI 0.13, 0.84).Methods: self-administered questionnaires were distributed to 10th grade school students in 14 participating schools in Berlin to assess socio-demographic characteristics, knowledge, and statements on vaccinations. Vaccination records were reviewed. Multivariable statistical methods were applied to identify independent predictors for HpV-vaccine uptake among female participants.Conclusions: HpV-vaccine uptake was low among school girls in Berlin. Both, physicians and parents were influential regarding their HpV-vaccination decision even though personal perceptions played an important role as well. school programs could be beneficial to improve knowledge related to HpV and vaccines, and to offer low-barrier access to HpV vaccination.Human papillomavirus vaccine uptake, knowledge and attitude among 10th grade students in Berlin, Germany, 2010 In Germany, a structured program for the evaluation and assessment of the impact...

BackgroundLyme borreliosis (LB) caused by spirochetes of the Borrelia burgdorferi sensu lato complex is the most common tick-borne disease in the northern hemisphere. Data on the distribution and on risk factors in Germany are sketchy.Methodology/Principal FindingsBlood samples of a nationwide population-based cross-sectional study from 2003–2006 in children and adolescents aged 1 to 17 years in Germany (KiGGS) were analysed (n = 12,614) to assess the seroprevalence of anti-Borrelia antibodies. Data from standardized interviews were used to assess potential risk factors. First, sera were screened for anti-Borrelia antibodies by ELISA. The overall prevalence was 4.8% (95% confidence interval (CI) 4.3–5.4%). Positive and borderline ELISA test results were confirmed by a line blot revealing a combined prevalence of 4.0% (95% CI 3.6–4.5%). Seroprevalence of ELISA was significantly higher in males (odds ratio (OR) = 1.37; CI 1.15–1.63) and in the southern part of Germany (OR = 1.41; CI 1.09–1.83), but significantly lower in children and adolescents with migration background (OR = 0.33; CI 0.24–0.44). Study participants from households with cats had a higher chance of seropositivity (OR = 6.7; CI 5.6–8.0). In a multivariable model the odds of seropositivity increases by 11% for every year of age for boys and 6% for girls.Conclusions/SignificanceThis survey is the first nationwide, representative seroprevalence survey of LB in children and young adolescents. The study shows that infections with Borrelia burgdorferi are endemic in all parts of Germany despite regional differences. Even at a young age children are exposed to tick bites including seropositivity. Encouraging a thorough check for ticks and promptly removal of ticks are the key public health strategies to reduce the risk of LB and other tick-borne diseases in children and adolescents. Further epidemiological studies are warranted to better understand the burden of disease related to LB.

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RV vaccination protects young children effectively from RV disease and can reduce disease severity. Breastfeeding might impair VE, but further research is needed to identify the critical time window for this interference and to develop appropriate recommendations.