Papers by Ulrich Heininger
Monatsschrift Kinderheilkunde
Treatable infectious and other diseases are frequent in immigrant children and adolescents and sh... more Treatable infectious and other diseases are frequent in immigrant children and adolescents and should be searched for using a rational diagnostic approach. Proposed diagnostic procedures should be performed as soon as possible after arrival in Germany. A careful history and thorough physical examination are substantial components of the diagnostic procedure. Various viral, bacterial, protozoan, and worm infections which should be considered are described. Some of these should be routinely included in the examination, while others should be symptom-dependent or should be especially considered when originating from a high-risk area. Tuberculosis, worm infestations, and malaria are noteworthy infectious diseases, hemoglobinopathies are the most common form of inherited diseases. Immigrants should be examined for malnutrition and poisoning, e.g., by insecticides or mercury. The vaccination status should be ascertained and possible missing inoculations should be administered.
Klinische Pädiatrie
Infections by Salmonella enteritidis commonly present with diarrhoea, vomiting and fever and comp... more Infections by Salmonella enteritidis commonly present with diarrhoea, vomiting and fever and complications such as septicaemia, pleural effusion and acute renal failure are usually rare. There are only few reports of cutaneous manifestations and especially septic shock in patients with Salmonella enteritidis infection. We report on a previously healthy seven-year-old boy suffering from Salmonella enteritidis septicaemia presenting with septic shock, pleural effusion, renal failure and an unusual maculopapular skin eruption on both wrists and ankles. The boy had no underlying immunodeficiency.
Vaccine
Children aged 9-11, 12-14 or 15-17 months, respectively were vaccinated with a measles, mumps and... more Children aged 9-11, 12-14 or 15-17 months, respectively were vaccinated with a measles, mumps and rubella (MMR) vaccine and serum antibody responses and reactogenicity were compared. The data of 118 children could be analysed (group 1=9-11 months, n=46; group 2=12-14 months, n=29, group 3, 15-17 months, n=43). The only significant difference observed was for seroconversion against measles virus between group 1 and group 3 (84.8% vs 100%, p=0.012). No serious adverse events were reported. Local side reactions were mild, infrequent and independent of age. Immunisation against MMR is safe and effective even when administered before the currently recommended age of 12 months.
Background: Human Metapneumovirus (hMPV) epidemics vary in time and severity. This study aims to ... more Background: Human Metapneumovirus (hMPV) epidemics vary in time and severity. This study aims to describe the pattern of hMPV epidemics in north-western Switzerland. Methods: In an ongoing surveillance program of respiratory viruses at the University Children's Hospital Basel, Switzerland, PCR for hMPV and respiratory syncythial virus (RSV) was performed on nasopharyngeal aspirates (NPA) of hospitalized and outpatient children and adolescents with respiratory tract infections between October 2004 and April 2008. Results: A total of 4987 NPAs were tested for hMPV and 3859 for RSV. Of these 198 (4%) were hMPV positiv (59% males) and 869 (22%) were RSV positive (60% males). Median age was 16 months (0.8-211) and 9 months (0.3-198) for hMPV and RSV, respectively. 53% of hMPV and 56% of RSV patients were hospitalized. Proportions of hMPV positive samples for the four winter seasons were 0.4%, 11%, 0.3% and 12%. For RSV, they were 28%, 15%, 28% and 28%. Conclusions: HMPV epidemics app...
Monatsschrift Kinderheilkunde
Bei sehr unreifen Frühgeborenen [Die EMA (,,European Medicines Agency“) empfiehlt seit 2008, dass... more Bei sehr unreifen Frühgeborenen [Die EMA (,,European Medicines Agency“) empfiehlt seit 2008, dass bei sehr unreifen Frühgeborenen erwogen werden sollte, die Atmung im Rahmen von Impfungen im Säuglingsalter für 48–72 h zu überwachen. Im vorliegenden Beitrag werden Vorschläge zur praktischen Anwendung dieser Empfehlung gegeben, welche auf der aktuellen publizierten Evidenz und Expertenmeinungen basieren.
Vaccine, 2015
The incidence of tuberculosis (TB) and the use of Bacille Calmette-Guérin (BCG) vaccines differ s... more The incidence of tuberculosis (TB) and the use of Bacille Calmette-Guérin (BCG) vaccines differ significantly worldwide. Information regarding recent changes in BCG use and immunisation policies is difficult to access. Therefore, this study aimed to systematically collect up-to-date data on the use of BCG in Europe. A web-based survey of members of the paediatric-tuberculosis-network-European-trials-group (ptbnet) and tuberculosis-network-European-trials-group (TBnet) was conducted between October 2012 and May 2013. A total of 89 individuals from 31 European countries participated. Participants from 27/31 (87%) countries reported to have a national BCG immunisation policy/guideline. Reported indications for BCG immunisation were: universally at birth (14/31; 45%), universally at older age (2/31; 6%), at birth for high-risk groups (12/31; 39%), at older age for high-risk groups (6/31; 19%), at older age for Mantoux-negative individuals (6/31;19%), for immigrants (4/31; 13%) and as a travel vaccine (10/31; 32%). Members from 11 (35%) countries reported changes in BCG policies in the previous 5 years: discontinuation of universal immunisation of infants/children (6/11), reintroduction of immunisation of high-risk children (3/11), and change in BCG vaccine strain (2/11). Members from 24/31 (77%) countries reported using BCG Denmark. Immunisation policies regarding BCG vaccine exist in the majority of European countries. Indications for BCG immunisation varied considerably, likely reflecting national TB incidence rates, immigration and other factors influencing TB control strategies. Importantly, the considerable number of recent policy changes highlights the need for regular collection of up-to-date information to inform public health planning.
Journal of Clinical Virology, 2007
BackgroundThe prevalence of measles antibodies was investigated by an enzyme immunoassay (EIA) in... more BackgroundThe prevalence of measles antibodies was investigated by an enzyme immunoassay (EIA) in students aged 14 every year since 1996 in a Swiss municipality. This region has wide measles vaccine coverage (first dose ≥95%, second dose ≥65%) without any reported measles outbreaks since 20 years. In 2003 and 2004, in contrast to previous years, surprisingly many negative results (33% and
Vaccine
BACKGROUND: Timing is critical for efficient hepatitis A vaccination in high endemic areas as hig... more BACKGROUND: Timing is critical for efficient hepatitis A vaccination in high endemic areas as high levels of maternal IgG antibodies against the hepatitis A virus (HAV) present in the first year of life may impede the vaccine response. OBJECTIVES: To describe the kinetics of the decline of anti-HAV maternal antibodies, and to estimate the time of complete loss of maternal antibodies in infants in León, Nicaragua, a region in which almost all mothers are anti-HAV seropositive. METHODS: We collected cord blood samples from 99 healthy newborns together with 49 corresponding maternal blood samples, as well as further blood samples at 2 and 7 months of age. Anti-HAV IgG antibody levels were measured by enzyme immunoassay (EIA). We predicted the time when antibodies would fall below 10mIU/ml, the presumed lowest level of seroprotection. RESULTS: Seroprevalence was 100% at birth (GMC 8392mIU/ml); maternal and cord blood antibody concentrations were similar. The maternal antibody levels of ...
Background/objectives: Diarrhea is one of the most common reasons for unplanned consultations in ... more Background/objectives: Diarrhea is one of the most common reasons for unplanned consultations in the first years of life. The first objective was to analyze which aspects of diarrhea are perceived as being most meaningful and worrying to parents. A second objective was to analyse congruence between a clinical measure of disease severity and the overall subjective parental appraisal of the diarrheal episode. Patients/methods: A written survey was completed in physician offices by 2.023 parents. Inclusion criterion was to have a child aged less than 2 years experiencing diarrhea during the last six months. Parents indicated their perception of the diarrheal episode in following dimensions: "clinical symptoms" (8 items), "treatment" (4 items), "behavioural symptoms/infants' constitution" (12 items), "parental feelings" (11 items). Questions were asked in closed-ended form. Parental feelings were expressed on a 6-point Likert scale. Parents we...
The Pediatric Infectious Disease Journal, 2015
Pertussis has reemerged as a problem across the world. To better understand the nature of the res... more Pertussis has reemerged as a problem across the world. To better understand the nature of the resurgence, we reviewed recent epidemiologic data and we report disease trends from across the world. Published epidemiologic data from January 2000 to July 2013 were obtained via PubMed searches and open-access websites. Data on vaccine coverage and reported pertussis cases from 2000 through 2012 from the 6 World Health Organization regions were also reviewed. Findings are confounded not only by the lack of systematic and comparable observations in many areas of the world but also by the cyclic nature of pertussis with peaks occurring every 3-5 years. It appears that pertussis incidence has increased in school-age children in North America and western Europe, where acellular pertussis vaccines are used, but an increase has also occurred in some countries that use whole-cell vaccines. Worldwide, pertussis remains a serious health concern, especially for infants, who bear the greatest disease burden. Factors that may contribute to the resurgence include lack of booster immunizations, low vaccine coverage, improved diagnostic methods, and genetic changes in the organism. To better understand the epidemiology of pertussis and optimize disease control, it is important to improve surveillance worldwide, irrespective of pertussis vaccine types and schedules used in each country.
Objective. To assess the diagnostic sensitivity and specificity of a Bordetella pertussis polymer... more Objective. To assess the diagnostic sensitivity and specificity of a Bordetella pertussis polymerase chain reaction (PCR) assay using nasopharyngeal (NP) specimens from subjects with cough illnesses participating in a large pertussis vaccine efficacy trial.
Archives of disease in childhood, 2014
ABSTRACT The midwife calls you to assess a newborn in the delivery room. The pregnancy was uneven... more ABSTRACT The midwife calls you to assess a newborn in the delivery room. The pregnancy was uneventful, but the mother's serology results show the following: hepatitis B surface antigen (HBsAg) negative, antibodies against hepatitis B surface antigen (anti-HBs) negative, but antibodies against hepatitis B core antigen (anti-HBc) positive. You wonder if the baby is at risk for perinatal transmission of hepatitis B virus (HBV) requiring preventive measures at this time.
Infection, 2014
Gastrointestinal infections are caused by a broad spectrum of pathogens. Conventional diagnostic ... more Gastrointestinal infections are caused by a broad spectrum of pathogens. Conventional diagnostic procedures are resource and time consuming due to single pathogen testing, often in different laboratories. We analyzed 312 consecutive stool samples from pediatric patients (n = 127) with gastroenteritis or from adult travelers returning from the tropics with suspected parasite infestation (n = 185) using commercial multiplex nucleic acid amplification testing (NAT) (xTAG gastrointestinal pathogen panel, Luminex) covering 15 diarrhea-causing pathogens. The results of the positive samples and a representative number of negative samples were compared to standard methods, including NAT, direct antigen detection (DAD), bacterial culture and microscopy. Of the 185 samples from adult travelers, 21 (11 %) were multiplexNAT-positive, with enterotoxigenic Escherichia coli (4 %) being the predominant pathogen. Microscopic examination revealed Blastocystis hominis in 23 % not covered by the panel....
Vaccine, Jan 25, 2014
Intervals longer than recommended are frequently encountered between doses of tick borne encephal... more Intervals longer than recommended are frequently encountered between doses of tick borne encephalitis virus (TBE) vaccines in both residents of and travelers to endemic regions. In clinical practice the management of individuals with lapsed TBE vaccination schedules varies widely and has in common that the underlying immunological evidence is scarce. The aim of this study was to generate data reliable enough to derive practical recommendations on how to continue vaccination with FSME-IMMUN in subjects with an irregular TBE vaccination history. Antibody response to a single catch-up dose of FSME-IMMUN was assessed in 1115 adults (age ≥16 years) and 125 children (age 6-15 years) with irregular TBE vaccination histories. Subjects of all age groups developed a substantial increase in geometric mean antibody concentration after a single catch-up TBE vaccination which was consistently lower in subjects with only one previous TBE vaccination compared to subjects with two or more vaccinatio...
Vaccine, Jan 28, 2010
In Switzerland, reporting of adverse events following immunization (AEFI) has been mandatory by l... more In Switzerland, reporting of adverse events following immunization (AEFI) has been mandatory by law since 1988. The goal of this study was a detailed analysis of reported AEFI received by the Swiss Federal Office of Public Health between 1991 and 2001. Overall, 1013 AEFI were reported which translates to 2.7 reports per 100,000 vaccine doses distributed during the study period. Most AEFI were classified as general systemic reactions (47%), followed by local (26%), neurological (16%) and allergic reactions (13%). The majority of all reported AEFI (N=513; 51%) had occurred in individuals 16 years and older. Causal relationship between immunization and AEFI was probable in 91 (10%) of 909 assessable reports and very likely or certain in 194 (21%), the majority of which (88%) were local reactions. Vaccines distributed in Switzerland have proven to be generally safe. Limitations of the passive surveillance system, however, warrant improvements in the future.
Vaccine, Jan 27, 2006
To evaluate the Brighton Collaboration case definition of acute intussusception, we reviewed all ... more To evaluate the Brighton Collaboration case definition of acute intussusception, we reviewed all episodes reported to the Swiss Paediatric Surveillance Unit (SPSU) during 1 year (4/2003--3/2004). Of 96 confirmed episodes 86 (90%, 95% CI 83--96) were captured by the case definition. Of the remaining 10 episodes, 9 resolved spontaneously following presentation with clinical signs and symptoms, and ultrasound findings compatible with intussusception. Eighty-two episodes met level 1 of the definition, the highest level of diagnostic certainty. Compared to level 1, the sensitivity of level 2 (intermediate level) and level 3 (lowest level) was 65% (CI 55--74) and 30% (CI 20--40), respectively. In conclusion, the case definition was useful and applicable to assess the background rate of intussusception in the light of potential future rotavirus immunization.
Swiss medical weekly, Jan 30, 2005
Only limited data are available regarding the reliability of the varicella zoster virus (VZV) his... more Only limited data are available regarding the reliability of the varicella zoster virus (VZV) history in children and adolescents. Our goal was to determine positive and negative predictive values of varicella history in a prospective cross-sectional study. Patients 1-18 years of age who were hospitalised in our institution between 1999 and 2000 were eligible for participation when a blood specimen was taken for any medical reason. Patients with current varicella, immunodeficiency, immunoglobulin treatment in the previous 6 months, or significant language barriers were excluded. After informed consent had been obtained, parents were asked whether their child had a history of varicella (categorized as definite, probable, possible, negative or unknown). Anti-VZV-IgG antibodies were then tested by ELISA (Enzygnost). If the ELISA result was indeterminate, the specimen was analysed by fluorescent-antibody staining of membrane antigen in VZV-infected cells (FAMA), the serological gold sta...
Swiss medical weekly, Jan 17, 2004
We report on two toddlers suffering from Mycobacterium bohemicum lymphadenitis. Acid-fast bacilli... more We report on two toddlers suffering from Mycobacterium bohemicum lymphadenitis. Acid-fast bacilli were cultured from submandibular lymph nodes and identified by molecular methods as Mycobacterium bohemicum. Surgical treatment was successful and complemented by oral treatment with clarithromycin and rifampicin.
The Pediatric infectious disease journal, 2004
IgG antibody values against measles, mumps, rubella and varicella-zoster virus in 71 full term an... more IgG antibody values against measles, mumps, rubella and varicella-zoster virus in 71 full term and 101 preterm infants and their 152 mothers and the decay of maternally acquired antibodies during infancy were studied. Both magnitude of transplacental antibody passage and cord blood antibody values correlated with gestational age. After 6 months preterm infants born before 32 weeks of gestation had lost maternal antibodies.
The Pediatric infectious disease journal, 2003
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Papers by Ulrich Heininger