Our investigations identified sprouts as the most likely outbreak vehicle, underlining the need to take into account food items that may be overlooked during subjects' recall of consumption.

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...

Social network recruitment permits fast and convenient access to young people. Sample characteristics can be manipulated by adjusting targeting strategies. There is further need for promoting knowledge of HPV vaccination among young women. Physicians have a major role in the vaccination decision-making process of young women.

BackgroundEstimates of Human Papillomavirus (HPV) prevalence in a population prior to and after HPV vaccine introduction are essential to evaluate the short-term impact of vaccination.MethodsBetween 2010 and 2012 we conducted a population-based cross-sectional study in Germany to determine HPV prevalence, genotype distribution and risk factors for HPV-infection in women aged 20-25 years. Women were recruited by a two-step cluster sampling approach. A home-based self-collection of cervicovaginal lavages was used. Specimens were analysed using a general primer GP5+/GP6+-based polymerase chain reaction and genotyped for 18 high-risk and 6 low-risk HPV- strains by Luminex-based multiplexed genotyping.ResultsAmong 787 included women, 512 were not vaccinated against HPV. In the non-vaccinated population, HPV prevalence of any type was 38.1%, with HPV 16 (19.5%) being the most prevalent genotype. Prevalence of any high-risk type was 34.4%, and in 17.4% of all women, more than one genotype was identified. A higher number of lifetime sexual partners and low educational status were independently associated with HPV-infection. In 223 vaccinated women, prevalence of HPV 16/18 was significantly lower compared to non-vaccinated women (13.9% vs. 22.5%, p = 0.007). When stratifying by age groups, this difference was only significant in women aged 20-21 years, who at time of vaccination were on average younger and had less previous sexual contacts than women aged 22-25 years.ConclusionWe demonstrate a high prevalence of high-risk HPV genotypes in non-vaccinated women living in Germany that can be potentially prevented by vaccination. Probable first vaccination effects on the HPV prevalence were observed in women who were vaccinated at younger age. This finding reinforces the recommendation to vaccinate girls in early adolescence.

Self-sampling by cervicovaginal lavage could be an attractive method to detect high-risk human papillomavirus (hr-HPV) infections to identify women with a risk of cervical precancer. The objective of our study was to use self-sampling for the first time in a cross-sectional approach to determine HPV prevalence and genotype distribution. We evaluated participants' acceptance and laboratory results from self-obtained samples versus endocervical brush samples obtained by gynecologists. To determine the sensitivity of both sampling methods in presumed high-and low-prevalence settings, two groups of women 20 to 30 years of age with (n ‫؍‬ 55) and without (n ‫؍‬ 101) a recent suspicious cytological smear were compared. Overall, 76% (95% confidence interval [95% CI], 65 to 88) of women with and 40% (95% CI, 30 to 49) of women without a recent suspicious cytological smear tested HPV positive. The prevalences of high-risk HPV strains were 71% (95% CI, 59 to 83) and 32% (95% CI, 22 to 41), respectively, for these two groups. The agreement for hr-HPV between the two sampling methods for women with and without suspicious cytology was 84% ( ‫؍‬ 0.65; 95% CI, 0.44 to 0.86) and 91% ( ‫؍‬ 0.78; 95% CI, 0.64 to 0.92), respectively. Participants rated the user-friendliness of the self-sampling method on a visual analog scale from 0 (easy) to 100 (difficult) with a median of 12. In conclusion, self-sampling by cervicovaginal lavage is a reliable method to determine hr-HPV prevalence and is well accepted by young adult females.Cervical cancer is the second most common cancer in women worldwide, with globally approximately 500,000 new cases and 250,000 deaths each year (http://www.who.int /reproductivehealth/topics/cancers/en/). The strong correlation between cervical cancer and a preceding persistent infection of the cervix with human papillomavirus (HPV) is beyond dispute (2, 18). More than 130 genotypes of HPV have been classified (6), of which about 40 genotypes can infect the anogenital tract (14). Of these 40 genotypes, nearly 20 are thought to be carcinogenic and are classified as high-risk HPV (hr-HPV). Genotypes 16 and 18 alone are associated with approximately 50% of high-grade cervical intraepithelial neoplasia (CIN) and 70% of cervical cancers (4, 20). Anogenital HPV infections are predominantly sexually transmitted, and nearly all sexually active women will be infected at some point during their lifetime (1). Most HPV infections are transient, but persistent infections can progress over years to high-grade CIN or cervical cancer.Vaccines against HPV genotypes 16 and 18 have been available since 2006. Results from clinical trials indicate high effectiveness against high-grade CIN when HPV-naïve girls and women are vaccinated (7,16,17). Numerous industrial countries have implemented vaccination programs to protect girls against infections with HPV types 16 and 18. Target groups for the vaccination are mainly adolescent women preceding their sexual debut. To monitor the impact of the vaccine and the implemented vaccination...