Controversially discussed indications for immunization 91 the vaccine could be administered intramuscularly if, in the opinion of a physician familiar with the patient’s bleeding risk, the vaccine can be admin- istered with reasonable safety by this route. A fine needle () 23 gauge) should be used for the immunization and firm pressure applied to the site, without rubbing, for *2 min. The patient or family should be instructed concerning the risk for hematoma from the injection. Patients with platelet counts of less than 50 × 10 9 /L should not receive intramuscular injections. The subcutaneous or intracutaneous route should be considered as an alternative to the intramuscular route in patients with bleeding disorders. Children with inherited coagulopathies should receive factor replacement prior to intramuscular injection [8, 17]. Immunization of recent recipients of human immunoglobulin With the exception of yellow fever vaccine, the immune response to live viral vaccines may be inhibited by normal human immunoglobulin. Therefore, live virus vaccines should be given 3 weeks before or 3 months after a dose of immunoglobulin. If an individual is under medical treatment with high-dose or intravenous immunoglobulin, the physician who initiated this treatment should be consulted [8]. Immunization and breast-feeding Breast-fed infants should be immunized according to routinely recom- mended schedules. Although live vaccines multiply within the mother’s body, the majority has not been demonstrated to be excreted in human milk. Rubella vaccine virus might be excreted in human milk. However, the virus usually does not infect the infant. Where infection has occurred in an infant, it has been mild because the virus is attenuated. Inactivated, recombinant, subunit, polysaccharide, conjugate vaccines and toxoids pose no risk for mothers who are breast-feeding or for their infants [8, 17]. Special recommendations for the immunization of hematopoietic stem cell transplant (HSCT) recipients and for solid organ recipients before transplantation exist [22–25]. Contraindications and false contraindications Contraindications Contraindications to immunization dictate circumstances when vaccines should not be given because the condition in an individual increases the risk for a serious adverse reaction following immunization. The majority of con- 92 Sieghart Dittmann traindications are temporary, and the vaccine can be given later. However, in many cases immunization is delayed or denied because of conditions falsely believed by the physician or the health worker to constitute a con- traindication. The World Health Organization and the majority of countries have established and periodically updated lists of contraindications (and often also false contraindications) to offer expert advice for physicians and health workers involved in immunization for individual cases where doubt occurs. Genuine contraindications are few and the numbers of individuals to whom they apply are fewer still. The various lists of contraindications include mainly: – acute illness – altered immunity – pregnancy – severe adverse events after a previous dose – children with neurological disorders – anaphylaxis and allergy to vaccines and vaccine constituents. Depending on the individual vaccines, contraindications are provided spe- cifically. False contraindications Conditions that are NOT contraindications to immunization are called ‘false contraindications’. Examples are the following conditions: – minor illness, such as upper respiratory infection or diarrhea, with tempe- rature < 38.5 °C – asthma or other atopic manifestations – family history of convulsions – treatment with antibiotics, low-dose or locally acting corticosteroids – dermatoses, localized skin infection – chronic diseases of heart, lung, kidney and liver – stable neurological conditions, such as Down’s syndrome – history of jaundice after birth – prematurity – malnutrition – mother pregnant – in incubation period of illness. Some of these conditions increase the risk from infectious diseases and such individuals should be immunized as a matter of priority [17, 26]. Controversially discussed indications for immunization 93 References 1 Dittmann S (2006) Elimination der Poliomyelitis. Polio-Nachrichten 2: 11–12 2 Dittmann S (2001) Vaccine safety: risk communication – a global perspective. Vaccine 19: 2446–2456 3 Campbell H, Ramsay M, Gungabissoon U, Miller E, Andrews N, Mistry A, Mallard R, Borrow R (2004) Impact of the meningococcal C conjugate vaccina- tion programme in England. Summary Surveillance Report from the Health Protection Agency, Centre for Infections Immunisation Department to end December 2004. 4 Centers for Disease Control and Prevention (2002) Epidemiology and preven- tion of vaccine-preventable diseases. In: Atkinson W, Hamborsky J, McIntyre L, Wolfe S (eds): The Pink Book, 9th edn, Appendix G: Reported cases and deaths for vaccine-preventable diseases. Public Health Foundation, Washington, D.C. 5 Six common misconceptions about vaccination and how to respond to them. htpp://www.cdc/nip/publications/6mishome.htm (accessed August 14, 2006) 6 Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, Gellin BG, Landry S (2002) Addressing parents’ concerns: do multiple vaccines over- whelm or weaken the infant’s immune system? Pediatrics 109:124–129 7 Public Health Agency of Canada (2002) Talking with patients about immuniza- tion. In : Canadian Immunization Guide 2002, Public Health Agency of Canada, Ottawa, 42–54. 8 Responding to questions and concerns about immunization. In: Australian Immunization Handbook, 8th edn 2003, online. htpp://www9.health.gov.au/ immhandbook (accessed August 14, 2006) 9 Global Advisory Committee on Vaccine Safety (2003) MMR and autism. Weekly Epidemiol Rec 78: 18 10 Global Advisory Committee on Vaccine Safety (2005) Thiomersal: neurobe- havioural studies in animal models. Wkly Epidemiol Rec 80: 3–4 11 Institute of Medicine Immunization Safety Reviews: Measles-mumps-rubella vaccine and autism. National Academy Press, Washington DC 2001. http://www. cdc.gov/nip/news/iom-04–24.htm (accessed August 14, 2006) 12 US Centers for Disease Control. Vaccines and autism – references. http:// www.cdc.gov/nip/vacsafe/concerns/autism/autism-ref.htm (accessed August 14, 2006) 13 Davis RL, Kramarz P, Bohlke K, Benson P, Thompson RS, Mullooly J, Black S, Shinefield H, Lewis E, Ward J et al (2001) Measles-mumps-rubella and other measles-containing vaccines do not increase the risk for inflammatory bowel disease. Arch Pediatr Adolesc Med 155: 354–359 14 US Centers for Disease Control. Measles vaccine and inflammatory bowel disease – references. http://www.cdc.gov/nip/vacsafe/concerns/autism/ibd. htm#references (accessed August 14, 2006) 15 (2002) Immunization Safety Review: Hepatitis B Vaccine and Demyelinating Neurological Disorders. National Academy Press, Washington, D.C. 16 (2003) Immunization Safety Review: Vaccinations and Sudden Unexpected Death in Infancy. National Academy Press, Washington, D.C. 17 (2002) Recommendations of the Advisory Committee on Immunization 94 Sieghart Dittmann Practices (ACIP). General recommendations on immunization. Morb Mortal Wkly Rep 51: No RR-2. 18 American Academy of Pediatrics (2003) Immunocompromised children. In: LK Pickering (ed): 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL, 69 19 Moss WJ, Clements CJ, Halsey NA (2003) Immunization of children at risk of infection with human immunodeficiency virus. Bull World Health Organ 81: 61–70 20 EPI Vaccines in HIV-infected Individuals. htpp://www.who.int/vaccines-dis- eases/diseases/HIV.shtml (accessed August 14, 2006) 21 Contraindications for childhood vaccinations. htpp://www.cdc.gov/nip/recs/con- traindications.htm (accessed August 14, 2006) 22 (2000) Guidelines for preventing opportunistic infections among hematopoi- etic stem cell transplant recipients. Recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. MMWR 49: RR-10 23 Avery RK, Ljungman P (2001) Prophylactic measures in the solid-organ recipi- ent before transplantation. Clin Infect Dis 33 (Suppl 1): 15–21 24 Stark K, Günther M, Schönfeld C, Tullius SG, Bienzle U (2002) Immunisations in solid-organ transplant recipients. Lancet 359: 957–965 25 Ljungman P (2004) Immunization in the immunocompromised host. In: SA Plotkin, WA Orenstein (eds): Vaccines, 4th edn. Saunders, Philadelphia, 155– 168 26 (1998) Contraindications for vaccines used in EPI. Wkly Epidemiol Rec 63: 279–281 Pediatric Infectious Diseases Revisited 95 ed. by Horst Schroten and Stefan Wirth © 2007 Birkhäuser Verlag Basel/Switzerland Gonorrheal ophthalmia neonatorum: Historic impact of Credé’s eye prophylaxis Axel Schmidt Axel Schmidt, Institute of Microbiology and Virology, Faculty of Medicine, University Witten/ Herdecke, Stockumer Str. 10, 58448 Witten, Germany Abstract In the pre-antibiotic era gonorrhea showed a high prevalence also in industrialized coun- tries. In Germany, more than 10% of all newborns developed gonorrheal ophthalmia neonatorum. Clinical courses of gonorrheal ophthalmia neonatorum were quite different in their severity but often caused significant impairment of eyesight up to total blindness in more than 5%. This accounted for 25–40% of cases of blindness in Germany. It was Carl Siegmund Franz Credé (1819–1892), a German obstetrician, who introduced the eye prophylaxis of eye drops containing 2% silver nitrate solution to every newborn child in his clinic in Leipzig on June 1st 1880. The incidence of gonorrheal ophthalmia neonato- rum immediately decreased from 10% to 0%. Credé actively communicated these results and immediately published them in four publications within a time period of 3 years. These publications, which are discussed here, are written in a very pragmatic and strictly clinical style, ignoring new basic scientific insights into the microbiology of gonorrhea and the discovery of the corresponding pathogen, the “Micrococcus” by Albert Neisser, which Credé considered unimportant for his purposes. Against a high degree of opposi- tion by many physicians, Credé put all enthusiasm into the call for education of midwives in this technique. Credé knew that this was the central way to ensure that all newborns could obtain this prophylaxis, including outpatients and home deliveries. Credé’s elo- quence led to the rapid spreading of “his” eye prophylaxis over the rest of the world. The concentration of silver nitrate was often reduced from 2% to 1% thereafter and in most countries the performance of this prophylaxis was rapidly enforced by law. By introduc- ing this method, Credé saved or improved the eyesight of millions of people – a signifi- cant contribution to obstetrics, neonatology and pediatrics, ophthalmology and mankind. Still today, in the antibiotic era, other topical regimens for antiseptic prophylaxis against ophthalmia neonatorum are often referred to as “Credé’s prophylaxis”. “However, the broad use of silver as a powerful clinical tool against infec- tions is still in the future, because its full range of activity remains to be elucidated.” Q.L. Feng et al., 2000 [1] 96 Axel Schmidt The endangered eyesight In the pre-antibiotic era, i.e., until almost the middle of the 20th century, gonorrhea and ophthalmia neonatorum showed a high prevalence also in industrialized countries [2–7]. In the middle of the 19th century more than 10% of all newborns in Germany developed gonorrheal ophthalmia neona- torum. Clinical courses of gonorrheal ophthalmia neonatorum were quite different in their severity but often caused a huge and irreversible damage to the eyes with a significant impairment of eyesight up to total blindness as final outcome of the disease in more than 5% of the infections. This accounted for 25–40% of cases of blindness in Germany [8–11]. What about silver as a broadly acting antiseptic? Carl Siegmund Franz Credé, introducer of the antiseptic eye prophylaxis with silver nitrate Carl Siegmund Franz Credé (23.12.1819–14.03.1892) (Fig. 1) [8, 12–15] was born in Berlin where he went to school and studied medicine, with the exception of one semester at the university of Heidelberg (Germany). The principle of “nihil nocere” – an attempt to keep necessary treatment approaches as mild and gentle as possible – was his general philosophy in medicine. After several years of postgraduate study in Austria, France, Belgium and Italy, he returned to Berlin in 1847 and was appointed assistant in obstetrics at Berlin’s clinic of obstetrics, where he remained until 1852. In 1850 he became a “Privatdozent” (university teacher) in obstetrics. In 1852 he was appointed Director of the Berlin School of Midwives and Physician in Chief to the inpatient division of obstetrics and gynecology of the Berlin Royal Charité Hospital. In 1856 Credé was appointed Professor of Obstetrics and Director of the inpatient hospital in Leipzig, Germany where he retired in 1887 because of his poor health condition due to prostate cancer. Within the time in Leipzig he became “Nestor of German midwifery” [8]. During his time in Berlin he made a significant contribution to obstet- rics by introducing a new and safer method for the delivery of the placenta (“Credé’scher Handgriff”/Credé’s method) [16, 17]. Credé was a consistent- ly modest person and did not claim priority for this method. This method is still used today in emergencies such as hemorrhage after delivery. The affiliation with Leipzig gave him the chance of fully living his talents as a clinician, academic teacher and administrator, and his depart- ment became very prestigious. He personally focused on obstetrics being convinced that improvements in obstetrics are a key parameter to reduc- ing the number of gynecological impairments. The famous obstetrician and gynecologist Gerhard Leopold was Credé’s son-in-law [8]. Credé wrote several textbooks and original articles; he took over the editorship of gynecological journals of high reputation and was awarded the Credé’s eye prophylaxis… 97 “Senckenberg Preis/Senckenberg Award” due to his outstanding achieve- ments in obstetrics and medicine [15]. Further, he received the prestigious post of a “Geheimer Medicinalrath/Aulic Counsellor”. After 1860, Credé began to work on optimizing warming devices for premature and feeble tiny children (“Erwärmungswanne”) [18], which he established at his department thereafter – a significant contribution to obstetrics and a precursor of the incubators for newborns today. Whereas the “Credé’scher Handgriff” and the “Erwärmungswanne” were mostly recognized by the public in the lifetime of Credé, he introduced an eye prophylaxis for ophthalmia neonatorum (“Credé’sche Prophylaxe”), which achieved highest recognition especially amongst physicians [15]. The prophylactic application of “Argentum nitricum/silver nitrate” 1:50 aqueous solution was introduced in all newborns from June 1st 1880 onwards in the Leipzig obstetrics department. Figure 1. Carl Siegmund Franz Credé (1819–1892) 98 Axel Schmidt Credé wrote three consecutive publications with the same title on this topic “Die Verhütung der Augenentzündung der Neugeborenen” [19–21] (Prevention of inflammatory eye disease in the newborn) in the Journal “Archiv für Gynäkologie” between 1881 and 1883. The first [19, 22] focused on methodological aspects of the eye prophylaxis and will be the core issue of this chapter. His second publication presented more cases, and stressed the performance by midwives and by general practitioners. The third sum- marized his results and comprehensively addressed new aspects of etiology and practicable everyday prevention of ophthalmia neonatorum by his method. The second and third paper are discussed on the background of the “revolutionary” first one later in this chapter. In 1884, Credé summarized central aspects of his three publications in a booklet version in English [23]. An abbreviated English translation, translated by the WHO [22], of the first paper is given below. For systematic purposes, the original of the first paper of Credé in German language [19] is attached to this chapter as an “Addendum”. “Prevention of Inflammatory eye disease in the newborn. Information from the Maternity Clinic Leipzig by Credé” [22] “I am (…) publishing the following information concerning the prevention of inflammatory eye disease in the newborn (…) in this Archive because the disease is almost invariably caused by infection during delivery and is therefore directly related to a diseased condition of the female genitals. Responsibility for prevention of the disease must also lie solely with obste- tricians and midwives. I shall confine my remarks exclusively to the practical question of prophylaxis. (…) My request for further testing of the prophylaxis I am recommend- ing is therefore addressed to those of my colleagues who work in maternity hospitals or obstetric clinics and (…) are frequently confronted with this condition. Most obstetricians would probably share my view that the case of vaginal catarrh and infections that are so frequently encountered are attributable to gonorrheal infection and that the discharge remain infectious long after the specific symptoms of gonorrhea have disappeared; moreover, in some cases where there is virtually no further trace of discharge, the infection may still be considered to have occurred in the mother’s vagina when an inflamma- tory eye condition develops in the first few days after birth. Transmission of the infectious substance from another child with eye disease is inconceivable (…) inasmuch as every child who is suffering from inflammatory eye disease is moved with its mother to a ward that is entirely separate in all respects from the maternity ward. The possibility of mothers infecting their children, for example through fingers soiled by lochial dis- Credé’s eye prophylaxis… 99 charge, is also remote because the child’s cot is always placed beyond reach of the mother, who only comes into contact with the child when the nurse places it on her breast. I am therefore convinced (…) that all affected children in (…) hospital (…) were infected solely by direct transmission of vaginal discharge to the eye during delivery. The infected eye usually begins to show symptoms of disease 2 or 3 days after birth, but also sooner or later – the sooner, the more serious the condition. (…) I have set myself the doubtless worthwhile task of finding effective ways and means of preventing this disease (…) and of detecting the infec- tious discharge. I initially focused on ensuring extensive and effective treatment and cleansing of the diseased vaginas of pregnant and delivering women. But the results were poor and unsatisfactory; although there were fewer cases of eye disease (…). I then began to disinfect the children’s eyes themselves and from then on the success recorded was surprisingly encouraging. My experiments proceeded as follows: first, the vaginas of all pregnant and delivering women admitted to the hospital with gonorrhea or chronic vaginal catarrh were cleaned out with lukewarm water or a light solution (2:100) of carbolic or salicylic acid as frequently as possible – every half hour in the case of delivering women. The incidence of eye disease declined but the problem persisted (…). In October 1879, I carried out my first test involving the introduction of prophylactic eye drops into the newborn babies immediately after birth, using a borax solution (1:60) because it seemed to be the mildest and least caustic substance. This was only done, however, in the case of children whose mothers were ill and whose vaginas had been cleansed during the whole delivery process in a manner described above. From December 1879, I replaced the borax by solutions of Argentum nitricum (1:40), which were injected into the eyes shortly after birth. The eyes were carefully washed beforehand with a solution of salicylic acid (2:100). The children of sick mothers who were treated in this way remained healthy, while other chil- dren who had not been given preventive treatment (…) still fell ill, in two cases quite seriously. From 1 June 1880, all eyes without exception were disinfected imme- diately after birth by means of a weaker solution of Argentum nitricum (1:50). (…) a glass stick was used to introduce a single drop of liquid into each eye, which was gently opened by an assistant and which had been cleaned beforehand with ordinary water. Then the eyes were cooled for 24 h with a canvas cloth soaked in salicylic water (2:100). The numerous vaginal douches, on the other hand, were abandoned (…). All children treated in this way remained free from even mild attacks of inflammatory eye disease, although many mothers showed advanced symptoms of vaginal blenorrhea (…). Only one child (…) fell ill on the 6th day with a moder- ate inflammation of the conjunctiva of the left eye, without swelling of the 100 Axel Schmidt eyelid, which healed within 3 days. It emerged that, quite by chance, owing to pressure of work, the prophylactic eye drops had not been administered to this child. To date, no adverse effect on the treated eyes has been observed. Not infrequently the administration of the eye drops is followed by a slight hyperemia and in some cases by slight increased secretion from the conjunc- tiva in the first 24 h. Then these symptoms disappear. They could perhaps be avoided if further tests indicate that a weaker solution of Argentum nitricum is sufficient. As has been shown, the procedure is simple, (…) completely without risk and seemingly reliable in terms of its effect. (…) my set of observations is (…) still sufficiently extensive and striking to warrant further urgent application of the procedure. I wish to lay special emphasis on the finding that the desired effects are achieved through dis- infection of the eyes themselves rather than the vagina. It is to be hoped that the future will tell whether the eye procedure that I have been using is the best and most reliable one (…). For the time being, I have no reason to deviate from my own method. Needless to say, the successful banishment of inflammatory eye dis- eases at least from maternity hospitals and clinics would constitute a major achievement in many respects. Lastly, I wish to present some figures for cases of inflammatory eye dis- ease observed in this maternity hospital in recent years. (…). Year Number of births Number of cases of inflammatory eye disease Percentage 1874 323 45 13.6 1875 287 37 12.9 1876 367 29 9.1 1877 360 30 8.3 1878 353 35 9.8 1879 389 36 8.2 1880 (until 31 May) 187 14 7.6 1880 (from 1 June to 8 December) 200 1* 0.6 *This is the case in which the eyes were not disinfected; the figure should therefore read 0.0% In the first paper (1881; [19]) Credé strictly focused on practical aspects of prophylaxis of ophthalmia neonatorum. It was recognized that the way of transmission was by direct contact with vaginal excretions. He described hygienic procedures of cleaning the vagina, described several interim stages of eye drops applied to the newborn, and ended up with the abandonment of vaginal douches/extensive cleaning of the vagina and introduction of [...]... (“Prevention of inflammatory eye disease in the newborn”) Arch Gynäkol 17: 50– 53 Credé’s eye prophylaxis… 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 1 13 Credé CSF (1881) Die Verhütung der Augenentzündung der Neugeborenen (“Prevention of inflammatory eye disease in the newborn”) Arch Gynäkol 18: 36 7 37 0 Credé CSF (18 83) Die Verhütung der Augenentzündung der Neugeborenen (“Prevention of inflammatory... Augenerkrankungen Procentsatz 1874 32 3 45 13, 6 1875 287 37 12,9 1876 36 7 29 9,1 1877 36 0 30 8 ,3 1878 35 3 35 9,8 1879 38 9 36 8,2 1880 (bis 31 Mai) 187 14 7,6 1880 (vom 1 Juni bis 8 Decbr.) 200 1* 0,6 *Es ist dies der Fall, bei welchem die Augen nicht desinficirt wurden; also eigentlich sind 0,0% zu verzeichnen 112 Axel Schmidt References 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Feng QL, Wu J,... Gonorrhoe eigenthümliche Micrococcenform” (“A form of Micrococcus typical for gonorrhea”) [33 ] In this paper he was the first person to describe that a very typical form of a somewhat peach-like (semmelartig) “Micrococcus/Diplococcus” (“Micrococcus” [33 , 34 ], “Micrococcenhaufen” [33 ], “Semmelform” [33 , 34 ], “Diplococcus” [34 ]) was always found as sole bacteria in a large quantity 104 Axel Schmidt in genital... Robson KS (1967) The role of the eye-to-eye contact in maternal-infant attachment J Child Psychol Psychiatry 8: 13 25 Nishida H, Risemberg HM (1975) Silver nitrate ophthalmic solution and chemical conjunctivitis Pediatrics 56: 36 8 37 3 Butterfield PM, Emde RN, Svejda MJ (1981) Does the early application of silver nitrate impair maternal attachment? Pediatrics 67: 737 – 738 Graf H, Retzke U, Schilling C,... herpes simplex type II to disinfection with povidone-iodine Am J Ophthalmol 109: 32 9 33 3 Isenberg SJ, Apt L, Yoshimori R, Leake RD, Rich R (1994) Povidone-iodine for ophthalmia neonatorum prophylaxis Am J Ophthalmol 118: 701–706 Isenberg SJ, Apt L, Wood M (1995) A controlled trial of povidone-iodine as prophylaxis against ophthalmia neonatorum N Engl J Med 33 2: 562–566 Reimer K, Fleischer W, Brogmann B,... tetracycline, erythromycin and no prophylaxis Pediatr Infect Dis J 11: 1026–1 030 Seiga K, Shoji T (19 93) Chemoprophylaxis of ophthalmia neonatorum through vertical infection Evaluation of Crede’s method using norfloxacin and gentamycin Jpn J Antibiot 46: 33 1 33 6 Kramer A, Behrens-Baumann W (1997) Prophylactic use of topical anti-infectives in ophthalmology Ophthalmologica 211 (S1): 68–76 Benevento WJ,... der Medizinischen Mikrobiologie”) Fischer, Stuttgart, 3 17 Credé C, Winckel F (1875) Handbook for Midwives (“Lehrbuch der Hebammenkunst”) S Hirzel, Leipzig, 117–118 / 237 –2 43 (§§167, 35 8 36 6) Credé C, Leopold G (1892) Handbook of Obstetrics for Midwives (“Lehrbuch der Geburtshülfe für Hebammen”) S Hirzel, Leipzig, 254–258 (§§ 35 8 36 5) Vail D (19 63) Lucien Howe: the laboratory and experimental ophthalmology... antimicrobial peptide and leptin [33 36 ] Children who are malnourished mount a partial acute phase response to infection and this defect is more marked in children with the edematous form [37 ] The activities of innate immune cells such a neutrophils, monocytes, macrophages, and dendritic and NK cells are affected by altered nutrient levels [38 – 43] These effects can be particularly critical in the perinatal... H, Burkhard P, Lanzendorfer A, Gumbel H, Hoekstra H, Behrens-Baumann W (1997) Povidone-iodine liposomes – an overview Dermatology 195 (S2): 93 99 Kramer A, Below H, Behrens-Baumann W, Muller G, Rudolph P, Reimer K Credé’s eye prophylaxis… 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 115 (2002) New aspects of the tolerance of povidone-iodine in different ex vivo models Dermatology 204 (S1): 86–91... (“Diagnosen Ärzteerinnerungen aus dem 20 Jahrhundert”) Der Morgen, Berlin, 416–417 Pediatric Infectious Diseases Revisited ed by Horst Schroten and Stefan Wirth © 2007 Birkhäuser Verlag Basel/Switzerland 117 Malnutrition and infection in industrialized countries Susanna Cunningham-Rundles and Deborah Ho Lin Department of Pediatrics Host Defenses Program, Weill Medical College of Cornell University, New . of inflammatory eye disease Percentage 1874 32 3 45 13. 6 1875 287 37 12.9 1876 36 7 29 9.1 1877 36 0 30 8 .3 1878 35 3 35 9.8 1879 38 9 36 8.2 1880 (until 31 May) 187 14 7.6 1880 (from 1 June to 8. for gon- orrhea”) [33 ]. In this paper he was the first person to describe that a very typi- cal form of a somewhat peach-like (semmelartig) “Micrococcus/Diplococcus” (“Micrococcus” [33 , 34 ], “Micrococcenhaufen”. Wkly Rep 51: No RR-2. 18 American Academy of Pediatrics (20 03) Immunocompromised children. In: LK Pickering (ed): 20 03 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk