LNSLNS We thank our correspondents for their letters and wish to take this opportunity to clear up possible misunderstandings. We wish to respond to individual letters as follows.

Dr Lattmann has slightly missed the point. It was important to point out again that the authors do not propose “compulsory vaccination,” but that “mandatory vaccination should be considered for medical personnel who look after immunosuppressed patients.” We would very much welcome clear regulations for dealing with these particularly vulnerable patients. In personnel with chronic viral infections (HIV or hepatitis B/C infection), relevant regulations have been in place for many years. We had already suspected that the discussion surrounding other, acute infections—such as influenza A—is often emotionally led. With regard to the case report of vitiligo after flu vaccination, we wish to point out that a merely temporal association of the initial manifestation of a disease after vaccination does not necessarily imply a causal association.

We are surprised about the comment made by Dr Kothe, that measures instigated by occupational physicians and hospitals in order to avoid nosocomial infections remind him of the regime in the former GDR. Just for information, in countries such as the United States (which certainly do not have a socialist regime), such measures have been established in the healthcare system for many years. Infection protection measures within hospitals (for example, by means of vaccination campaigns or by wearing face masks) are not a step backwards: they prevent nosocomial infections and protect staff as well as patients. Phrases such as -“compulsory vaccinations” and “muzzle” seem to be redolent of an emotional approach to the vaccination debate. None the less, the authors thank Dr Lattmann and Dr Kothe for their comments, which clarify that further information campaigns and interdisciplinary discussion are urgently required. The letter by Friedberg provides a welcome opportunity to focus in greater detail in the problems associated with choosing the right type of face mask. The question of which mask is appropriate is currently the subject of controversial discussion (1–4). Recent data have, however, shown a comparable protective effect of surgical masks and FFP2 masks (2, 3). Compared with surgical masks, FFP2 masks have been less well accepted by medical personnel, because of the increased resistance to breathing and possible skin irritations (1). The necessary protective measures for medical personnel who look after patients with infections transmitted as aerosols will have to be further evaluated, in order to achieve the best possible protection of, as well as good acceptance among, medical staff.
DOI: 10.3238/arztebl.2010.0194

Prof. Dr. rer. med. Holger F. Rabenau
Prof. Dr. med. Volkhard A.J. Kempf
Dr. med. Christian Brandt

Dr. med. Dr. med. habil. Sabine Wicker
Betriebsärztlicher Dienst
Klinikum der Johann Wolfgang Goethe-Universität Frankfurt
Theodor-Stern-Kai 7
60590 Frankfurt am Main, Germany
Sabine.Wicker@kgu.de

Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
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2.
Johnson DF, Druce JD, Birch C, Grayson ML: A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. CID 2009; 49: 2757. MEDLINE
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Loeb M, Dafoe N, Mahony J, et al.: Surgical mask vs N95 respirator for preventing influenza among health care workers: A randomized trial. JAMA 2009; 302: 1865–71. MEDLINE
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Shine KI, Rogers B, Goldfrank LR: Novel H1N1 influenza and respir-atory protection for health care workers. N Engl J Med 2009; 361: 1823–5. MEDLINE
5.
Wicker S, Rabenau HF, Kempf V, Brandt C: Vaccination against classical influenza in health-care workers: self-protection and patient protection [Impfung gegen die klassische Influenza bei medizinischem Personal: Selbstschutz und Patientenschutz]. Dtsch Arztebl Int 2009; 106(36): 567–72. VOLLTEXT
1. Jefferson T, Del Mar C, Dooley L, et al.: Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ 2009; 339: 3675. MEDLINE
2. Johnson DF, Druce JD, Birch C, Grayson ML: A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. CID 2009; 49: 2757. MEDLINE
3. Loeb M, Dafoe N, Mahony J, et al.: Surgical mask vs N95 respirator for preventing influenza among health care workers: A randomized trial. JAMA 2009; 302: 1865–71. MEDLINE
4. Shine KI, Rogers B, Goldfrank LR: Novel H1N1 influenza and respir-atory protection for health care workers. N Engl J Med 2009; 361: 1823–5. MEDLINE
5. Wicker S, Rabenau HF, Kempf V, Brandt C: Vaccination against classical influenza in health-care workers: self-protection and patient protection [Impfung gegen die klassische Influenza bei medizinischem Personal: Selbstschutz und Patientenschutz]. Dtsch Arztebl Int 2009; 106(36): 567–72. VOLLTEXT