Correspondence (reply): In Reply

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.