Zika virus intrauterine infections from the obstetrician’s perspective

Zika virus (ZIKAV) infections could potentially occur in Poland due to international travel made by its nationals to regions where the Aedes mosquito is active. A causal relationship between prenatal ZIKAV infection and microcephaly and other serious brain anomalies has been found due to the time association between the infection in pregnancy and a presence of congenital nervous system malformations, together with the detectable pathogen in amniotic fluid and fetus’s tissues. Two ZIKAV infection cases of pregnant women who were diagnosed with fetal microcephaly in the state of Paraiba, Brazil, later described in Ultrasound Obstetrics and Gynecology by Oliveira Mello et al. are discussed, in the context of the possible introduction of ZIKAV into Poland and the role the obstetrician should play in the detection and rapid reaction to potential threats. According to recommendations of international agencies for disease control and prevention, Polish obstetricians who take care of pregnant women and of those planning to become pregnant in the nearest future, and declaring travels to areas of the Aedes mosquito activity, should advise their patients to consider postponing travel or if they must travel, to take necessary precautionary measures to avoid mosquito bites. Pregnant women who have travelled to areas with ZIKAV transmission, or whose male partners had travelled to such areas and returned in the period of their female part­ner’s pregnancy, should be monitored appropriately in the context of congenital abnormalities, including microcephaly

Fear of HIV infection and impact of training on the attitudes of surgical and emergency nurses toward inpatient HIV testing

This study evaluates the association between the degree of fear of human immunodeficiency virus (HIV) infection and support for different HIV testing policies. A strong fear of acquiring HIV infection at work was widespread among a sample of 601 Polish surgical and emergency nurses. Most favored inappropriate HIV testing of all surgical patients and inpatients. Previous training about HIV and acquired immunodeficiency syndrome (AIDS) and experience caring for HIV‐positive patients had a significant impact on reducing support for testing of all inpatients but not for testing of surgical patients

ATTITUDES OF MEDICAL SPECIALISTS TOWARD HBV, HCV OR HIV INFECTED SURGICAL STAFF AND A SERO-SURVEY AMONG STAFF MEMBERS

Background: Issues regarding the transmission of blood-borne viruses from infected medical personnel to patients are controversial to both parties. The aim of this study was to evaluate the attitudes towards disclosure of HBV/HCV/HIV-infected surgeons and the possibility of being forced to give up surgical procedures, as well as to assess the prevalence of anti-HBc total, HBsAg, anti-HCV and anti-HIV in surgical staff. Material and Methods: Using an anonymous questionnaire a cross-sectional sero-survey was conducted among surgeons and nurses of surgical wards in 16 randomly selected hospitals, Western Pomerania, Poland, from January to June 2009. Serum samples were tested for anti-HBc, HBsAg, anti-HCV and anti-HIV by ELISA tests. Results: In the group of 427 participants (232 nurses, 65 doctors; a median age: 42 years), anti-HBc was found in 16.6%, HBsAg in 0.7%, anti-HCV in 1.4% and anti-HIV in 0%. The risk of a single exposure to HBV was correctly defined by 26.5% of participants, to HCV by 19.7%, to HIV by 18.7%. 16.2% participants stated that infected surgeons should disclose their HBV, HCV, or HIV serostatus, 39.8% and 42.6% that those HBV/HCV-infected and HIV-infected, respectively, should discontinue practicing surgery. Participants who correctly assessed the risk of contracting HIV/HBV/HCV after a single exposure were significantly (p = 0.0001; p = 0.03; p = 0.01, respectively) less likely to favor infected staff being forced to discontinue surgical procedures. Conclusions: A fraction of surgical staff showed detectable markers of HBV/HCV infection, they may be a source of infection for operated patients. Surgical staff's knowledge about occupational blood exposure risk was not satisfactory, which might have influenced the restrictive attitudes to force those infected with HBV/HCV/HIV to give up surgical procedures and a willingness to disclose their serological status. Med Pr 2013;64(5):639–64

Changes in disease burden in Poland between 1990-2017 in comparison with other Central European countries : a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND:Systematic collection of mortality/morbidity data over time is crucial for monitoring trends in population health, developing health policies, assessing the impact of health programs. In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides data on the burden of over 300 diseases in 195 countries since 1990. We used the GBD database to undertake an assessment of disease burden in Poland, evaluate changes in population health between 1990-2017, and compare Poland with other Central European (CE) countries. METHODS:The results of GBD 2017 for 1990 and 2017 for Poland and CE were used to assess rates and trends in years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs). Data came from cause-of-death registration systems, population health surveys, disease registries, hospitalization databases, and the scientific literature. Analytical approaches have been used to adjust for missing data, errors in cause-of-death certification, and differences in data collection methodology. Main estimation strategies were ensemble modelling for mortality and Bayesian meta-regression for disability. RESULTS:Between 1990-2017, age-standardized YLL rates for all causes declined in Poland by 46.0% (95% UI: 43.7-48.2), YLD rates declined by 4.0% (4.2-4.9), DALY rates by 31.7% (29.2-34.4). For both YLLs and YLDs, greater relative declines were observed for females. There was a large decrease in communicable, maternal, neonatal, and nutritional disease DALYs (48.2%; 46.3-50.4). DALYs due to non-communicable diseases (NCDs) decreased slightly (2.0%; 0.1-4.6). In 2017, Poland performed better than CE as a whole (ranked fourth for YLLs, sixth for YLDs, and fifth for DALYs) and achieved greater reductions in YLLs and DALYs than most CE countries. In 2017 and 1990, the leading cause of YLLs and DALYs in Poland and CE was ischaemic heart disease (IHD), and the leading cause of YLDs was low back pain. In 2017, the top 20 causes of YLLs and YLDs in Poland and CE were the same, although in different order. In Poland, age-standardized DALYs from neonatal causes, other cardiovascular and circulatory diseases, and road injuries declined substantially between 1990-2017, while alcohol use disorders and chronic liver diseases increased. The highest observed-to-expected ratios were seen for alcohol use disorders for YLLs, neonatal sepsis for YLDs, and falls for DALYs (3.21, 2.65, and 2.03, respectively). CONCLUSIONS:There was relatively little geographical variation in premature death and disability in CE in 2017, although some between-country differences existed. Health in Poland has been improving since 1990; in 2017 Poland outperformed CE as a whole for YLLs, YLDs, and DALYs. While the health gap between Poland and Western Europe has diminished, it remains substantial. The shift to NCDs and chronic disability, together with marked between-gender health inequalities, poses a challenge for the Polish health-care system. IHD is still the leading cause of disease burden in Poland, but DALYs from IHD are declining. To further reduce disease burden, an integrated response focused on NCDs and population groups with disproportionally high burden is needed

Zika virus infections from the perspective of the general practitioner

In February 2016, the World Health Organization declared the Zika virus (ZIK V) a global health emergency due to the rapid spread of this infection. ZIK V has been responsible for major outbreaks in Africa and Asia, and between 2013–2015, in previously infection-naive territories of the Pacific area, South and Central America. Poland is not considered an endemic territory regarding ZIK V due to low temperatures which limit the survival of the Aedes mosquito. However, imported cases are possible due to numerous international travel made by Poles to countries in which ZIK V vectors are present. Three Zika cases imported from the endemic countries to Italy, the US and Japan are discussed in the article – together with epidemiology, modes of transmission, clinical manifestations of ZIK V disease and diagnostic options – in the context of possible cases imported to Poland. The role a GP should play in the detection of ZIK V infections and in the rapid response to potential threats is also stressed. ZIK V infection represents both clinical and diagnostic challenges for GPs and other specialists, due to similar symptoms to other arboviral diseases and cross-reaction with other flaviviruses, which could lead to misdiagnosis. For a Polish doctor, the current epidemiological situation and clinical manifestation should be the main criteria to suggest ZIK V infection. Despite establishing diagnosis and treatment of imported ZIK V infections, a GP should be prepared for sharing information with patients who will travel to areas of the vector activity (especially pregnant women and those planning to become pregnant in the near future, as well as their partners) about the necessity to take precautions during and after their journey

Risk of occupational exposure to blood-borne pathogens in paramedics

Paramedics constitute a group of professionals who are constantly exposed to potentially infectious biological material through frequent and close contact with patients, possibly resulting in occupationally acquired infections. The paper’s objective has been to assess the occupational risk regarding blood-borne infections and identify preventive measures used among paramedics worldwide, on the basis of the related literature review. The literature search, covering the period 1987–2017, was performed using PubMed, Elsevier, Springer and Google Scholar databases. A comparative analysis of blood exposure was conducted and the report of such events and the use of personal protective equipment among paramedics in Poland and other countries worldwide was developed. The data on occupational blood exposures among paramedics is sparse. The resulting comparisons obtained in various scientific studies are difficult due to diverse data collection methods, influencing the resulting consistency. Additionally, there were some methodological errors found in previously published studies, such as selection bias. The percentage rate of paramedics exposed to blood in the last 12 months varies from 22% in the USA to 63% in Thailand; in Poland that rate fluctuates widely, ranging between 14–78%. Paramedics are frequently exposed to blood while performing their duties, but almost 50% of paramedics do not report any exposure which is mitigated by the systematic use of personal protective equipment: gloves are regularly used by 53–98% of paramedics, masks and goggles are worn by 33–62% of them. This fact puts the paramedics group at risk of blood-borne infections. Therefore, there is an urgent need to conduct further, methodologically correct, multi-center studies to accurately assess occupational blood exposure in paramedics. Med Pr 2018;69(6):685–69

HBV, HCV, and HIV infection prevalence among prison staff in the light of occupational risk factors

Wstęp Celem pracy jest ocena zawodowych czynników ryzyka wśród personelu więziennego: częstości, okoliczności ekspozycji na krew i stosowanych metod prewencji, oraz oszacowanie występowania zakażeń wirusem zapalenia wątroby typu B (hepatitis B virus – HBV) i typu C (hepatitis C virus – HCV) oraz ludzkim wirusem niedoboru odporności (human immunodeficiency virus – HIV). Materiał i metody Badanie ankietowe połączone z wykonaniem testów immunoenzymatycznych (enzyme-linked immunosorbent assay – ELISA) III generacji zostało przeprowadzone w okresie czerwiec–lipiec 2015 r. w Zakładzie Karnym w Goleniowie. Wyniki Zwrotność ankiet wynosiła 38%. W badaniu wzięło udział 87 osób (w wieku 22–64 lata, mediana: 34 lata). Mężczyźni stanowili 88,5% badanych. Strażnicy więzienni stanowili 87,4% uczestników badania. Przynajmniej 1 ekspozycji zawodowej na krew w czasie kariery zawodowej doznało 28,7% respondentów, w roku poprzedzającym badanie 8% uległo skaleczeniu, dla strażników więziennych były to skaleczenia igłą ze światłem lub ostrzem żyletki podczas przeszukiwania celi lub rewizji osobistej. W szkoleniach dotyczących zakażeń zawodowych uczestniczyło 85,1% respondentów. Realizacja szczepień przeciwko HBV wynosiła 83,9%. Rękawic ochronnych używało 75,9% badanych, ochrony oczu – 28,7%, 9,2% respondentów zawsze używało rękawic i okularów ochronnych. Najczęstszym powodem niestosowania (79,7%) środków ochrony była ich niedostępność. Większość eksponowanych (81,3%) nie zgłosiła skaleczenia odpowiednim służbom. Rozpowszechnienie występowania całkowitych przeciwciał anty-HBc (hepatitis B core antygen – antygen rdzeniowy wirusa zapalenia wątroby typu B), anty-HCV i anty-HIV wynosiło odpowiednio: 2,3%, 1,1% i 0%. Wnioski Personel więzienny jest narażony na ekspozycje zawodowe na krew. Zgłaszanie tych incydentów jest rzadkie, podobnie jak stosowanie rękawic i okularów ochronnych, co stwarza zagrożenie zakażeniem krwiopochodnym. Częstość występowania przeciwciał anty-HCV jest podobna jak w populacji ogólnej, natomiast przeciwciał całkowitych anty-HBc – niższa, prawdopodobnie z powodu powszechnych szczepień przeciwko HBV, jednak mała zwrotność ankiet nie pozwala na precyzyjną ocenę prewalencji. Med. Pr. 2017;68(4):507–516Background Objectives of the study: to assess the occupational risk for blood-borne infections (BBIs) among prison staff (number/ circumstances of blood exposures and preventive methods used), and to estimate the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Material and Methods The survey, which included serological testing with the use of 3-generation enzyme-linked immunosorbent assays (ELISA) was completed on active staff at a correctional facility in Goleniów, Poland, between June–July 2015. Results Response rate was 38%, 87 participants (aged 22–64 years, median: 34 years) agreed to participate. There were 88.5% males, correctional officers comprised 87.4% of the participants. Having had ≥ 1 blood exposure during professional career was reported by 28.7% respondents, 8% – sustained it in the preceding year. For correctional officers the last blood exposure was caused by a hollow-bore needle/razor blade during cell or manual searches. This was not reported by 83.3%. Participation rate in an infection control training was 85.1%. Hepatitis B virus vaccination uptake was 83.9%. Compliance with glove use was 75.9%, with protective eyewear – 28.7%. Regular use of both was reported by 9.2% of participants. The lack of their availability was the most common reason (79.7%) for non-compliance. Anti-HBc (hepatitis B core antigen) total/anti-HCV/anti-HIV prevalence was 2.3%, 1.1%, and 0%, respectively. Conclusions Prison staff are at risk for occupational exposures to blood. Reporting of such incidents is poor, as well as compliance with personal protective equipment use, which place them at risk for acquiring BBIs. Anti-HCV prevalence is similar to that observed in the general population, anti-HBc total prevalence is lower, possibly due to high vaccination uptake, however, poor response rate limits precise prevalence estimates. Med Pr 2017;68(4):507–51

The Comparison of Sharps Injuries Reported by Doctors Versus Nurses from Surgical Wards in the Context of the Prevalence of HBV, HCV and HIV Infections

The aim of the study was to evaluate the nature and frequency of sharps injuries among doctors and nurses from the same surgical/gynecological wards and the prevalence of HBV/HCV/HIV infection.Material and methods. An anonymous cross-sectional sero-survey, with ELISA system used to detect anti-HBc, anti-HCV, anti-HIV, was conducted among 89 doctors and 414 nurses from 16 randomly selected hospitals in West Pomerania, Poland, between January-June 2009.Results. During the preceding 12 months, 82% doctors and 44.4% nurses (p0.28; anti-HCV - in 1.1% of doctors vs 1.4% of nurses, p>0.79; no anti-HIV positive cases were found. The analysis of potential risk factors for contracting a HBV revealed that for both job categories only length of employment was associated with an increased odds of being infected.Conclusions. Although the prevalence of HBV/HCV infection between doctors and nurses does not differ significantly, modifiable risk factors for contracting a BBI such as frequency and nature of sharps injuries may differ, which call for tailoring preventive measures to specific job categories. Long lasting exposure to injury events should be taken into consideration while assessing the risk for accuiring an occupational infection with HBV, HCV or HIV