Proste interwencje poprawiające przestrzeganie zaleceń terapeutycznych przez dzieci z przewlekłymi chorobami wątroby — doświadczenia jednego ośrodka i przegląd piśmiennictwa

Leczenie przewlekłych chorób wątroby u dzieci często jest nieskuteczne ze względu na nieprzestrzeganie zaleceń terapeutycznych. Celem pracy było wypracowanie prostych, łatwych do wprowadzenia interwencji poprawiających akceptację przewlekłego leczenia przez dzieci. W bazie PubMed przy użyciu słów kluczowych: adherence, compliance, therapy, chronic diseases, children wyszukano anglojęzyczne publikacje z ostatnich 10 lat, poświęcone przestrzeganiu zaleceń terapeutycznych przez dzieci, skupiając się na chorobach wątroby. Następnie przeprowadzono dyskusję okrągłego stołu, mającą na celu wypracowanie interwencji poprawiających akceptację długotrwałego leczenia. W dyskusji wzięli udział pracownicy Kliniki Pediatrii i Chorób Infekcyjnych we Wrocławiu (9 lekarzy, średni staż pracy 15 lat) — ośrodek ten zajmuje się dziećmi z przewlekłymi chorobami wątroby w wieku 0–18 lat. W ostatnich 5 latach odnotowano: 556 przypadków zachorowań na zapalenie wątroby typu B, 409 na zapalenie wątroby typu C, 37 na chorobę Wilsona, 50 na autoimmunologiczne zapalenie wątroby, 39 na niealkoholowe stłuszczeniowe zapalenie wątroby oraz 138 nieprawidłowych prób wątrobowych. Wyszukiwanie PubMed przyniosło 321 wyników. Na podstawie streszczeń do dyskusji wybrano 7 publikacji. Za czynniki sprzyjające nieprzestrzeganiu zaleceń uznano: przyjmowanie licznych tabletek, zwłaszcza kilka razy dziennie, terapię lekami o częstych działaniach ubocznych, brak wiedzy o możliwych działaniach ubocznych, wieloletnie leczenie, chorobę Wilsona, wiek dojrzewania, częstą zmianę lekarza prowadzącego i niski status społeczno-ekonomiczny. Za interwencje poprawiające adherencję uznano: budowanie bardziej osobistych relacji z pacjentem, zaangażowanie emocjonalne, zainteresowanie problemami zdrowotnymi oraz osobistymi nastolatków (np. stały lekarz prowadzący), zmniejszenie liczby przyjmowanych tabletek przez stosowanie wyższych dawek, uprzedzenie o możliwych działaniach niepożądanych, zwiększenie częstości konsultacji, regularną kontrolę prób wątrobowych w celu wczesnego wykrycia przerwania leczenia, edukację dzieci na temat ich choroby i telefoniczne nadzorowanie leczenia. Wyniki leczenia dzieci z przewlekłymi chorobami wątroby można poprawić przez wprowadzenie prostych interwencji zwiększających akceptację dla terapii, na przykład częstsze kontrole, bardziej osobiste relacje z lekarzem prowadzącym, zmniejszenie liczby tabletek oraz edukację pacjentów i ich rodziców na temat choroby. Forum Medycyny Rodzinnej 2011, tom 5, nr 4, 345–35

Genetic Characterization of Human Enteroviruses Associated with Hand, Foot and Mouth Diseases in Poland, 2013–2016

The objective of the present study was to describe the molecular characteristics of enteroviruses associated with hand, food, and mouth disease (HFMD) in Poland. Clinical material from HFMD cases, that occurred during 2013–2016 were examined. It has been showed that coxsackievirus A6 (CVA6), CVA10 and CVA16 were circulating in the country. Phylogenetic analysis showed that Polish CVA6 strains were divided into two distinct clusters suggesting two independent introductions. This is the first report of CVA6 infections associated with HFMD in Poland. These results emphasize the need for continuous monitoring of HFMD and facilitation of the diagnosis using molecular approaches

Recommendations of the Polish Society of Gynaecologists and Obstetricians, Polish Paediatric Society, Polish Society of Family Medicine, Polish Society of Vaccinology, Polish Society of Oncological Gynaecology and Polish Society of Colposcopy and Pathophysiology of the Uterine Cervix on prophylactic vaccinations against infections with human papillomaviruses in Poland

Several hundred million people are infected with genital genotypes of the human papillomavirus (HPV) annually in the world. The infections transmitted mainly through sexual routes are usually asymptomatic, but can lead to the development of cervical, vulvar, vaginal, anal, penile cancers, some head and neck cancers and genital warts (condylomas). The fraction HPV-related cancers range from nearly 100% in the case of cervical cancer to several/over a dozen percent in the case of other cancers and diseases. There are no effective drugs against HPV, but prophylactic HPV vaccines are available free of charge in immunization programmes in many countries around the world. In Poland, HPV vaccinations have so far been executed out on the pocket or in free-of-charge, local-governmental prevention programs, but the vaccination coverage of the target population does not exceed 10%. From November 2021, one of the vaccines is available with a 50% reimbursement, work is underway to reimburse the next ones, and the National Oncology Strategy assumes the implementation of the HPV immunization programmes and vaccination of 60% of the teen population by 2028. Three prophylactic HPV vaccines are registered. All of them are safe and their effectiveness in the prevention of diseases caused by vaccine genotypes reaches almost 100%, provided that full post-vaccination immunity is obtained before the contact with the virus. Girls aged 11-13 are the priority target cohort for HPV vaccination in Poland. The implementation of routine, free-of-charge HPV immunization in the Preventive Immunization Program (PIP) for all adolescents should be pursued. Persons over the age of 13 may also benefit from HPV vaccination and should be vaccinated according to product specifications. In addition to free access under the PIP, the key element for the success of the implementation of HPV vaccinations in Poland will be the education of medical personnel and parents of adolescents to be vaccinated

A phase III, multicenter, randomized, double-blind, active comparator-controlled study to evaluate the safety, tolerability, and immunogenicity of catch-up vaccination regimens of V114, a 15-valent pneumococcal conjugate vaccine, in healthy infants, children, and adolescents (PNEU-PLAN)

Background: Despite widespread use of pneumococcal conjugate vaccines (PCVs) in children, morbidity and mortality caused by pneumococcal disease (PD) remain high. In addition, many children do not complete their PCV course on schedule. V114 is a 15-valent PCV that contains two epidemiologically important serotypes, 22F and 33F, in addition to the 13 serotypes present in PCV13, the licensed 13-valent PCV. Methods: This phase III descriptive study evaluated safety and immunogenicity of catch-up vaccination with V114 or PCV13 in healthy children 7 months–17 years of age who were either pneumococcal vaccine-naïve or previously immunized with lower valency PCVs (NCT03885934). Overall, 606 healthy children were randomized to receive V114 (n = 303) or PCV13 (n = 303) via age-appropriate catch-up vaccination schedules in three age cohorts (7–11 months, 12–23 months, or 2–17 years). Results: Similar proportions of children 7–11 months and 2–17 years of age reported adverse events (AEs) in the V114 and PCV13 groups. A numerically greater proportion of children 12–23 months of age reported AEs in the V114 group (79.0%) than the PCV13 group (59.4%). The proportions of children who reported serious AEs varied between different age cohorts but were generally comparable between vaccination groups. No vaccine-related serious AEs were reported, and no deaths occurred. At 30 days after the last PCV dose, serotype-specific immunoglobulin G geometric mean concentrations were comparable between vaccination groups for the 13 shared serotypes and higher in the V114 group for 22F and 33F. Conclusions: Catch-up vaccination with V114 in healthy individuals 7 months–17 years of age was generally well tolerated and immunogenic for all 15 serotypes, including those not contained in PCV13, regardless of prior pneumococcal vaccination. These results support V114 catch-up vaccination in children with incomplete or no PCV immunization per the recommended schedule.publishedVersionPeer reviewe

Upper respiratory tract infections and influenza-like illnesses among healthcare workers: are serological tests useful in monitoring influenza and influenza-like illness?

Background Healthcare workers (HCWs) are at high risk for exposure to upper respiratory tract infections (URTIs) and influenza-like illnesses (ILIs). The present study aimed to surveil URTIs and ILIs and their impact among the Department of Pediatric Infectious Diseases in Wroclaw employees and evaluate their humoral response to influenza. Material and Methods Thirty-six HCWs participated in the first season and 32 HCWs in the second season during years of the study. The authors carried out a URTI/ILI surveillance, and all HCWs were asked to complete a weekly report during 2 influenza seasons: 2016/2017 (S1) and 2017/2018 (S2). In S1 both IgG and IgM antibodies against influenza A and B were assessed. The HCWs with symptoms of ILI were encouraged to undergo PCR tests for influenza. Results No significant differences in reporting URTI were found among vaccinated and non-vaccinated HCWs and HCWs and the control group. Depending on the year 5.5–17.2% of HCWs were treated with antibiotics because of URTI. In the study 58.7% of participants in S1 and 66.7% in S2 decide to work despite the URTI symptoms. There was no statistical relationship between the concentration of anti-influenza IgG and the number of URTIs and ILIs reported. Only vaccinated were willing to undergo voluntary influenza testing. Conclusions The URTI and ILI occur commonly in HCWs, and HCWs contract URTIs as often as the control group. Despite their medical education, HCWs work with the symptoms of infection and overuse antibiotics to treat the URTI. Serology testing is not able to follow the infection’s dynamics or identify the people immune to the influenza-like illness. The diagnostic value of IgM antibodies in acute influenza infection is negligible. Vaccinated HCWs are more focused on their health and are more willing to undergo influenza tests. Med Pr. 2022;73(6):441–

Upper respiratory tract infections and influenza-like illnesses among healthcare workers: are serological tests useful in monitoring influenza and influenza-like illness?

Background Healthcare workers (HCWs) are at high risk for exposure to upper respiratory tract infections (URTIs) and influenza-like illnesses (ILIs). The present study aimed to surveil URTIs and ILIs and their impact among the Department of Pediatric Infectious Diseases in Wroclaw employees and evaluate their humoral response to influenza. Material and Methods Thirty-six HCWs participated in the first season and 32 HCWs in the second season during years of the study. The authors carried out a URTI/ILI surveillance, and all HCWs were asked to complete a weekly report during 2 influenza seasons: 2016/2017 (S1) and 2017/2018 (S2). In S1 both IgG and IgM antibodies against influenza A and B were assessed. The HCWs with symptoms of ILI were encouraged to undergo PCR tests for influenza. Results No significant differences in reporting URTI were found among vaccinated and non-vaccinated HCWs and HCWs and the control group. Depending on the year 5.5–17.2% of HCWs were treated with antibiotics because of URTI. In the study 58.7% of participants in S1 and 66.7% in S2 decide to work despite the URTI symptoms. There was no statistical relationship between the concentration of anti-influenza IgG and the number of URTIs and ILIs reported. Only vaccinated were willing to undergo voluntary influenza testing. Conclusions The URTI and ILI occur commonly in HCWs, and HCWs contract URTIs as often as the control group. Despite their medical education, HCWs work with the symptoms of infection and overuse antibiotics to treat the URTI. Serology testing is not able to follow the infection’s dynamics or identify the people immune to the influenza-like illness. The diagnostic value of IgM antibodies in acute influenza infection is negligible. Vaccinated HCWs are more focused on their health and are more willing to undergo influenza tests

PERTUSSIS AS HEALTH CARE WORKERS INFECTIOUS DISEASE - THE CLINICAL CASE WITH A COMMENTARY

We discuss the changing epidemiological situation of pertussis observed in recent years, with a focus on the shift of cases from young children to older age groups, teenagers and adults. Whooping cough may affect healthcare workers who belong to a high-risk group and cause hospital infections. We present a case report of pertussis in a nurse and the recommended prophylactic measures in healthcare workers. The current definition and diagnosis of pertussis is also discussed. The clinical course of pertussis can be significantly alleviated and highly non-specific, with no typical coughing and vomiting in people vaccinated against whooping cough a few years earlier. Pertussis should be considered in the differential diagnosis of cough lasting more than fourteen days. Improvement of the epidemiological situation requires, besides immunization of infants, regular and universal booster immunization for adolescents and adults. Vaccinations for health care workers of neonatal and pediatric wards are recommended in the National Program of Immunization for 2013. It seems that booster vaccination of health care workers with a triple vaccine against diphtheria, tetanus and acellular pertussis (dTpa) of the reduced quantity of antigens, particularly of health workers caring for infants, children and the elderly, may be the most effective way to reduce the risk of pertussis transmission in the health care environment. Med Pr 2013;64(5):731–73