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Forex4you trade forex Forex4you is offering highly technological and professional service. To browse Academia. Skip to main content. Log In Sign Up. Download Free PDF. Magdalena Muszynska. Agnieszka Fihel. Download PDF. A short summary of this paper. Instructions for the preparation of the man- demiologiczny - Epidemiological Review are reserved uscript for the publisher — the National Institute of Public The manuscript should be prepared in accordance with Health-National Institute of Hygiene.

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W pracach oryginalnych badawczych pismo 2. Redakcja zastrzega sobie prawo poprawiania uste- cal Review. Per- formacje. Clin Infect Dis ;—6. Ann Intern Med ; 11 —3. Przegl Epidemiol ;— Wyd 2. Warszawa: Wydaw. PZWL; strona od — do. Szczepienia ochronne. Enforcement of data protection, privacy and se- manuskryptu. Action on the determinants of health that represent Health and well-being are universal human goals outcomes for these sectors leads to wider benefits for that are currently considered to be vital human rights; society, including economic benefits.

Ex- These goals are increasingly seen as central to human amples include ageing; migration; the predominance of development and security. Health is no longer seen noncommunicable diseases and mental health problems; as simply items of consumption to be financed but the remaining challenges from communicable diseases; is considered an asset that needs to be nurtured and the performance and financial challenges affecting equitably improved and also as a positive concept, health systems; and the poor state of development of emphasizing social and personal resources as well as public health services in many places.

Nevertheless, physical capacity. Given what is needed is a new type of governance for health for the is known, and the technologies available, we can and 21st century based on: the social determinants of health, must do better. Health is a major component This is both our challenge and our opportunity.

The health sector is a major economic sector in its own right, a very significant employer and a driver of science, re- HEALTH search and technology. The human rights dimensions of health loom large but are often ignored: for example, as The 53 countries of the European Region are richly concerns about mobility and migration spill over into diverse in terms of culture, history, development, wealth prejudice and stigma. These are some of the reasons and resources. Despite this diversity, the countries came why health matters so much.

Such influence pean health policy framework for Europe, Health Then the wide Health was supported by an extensive consultation breadth of determinants of health means that health can- process both within and external to the WHO Regional not just be the responsibility of the health sector alone, Office for Europe and several new studies. The review has been a two-year project in two A review of the experience gained with intersectoral phases chaired by Michael Marmot. The full report was work was published in 4.

This documented published in September The review analysed the experience with health in all policies and assessed the level of health inequities between and within countries evidence on and compared the effectiveness of various within the European Region and reviewed policy op- governance structures in producing action on social tions to address these.

The review drew on the work of determinants of health and ultimately on population 13 task groups and on the findings and recommenda- health outcomes. The publication captures the research tions of the global Commission on Social Determinants showing how intersectoral governance structures can of Health: most importantly, that health inequities arise be successfully established, used and sustained.

It from the conditions in which people are born, grow, also provides accessible and relevant examples for live, work and age and the inequities in power, money policy-makers of the governance tools and instruments and resources that give rise to these conditions of daily available. Based on this evidence and analysis, the review Finally, an examination of the economics of disease provides specific and practical recommendations for prevention is about to be published.

This will explore policy interventions across the life course and genera- the strong developing evidence supporting greater in- tions that have the potential and capability to reduce vestment in health promotion and disease prevention health inequalities.

The European poli- to feed directly into the development of Health 2. It was informed by a set of back- as key strategic policy advice for putting Health ground papers that provide additional in-depth analysis into practice. The longer Health policy framework of the issues raised.

The study highlights the ongoing and strategy 6 provides much more detail in terms of diffusion of governance to a collaborative model in evidence and practice related to health and well-being which governance is co-produced between a wide range and is meant for those who practice policy development of state ministries, parliaments, agencies, authorities, and implementation at operational levels.

The Health commissions etc. It is not a prescription Union, United Nations, etc. Regional Committee for Europe in the previous 10 years Health has been improving, but inequalities in health and of World Health Assembly resolutions and declara- remain severe.

The countries differ 3. This review of commitments indicates that profoundly, largely along an east-west gradient. Further Health may be seen as a reframing of many such illustrations are that a child born in the Commonwealth commitments within a coherent and visionary approach, of Independent States is three times as likely to die overcoming fragmentation and facilitating implementa- before the age of five years as a child born in an EU tion.

However, some issues need more attention now, country, and maternal mortality rates are up to 43 times such as the health of older people, the management of higher in some countries in the Region than others. In addition, the study services differs between these countries. However, suggests that the mechanisms and principles underlying all available evidence indicates that these differences the implementation of complex strategies should be bet- substantially reside in different social and economic ter defined and developed.

Finally, the study proposes circumstances. Present-day economic studies show a range of cross-cutting issues. They have a clear responsibility share of government budgets spent on health systems is to develop intersectoral national strategies that combine significant, and health care costs have grown faster than planning and oversight together with goals and targets national income.

Such intersectoral strategies, for example, use health risks and for high-quality health care interven- fiscal policies and regulation; focus on action in settings tions. Health systems, like other sectors, need to adapt such as schools or workplaces; and promote secondary and change, with such change focusing on primary care prevention, including risk assessment and screening. About one fourth of the people in the European secondary care or between providing health care and so- Region experience some type of mental health prob- cial care.

As an illustration of the needed changes, health lem during their lives. Evidence suggests that like other adverse HEALTH health effects of the economic downturn, such increases can be significantly mitigated by well-targeted social protection and active labour market policies. It supports the glob- ally intensifying efforts to control noncommunicable for health. To accommodate these and community levels.

Resilient communities have, or uncertainties, smaller-scale interventions that encour- are able to develop, assets that allow them to respond age learning and adaptation are proving increasingly proactively to new or adverse situations. They are also important. Health of health, with many health conditions being linked to systems need to be financially viable and sustainable, such factors as air pollution and the impact of climate fit for purpose and evidence-informed.

This requires change. Such factors interact with the social determi- reorientation to give priority to disease prevention, in- nants of health. Providing universal access remains opment. Health was supported by the development of a European Action Plan for Strengthening Public Health It is recognized that, in tackling health develop- Capacities and Services, which was also approved by ment, countries will engage with Health from the WHO Regional Committee for Europe in as different contexts and with different capabilities.

At a key pillar of implementing Health The Action the same time, the policy framework is intended to be Plan focuses on improving public health services and coherent and practical despite these different starting- infrastructure, including the public health aspects of points. Specific aims would include achieving strong health care services.

The Action Plan proposes a set political commitment to health and moving health up of 10 horizontal essential public health operations to the policy agenda; adopting a health in all policies ap- become the unifying and guiding basis for European proach; strengthening the policy dialogue on health health authorities to monitor, evaluate and set up poli- and its determinants; and building accountability for cies, strategies and actions for reforms and improving health outcomes.

Achieving better health outcomes requires Health provides evidence-informed solutions substantially strengthening public health functions and to all these challenges. To facilitate its work with coun- capacity; investing in public health institutional arrange- tries and to support Health , the WHO Regional ments; making efforts to strengthen health protection, Office for Europe is constructing a package of services health promotion and disease protection.

Nevertheless, cities can also concentrate detailed aspects of the policy framework. For each of poverty and ill health. Some circumstances of urban the package components, a limited menu of priority life, especially segregation and poverty, contribute and high-net-gain services, guidance and tools will be to and reinforce such discrepancies, by imposing dis- provided.

The package will be regularly updated to proportionate exposure to health-adverse and socially reflect learning from progress in countries and make undesirable patterns of response to economic and social available promising practices and expertise. Based on a solid needs assessment, what interventions, including those addressing social exclu- is the country hoping to achieve in terms of equitable sion and support; healthy and active living; safety and health improvement?

What multisectoral policies and environmental issues; working conditions; preparedness strategies will it use, for example for noncommunicable to deal with the consequences of climate change; expo- diseases?

The Health package of tools and instru- sure to hazards and nuisances; healthy urban planning ments is intended to help here. In terms of public health, and design; and participatory and inclusive processes analysing the European Action Plan for Strengthening for citizens. The WHO Regional Office for Europe will establish Health impact assessment and economic evaluation and maintain effective collaboration with all such part- are also valuable tools in assessing the potential impact ners and networks across the Region: engaging widely; of policies and can also be used to assess how policies helping to increase policy coherence; sharing health affect equity, and both qualitative and quantitative health data sets; joining forces for surveillance; and contrib- data can be used to assess how policies affect health.

The WHO Regional Office for Europe is now taking a systematic approach to support- Political commitment to this process of implemen- ing countries in their Health implementation work tation is essential globally, regionally, nationally and during — As another initiative, the Regional subnationally. Countries propose setting regional targets Office will also support the development of new forms to express this, to estimate progress and to promote of networking among countries, institutions and people, accountability.

Suggested headline targets prepared for including web-based collaboration. Reduce premature mortality in Europe by Increase life expectancy in Europe. Working with the EU will provide a strong 3. Reduce inequities in Europe social determinants of foundation, significant opportunities and additional health target.

Many other organizations and networks too 4. Enhance the well-being of the European population. Although attitudes towards the private business 6. National targets or goals set by Member States. Cities can nature of policy responses and interventions. Whole-of-government and whole-of-society policies 3. Analysis in the light of the Health networked, information-based societies.

Intersectoral governance for health in all policies: structures, actions and experiences. Copenhagen, WHO noncommunicable diseases are controlled; and countries Regional Office for Europe, Observatory Studies cope with disease outbreaks and natural disasters.

Series, No. Health can help achieve all these objectives. Health a European policy framework supporting It is a powerful vehicle for collective action across the action across government and society for health and well- whole of the WHO European Region to seize new op- being. Health a European policy framework and strategy said in the foreword to the Health publication: 8 for the 21st century.

Health targets, indicators and monitoring frame- work. Health targets. It is for these 8. Health a European policy framework and strategy reasons that I greatly welcome the new European health for the 21st century. Received: Marmot Review Team. European review of social de- Address for correspondence: terminants of health and the health divide. Kickbusch I, Gleicher D.

Governance for health in the Al. Jerozolimskie , Warsaw, Poland 21st century. It was an opportunity to organize a conference so as to remind the events concerning a birth of the institution which, after the First World War, had originated structures of epidemiological and sanitary supervision in Poland, the one we have nowadays. A conference took place on 16th December in Warsaw, at Palladium Theatre. There Inspection. On that occasion Chief Sanitary Inspector- were also speeches of honorary guests.

Just to mention ate, in cooperation with Polish Society of Hygiene and few of them: Mr. The event held the honorary pa- parliament , and Mrs. The event counted also with Mr. A media patronage was the presence of Mrs. After all, there were also invited present article - acting Chief Sanitary Inspector.

There were scheduled three lectures in the Functionaries of State Sanitary Inspection and other agenda of the conference. The act of decoration was made by evolution of sanitary services in Poland; subsequently, Mr. Irrespective of issuing above mentioned laws, the work on construction of sanitary-epidemiological Independence regained in , after long system in Poland had begun in On 1st October years, was a base and impulse for construction of public Polish government set up Institute of Epidemiol- administration in Poland.

There were being organized ogy within Department of Medical Microbiology of national and local structures, including sanitary and Warsaw University 8. Department was in charge of infectious October and that the first legal act concerning diseases recognition and prevention, production of vac- health issues was a Decree of Regency Council on cines and coordination of epidemiological actions on creation of Ministry of Public Health and Welfare, and a national scale 9.

Ministry of Protection of Work. Therefore, which established a Ministry of Public Health 4. Article 2 of hygiene, hygiene of nutrition, food and food contact that law mentioned minutely competences of Ministry materials testing, sanitary engineering, sanitary admin- of Public Health, i.

There was also established the Department above all, the infectious, acute and chronic ones, issues of Production of Serum and Vaccines within National concerning water delivery, air quality, water quality, soil Institute of Hygiene. There were being produced doz- quality, food and nutrition safety, food contact materi- ens of them. Since the Department had been an als safety, supervision of production and distribution unique entity in Poland producing an insulin.

Vaccines of cosmetics, as well as sanitary hygiene of spaces, produced by NIP were known worldwide. An Law of 19th July regulated equally issues regard- agency in Gdynia was then transformed into Institute of ing production and distribution of serum and vaccines, Maritime and Tropical Medicine in , which still but also many other questions concerning health such exists Furthermore, in there were created as functioning of hospitals, ambulatories, rest homes, job posts for epidemiologists in territorial agencies.

Those solutions were pretty general and health entities and with the national ones in poviats frame, were treating problems in a quite brief manner; and voivodeships 8. More combat with infectious diseases was the Extraordinary detailed provisions concerning a combat with infec- Epidemics Commissioner. A Committee demics. Article 2 of the Law on appointing Extraordinary was in possession of merely few cars in Difficul- Epidemics Commissioner for the combat of epidemics ties in communication ended up in decentralization of issued on 14th July provided that Minister of the Committee.

Each commissioner was obliged to combat, ly a process of development both of National Institute of individually, epidemics. He was given an instruction and Hygiene and of a constructed sanitary-epidemiological technically could count with support of headquarters system. During the occupation an epidemiological activ- in Lublin. Provincial commissioners could cooperate ity was practically restricted to the territories of General with doctors in poviats and towns, and were entitled to Government.

The Germans were aiming to preserve ter- lead their work. Headquarters in Lublin were organiz- ritories remaining outside the front free from epidemics. Trainings for those such as posters and leaflets Between and German between and Each column consisted of prepared personnel activity.

Under its cover, there was arising an underground which was in charge of making an epidemiological activity which resulted i. In case of occurring of any infectious disease, vaccine for typhus for Polish citizens, secret delivery of they made a disinfection and pest control of spaces vaccines to concentration camps and clandestine educa- and environment where a sick person remained in. An identification of epidemics as well as screening of epidemiological situation were led on a basis of reports made by territorial agents.

The Committee was incorporated into Ministry of of Warsaw, which affected also a building of National Health in Institute of Hygiene Chocimska Street 24 , Minister Should be emphasized here an exceptional commit- of Health decided that headquarters of Institute will be ment of columns in combating with infectious diseases.

Furthermore, departments so rarely, exposed their life and health. Each unit epidemics i. An initiative taken by Minister municipal hygiene and epidemiology Some kind of Defence and Commander-in-chief on 24th November of breakthrough for sanitary services in Poland was a resulted in appointment of Extraordinary Com- creation of sanitary-epidemiological stations by virtue mittee for Epidemics in Lublin. Its first commissioner of Resolution of Council of Ministers n.

In this way, territorial agencies of Ministry of Health By a decree on State Sanitary Inspection issued on Thus: decree on State Sanitary Inspection stated 14th August , there was formed a State Sanitary that inspectors who were deputy heads of health units Inspection According to that act, Chief Sanitary were appointed by National Councils.

According to the article 11 of miological matters. One of main tasks Sanitary Inspection. There were established territorial of such shaped Inspection was a preventive and regular organs of State Sanitary Inspection: for voivodeship, sanitary supervision, prevention of occupational and municipalities, towns, districts, harbours. Therefore, infectious diseases and promotion of hygiene.

A law was providing that inspectors in inspectors. All inspectors were appointed by Minister of voivodeships, poviats, towns and districts were simul- Health and Welfare in agreement with territorial organs taneously deputy heads of sanitary-epidemiological in voivodeship. By the same decree there were formed At the time of its issue 20 , there was a vertical sanitary inspectors of Minister of Defence and Minister structure of Inspection.

Respectively, tions in Poland. There were being enhanced procedures each inspector, in case of necessity or urgency, could act of supervision of food and nutrition safety, as well as in relation to the inspector structurally inferior. A very relevant change in situation of Inspection Moreover, there were being supervised conditions of within public administration system was a fruit of ter- work, learning and leisure, eventually, there was being ritorial reform in Poland that took place in The voivode became thus Poland occurred in Totally, people died because of polio.

A station was Another relevant matter from the point of view of a part of so called integrated administration. The Law authorized inspectors to take actions in case of health risk, upon Each decade brought some organizational and request of starosts, mayors and vogts presidents of structural changes in State Sanitary Inspection. They the cities. Tasks of Inspection were performed stations. These decisions are made in agreement with voivode in rela- 1.

Zarzycki A. II, strony od 42 do First of all, 3. U z r. An amendment to Law on Sanitary Inspec- 5. Zasadnicza ustawa sanitarna z dnia 19 lipca r. Inspection Ustawa z dnia 19 lipca r. Nr 63, Inspection were re-integrated Ustawa z dnia 25 lipca r. Nr 67, poz. Magdzik W. This is the current state According to the article podpisanym w dniu 29 marca r.

Nr 78, Rok. Bilek M. Ustawa z dnia 14 lipca r. A very new task, performed since , z r. Klingberg A. It was a very first trial of response to massive Polski w r. Since ariat do Walki z Epidemiami , Morzycki J. Ustawa z dnia 24 lipca r. Morzycki J. Nr 70, poz. Ustawa z dnia 21 stycznia r. Nr 12, poz. Ustawa z dnia 1 marca r. Dekret z dnia 14 sierpnia r. Nr Sanitarnej Dz. Ustawa z dnia 23 stycznia r.

Ustawa z dnia 28 maja r. Ustawa z dnia 14 marca r. Sprawozdanie statystyczne MZA za rok Address for correspondence: Nr , poz. Targowa 65 Ustawa z dnia 24 sierpnia r. Current epidemic in West Africa is the largest EVD epidemic reported so far, exceeding the number of cases notified and geographical regions af- fected. This article discusses selected aspects of Ebola virus biology and ecology which are of significance for the processes of primary infection in humans and the spread of epidemic in population.

A special attention was drawn to the issues essential for the diagnosis of infection and safety of testing. The remaining genera of Filovi- dae, consequently leading to the discoveries of many ruses are represented by single species: Marburgvirus interesting biological features of this systematic group. Order of Mononegavirales tion. In case of Ebola virus, fruit bats belonging to the also comprises other free families: Rhabdoviridae species: Hypsignathus monstrosus, Epomops franqueti, e.

RSV, measles Rousettus aegyptiacus and Myonycteris torquata are virus etc. Avian bornavirus. For Marburg virus, Rhinolophus eloquens Compared to other viruses, Filoviruses have distinc- and Miniopterus inflatus are the hosts, while for Lloviu tive morphology. Filamentous particles of length up virus — an European bat Miniopterus schreibersii 2. Other RNA of Filoviruses into the genome of hosts was indi- viruses of the order Mononegavirales have various cated. Most commonly, this fragment is homologous to morphological features, including both spherical and the matrix protein VP35 or nucleoprotein NP.

Based short filamentous form. All viruses belonging to this on the integration of filovirus gene fragment into animal order have similar genome structure, ss - RNA, where genome, it is estimated that this family exists for at least after initial noncoding region, nucleoprotein NP gene 50 million years 3.

Currently, Filoviruses consist of three genera: Ebo- 1 Literature provides different abbreviations. Currently, there lavirus, Marburgvirus and Cuevavirus. Genus Ebolavi- are no recommendations which of them should be used. In this rus EBOV is composed of 5 species - Zair ebolavirus article, two most common abbreviations were presented.

Scheme of Ebola virus genome Ebola virus envelope is a host-derived lipid mem- Africa in , was determined as single lineage of brane, where specific viral proteins are located, i. It was also observed that VP40, VP24 — at the inner side and glycoprotein at the compared to the viruses studied in previous periods, the outer side of the membrane. Matrix proteins - VP40 and mutation rate for those analyzed in was consider- VP24 take part in binding of ribonucleoprotein and the ably higher.

Distribution of substitution rate in was inner surface of virus envelope. They participate in the closer to the normal distribution while in case of viruses processes of virion and virus assembling and budding. Authors suggest that this change was a result of virus replication in different hosts and in that way - of the character of epidemic — forest epidemics present on species specificity. Such proteins play an important in small and closely related populations would be of role in the virulence of Ebola and Marburg viruses by lower virus variability An attention should be also inhibiting the synthesis of type I and II interferon During Glycoproteins GP1 and GP2 are the products of en- epidemic, virus genome was sequenced directly zymatic digestion of the precursor of viral glycoprotein from the material of patients, so viruses were replicated GP 9.

Glycoproteins play a role in virus binding to in different cells of patients. In previous studies, viruses target cells of a host endothelium and monocytes are were first isolated in Vero cells and then analyzed. Thus, the targets for GP1 , viral entry, endothelial cells dam- they were pre-selected which consequently sharpened age and cytotoxicity in vessel cells.

Glycoprotein is also the curve of distribution of substitution rate. Recent publications suggest that this protein activates non-infected dendritic cells, leading to the Following the entry to an infected organism, secretion of pro-inflammatory and anti-inflammatory monocytes, macrophages and dendritic cells are early cytokines TNFa, IL1b, IL6, IL8, IL12p40 and IL1-RA, targets for Filoviruses 12, Then, virus is replicated IL Several authors state that sGP has also cytotoxic in these cells and concurrently transported to other re- activity 9.

Virus is also replicated in Polymerase complex, composed of polymerase, a number of different cell types, including endothelial polymerase cofactor VP35 and nucleoprotein, partici- cells, fibroblasts, hepatocytes, adrenal cortical cells and pates in the process of replication while for transcription several types of epithelial cells Authors suggest — VP30 protein is also required 2.

Its concentration determines the level of cell damage No 1 Filoviruses in the view of Ebola virus disease epidemic 17 Table I. Infection with Filoviruses leads to extensive patho- manifestations are reported in all symptomatic cases of logic lesions, including hemorrhagic lesions which Ebola virus infection 13, Lesions in the region of liver include necrosis and Clinical course of infection with Ebola virus may apoptosis of hepatocytes, steatosis and hyperplasia differ dependent on virus species.

In general, Ebola of Kupffer cells. Eosinophilic cytoplasmic inclusions hemorrhagic fever is present after the incubation period present in these cells constitute the aggregates of virus of days on average. It is characterized by nucleoprotein. Hemorrhagic lesions and diffuse inju- fever, chills, malaise and muscle pain. Within a short ries are observed in lungs Laboratory findings of time, subsequent multiple organ symptoms appear, in- patients in the first phase of infection show leukopenia cluding those referring to the following systems: gastro- with lymphopenia and then leukocytosis and thrombo- intestinal anorexio, nausea, vomiting, abdominal pain, cytopenia.

Liver damage results in an increased serum diarrhoea , respiratory chest pain, dyspnoea, cough, concentration of aspartate and alanine aminotransfer- rhinorrhoea , vascular hypotension and neurologi- ases. At the end of the first week of infection, kidney cal headache, confusion, coma. At the final phase of damage leads to oliguria and increased concentration of disease, external bleeding, ecchymoses, uncontrolled creatinine and urea in serum.

Infected patients present leakage from vein puncture sites and internal bleeding the symptoms of disseminated intravascular coagula- are reported. They are frequently accompanied by rash tion. Hemorrhagic lesions may be associated with a and abrupt weight loss. Such symptoms are present decreased concentration of coagulation factors and other days following the infection. In the successive days, a plasma proteins resulting from liver and adrenal cortical part of infected patients may experience shock, con- cell necrosis.

As the adrenal cortex has an important role vulsions, severe metabolic and coagulation disorders in the control of blood pressure, impaired function of which can be fatal. In case of convalescents, symptoms this organ results in hypotension and sodium loss.

Such of days gradually disappear. As with human and apes, Sudan Ebola virus, respectively. The lowest whose fatality rate is very high. In case of forest epidem- fatality rate was reported in the Bundibugyo Ebola virus ics, both epidemiological investigations and analyses outbreak in , i. Having crossed the barrier between hu- It should be noted, however, that the percentage of fatal mans and animals, the infection is transmitted in humans cases differs by regions and level of medical care.

Only via physical contact. Fatality of EBOV infection is associated with the ac- As other animals, including pets and domestic animals, tion of virus, reducing the innate immune response, thus, may have contact with Filoviruses, a special attention leading to uncontrolled release of inflammatory media- was drawn to dogs.

In African villages, dogs are not fed, tors and chemokines in the late stage of infection. Such thus, they eat carcasses of animals found in the vicinity process correlates with extensive apoptosis of T and B of villages as well as internal organs and remainings lymphocytes despite they were not infected. Survival of animals hunted by locals.

Irrespective of the fact and recovery of patients infected with EBOV is linked that transmission of Filoviruses in dogs has not been with neutralizing EBOV-specific immunoglobulin G documented, dogs behaviour and feeding may suggest IgG response, whose level in fatal cases is more than their role in infection spread. Allela and the team 18 fold lower or undetectable IgG antibodies, examined three populations of dogs for the presence other than neutralizing ones, are frequently detected, of Ebola virus—specific immunoglobulin Ig G.

Dog using ELISA or similar test while neutralizing IgG are populations were sampled from areas in which Ebola tested only by neutralization assay in BSL-4 labora- virus infections in humans were reported. Spectacular results were achieved. Production of large amount of non-structural soluble Results suggest that Ebola virus antibody prevalence in glycoprotein sGP during an infection is considered dogs reflects the virus activity. It may be indicative of to be an additional element of virus protection against a risk of infection with this virus in humans.

This protein is Olson et al. It is a strong inducer of humoral immune response, by Analysis included not only the methodol- however, the antibodies antisGP do not neutralize Ebola ogy virus detection or seroprevalence study , but also virus. In the process of co-immunization with sGP and the material studied alive animals or carcasses. In GP in experimental animals, a shift of humoral response total, data on 13, animals representing species, toward non-neutralizing antibodies was reported In a group of containing Ebola virus, serum proteins and cellular ele- alive animals, the most common were bats and rodents.

In a group of such as UV radiation, gamma radiation, temperature, dead animals, the carcasses of non-human primates chlorine-based disinfectants etc. Then, aerosol, contain- predominated. During epidemics in humans, Ebola ing infectious virus particles, may be produced 20, Having considered the possibility of elements was also demonstrated in studies, using liquid dog-to-human transmission of Ebola virus, it should be media — infectious Ebola virus was identified even after highlighted that antibodies were detected in Temperature is an important factor, studied animals, but neither alive nor dead dogs were affecting Ebola virus.

In case of apes studied, neither antibodies nor survival is considerably prolonged, while heating for the virus were detected in alive animals, but Such data suggest the lack of symptomatic Ebola Irrespective of the fact that Ebola virus in an en- virus infection, leading to death in dogs. Asymptom- veloped virus, it is recommended to use virucides also atic infections in these animals are reported frequently against non-enveloped viruses and those of higher re- during epidemics.

There is a lack of data on the role sistance compared to enveloped viruses in accordance of asymptomatic animals, other than bats, in the trans- with PN-EN Furthermore, such mission of virus to humans. Specific route of disease disinfectants, beside virucidal formulations, should also transmission, i.

Simultane- ously, the lack of such observations during outbreaks reported so far suggests that the role of asymptomatic EVD DIAGNOSIS animals in the transmission of infection in humans is very important for the first case case 0 and marginal In the course of Ebola virus disease, the symptoms, or even non-essential in the progression of epidemic. Thus, it is required infection from such animals to humans were raised.

For the Studies carried out so far demonstrated that there is a purpose of microbiological diagnosis of Ebola virus possibility of Ebola virus infection in pigs. In , infection, molecular diagnostics is applied polymerase infections with REBOV in pigs were reported in the chain reaction with reverse transcriptase or tests for the Philippines.

Furthermore, antibodies were detected in presence of antigens rapid tests or ELISA or IgM and humans who had contact with these animals. It should IgG antibodies Tab. I 24, As it was stated earlier, be noted, however, that pigs presented mainly symptoms neutralizing antibodies may be detected exclusively by of respiratory system atypical course of infection. It neutralization assay - test performed in biosafety level 4 may indicate the possibility of infection via infected laboratory.

IgM and IgG antibodies, other than neutral- aerosol. Furthermore, infection described referred to virus adapted to the stage of infection. At the beginning - since which is non-pathogenic for humans. Antibodies were ca days, virus genome is detected PCR , while in detected only in persons who had close contact with case of some patients also IgM. From the day 4 and 10, animals. Contrary to a number of other viral pathogens, the Recent studies suggest that Ebola virus transmission presence of EBOV in specimens may be demonstrated via aerosol cannot be excluded.

It was found that dry- following the onset of symptoms. Ebola and Marburg material collected from vagina and semen up to weeks haemorrhagic fever viruses: major scientific advances, 4, 9 and 13, respectively 8.

Clin Samples collected from patients suspected of Microbiol Infect ; Ebola virus infection should be considered as highly 5. The infectious. Tests in biosafety level 2 laboratory may Ebola virus VP35 protein inhibits activation of interferon be performed only after the inactivation of sample regulatory factor 3. J Virol ; — Until the sample is inactivated, it should be 6. Ebola Zaire managed as a potentially very dangerous material and virus blocks type I interferon production by exploiting proper protective measures should be undertaken PLoS Pathog It applies for both analytical examinations white blood ; 6 : e Ebola virus vp35 and microbiological tests Tab.

Ansari A. Clinical features and pathobiology of Eb- olavirus infection. J Autoimmunity ; Currently, EVD cases are treated, using immuno- Science ; — Ectodomain provisionally - ZMapp. ZMapp is a product, containing shedding of the glycoprotein gp of Ebola virus. Ebola virus. Furthermore, studies are conducting on the Genomic surveil- use of another product by Tekmira , employing short lance elucidates Ebola virus origin and transmission during the outbreak.

Science ; Feldmann H, Geisbert TW. Ebola haemorrhagic fever. Another product, which may be applied in the future, Lancet ; — J Pathol ; The most advanced works Paessler S, Walker DH. Pathogenesis of the Viral Hem- focus on two vaccines: the first vaccine containing orrhagic Fevers. Annu Rev Pathol ; Ebola virus disease, fact sheet. Animal studies Identi- demonstrated their effectiveness and lack of toxicity fication of Continuous Human B-Cell Epitopes in the 12, Probably, phase I clinical trial for these Virus.

These are: Russian product Basler CF. A novel mechanism of immune evasion me- containing recombinant influenza and Ebola viruses and diated by Ebola virus soluble glycoprotein. Expert Rev 2-dose vaccination with two different vaccines referred Anti Infect Ther ; Ebola Virus Antibody and Bavarian Nordic Lauber C, Gorbalenya AE. Genetics-Based Classifi- Sagripanti J. L, Lytle C. Sensitivity to ultraviolet ra- cation of Filoviruses Calls for Expanded Sampling of diation of Lassa, vaccinia, and Ebola viruses dried on Genomic Sequences Viruses ; 4, Arch Virol ; Smith I, Wang L-F.

Bats and their virome: an important The survival of source of emerging viruses capable of infecting humans. J Appl Microbiol ; Holmes EC. No 1 Filoviruses in the view of Ebola virus disease epidemic 21 Metody inaktywacji wirusa PN-EN Laboratory diagnosis of Received: Bull Soc Pathol Accepted for publication: JID ; It is a Gram negative intracellular bacterium belonging to the Anaplasmataceae family. Worldwide 23 cases were described, among which 16 in Europe.

Infection with Candidatus Neoehrlichia mikurensis in humans runs mainly with fever, headache, nausea, arthralgia, thrombotic or haemorrhagic lesions, subcutaneous haemorrhages, haemorrhagic rash, general malaise, weight loss.

The course of infection may be acute or chronic. The drug of choice is doxycycline. Due to the fact that the Ixodes ricinus ticks are common in Poland, there is a probability of infection with Candidatus Neoehrlichia mikurensis among patients bitten by ticks. The possibility of non-symptomatic human infection Candidatus Neoehrlichia mikurensis in north-eastern Poland was shown, confirming the necessity to conduct research on a larger scale.

Moreover, awareness of physicians about the possibility of infection in patients with non-specific symptoms after tick bite should be increased. Common tick: Ixodes ricinus is the most important Infection of I. In Poland, infection rate varies from 0.

Recently in several European countries, eg. It is a Gram negative including 9. They intracellular bacterium belonging to the family Ana- also proved coinfection of Candidatus Neoerlichia plasmataceae. Candidatus Neoehrlichia mikurensis species was afzelii 6. Lommano et al. The presence of the bacteria was confirmed in In Candidatus Neoehrlichia mikurensis was various species of rodents in Europe and Asia 4,5.

In Europe, the disease was described in 12 patients The frequency of Candidatus Neoerlichia mikurensis 2, 3, 15, Less than half of the patients in Europe detection in I. No 1 immunosuppressive therapy 15, The infection may take an acute or chronic course. One fatal case was described. The longest de- The first described case of neoehrlichiosis was scribed duration of symptoms was chronic relapsing published in A year old male, has suf- fever manifested itself for 8 months in addition to the fered from chronic lymphocytic leukaemia B-cells symptoms of thrombotic disease, inflammatory changes with autoimmune haemolytic anaemia treated with cor- in the lungs, swelling of limbs and aching joints 2, 3, ticosteroids since In the second half of due 15,16, In June , after splenectomy, platelet count normalized.

He was treated with ceftazidime and among which the most frequently observed are B-cell anti-thrombotic drugs. Etiologic agent of sepsis has not chronic lymphocytic leukaemia, chronic lymphocytic been established. In good general condition patient was leukaemia, lymphoma, large B-cell disorders, post- discharged home. After a month the disease relapsed.

Developed a rash T-cell large granular lymphocyte. Laboratory tests: HGB He was treated with cloxacillin, meropenem. Multiple All of the 7 patients of surveyed in China because cultures 3 blood cultures, 2 urine cultures and 1 swab of fever after a tick bite were immunocompetent in whom from the throat were negative. On the August 21st was Candidatus Neoehrlichia mikurensis was confirmed, no discharged home with the recommendation of the use of patient was suffering from haematological disorders or loracarbef.

On the 11th of September, despite antibiotic autoimmune diseases. All patients were farmers, at the therapy symptoms occurred again: fever with chills, average age of 41 years. None of them have been vac- infection of the upper respiratory tract, erysipelas of cinated against TBE, and the average time from the tick the right lower limb. In the treatment clindamycin was bite to the onset of symptoms was 8 days On the 22nd of September patient symp- Similarly, described four cases of infection of healthy toms reappeared.

Laboratory tests individuals concerned foresters without deviation in the revealed anaemia, leucocytosis, increased CRP concen- immune system The most common symptoms were tration and procalcitonine, hyponatremia. Tests performed on the samples from the preceding hospital- ization gave the same result. On the 5th of October the patient was discharged home with normalization of laboratory Analysis of symptoms and laboratory tests may parameters.

Samples taken in November for check-up indicate a significant difference between infection in by PCR, showed no bacterial DNA in the blood Europe and China. No 1 Neoehrlichiosis — a new tick-borne disease 25 Differences in laboratory between patients infected and Borrelia afzelii in Ixodes ricinus ticks in southern with Anaplasma phagocytophilum and Candidatus Sweden.

First detection Table I. Euro Surveill ; 8. J Clin Microbiol ; 48 7 : mikurensis Symptoms Similar Parasit Vectors ; 19;5 1 : Appl Environ Microbiol ; 79 3 : Richter D, Matuschka FR. J Clin Mi- are used for diagnostics.

There is neither possibility of crobiol ; 50; 3: — High- to cross-reactions. Often, based on laboratory tests throughput screening of tick-borne pathogens in Europe. Candidatus Neoehrlichia mikurensis infection can Frontiers in Cellular and Infection Microbiology ; be assumed. Laboratory abnormalities suggestive of 4:

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General Category. General Discussion Feel free to talk about anything and everything in this board. Forum Stats. On the August 21st was Candidatus Neoehrlichia mikurensis was confirmed, no discharged home with the recommendation of the use of patient was suffering from haematological disorders or loracarbef. On the 11th of September, despite antibiotic autoimmune diseases. All patients were farmers, at the therapy symptoms occurred again: fever with chills, average age of 41 years.

None of them have been vac- infection of the upper respiratory tract, erysipelas of cinated against TBE, and the average time from the tick the right lower limb. In the treatment clindamycin was bite to the onset of symptoms was 8 days On the 22nd of September patient symp- Similarly, described four cases of infection of healthy toms reappeared. Laboratory tests individuals concerned foresters without deviation in the revealed anaemia, leucocytosis, increased CRP concen- immune system The most common symptoms were tration and procalcitonine, hyponatremia.

Tests performed on the samples from the preceding hospital- ization gave the same result. On the 5th of October the patient was discharged home with normalization of laboratory Analysis of symptoms and laboratory tests may parameters. Samples taken in November for check-up indicate a significant difference between infection in by PCR, showed no bacterial DNA in the blood Europe and China. No 1 Neoehrlichiosis — a new tick-borne disease 25 Differences in laboratory between patients infected and Borrelia afzelii in Ixodes ricinus ticks in southern with Anaplasma phagocytophilum and Candidatus Sweden.

First detection Table I. Euro Surveill ; 8. J Clin Microbiol ; 48 7 : mikurensis Symptoms Similar Parasit Vectors ; 19;5 1 : Appl Environ Microbiol ; 79 3 : Richter D, Matuschka FR. J Clin Mi- are used for diagnostics. There is neither possibility of crobiol ; 50; 3: — High- to cross-reactions. Often, based on laboratory tests throughput screening of tick-borne pathogens in Europe. Candidatus Neoehrlichia mikurensis infection can Frontiers in Cellular and Infection Microbiology ; be assumed.

Laboratory abnormalities suggestive of 4: Candidatus Neoehrlichia mikurensis and its co- tonine, thrombocytopenia, anaemia, and hyponatremia circulation with Anaplasma phagocytophilum in Ixodes 2,3,15 - Parasit Vectors ; 7: Parasit Vectors 17; 6 1 : Ixodes The drug of choice is doxycycline, also used in the ricinus abundance and its infection with the tick-borne infection with Borrelia burgdorferi and Anaplasma pathogens in urban and suburban areas of Eastern Slo- phagocytophilum 3, Parasit Vectors ; 16; 6 1 : Parasit Vectors a; 24; 7: Due to the fact that the Ixodes ricinus ticks are com- Tick-borne mon in Poland, there is a probability of infection with pathogens in ticks collected from breeding and migratory birds in Switzerland.

Welc-Faleciak et al. Vet Microbiol ; awareness of physicians about the possibility of infec- : Can- bite should be increased. Emerg Infect Dis ; 18 12 : J Clin Microbiol ; 51 1 : 1. Co- No 1 First case of Neoehrlichia mikurensis. J Clin Microbiol ; 52 8 : Human infection with Can- Emerg Infect Dis ; 18 10 : Received: 3. Infections Accepted for publication: Clin Anna Moniuszko Infect Dis ; 58 12 : Department of Infectious Diseases and Neuroinfections, Diagn Microbiol Infect Dis fax: 00 48 85 ; 69 3 : E-mail: annamoniuszko op.

Sanitary and Epidemiological Station in Opole 2. This article aimed at evaluating the impact of HBV vaccination in population included and not listed in the National Immunization Programme NIP on hepatitis B incidence in Opolskie province in — Analysis was based on data provided by the Sanitary and Epidemiological Inspec- tion under epidemiological surveillance conducted, i.

A total of records of detected and confirmed hepatitis B cases, registered in in district sanitary and epide- miological stations, were subject to analysis. In —, hepatitis B incidence in Opolskie province was higher compared to the average in- cidence in Poland and was increasing in the successive years 5. An increase of incidence resulted from increasing number of patients with chronic hepatitis B chronic HBV , i. In the analyzed period, no new infections were reported in the following age group 0—9 years in Opolskie province.

Only 3 cases chronic stage were noted in the age group 10—14 years. Of patients, diagnosed with hepatitis B, The remaining cases of acute or chronic hepatitis B were vaccinated, including In case of individuals at the age older than that specified in the NIP, especially adults, it is recommended to perform diagnostic tests for HBV infection prior to vaccination. Furthermore, it is required to undertake activities aimed at promoting HBV vaccination in populations which are not included in the NIP.

Number of HCV-infected individuals, actively using a first generation plasma-derived vaccine, in replicating virus, is estimated at approximately mil- which hepatitis B surface antigen HBsAg was vac- lion and , in the world and Poland, respectively. In , a second generation vaccine was In the last 20 years, there was a considerable improve- launched.

It was produced, using yeast cells in recombi- ment of epidemiological situation of hepatitis B in Po- nant DNA technology, where plasmid carrying coding land number of infections and incidence decreased by sequences for HBsAg was inserted. Undoubtedly, vaccines are also administered globally. Provided they still do not respond they have not been even registered 4,5,6.

Non-response to monovalent and combined vaccines. Currently, monova- revaccination with double-dose of vaccine should be lent vaccines in doses for adults and children are regis- considered as sustained non-response to vaccination tered: Engerix B GSK , HBVaxPro MSD , Hepavax and it should not be repeated 1,4,5,9, Furthermore, it was high hepatitis B endemicity.

In such cases, vaccination continually increasing in the successive years — from is not obligatory, but it is payable 8,10, Probably, vaccine-induced and natural immunity are long-term, providing life-long protection. Immu- Table I. Few individuals, i. Poorer response or its lack is usually reported In the age groups and infection, i. B cases in the analyzed five years amounted to It was determined that no in- fections were reported for age groups: and years From the data transpires that since , the number of while only 3 cases occurred in individuals aged 10—14 individuals vaccinated against HBV was gradually increas- years exclusively chronic cases.

The highest number ing within the execution of the NIP. Therefore, after , of cases was noted in the following age groups - individuals aged more than 25 years were not vaccinated. Compared to Poland, epidemiological situation It seems to be highly probable as the highest number of hepatitis B in Opolskie province in dif- of infections was reported in the following age groups: fered considerably.

Furthermore, the they were on the increase from year to year, exceeding highest number of infections was registered in and more than twofold the average for country. It should , i. Moreover, having cases in Opolskie province could be associated not analyzed HBV infections by acute and chronic stage only with increased incidence, but also with improved of infection in the aforesaid age groups, i.

There is also a possibility that infections in vaccinat- Irrespective of higher HBV incidence rates in Opol- ed individuals were with regard to those that underwent skie province compared to other provinces, a positive incomplete vaccination and did not provide that infor- impact of vaccination on restricting the number of mation or neither humoral nor cell-mediated immunity HBV infections was observed. In the analyzed period, was achieved following complete vaccination.

Available a decreasing incidence of acute hepatitis B was reported studies suggest that HBV vaccine results in protective from 1. Undoubtedly, it is associated with nity is not sufficient enough, with antibody titres not obligatory vaccination against HBV which was intro- exceeding the protective level, i. Since B incidence in Opolskie province showed an important , an increasing tendency of chronic compared to role of vaccination in the prevention of HBV infections.

Such From the analysis transpires that HBV vaccination is not predominance of chronic stages of infection seems to always justified, e. The fact that B cases , underscores an important role of vaccination Lack of awareness in vaccinated individuals on in the prevention of HBV infections. Moreover, it poses titis B. Such situation should raise concerns. It cannot an epidemiological threat as hepatitis B virus may be be, however, entirely explained as serologic status of further transmitted in the population.

Juszczyk J. In: Dziubek Z. PZWL; Iorio R, Paribello N, 2. Vaccine ; — Simon K. Trudeau G, De Serres G. Comparative long term immu- Termedia; Cianciara J, Juszczyk J. Czelej Sp. Ped Infect Dis J ; 24 3 Szczepienia ochronne w Polsce w roku , , , 5. Sanitary and Epidemiological Station in Opole, 9.

This article aimed at evaluating the incidence and distribution of healthcare-associated HAI gastroenteritis GE in patients hospitalized on paediatric ward in St. Gastroenteritis remains a common manifestation of healthcare-associated infections on paedi- atric wards. In Poland, there are limited data on the proportion of healthcare-associated GE in the epidemiology of healthcare-associated infections.

It was decided to present the incidence and etiology of these infections in a 7 year study period. For the purpose of this study, standard definitions of healthcare-associated infections issued by the European Centre for Disease Prevention and Control ECDC were adopted. Cumulative incidence rates and incidence density rates were calculated. A total of 11, records of children hospitalized in were subject to analysis. In this period, healthcare-associated gastroenteritis cases of viral etiology were identified.

GE was most frequently reported in children aged less than 2 years average Average hospitalization of a child who was not diagnosed with healthcare-associated GE was 6. GE was equally present in girls and boys, i. Such virus was identified in children CIR Rotavirus GE was followed by concomitant infections with rotaviruses and adenovi- ruses.

A total of 12 patients were diagnosed with such co-infection CIR Rotaviruses were the most commonly identified etiological agents of healthcare-associated gastro- enteritis on paediatric ward. Children aged less than 2 years were those most frequently affected. Nowadays, it is considered that viruses rotaviruses, noroviruses, adenoviruses are the most sig- Healthcare-associated gastroenteritis GE of viral nificant etiological agents of healthcare-associated GE on etiology still remains a problem in hospitals in Poland.

Infections, Due to the enhancement of hygienic and sanitary stan- accompanied by acute viral diarrhoea occur in infants and dards, improvement of life conditions and introduction of children, however, they are also present in adult patients surveillance over food production, there was a change in treated in hospital settings.

Rotaviruses, noroviruses and the distribution of etiological agents causing healthcare- adenoviruses are pathogens of high communicability and associated gastroenteritis in Poland. In the 70s of the 20th resistance to unfavourable environmental conditions.

Consequently, it hinders their hospitalized due to community-acquired diarrhoea elimination from patient care settings. Noroviruses and were excluded from analysis. Data on gender and age adenoviruses can survive on surfaces up to 7 days max. Gastro- On paediatric wards, infected patients children, parents, enteritis was diagnosed pursuant to the definition issued personnel , who excrete such pathogens while suffer- by the European Centre for Disease Prevention and Con- ing from acute viral diarrhoea, are the reservoir of the trol ECDC in Stockholm Healthcare-associated viruses, thus, leading to a substantial contamination of gastroenteritis, detected in hospitalized children, was environment.

Viruses may be transmitted days prior grouped by the etiological agents identified, including to the onset of symptoms and for up to 14 days after rotaviruses, adenoviruses and unspecified etiology. Observations, however, suggest that com- Cumulative incidence rate was calculated, using the municability may be prolonged up to several weeks 4.

Therefore, infections caused by by the number of person-days and multiplied by 1, In , a total of 23, cases of viral least two infections caused by the same pathogen, sug- diarrhoea were reported in Poland incidence However, this number includes both commu- Frequency of hand disinfections per one patient was nity-acquired and healthcare-associated infections 6. Nevertheless, there is a children. Having presumed that hands should be disin- number of studies discussing such problem 2, 4, 5, No testing for not with healthcare-associated infection , children noroviruses was conducted.

Table I. No 1 Gastroenteritis in hospitalized children 35 Table II. Table III. It may be assumed that noroviruses were attributable In a 7-year period, a total of 11, children were to a part of GE identified Tab. Analysis of demographics of study population sug- Of them, were diagnosed with gastroenteritis, in- gests that the average age of hospitalized children was cluding healthcare-associated gastroenteritis. In a group were estimated at: CIR In of children aged less than 2 years, healthcare-associated the study group, no healthcare-associated gastroenteritis GE was most commonly reported in those between 1 of bacterial origin was identified.

Cumulative incidence rates for CIR Children diagnosed rotaviruses and adenoviruses was separated. Such co- infections were identified in 12 patients CIR Age years and gender of children hospitalized on IDR B 4. For 43 children — standard deviation, HAI - healthcare-associated infection. The 1 An increase 5 5. Comparative analysis 8 2. Authors suggest 11 2. A list of such actions includes: isolation, meticu- lous compliance with the principles of hygiene, espe- Table VI.

Frequency of hand disinfection and number of confirms an increase in the total number of gastroen- diagnostic gloves used on paediatric ward in teritis of viral unspecified origin. It is possible that such infections include those caused by noroviruses but Frequency of hand Number of diagnostic were not diagnosed. Such situation results from limited Year disinfection gloves used laboratory diagnostics, mainly in case of outbreaks In 62 31 the study of Sulik et al.

Study of Jackowska et al. In studies per- Total formed in Warsaw in by Kuchar et al. According of equipment and rooms where patients stay. Kuchar et al. It suggests of control in children over excretions and secretions, that approximately 0. A total of On paediatric ward studied, the average age of a 4. For A number of publications also confirm such obser- etiological agents were determined. Several authors claim are very common. It is estimated that for boys.

The report of the Provincial Sanitary and der. GE-RV infections were diagnosed in boys and girls Epidemiological Station in Cracow as of sug- to the same extent 18, Healthcare-associated GE gests a systematic increase in the number of registered prolongs the hospitalization of patients. From studies gastroenteritis of rotavirus and norovirus origin. Such considerations, we claim that effective methods of data are similar to literature data. A number of authors prevention of healthcare-associated GE are: precise emphasize that healthcare-associated GE prolongs epidemiological interviewing, rapid microbiological hospitalization by days 5, On paediatric ward suspected of infection, compliance with hand hygiene studied, the peak of infections was reported between principles by personnel, patients, guardians and visiting January and March.

From the meta-analysis of Kuchar persons and promoting vaccination against rotavirus. Routine testing of patients for noroviruses may Based on the analysis of healthcare-associated GE-RV be of assistance in explaining GE of unknown etiology. A part of these infections could have been Lewandowski T. Przegl Epidemiol ;37 2 An hospitalized due to acute viral gastroenteritis in north- in-depth analysis of data suggests that the peak of GE- eastern Poland. February and March.

Literature data underscore the 3. How long do role of noroviruses in the etiology of GE and outbreaks nosocomial pathogens persist on inanimate surfaces? A Introduction of routine testing for noroviruses ststematic review, BMC Infect Dis ; 16 6 Przegl Gastroenterol ;6 2 Having responded to a high GE incidence in Pediatr Pol ; Accessed on: Korycka M. Furthermore, ward w latach Med Wieku Rozw ; rooms were modernized by placing a cooker for parents Przegl Epidemiol ; No 1 Gastroenteritis in hospitalized children 39 Stowarzyszenie Higieny Lecznictwa.

Przegl epidemiol ; Brudnowska, A. Departament Przeciwepi- Thang J. Zasady children with diarrhea in Lulong Country in Wille B. Zentralbl Gy- T. Epidemiology and impact of rotavirus diarrhoea in nekol ; Acta Pediatr Suppl. Sytuacja epidemiologiczna Sytuacja Koopmans M. Noroviruses in Healthcare settings: a J Hosp infect ; Emerg Infect Przegl Epidemiol ; Dis ; Prevelence and clinical char- tertiary paediatric hospital — a major problem of children acteristics of norovirus gastroenteritidis in hospitalized hospitalzed primary due to respiratory tract infections.

Pediatr Infect Dis J ; Bonn Germany , June J Clin Virol ; CD-ROM; poz. Zachorowania dzieci na St. Men who have sex with men MSM contribute disproportionally to the spread of several sexually transmitted infections STIs in many European and other industrialised countries. To describe and compare clinical and epidemiological data on MSM and men who have sex with women MSW treated for syphilis in Bialystok, Poland in Analyzed characteristics included the age, residency, marital status, professional activity, number of sexual contacts, relation to the source contact, stage of syphilis, concomitant STIs including HIV, adherence to follow-up visits and efficacy of partner notification and contact tracing.

Among 49 male patients with syphilis, 19 The majority of patients in both groups were residents of urban areas and single. More than five lifetime sexual partners were declared by Most of the syphilis cases were diagnosed during early symptomatic stage in Other concomitant STIs were detected in Partner notifica- tion and contact tracing was not possible in Taking into consideration the important role of MSM in the spread of STIs, including syphilis, it is crucial to continue the present study but also to conduct similar investigations on national level.

At first, the outbreaks of syphilis in several behavioural factors, e. Since , syphilis of recreational drugs before and during intercourse 1,2. MSM vs. Worryingly, syphilis frequently co-exists with years 12 Ac- Over 34 years 4 Rural areas 4 Data status in steady 1 5.

Driver 0 4 Data on sexual history for male syphilis patients in The aim of this study was to describe and com- Bialystok, Poland in pare socio-demographic, clinical and epidemiological P value MSM MSW characteristics of male patients, i. Casual 8 Analyzed characteristics included the age of patients, Table III. For MSM vs. Stage of syphilis Early latent 3 The high- gonorrhoea in one MSM.

Follow-up is ongoing in the remaining For com- patients. Briefly, the average age of the MSM was The majority nearly half of the cases were diagnosed among MSM of patients in both groups were residents of urban areas France, the Chechen Republic, Russia. A tradesman and a driver Netherlands, Denmark and Ireland The 2. Significantly higher propor- Bialystok has mainly been lower in average 2. In neighbouring countries, the inci- are shown in table III.

Men in both groups were most dence in was higher and ranged from 3. Republic through 5. Concomitant Lithuania to HIV tion e. However, the to diagnosis of syphilis. Decree of the Minister of Health of July 10th Dz. Contact tracing was completed in only three In 10 form for STIs the annex 4 of the Decree in which Unfortunately, was initiated but not completed, and in six MSM and seven The percentage MSM and 12 In , The follow-up was also suboptimal in both groups: MSM constituted only 4.

Similarly to our findings the small sample size despite clear differences in fre- those patients were most frequently diagnosed during quencies, it was not possible to demonstrate statistical early symptomatic syphilis in Nevertheless, the study will In subsequent years , MSM were reported continue to increase the sample size. The , 21 European Centre for Disease Prevention and Control. Stockholm: ECDC; An outbreak no to MSM.

The majority of patients in both groups were longer: factors contributing to the return of syphilis in residents of urban areas and were single. MSM had Greater Manchester. Sex Transm Infect ;79 4 significantly more lifetime sexual contacts, including 3. Increase in sexu- The over two-fold higher prevalence of STIs ally transmitted infections among homosexual men in other than syphilis and, especially, several times higher Amsterdam in relation to HAART.

Syphilis surveillance and trends of the syphilis epidemic in Germany since the studies 1,3, In Poland, in MSM constituted mids. Euro Surveill ;9 12 The syphilis outbreak in years , however the information of trans- in Northern Ireland. Recent syphilis trends in Disquietingly, the contact tracing for the syphilis pa- Belgium and enhancement of STI surveillance systems.

Syphilis epide- miology in Norway, resurgence among men patients, which was due to the frequently anonymous who have sex with men. BMC Infect Dis ,10, Syphilis epidemiol- disclose personal data of sexual contact s. Similar dif- ogy in Sweden: re-emergence since primarily due to ficulties in contact tracing in MSM have been reported spread among men who have sex with men.

Euro Surveill in other international studies 22, Stock- Disease Control in Northern Europe. Available at: www. Mayer J, Brzewski M. In Polish Medical Academy during the years ]. Przegl Dermatol ;67 2 Przegl Epidemiol Przegl Dermatol management of the syphilis outbreak in Hereford- ;71 3 In Polish shire Seksuologia ; Current Mazurkiewicz W, Burkacka E.

BMC Infect Dis ; Seksuologia ; In Polish Przegl Dermatol ;76 2 In Polish Address for correspondence: Agnieszka B. Serwin, M. Department of Dermatology and Venereology pzh. National Institute of Public Health. Infectious diseases Bialystok, Poland and poisonings in Poland annual report. Available at: e-mail: agabser umb. Very high effectiveness of hepatitis B vaccination has been reported in a number of studies worldwide. A number of studies have also confirmed the occurrence of anamnestic response to a booster injection of HB vaccine even after 20 years following primary immunization.

From the numerous studies transpires that cellular response following hepatitis B vaccination persists longer compared to humoral response. Irrespective of gradual decline and loss of anti-HBs antibodies, adequately performed primary immunization in healthy persons ensures long-term protection against acute and chronic stages of hepatitis B. In fact, T and B lymphocytes, whose responsiveness prevails the presence of anti—HBs antibodies in serum, are true markers of immunity.

A special attention should be given to persons with secondary immunodeficiencies or immunosuppressed patients whose immunization against hepatitis B raises difficulties. High risk of HBV infection is also attributed to nasal or injecting drug use as well as sexual contacts Effectiveness of vaccination against hepatitis B has with infected partner. HBV may be also vertically trans- been of interest in the past as well as present times 1.

In Incidence of hepatitis B in Poland decreased sig- , information on it as of the end of 90s of the last nificantly in the last years. At the beginning of 80s, it century was published in the Epidemiological Review amounted to In the present 2.

Since that time, immunogenicity of vaccines and time, its value ranges from 3. Improvement of epidemiological situation results especially in case of persons with immunodeficiencies. Introduction of effec- infection. According to the World Health Organization tive vaccination of the selected groups and then the WHO data, en estimated , persons die annually whole population, however, contributed to such situ- due to the consequences of infection with HBV such ation to the largest extent.

In , Poland joined the as liver cirrhosis or hepatocellular carcinoma HCC. On a blood or other body fluids with broken tissues. A list of basis of this program, newborns were covered by this risk factors of infection with HBV include: medical pro- integrated immunization system. In Poland, primary cedures i. Second dose of primary who received a 4-dose series 0-, 1-, 2-, month series should be given 4 weeks after the first dose while schedule and concomitantly a single dose of hepatitis the third one, complementary to primary vaccination, B immunoglobulin, high percentage demonstrated im- should be given 6 months following the first dose.

A munity, marked by anti-HBs antibody titer at the age of 4-dose series on a 0-, 1-, 2-, month schedule or 0-, 20 years. In 0-,1-,2-,month schedule. In case of antibodies 1 month after the administration of last dose children, this percentage ranges from 0.

In the similar study, conducted in failed immune response to HB vaccine are demographic Thailand, the highest antibody titers was reported not factors age, gender and health behaviours obesity, until 12 month following vaccination 5.

In a number tobacco smoking A separate issue is a group of of studies, long-term immunogenicity was confirmed persons with primary or secondary immunodeficiencies, by eliciting the persistence of anti-HBs antibodies 10, including i. From the marrow recipient, patients with cirrhosis or a history longest observations transpires that of the newborns of liver transplantation, persons infected with HIV, Table I.

Immunization schedule for persons with impaired immunity against hepatitis B and the percentage of persons who responded to vaccination, based on the available data. An expected effect follow- schedules are to be frequently adopted in such patients ing vaccination is the activation of immunity protecting as immune response following vaccination is consider- against infection. A number of observations were con- ably lower.

Due to the multiplicity of disorders, patients ducted with an objective to determine the prevalence with immmunodeficiencies require, i. In study groups, the nization to enhance the immune response rate following prevalence of breakthrough infections was low. These vaccination Table I. Occurrence of achieved Table I ; persons with immunodeficiencies anamnestic response after vaccination is dependent on do not gain long-term immunity against hepatitis B.

According to researchers, higher nomena may be fundamental in responsiveness to percentage of non-responders to booster doses in older HBsAg. From one of the first studies, which was con- persons results from age-related waning of immune ducted by Walker et al. This study initiated research on the vaccination and possibility of effective secondary im- successive stages of immune response to vaccine, i. Due to a number of in vitro experiments, it APC , proliferation of the T cell lines, activation of the was possible to understand the mechanisms of immune T lymphocytes and memory B cells.

Studies conducted memory. Pioneer in this respect was the team presided so far demonstrate that for poor-or non-responders to by van Hattum and Boland In the study group, vaccine, a characteristic feature is a defect of T lym- anti-HBs titers were investigated 10 years following phocytes, which have receptors to recognize HBsAg. Peripheral mononuclear cells were also According to Desombere et al. On a basis of T lymphocyte proliferative response, Leuridan and Van Damme proved the responsiveness From numerous studies conducted so far transpires of B and T lymphocytes to antigens of vaccine in vac- that standard vaccination against hepatitis B with ap- cinated person Similarly, the provides long-term protection in case of adequately presence of memory B cells and anti—HBs-producing vaccinated persons due to immune memory.

Humoral and cellular performed primary immunization - due to long-term immune responses to a hepatitis B vaccine booster 15—18 immune memory - provide life-long protection against years after neonatal immunization. J Infect Dis ; hepatitis B was published. This paper was accepted by —26 9. Immunogenicity of Engerix B vaccine in onstrate very high effectiveness of vaccination against children with risk of hepatitis B infection.

Hepatologia hepatitis B. Irrespective of gradual decline and loss of Polska , 5: 93—8 anti-HBs antibodies, adequately performed primary Two booster dose hepatitis B virus vaccination in patients with leukemia. Leukemia B It suggests that there is no need for periodic Research , —9 testing for anti-HBs each 5 years which recently was a Immuno- routine practice in Poland. In fact, T and B lymphocytes, genicity of recombinant hepatitis B vaccine rHBV in whose responsiveness prevails the presence of anti—HBs recipients of unrelated or related allogeneic hematopoi- antibodies in serum, are true markers of immunity.

A etic cell HC transplants. Safety and efficacy et al. Adv Virol mL do not suggest the lack of immunity. Furthermore, , ID recommendations promoted worldwide suggest more Vaccination against than year-lasting protection against hepatitis B fol- hepatitis B in liver transplant recipients: Pilot analysis of cellular immune response shows evidence of HBsAg- lowing primary immunization Phung BC, Launay O.

Vaccination against viral hepatitis of HIV—1 infected patients. Sprawozdanie z XV spotkania Przegl Epidemiol Kidney Dis Transpl , —91 ; Afsar B. The relationship between erythropoietin resis- 2. Przegl hemodialysis patients. Nephro Urol Mon , 5: —12 Epidemiol ; Genetics of anti- 3.

Zielinski A, Stefanoff P. Herd immunity and effectiveness HBs responsiveness. Transfusion ; of vaccination. Przegl Epidemiol. Characteriza- 4. Gesemann M, Scheierman N. Quantification of hepatitis tion of the T cell recognition of hepatitis B surface antigen B vaccine-induced antibodies as a predictor of anti-HBs HBsAg by good and poor responders to hepatitis B persistence. Vaccine ; —7 vaccines. Clin Exp Immunol ; —9 5. Leuridan E, Van Damme P. Hepatitis B and the need for al.

Long—term anti—HBs antibody persistence following a booster dose. Clin Infect Dis. Jafarzadeh A, Montazerifar SJ. Persistence of anti-HBs of anamnestic response: A 20—year follow—up study in antibody and immunological memory in children vac- Thailand. Hum Vaccin Immunother ; 9: —84 cinated with hepatitis B vaccine at birth. J Ayub Med 6. Differences in bian adolescents vaccinated in infancy and immune response to a hepatitis B vaccine booster dose among response in HBV booster trial in adolescence.

PLoS One Alaskan children and adolescents vaccinated during ; 2: e infancy. Pediatrics ; —81 7. Hepatitis Long-term im- B immunity in children vaccinated with recombinant munogenicity of hepatitis B vaccination in a cohort of hepatitis B vaccine beginning at birth: a follow—up study Italian healthy adolescents. Vaccine ; —32 at 15 years. Determination of World J Gastroenterol ; —3 Bauer T, Jilg W.

Hepatitis B surface antigen-specific T Received: Vaccine ; —7 Address for correspondence: Hepatitis Warsaw B vaccination: a completed schedule enough to control Tel. An analysis of HPV vaccination strategies and vaccination coverage in adolescent girls worldwide for the last eight years with regard to potential improvement of vaccination coverage rates in Poland. Literature search, covering the period —, was performed using Medline. Comparative analy- sis of HPV vaccination strategies and coverage between Poland and other countries worldwide was conducted.

In the last eight years, a number of countries introduced HPV vaccination for adolescent girls to their national immunization programmes. Usually, there are also disparities at national level. The highest HPV vaccination coverage rates are observed in countries where vaccines are administered in school settings and funded from the national budget.

Poland is one of the eight EU countries where HPV vaccination has not been introduced to mandatory immunization programme and where paid vaccination is only provided in primary health care settings. HPV vaccination coverage in adolescent girls is estimated at 7. Disparities in HPV vaccination coverage rates in adolescent girls worldwide may be due to different strategies of vaccination implementation between countries.

Having compared to other countries, the low HPV vaccination coverage in Polish adolescent girls may result from the lack of funding at national level and the fact that vaccines are administered in a primary health care setting. A multidimensional approach, involving the engagement of primary health care and school personnel as well as financial assistance of government at national and local level and the implementation of media campaigns, particularly in regions with high incidence of cervical cancer, could result in an increase of HPV vaccination coverage rates in Poland.

Infections with HPV are prevalent ma-viridae family. HPV infects the cells of the basal in both females and males aged years. Up to layer of epithelium or mucous membranes of epidermis. Of HPV at least once in their lifetime 1,2. The majority of cervi- 33, 35, 39, 45, 51, 52, 56, 58 and non-oncogenic 1, 2, cal cancer cases are attributed to high-risk HPV types, 3, 4, 6, 7, 10, 11, 40, 42, 43, 44, 54, 61 1,2.

They are also associated with An estimated million persons are infected with serious complications in males, including cancers of HPV worldwide. Approximately thousands new penis, anus and genital warts 2,4. For example, since HPV infections occur every year 2,3. These tries. Epidemiological data vary substantially between HPV types can also cause malignant oropharyngeal neo- geographical regions. A significant population risk is plasms and recurrent respiratory papillomatosis 2,6.

For females that compared to HCV and liver cancer 1. Due persons tested up to 4 years after vaccination 1. Vaccines against HPV. Analysis of data on HPV vaccination strategies in His discovery enabled the creation of vaccines against Poland and worldwide was performed, based on litera- 4 types of HPV 8. Vaccination coverage rates and vaccination 18, Cervarix GlaxoSmithKline Biologicals , a bivalent financing systems in particular countries were subject vaccine against 16 and 18 types and Gardias Merck to comparative analysis.

Sharp Dohme against 6,11,16,18 types 2,9. Since , HPV vaccines quadrivalent vaccines girls aged 11—12 years and a catch-up vaccination for — Silgard, Gardias and bivalent vaccine — Cervarix those at the age of 13—18 as well as persons who are were licensed in more than countries while 6 years not yet sexually active 10, It should be noted that later they were introduced to national immunization vaccinated persons should also undergo cytology-based programmes in at least 40 countries Percentages screening.

Immunogenicity studies in young females vac- Fig. Estimated HPV vaccination coverage in adolescent girls in selected countries based on medical literature review. No 1 HPV vaccination strategies 55 Australia. Australia was the first country worldwide HPV vaccination is provided within the public health which in introduced HPV vaccination free of care system, even at times of economic crisis In , a catch-up pro- South America.

It prompted local authorities to bear implemented. Vaccination for younger adolescents is the costs of HPV vaccination from public resources. The would be vaccinated against HPV. North America. At the end of , HPV vacci- HPV vaccination coverage rates in adolescents nation started to be funded by the government of the in other South America countries are also high with United States.

In Brazil, the Ministry of Health approved the was reported in persons aged years and living introduction of quadrivalent vaccine in , however, in north-eastern states. HPV informa- tor. Wide-spread implementation of HPV vaccination tion is mainly disseminated by media campaigns High vaccination coverage rates may be Since , HPV is also recommended for males at the achieved by providing vaccination in schools which are age of years.

Irrespective of the similarities regard- enrolled into school-based immunization programme as ing vaccination funding between the United States and well as gradual vaccinating girls who were not subject Canada public resources , vaccination coverage rates to primary vaccination schedule Parents are provided Africa. In many regions of Africa, cervical cancer with information on HPV vaccination for children by is the most prevalent cancer in females 1. Low- and means of school-based education. Disparities in vacci- middle-income countries frequently meet serious nation coverage rates in adolescent girls results mainly obstacles in introducing new vaccines to national im- from the fact that girls from less affluent districts cannot munization programmes.

A total of communities of the lowest Uganda is one of the countries selected to be en- human development index, classifying as areas of the rolled into the PATH. Asian countries succeeded in achieving high Central America. Haiti is one of such countries. Little interest in vaccination among parents results from the lack of adequate information on HPV infection Europe. Countries which first introduced HPV vac- and its association with cervical cancer that should be cination in were: Belgium, France and Germany.

Poland, as well as covered by patients, free of charge or co-financed from Cyprus, Estonia, Finland, Hungary, Lithuania, Malta public resources with regard to adolescents and adult and Slovakia, belongs to EU countries which have not females in European countries result in disparities introduced HPV vaccination to mandatory immuniza- between vaccination coverage rates. The highest vac- tion programmes Such a fact should raise concerns, cination coverage rates are reported in Western Europe especially while collated with data on cervical cancer and Scandinavia.

For example, in Sweden, where a incidence. In , it was diagnosed in 3, females, school-based immunization programme was introduced, of whom 1, died In Italy, where immunization programmes in low acceptance of HPV vaccination among parents are planned locally, the vaccination coverage rate in and their adolescent children. HPV vaccines are funded from public resources enables to formulate recommendations which could exclusively in Romania.

In several countries, vaccines enhance HPV vaccination coverage rates in Polish ado- are provided within school-based health protection lescents and young females. Analysis of costs suggests programmes while in others vaccines are administered that school-based HPV vaccination in adolescent girls in health care units, including fully paid vaccines.

Vac- is the most cost-effective Experiences of a number cination coverage rates in these countries range from a of countries demonstrate that such a strategy ensures few to several percent Having referred to HPV national immunization programme for girls aged vaccination, it was demonstrated that compared to a years.

The Expert Committee, appointed on the initiative school-based programme, such a strategy incurs higher of the PPS Polish Pediatric Society in , recom- costs 11 , i. To obtain high vaccination coverage who have not been vaccinated previously The rates, it is necessary to initiate multidimensional ac- cost of vaccine is entirely covered by the patient. No tions, with engagement of local medical personnel and national register of HPV vaccinations operates.

HPV the government sector as well as with the use of media vaccination in adolescents is provided free of charge campaigns. Such campaigns aimed at motivating parents exclusively within programmes financed by local au- to vaccinate their children against HPV are effectively thorities 12,25, On the other Its cost was estimated at nearly PLN 33 million In Poland, parents could be educated by Results of our study demonstrate that 7.

Educational programme on cervical cancer and were vaccinated against HPV in in Zgorzelec No 1 HPV vaccination strategies 57 HPV prevention for secondary school students, which of vaccination coverage rates 22, Such actions are is performed in several provinces in cooperation with especially recommended in areas where there is high i. It may be presumed that stations and Education Offices, should be considered covering the cost of vaccination in case of the groups as an initiative in the right direction.

Within the frame- of the lowest income would lead to an increase in the work of this programme, teachers are offered training. Medical personnel should be able to inform on the SUMMARY safety of vaccination and present health-related risks for unvaccinated persons It was demonstrated that 1. Disparities in HPV vaccination coverage rates in general practitioners GPs play a significant role in ac- adolescent girls worldwide result mainly form dif- tions directed at enhancing HPV vaccination coverage ferent strategies of HPV vaccination implementation rates 11,29, Thus, GPs should be a target group of adopted in particular countries.

Consequently, they would become 2. Compared to other countries, low HPV vaccination an important element of prevention against HPV infec- coverage rate in adolescent girls in Poland may result tion. Not only GPs, but also other medical specialities, from the fact that it is not funded from the national including paediatricians, gynaecologists and midwifes, budget and is provided only in primary health care should be aware of the importance of recommending settings.

Increase in HPV vaccination coverage rate could It is not simply young persons who should be be achieved through multidimensional actions with provided with information by medical personnel, but the engagement of primary health care personnel, also their parents, especially those who do not have schools and the financial assistance of governmen- access to other information sources as well as those for tal sector at national and local level and the use of whom stress resulting from visiting GP precludes ask- media campaigns, especially in areas of the highest ing questions.

Having considered the fact that patients cervical cancer incidence. It could be of benefit to introduce a centralized elec- tronic database, including information on administered 1. Rak szyjki macicy. Profilaktyka, diagnostyka i leczenie.

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