Ernest Kuchar

Influence of Rapid Influenza Test on Clinical Management of Children Younger than Five with Febrile Respiratory Tract Infections

Children are an important vector for spreading influenza and they are at increased risk for complications. The appropriate diagnosis of influenza may help start early antiviral treatment and may optimize the use of antibiotics and additional laboratory tests. The objective of this study was to describe the influence of rapid influenza detection test (RIDT) on clinical management of children with acute febrile respiratory tract infections. The method consisted of a prospective, open, cohort study conducted in three primary care clinics in Warsaw, Poland, during the epidemic influenza seasons of 2009/2010 and 2010/2011. A total number of 256 children of the age 0-5 years with symptoms of febrile respiratory tract infection were enrolled into the study. A 115 of them were tested with RIDT (BD Directigen EZ FluA + B) and another 141 children, who were not tested, constituted a control group. We found that RIDT gave positive results in 35 (30%) out of the 115 tested children. Antibiotics, additional blood tests and urinalysis were administered more often in the control group compared with the rapid test group (16% vs. 7%; 14% vs. 5%, and 47% vs. 32%, respectively). Chest radiograms were made only in six cases of children from the control group. We conclude that in children with symptoms of acute febrile respiratory tract infection, the rapid influenza detection test provides a rational use of antivirals, reduces an inappropriate use of antibiotics, and decreases a number of additional tests conducted.

A review of guidance on immunization in persons with defective or deficient splenic function

The spleen acts as a blood filter and lymphopoietic organ. Asplenic and hyposplenic individuals are more susceptible to serious infections caused by encapsulated bacteria but they can be protected by antibiotic prophylaxis and immunizations. Recent progress in vaccinology means prophylaxis is now successful in the vast majority of serious infections with pneumococci, meningococci and Haemophilus influenzae type b responsible for the majority of cases of overwhelming sepsis in asplenic patients. Current guidelines are coherent. Physicians treating patients with conditions associated with hyposplenism are ethically obliged to immunize their patients using the vaccines currently available to protect them from largely preventable, life‐threatening infections.

Liver steatosis in Polish children assessed by medicolegal autopsies

BackgroundCases of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are increasing in the pediatric population. Their growing prevalence coincides with the obesity epidemic. Assessment of the incidence requires liver biopsies on a representative population sample, which are hampered by the absence of indications for invasive examination on children without clinical symptoms. The aim of the current study was to assess the incidence of liver steatosis in the population of children up to 18 years old from Lower Silesia.MethodsWe retrospectively reviewed 342 medico-legal autopsy reports from 2000 to 2009. We separated a group of 256 children whose death was caused by trauma. Liver steatosis was diagnosed according to the results of histopathological examinations and typical macroscopic imaging.ResultsIn the 265 children who died from trauma, liver steatosis was reported in 11 (4.2%) children (6 boys) aged between 6 months and 18 years old. Six of the 11 children (54.5%) were found to be overweight. In all 342 children, steatosis was found in 18 (5.3%) children (13 boys), while NASH was diagnosed in 1 (0.3%). Excess body weight was observed in 55.6% (10/18) of children with steatosis.ConclusionsLiver steatosis can occur at any age, even in infancy. Being overweight is a very important risk factor. Gross examination of the liver is insufficient for the diagnosis of steatosis because of its lower sensitivity and specificity. Verification of liver steatosis requires reference histopathological examination.

Epidemiological and immunological reasons for pertussis vaccination in adolescents and adults

The resurgence of pertussis has been the subject of considerable debate. Hypotheses to explain increased reporting in developed countries have focused mainly on three aspects: (1) increased recognition of the disease in adolescents and adults; (2) waning of vaccine-induced immunity and (3) loss of vaccine efficacy due to an antigenic shift of Bordetella pertussis. Waning immunity after vaccination or natural infection combined with the absence of regular boosters either in the form of vaccine boosters or natural exposure to B. pertussis - due to the low circulation of the bacterium in well-immunized populations - has been suggested to explain this shift in the age distribution of pertussis. The highest incidence of the disease is currently reported among adolescents and adults who may additionally serve as the source of infection for susceptible infants. Immunological and epidemiological data indicates the need for a universal booster vaccination against pertussis for adolescents and adults.

Influenza vaccine coverage among children under the age of 5 years in Poland during 2004-2008.

IntroductionInfluenza is a considerable health problem all over the world. The most important group for influenza vaccination are children: the highest attack rate during community out-breaks of influenza can be found among school-aged children or their family members; children bear a considerable risk for complications due to influenza, leading to an increased need for healthcare resources (including hospitalization). The high level of vaccine coverage among school children could provide protection against influenza among households and could reduce mortality rates among older individuals.ObjectiveThe aim of this study was to estimate the influenza vaccine coverage among children younger than 5 years and to find any trends in influenza vaccine coverage in 2004-2008 in Poland.Material and methodsOfficial data (number of administrated vaccines and the age of vaccinated individuals) collected by the National Institute of Hygiene, the National Institute of Public Health, and the Central Statistical Office in Poland were analyzed. This data are reported by physicians and collected from reports prepared annually by the Sanitary-Epidemiological Stations at a local level. The vaccine coverage rate was calculated as a percentage of vaccinated individuals among all children under the age of 5 years.ResultsThe influenza vaccine coverage among children younger than 5 years varied from 1% (2007 and 2008) to 1.9% (2005). The proportion of vaccinated children aged less than 5 compared with the total number of flu shots administrated irrespective of age also varied from 1.4% (2007) to 2% (2005).ConclusionsThe influenza vaccination coverage among Polish children aged less than 5 years is low and has persisted at the same level. More educational activities directed both to patients (parents) and healthcare workers would be needed to improve a general knowledge about influenza vaccination benefits among young children.

Antibiotic Consumption Pattern in the Neonatal Special Care Unit Before and After Implementation of the Hospital’s Antibiotic Policy

Current and detailed knowledge of antibiotic use is essential in order to implement strategies for reducing the overuse of antibiotics. The objective of our study was to determine the effectiveness of the implementation of the hospital antibiotic policy (HAP) by assessing antibiotic consumption in the Special Neonatal Care Unit (SNCU) in Warsaw, Poland, before and after this intervention. Antibiotic use was calculated in daily defined doses (DDDs) per 100 patient-days and DDDs per 100 admissions. The antibiotics were ranked by volume of DDDs and the number of antibiotics, which accounted for 90 % and 100 % of the total volume, respectively: DU90% and DU100% (where DU stands for drug use). Total antibiotic consumption increased slightly after the introduction of the HAP: the total DDDS was 707.87 and 753.12 in 2011 and 2012, while the number of DDDs/100 admissions was 352.17 and 369.12 in 2011 and 2012, respectively. After the introduction of the HAP, an increase in ampicillin and aminoglycoside use was observed, along with a reduction in the DU100% and DU90% rates (15 vs. 9 and 4 vs. 3, respectively). The introduction of the HAP resulted in changes in antibiotic consumption patterns, but the general antibiotic consumption density remained the same.

Nosocomial rotavirus gastroenterocolitis in a large tertiary paediatric hospital in Warsaw, 2006-2010.

Introduction Rotaviruses are the leading cause of community-acquired and nosocomial gastroenterocolitis in children. There are limited data concerning the epidemiology of nosocomial rotavirus gastroenterocolitis (NRVG) in Central European countries, including Poland. The aim of our study was to analyse the epidemiology of NRVG in a large tertiary hospital in Warsaw. Material and methods We analysed retrospectively data of 63 173 patients aged 0-18 years hospitalized in the period 2006-2010. Nosocomial rotavirus gastroenterocolitis was defined as acute gastroenterocolitis (> 3 loose, or looser than normal, stools in 24 h and/or vomiting), confirmed with rapid immunochromatographic test (BioMaxima, Poland), if symptoms developed > 48 h after admission. Results In total 575 cases of NRVG were diagnosed. The cumulative attack rate of NRVG was calculated as 0.91% (95% CI: 0.85-0.98%). The incidence density was 2.05/1000 bed-days (95% CI: 0.19-0.22/1000 bed-days). The mean proportion of NRVG among all rotavirus infections was 24%. The highest rates of NRVG were noted at wards where the mean duration of hospital stay was longer than 5 days (General Paediatrics and Neonatal Pathology). Seventy-one percent of children with NRVG were younger than 2 years. The mean duration of hospital stay of children with NRVG was longer than the average duration of hospitalization (11.6 days vs. 4.6 days, p < 0.01). Conclusions Our study showed a relevant incidence of NRVG, which can prolong the childrens hospital stay. Limiting the number of NRVG is important to improve patients’ safety and to avoid additional costs. Routine vaccination against rotavirus diseases could reduce the number of NRVG.

Implementation of Hospital's Antibiotic Policy Decreases Antimicrobial Use in the General Pediatric Ward.

Hospitalized children are often treated with antibiotics. However, 30-75% of antibiotic treatment in pediatric hospitals is administrated incorrectly or unreasonably. Implementation of Hospitals Antibiotic Policy (HAP) should improve antibiotic consumption patterns in pediatric wards. The objective of this study was to determine the effectiveness of HAP by assessing antibiotic consumption in the General Pediatric Ward of an academic hospital in the city of Warsaw, Poland before and after this policy was introduced in the years 2012 and 2013, respectively. Antibiotic use was calculated in daily-defined doses (DDDs) per 100 patient-days and DDDs per 100 admissions. Antibiotics were ranked by the volume of DDDs and the number of antibiotics which accounted for 90% and 100% of the total volume: DU90% and DU100% (where DU stands for drug use). The total antibiotic consumption and significantly decreased after the implementation of HAP; DDDs were 2,177.5 before and 1,335.4 after implementation of HAP. The number of DDDs/100 patient-days was also lower; 36.3 vs. 24.9 before and after HAP, respectively. After implementation of HAP a decreased use of ceftriaxone and cefuroxime was observed. The most commonly used antibiotic was amoxicillin with clavulanic acid. The DU100% rates remained the same (8 antibiotics) and DU90% increased (from 3 in 2012 to 5 in 2013). We conclude that implementation of HAP resulted a decreased consumption of antibiotics in the General Pediatric Ward, despite the hardly changed number of children treated with antibiotics.

Influenza Immunization Rates in Children and Teenagers in Polish Cities: Conclusions from the 2009/2010 Season

The aim of this study was to determine influenza vaccine coverage among children aged 0-18 years in inner city practices in Poland in the 2009/2010 season and factors that might have influenced low vaccination coverage. A retrospective review of 11,735 vaccination charts of children aged 0-18 from seven randomly selected general practices in the capital city of Warsaw and one large practice in the city of Wroclaw was performed. We calculated the numbers of children who were vaccinated in the 2009/2010 season and analyzed the age distribution of vaccinated children. We also reviewed the vaccination history in patients who were vaccinated against influenza including: previous influenza vaccinations, modification (widening) of standard immunization scheme, and a proportion of children who completed the recommended two-dose schedule of vaccination. In the calculations, 95% confidence intervals were used. Out of the total of 11,735 children surveyed, 362 (3.1%, CI: 2.8-3.4%) were vaccinated against influenza in the 2009/2010 season. For 115 of these 362 (31.8%, CI: 27.0-36.6%) children it was their first vaccination against influenza. The mean age of a vaccinated child was 6.0 ± 4.3 years. Children aged 2-5 were most commonly vaccinated (153/362, 42.3%, CI: 37.2-47.4%), while infants (aged 6-12 months) were vaccinated rarely (15/362, 4.4%, CI: 2.2-6.2%). In the group of children younger than 8 years (86/362 children) who were vaccinated for the first time in their life only 29/86 (33.7%, CI: 23.7-43.7%) completed the recommended two-dose schedule. In conclusion, the importance of vaccinating children against influenza is hugely understated in Poland. General physicians should actively recommend annual influenza immunization of children. Recommendations of National Immunization Program concerning influenza vaccine should be clearer, simpler, and easier to implement.

Influenza vaccination: key facts for general practitioners in Europe—a synthesis by European experts based on national guidelines and best practices in the United Kingdom and the Netherlands

Currently there is no influenza vaccination guidance for European general practitioners. Furthermore, although the European Council recommends a target seasonal influenza vaccination rate of 75% in the elderly (65 years and above) and in anyone aged >6 months with a chronic medical condition, there remain wide discrepancies throughout Europe. A harmonised guideline regarding not only vaccination strategy but also for the consistent diagnosis of influenza across Europe is essential to support a common approach for the implementation of seasonal influenza vaccination across Europe. This document is based on pre-existing guidelines available in the UK and Netherlands and has been approved by a group of European experts for use throughout Europe. As well as providing a standardised influenza diagnosis, it also reviews the current recommendations for influenza vaccination, the types of vaccine available, the contraindications, vaccine use in special populations (in pregnancy, children, and in those with egg allergy), and concomitant administration with other vaccines. The effectiveness, safety, and timing of the seasonal influenza vaccine are also reviewed. A second section provides practical guidance for general practitioners for the implementation of a seasonal influenza vaccination program, including the selection and notification of those eligible for vaccination, as well as suggestions for the organisation of a vaccination programme. Finally, suggested responses to common patient misconceptions and frequently asked questions are included. The aim of this article is to harmonise the diagnosis of seasonal influenza and the approach of European general practitioners to seasonal influenza vaccination in order to better identify influenza outbreaks and to move towards reaching the target vaccination rate of 75% throughout Europe.