Henrieta Hudeckova

Immunogenicity and reactogenicity of a novel hexavalent DTPa-HBV-IPV/Hib vaccine compared to separate concomitant injections of DTPa-IPV/Hib and HBV vaccines, when administered according to a 3, 5 and 11 month vaccination schedule.

Abstract. In an open randomised trial, 312 eligible infants were enrolled to receive either a single injection of the hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B virus-inactivated polio/Haemophilus influenzae b (DTPa-HBV-IPV/Hib) vaccine, or concomitant injections of commercial DTPa-IPV/Hib and HBV vaccines (comparator). Vaccines were administered at 3, 5 and 11 months of age. The statistical approach for non-inferiority showed that the DTPa-HBV-IPV/Hib vaccine was at least as immunogenic as the comparator vaccines in terms of immunogenicity of all antigens 1 month after the 2nd dose. Non-inferiority criteria were also met immediately before and 1 month after the 3rd dose for all antigens except poliovirus type 3 prior to the 3rd dose. The majority of subjects were seroprotected against diphtheria, tetanus, polyribosyl-ribitol-phosphate, hepatitis B and poliovirus after the 2nd dose and maintained seroprotective antibody levels until the 3rd dose. A marked difference was observed in anti-HBs antibody geometric mean antibody concentrations (GMCs) at 1 month after the 2nd dose (higher GMCs in DTPa-HBV-IPV/Hib group). Reactogenicity (incidence of solicited local and general symptoms) was similar between the two study groups and no vaccine-related serious adverse events occurred. Conclusion: the new diphtheria-tetanus-acellular pertussis-hepatitis B virus-inactivated polio/Haemophilus influenzae b vaccine administered at 3, 5 and 11 months of age was safe and at least as immunogenic as the comparator vaccines thus providing an effective and more comfortable option for this infant vaccination schedule.

Costs analysis of the treatment of imported malaria

BackgroundTo document the status of imported malaria infections and estimate the costs of treating of patients hospitalized with the diagnosis of imported malaria in the Slovak Republic during 2003 to 2008.Case studyCalculating and comparing the direct and indirect costs of treatment of patients diagnosed with imported malaria (ICD-10: B50 - B54) who used and not used chemoprophylaxis. The target sample included 19 patients diagnosed with imported malaria from 2003 to 2008, with 11 whose treatment did not include chemoprophylaxis and eight whose treatment did.ResultsThe mean direct cost of malaria treatment for patients without chemoprophylaxis was 1,776.0 EUR, and the mean indirect cost 524.2 EUR. In patients with chemoprophylaxis the mean direct cost was 405.6 EUR, and the mean indirect cost 257.4 EUR.ConclusionsThe analysis confirmed statistically-significant differences between the direct and indirect costs of treatment with and without chemoprophylaxis for patients with imported malaria.

Tick-borne encephalitis and golden agers: position paper of the International Scientific Working Group on Tick-borne encephalitis (ISW-TBE).

ZusammenfassungEines der Hauptziele der 11. Jahrestagung der International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE) im Jahr 2009 war es, die erste Aktualisierung des Positionspapiers zur Frühsommer-Meningoenzephalitis (FSME) in der 50-plus-Generation auszuarbeiten und die wichtigsten Aspekte der Erkrankung in dieser Altersgruppe zusammenzufassen. Die Morbidität infolge FSME ist auch in der letzten Jahren weiter angestiegen, wofür ein Zusammenspiel zwischen sozialen, politischen, ökologischen, ökonomischen und demographischen Faktoren in Kombination mit dem Klimawandel verantwortlich gemacht werden. Die 50-plus-Generation von heute ist gesünder und mobiler, führt einen aktiveren Lebensstil und verbringt einen Gutteil ihrer Zeit mit Reisen und Freizeitaktivitäten im Freien. Dies erhöht auch ihr Infektionsrisiko. Dabei kommt es mit zunehmendem Alter zu einer quantitativen und qualitativen Schwächung der angeborenen und erworbenen Immunität, weshalb ältere Personen anfälliger für Infektionen und schwerere Krankheitsverläufe sind als jüngere Menschen. Auch die Immunreaktion älterer Personen auf Impfungen ist in der Regel langsamer und die erreichten Antikörperkonzentrationen sind niedriger und sinken früher als im jüngeren Lebensalter. Laufend belegen Studienergebnisse, dass dies auch für die FSME-Impfung zutrifft. Dies unterstreicht, wie wichtig es ist, die erste FSME-Auffrischungsimpfung in dieser Altersgruppe wie empfohlen spätestens 3 Jahre nach Abschluss der Grundimmunisierung durchzuführen, eventuell sogar früher. Gleichzeitig allerdings zeigen jüngste Studienergebnisse auch, dass die Wirksamkeit der FSME-Impfung in der breiten Anwendung über 97 % liegt und zwischen verschiedenen Altersgruppen keine signifikanten Unterschiede vorliegen.SummaryOne of the primary goals of the 11th Annual Meeting of the International Scientific Working Group on Tick-borne encephalitis (ISW-TBE) held in 2009 was to develop the first update of the Position Paper on TBE in Golden Agers, summarizing the most essential aspects of the disease in this age group. TBE morbidity has continued to increase in recent years, which is thought to be due to an interplay of social, political, ecological, economic and demographic factors combined with climate changes. Todays golden agers i.e. individuals aged 50 years or above, are healthier and more mobile, lead more active lifestyles and spend more time travelling and performing outdoor leisure activities. This places them at an increased risk of infection. At the same time, increasing age is associated with a quantitative and qualitative decline in innate and adaptive immunity, which is why elderly individuals are more susceptible to infection and severe disease than younger people. Also, their response to vaccination tends to be slower, antibody titres generally reach lower levels and titres tend to decrease earlier than in younger individuals. Evidence is accumulating that this is also the case with TBE vaccination, emphasizing the importance of administering the first TBE booster vaccination no later than 3 years after the completion of primary immunization or at an even shorter interval. Encouragingly, recent data have shown that the field effectiveness of TBE vaccination exceeds 97%, with no significant differences between age groups.

Validation of the Slovakian version of the P-QOL questionnaire

Introduction and hypothesisThis study aimed to validate the Slovakian version of the prolapse quality-of-life (P-QOL) questionnaire.MethodsThe P-QOL questionnaire was translated into the Slovakian language and administered to women recruited from a urogynecology outpatient clinic at a tertiary referral teaching hospital. After completing a questionnaire, all women were examined in supine position using the Pelvic Organ Prolapse (POP-Q) Quantification system. The reliability was assessed by using a 2-week test–retest analysis.ResultsFifty symptomatic and 79 asymptomatic women were included. The score of P-QOL was strongly correlated with the vaginal examination findings among the symptomatic group (p < 0.001 in eight domains). P-QOL domain scores were significantly different between symptomatic and asymptomatic women. The test–retest reliability confirmed a highly significant correlation between the total scores for each domain (p < 0.001).ConclusionThe Slovakian version of the P-QOL questionnaire is a valid, reliable, and easily comprehensible instrument to assess quality of life of women with uterovaginal prolapse.

Skeletal fluorosis from the point of view of an occupational exposure to fluorides in former Czechoslovakia

Skeletal fluorosis from the point of view of an occupational exposure to fluorides in former Czechoslovakia Electrolytic production of aluminium in former Czechoslovakia started in the year 1953 in the Žiar valley in the central Slovakia. However, till 1995 the hygienic conditions for health protection were not met in the factory. It underwent a reconstruction afterwards. The authors demonstrate cases of occupational skeletal fluorosis (currently rare in Europe) in 14 metallurgists which were all disclosed in foundry workers in Žiar nad Hronom as to the year 2005. The occupational disease was diagnosed after 17.7 ± 7.67 years (x ± SD) of exposure in the foundry. The authors describe the clinical conditions, haematological and biochemical tests (decreased level of ionising calcium was found in serum). The content of fluorides in urine was increased (254.4 ± 130.95 μmol/l). The average age of patients at the time of recognition of the professional etiology of the disease was 57.93 ± 7.95 years. Eight patients were older than 60 years. Skeletal abnormalities were evaluated by using X-ray skiagraphy, estimating the Stage I-III of the skeletal fluorosis. Typically an increase of bone density was found, the compact part of long bones was coarsed, there were calcifications of the interosseous membrane between radius and ulna and some ossifications of the sacrospinal and sacrotuberous ligaments. Twelve patients suffered sensorimotor polyneuropathy of extremities, chronic bronchitis was found in 6 patients (two of them were smokers). The last occupational case was registered in the year 2001. The authors assume that aluminium production with modern technology of better safety and protection of health of workers is the key which will make the skeletal fluorosis the history in the Czech and Slovak Republic.

NATIONAL ANALYSIS OF BACTERIAL MENINGITIS IN SLOVAKIA, 1997-2007

Public Health Reports / January–February 2010 / Volume 125  129 This article by Hudeckova et al. provides a very interesting look at causation and disease patterns of bacterial meningitis in Slovakia, a small country of about five million people with one of the fastest-growing economies in Eastern Europe. The authors were able to analyze and compare retrospectively the mortality and morbidity rates of bacterial meningitis during two periods of time: 1997–2001 and 2002–2007. This analysis was facilitated by the requirement for obligatory vaccination of infants against invasive infections caused by Haemophilus influenzae type b (Hib) in 2000. This “natural experiment” provided evidence of the value of comprehensive and obligatory vaccination programs. As the authors note, the improvement of the epidemiologic situation of bacterial meningitis caused by Hib was seen most dramatically in children younger than 4 years of age—in other words, those who are most susceptible to this pathogen. Their results follow findings in other developed countries. In 2003, Sáez-Llorens and McCracken found that the beginning of this millennium has witnessed the virtual disappearance of Haemophilus invasive disease in some countries, emergence of pneumococcal strains that are resistant to multiple antibiotics, isolation of pneumococci with tolerance to vancomycin, outbreaks and clusters of meningococcal meningitis in several geographic areas, and intense research in the development of effective conjugate pneumococcal and meningococcal vaccines.1 In April 2009, British Department of Health Director of Immunization David Salisbury commented that since the Hib vaccine was introduced in 1992, cases of bacterial meningitis have dropped by 99%—from about 800 cases a year to a record low of 12 cases in 2008 in children younger than 5 years of age.2 The work reported from Slovakia and other locations reinforces the importance of basic public health measures in improving the overall quality of life for a particular country’s citizens. In Slovakia and many other locations, Hib is the leading cause of bacterial meningitis and other invasive bacterial disease among children younger than 5 years of age. Mark Gregory Robson, PhD, MPH Dean of Agricultural and Urban Programs Rutgers, The State University of New Jersey, New Brunswick, New Jersey

Analysis of the direct and indirect costs of treatment of imported malaria in the Slovak Republic

This study analyzed the approximate cost of treatment of patients hospitalized with a diagnosis of imported malaria in Slovakia. Between 2003 and 2007, 15 patients with imported malaria were hospitalized. The mean direct cost of the treatment was 970.75 euros and the mean indirect cost was 53.15 euros. For the patient with the highest cost of treatment, the use of mefloquine prophylaxis would have represented only 0.5% of the total direct cost of treating the disease. Despite the partial resistance of plasmodia, malaria chemoprophylaxis is unequivocally a cheaper choice than subsequent treatment of malaria.

Comparison of chromosomal aberrations frequency and polymorphism of GSTs genes in workers occupationally exposed to cytostatics or anaesthetics

Comparison of chromosomal aberrations frequency and polymorphism of GSTs genes in workers occupationally exposed to cytostatics or anaesthetics Authors compared the incidence of chromosomal aberrations (CAs) of workers occupationally exposed to cytostatics (group EXP1) or anaesthetics (group EXP2) in relationship to polymorphism of GSTM1, GSTP1 and GSTT1 genes. The cytogenetic analysis for chromosomal aberrations frequency and for polymorphisms of genes the PCR and PCR-RFLP method were used. Statistically higher frequency of total CAs was detected in both exposed groups: group EXP1 1.90±1.34%; Mann-Whitney U-test, p=0.001; group EXP2 2.53±1.46%, p=0.0008) as compared to control (1.26±0.93%). In group EXP2 was detected statistically higher frequency of aberrations CSA-type as compared to CTA-type. In xenobiotic metabolizing genes for GST higher frequency of total CAs and constituent types chromatid-type aberrations (CTAs) and chromosome-type aberrations (CSAs) of genes GSTM1 and GSTT1 with null genotype was detected. Statistically significant difference was detected only in CSA-type of aberrations in GSTT1 gene. In gene GSTP1 was not detected any difference in frequency of aberrations in presence of the variant allele. Presented results point out importance of individual susceptibility in evaluation of genotoxic agents of anaesthetics or cytostatics.

Estimation of the Population Susceptibility against Measles in Slovakia

OBJECTIVE In Slovakia, thanks to a highly effective vaccination programme, no domestic cases of measles have been reported since 1999. However, there are several outbreaks of measles currently hitting some countries in Europe. Difficulties in reaching the goal of measles elimination make it necessary to monitor the status of the population susceptibility to prevent similar outbreaks in the future. We hypothesize that immunity wanes overtime, which can substantially impact the population susceptibility. This work introduces a model that estimates a proportion of individuals susceptible to measles in the Slovak population in 2015. METHODS Our analysis is based on an age-cohort model that incorporates waning immunity, vaccination schedule and changes in demographic structure. The inputs of the model are data on the vaccination coverage, last seroprevalence survey in 2002 and age structure of the population. RESULTS In a short-term horizon, waning immunity does not affect the estimated proportion of the susceptible population. However, in a long-term horizon, the antibody titers can fall below the level of protection, which would result in a substantial transfer of initially immune individuals to the compartment of the susceptible ones. Incorporating of waning immunity in the cohort model has indicated that the most susceptible cohorts are not-vaccinated youngest children and cohorts born between 1969 and 1986. CONCLUSIONS Applying the model to the current situation shows that people aged 30-45 years and unvaccinated infants represent the most susceptible groups. Model partially replaces missing seroprevalence survey, but, because the parameters of model and phenomenon of waning immunity are not exactly known, we suggest reintroducing the regular national serosurveys in order to empirically determine the level of susceptibility for measles in Slovakia.

Nanomaterials - a New and Former Public Health Issue. the Case of Slovakia

Nanoparticles exist for a long time as both inorganic and organic parts of nature. Recently, massive expansion of nanotechnologies is evidenced, together with intentional production of new nanoparticles which have not been in contact with living organisms until now. Besides obvious positive aspects, potential threats related to their exposure should be taken into consideration. Unique physical-chemical properties of nanoparticles cause a high bioactivity following their intake (through air, ingestion and skin) and unrestricted spread in exposed organs. Primary effects of nanoparticles on cellular level represent oxidative stress and reactions leading to apoptosis, autophagocytosis and necrosis. Number of studies indicating contribution of nanoparticles to numerous disorders has been recently increasing. However, detailed mechanisms of health effects are not well known. Similarly, there is insufficient information on life cycle of nanoparticles in the environment. Research in this field as well as legislation is behind rapid development and use of nanotechnologies. Considering absence of mandatory exposure limits and other protective measures, nanomaterials represent a potential threat for population health. Recommendations and guidelines of international institutions can contribute to deal with situation, however, passing of effective legislation both on national and European level is urgently needed.