Surveillance of hantaviruses in Poland: a study of animal reservoirs and human hantavirus disease in Subcarpathia.

The first cluster of hemorrhagic fever with renal syndrome (HFRS) in Poland was identified in 2007 in the Subcarpathian region. The natural environment of this area is a key habitat for hantavirus vectors. The animal reservoir of existing human HFRS clusters was studied to assess the occurrence of viruses (including Tula virus, Puumala virus, and Dobrava-Belgrade virus) among rodents. We examined 70 suspected human cases with symptoms corresponding to the clinical picture of HFRS. Serological analysis (indirect immunofluorescence assay and immunoblot) confirmed the presence of anti-hantavirus antibodies in 18 patients, which were surveyed with regard to developed symptoms and presumed rodent contact. Seroepidemiological analysis of newly confirmed human cases was performed, putative areas of human exposure were studied, and 194 rodents were subsequently captured from identified areas. Internal organs (lungs, heart, spleen, bladder, and kidneys) were collected from 64 Apodemus flavicollis, 55 Apodemus agrarius, 40 Myodes glareolus, 21 Mus musculus, and 14 Microtus arvalis and tested for the presence of hantavirus RNA by reverse transcription and subsequent real-time PCR. Positive samples were also tested by indirect immunofluorescence. Animal reservoir surveillance enabled the first detection of Puumala virus and Dobrava-Belgrade virus among animals in Poland. Furthermore, some places where rodents were captured correlated with areas of residence of laboratory-confirmed human cases and likely detected virus species. Moreover, three species of hantaviruses coexisting in a relatively small area were identified.

Acute respiratory distress syndrome (ARDS) in the course of influenza A/H1N1v infection--genetic aspects.

Influenza is a contagious respiratory disease caused by viruses belonging to the family Ortomyxoviridae. Among the influenza viruses type A, B and C, the A type virus shows the most pathogenic potential. Its surface receptor glycoproteins, hemagglutinin (HA) and neuraminidase (NA), are characterized by high antigenic variation, thus a host organism cannot develop permanent resistance. The case is described of a male patient with severe acute respiratory distress syndrome in the course of influenza A/N1H1v infection, confirmed by virological molecular analysis. During diagnostic procedures based on the MSSCP genotyping it was observed that the WHO recommended RT-PCR kits and/or procedure of sample collection from patients for molecular investigation could lead to false positive A/H1N1 pandemic strain detection because of the co-amplification during the RT-PCR fragments of the human genome.

Injuries caused by sharp instruments among healthcare workers--international and Polish perspectives.

Health care workers (HCW) worldwide are especially exposed to injury by sharp instruments in the course of their duty. The most often executed procedures with injury risk are: intramuscular or subcutaneous injection (22%), taking blood samples, or during intravenous cannulation (20%), and repeatedly replacing the cap on an already used needle (30%). Even a minor sharp injury with only a small loss of blood carries the risk of transfer of over 20 pathogens: Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), HIV/AIDS virus, malaria, syphilis, tuberculosis, brucellosis, herpes virus and diphtheria. The World Health Organization (WHO) estimates that more than two million health care workers experience the stressful event of a percutaneous injury with a contaminated sharp object each year (25-90% of them, however, remain unreported). These exposures result in about 16,000 infections with HCV, 66,000 with HBV and about 1,000 (200-5000) with HIV, which lead to about 1,100 deaths or significant disability. Exposures to sharp injuries and their consequences are highly preventable through simple interventions, such as HBV vaccination, education and providing containers for sharp instruments. Specific guidelines, similar to the American Occupational Safety and Health Administration (OSHA) regulations that have lowered by up to 88% of needle stabbing incidents, should be introduced by the European Union (EU) and other countries. The results of a review of reports leads to the following conclusions: 1) elaboration and implementation of new State regulations, especially in EU countries and in countries where such regulations do not exist; 2) the training of health care personnel should always be undertaken for new employees, and periodically for those already employed; 3) periodical control by appointed inspectors of knowledge of procedures for the prevention of injuries by sharp instruments among health care workers; 4) introducing and training in the use of equipment, which can prevent the sharp injuries; 5) an advanced monitoring system of sharp injuries sustained by worker should also be introduced. Successful implementation of these prevention measures will result in progress for public health and HCW's health and safety.