Benign Acute Childhood Myositis During Influenza B Outbreak.

Benign acute childhood myositis (BACM) is a syndrome classically occurring in children during the convalescent phase from a febrile upper respiratory tract infection, most commonly after influenza B. BACM can cause difficulty walking due to severe calf pain. Laboratory results show increased serum creatinine kinase and AST. Although alarming, BACM is self-limiting with symptoms disappearing within a week. Herein, we described a case series of BCAM in children in two cities in Poland during the influenza outbreaks in 2012/2013 and 2014/2015. We discussed the presentation and the clinical workup and examinations of the myositic syndrome. In addition, we evaluated the association of BACM with influenza B. We detected specific IgG against influenza B virus in 83% of the children diagnosed with BCAM. Reports from the National Institute of Public Health - National Institute of Hygiene in Warsaw, Poland confirmed a high rate of influenza B cases during both epidemic seasons in question.

Immunogenicity, safety and reactogenicity of the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in 2-17-year-old children with asplenia or splenic dysfunction: A phase 3 study.

BACKGROUND: Immunization with pneumococcal vaccines is an important prophylactic strategy for children with asplenia or splenic dysfunction, who are at high risk of bacterial infections (including S. pneumoniae). This study aimed to assess immunogenicity and safety of pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV, GSK) in this at-risk population. METHODS: This phase III, multi-centre, open-label, controlled study, in which at-risk children with asplenia or splenic dysfunction were enrolled (age strata: 2-4, 5-10 and 11-17years), was conducted in Poland and the Russian Federation. For the 2-4years at-risk group, healthy age-matched children were enrolled as control. Unprimed children (not previously vaccinated with any pneumococcal vaccine) received 2 PHiD-CV doses (≥2months apart) and pneumococcal vaccine-primed children received 1 dose. Immune responses were assessed pre-vaccination and one month post-each dose. Solicited and unsolicited adverse events (AEs) were recorded for 4 and 31days post-vaccination, respectively, and serious AEs (SAEs) throughout the study. RESULTS: Of 52 vaccinated children (18 at-risk primed, 28 at-risk unprimed and 6 control unprimed), 45 (18, 23 and 4, respectively) were included in the according-to-protocol cohort for immunogenicity. Post-vaccination (post-dose 1 in primed and post-dose 2 in unprimed children), for each vaccine pneumococcal serotype and vaccine-related serotype 6A all at-risk children had antibody concentrations ≥0.2µg/mL, and for vaccine-related serotype 19A at least 94.4%. Increases in antibody geometric mean concentrations were observed. For most serotypes, all at-risk children had post-vaccination opsonophagocytic activity (OPA) titers ≥8 and increases in OPA geometric mean titers were observed. No safety concerns were raised. One non-fatal SAE (respiratory tract infection, considered not vaccine-related) was reported by one at-risk unprimed child. CONCLUSION: PHiD-CV was immunogenic and well tolerated in 2-17-year-old children with asplenia or splenic dysfunction. Clinical Trial Registry: www.clinicaltrials.gov, NCT01746108.

The Incidence of Respiratory Tract Infections in Vertically HIV-Infected Children in Lower Silesia in Poland and the Approach to Infection Prevention.

Human immunodeficiency virus (HIV) is a risk factor associated with respiratory tract infections. However little is known about the prevalence of these infections in HIV-infected children in Poland. We investigated the incidence of respiratory tract infections in 26 HIV-infected children (aged 4-18, mean 10.3 years, including 17 girls) treated in our center and compared it with the age-matched control group of 70 children. The prevalence of chronic diseases and other factors such as cigarette smoking by household members or attending educational institutions were also taken into consideration. Among the HIV-infected children, 48 respiratory infections were observed, including 4 cases of pneumonia and 44 other respiratory infections for 312 person-month observations vs. 256 infections including 13 cases of pneumonia and 243 other respiratory infections for 840 person-month observations in the control group. Thus, incidence of respiratory infections per month was lower in HIV-infected children (14%) compared with the control group (29%), i.e., 0.14 95% CI (0.10-0.18) infections per month vs. 0.29 95% CI (0.26-0.32). There was no difference in the incidence of pneumonia. The lower incidence of respiratory infections in HIV-infected children may be explained by their avoiding sick people, taking influenza vaccination on the annual basis, and possibly antiviral medication. We conclude that the influence of modifiable environmental factors that reduce the risk of respiratory tract infections is more significant than the HIV infection itself.

Pathophysiology of Clinical Symptoms in Acute Viral Respiratory Tract Infections.

In this article we discuss the pathophysiology of common symptoms of acute viral respiratory infections (e.g., sneezing, nasal discharge, sore throat, cough, muscle pains, malaise, and mood changes). Since clinical symptoms are not sufficient to determine the etiology of viral respiratory tract infections, we believe that the host defense mechanisms are critical for the symptomatology. Consequently, this review of literature is focused on the pathophysiology of respiratory symptoms regardless of their etiology. We assume that despite a high prevalence of symptoms of respiratory infection, their pathogenesis is not widely known. A better understanding of the symptoms' pathogenesis could improve the quality of care for patients with respiratory tract infections.

Immunizations against respiratory infections in children in primary health care in poland: coverage and delays.

Pneumococcal infections, pertussis, and influenza are vaccine-preventable diseases. The aim of this study was to determine vaccine coverage and compliance with the dosage regimen among children in Poland. We performed a retrospective chart analysis of 1,356 children in a large primary healthcare establishment. The complete primary pertussis vaccination, 3 doses in the first year of life, was administered to 1,310/1,356 patients (96.6 %). The self-paid combined acellular vaccine was given in 55.2 % of children. The first dose of the pertussis vaccine was administered in a timely manner to 67.1 % of children. The self-paid pneumococcal vaccine was administered in 499/1,356 (36.8 %) children. In 46.1 % of them immunization started within the first 6 months of life; in 12.6 % aged 7-11 months, in 12.6 % aged 12-23 months, and in 28.7 % aged over 24 months. The dosage regimen was compliant in 49.2 % of patients. Only 3.5 % of patients were immunized against both pneumococci and influenza. Compliance with the Polish immunization program should be increased by reducing the number of injections and the cost of vaccines. Education is essential to facilitate simultaneous administration of vaccines during one visit and to prepare the parents for judicious decision-making when it comes to vaccinations.

Respiratory tract infections in children in primary healthcare in Poland.

Respiratory tract infections are the most common diseases in children. The aim of the study was to assess their frequency and antibiotic treatment in Poland. We retrospectively analyzed 91 randomly-selected children aged 0-17 years receiving care from birth in a large primary healthcare establishment in the city of Wroclaw in Poland. Respiratory tract infections were responsible for 25-40 % of all primary healthcare visits. The median of visits due to upper respiratory tract infections was 1.8 per year in all children and 2.0 per year in children 0-3 years old. Antibiotics were overused; the majority (57.4 %) of the respiratory infections were treated with antibiotics: acute tonsillitis in 90.7 %, bronchitis in 67.5 %, otitis media in 65.9 %, pneumonia in 60.9 %, non-specific upper respiratory tract infections in 25.8 %, laryngitis in 22.2 %, and sinusitis in 12.5 %. The higher the number of antibiotic therapies, the higher the total number of visits including visits due to respiratory tract infections. In conclusion, implementation of careful and responsible management of a rational use of antibiotics is urgently needed since a reduction in their use may lead to a decrease in the number of visits due to upper respiratory tract infections and a total number of primary care visits.

Spotlight on measles 2010: An epidemiological overview of measles outbreaks in Poland in relation to the measles elimination goal.

The objective of this study was to describe transmission chains of measles observed in Poland during 2008-2009. A decade ago, the incidence of measles in Poland declined and approached one case per million inhabitants one of the World Health Organization's criteria for measles elimination. Following a period of very few reported measles cases (2003 to 2005), an increase in incidence was observed in 2006. Since then, the incidence has constantly exceeded one case per million inhabitants. Of 214 measles cases reported in 2008 and 2009 in Poland, 164 (77%) were linked to 19 distinct outbreaks, with 79% of cases belonging to the Roma ethnic group. Outbreaks in the non-Roma Polish population had different dynamics compared to those in the Roma population. On average, measles outbreaks in Roma communities involved 10 individuals, seven of whom were unvaccinated, while outbreaks in the non-Roma Polish population involved five individuals, half of whom were incompletely vaccinated. The majority of outbreaks in Roma communities were related to importation of virus from the United Kingdom. In six outbreaks, the epidemiologic investigation was confirmed by identification of genotype D4 closely related to measles viruses detected in the United Kingdom and Germany. Our data indicate that Poland is approaching measles elimination, but measles virus circulation is still sustained in a vulnerable population. More efforts are needed to integrate the Roma ethnic group into the Polish healthcare system and innovative measures to reach vulnerable groups should be explored.

[Acellular pertussis vaccines--safe alternative]. / Bezkomórkowe szczepionki przeciw krztuscowi--bezpieczna alternatywa.

UNLABELLED: This study was undertaken to assess the safety of various acellular vaccines (ACV) TripAcel, PacMarieux--Pasteur Merieux, Infanrix-SKB, Acel-P-Lederle and DTaP-SSI in 355 children, aged 7 weeks to 7 years, dismissed from immunization against pertussis with a whole-cell vaccine. All ACV contained varying concentrations of pertussis toxin; some vaccines contained filamentous hemagglutinin, pertactin and/or agglutinogens. The indication of using ACV were adverse effects following immunization (AEFI) after wP vaccine (n = 29) and others reasons, mostly underlying perinatal and CNS pathology (n = 277). The 564 doses of ACV were given in 4 to 1 doses. Reaction forms and clinical follow-up were uniform throughout the study. RESULTS: Serious AEFI cases were not observed not only among children with CNS damage, but also in children with previous AEFI after DTwP vaccine. All ACV recipients consistently reported low rates of reactions in the 48 hours following immunization. We concluded that all investigated ACV were safe and well tolerated even in the group of high-risk children.

[Current status of immunization against Haemophilus influenzae type b in children in Poland]. / Aktualnosc szczepien przeciw Haemophilus influenzae b w Polsce.

The estimated incidence of Hib infections in Poland is about 29/100,000 children below 5 years of age (like in UK), the number of invasive infections particularly of purulent Hib meningitis is about 425-850 cases yearly. It indicates on necessity of immunisation against Haemophilus influenzae type B. The first own experience in vaccination with TetractHib or ActHib in 368 infants confirmed its safety in agreement with large studies of many foreign authors.

[Isoprinosine and climatotherapy at the Czerniawa-Zdrój health resort in the treatment of children with recurrent respiratory tract infections]. / Isoprinosina oraz klimatoterapia w czerniawie zdroju w leczeniu dzieci z nawracajacymi zakazeniami dróg oddechowych.

The authors used in children in with recurrent respiratory infections in 28 cases isoprenosine, in 30 climatic therapy and in 15 isoprenosine followed by climatic therapy. Isoprenosine was used in a dose 50 mg per kg b.w. for two weeks, followed by 10 days of an interruption, after which isoprenosine was gain given for ten days. Climatic therapy was carried out for six weeks. Thirty healthy children of the same age made up the control. Good or excellent results were seen in 19 out of 28 children treated with isoprenosine, in 16 out of 30 that underwent climatic therapy, and 11 out of 15 in which both modes were used. The authors discuss their own experience in treating children with recurrent respiratory infections suggesting that this model for treating sick cases be used, observing good results in two thirds.