Hepatitis B Elimination in Children of Slovenian Origin Born in Slovenia After the Introduction of Preventive Strategies: the Results of a National Study.

Introduction: In Slovenia national strategies to prevent hepatitis B virus (HBV) infection in children were introduced in the mid-nineties. The aim of the present study was to analyze the epidemiological characteristics of chronic hepatitis B infection in children in Slovenia after the introduction of mandatory HBV vaccination of children and mandatory screening of pregnant women for HBV surface antigen (HBsAg) with consecutive active and passive immunization of newborns of HBsAg-positive mothers. Methods: Children from all regions of Slovenia whose blood samples tested positive for HBsAg at the national reference laboratory for viral hepatitis between January 1997 and December 2010 were included. Demographic, epidemiological and virological data were reviewed retrospectively. Statistical evaluation of the patients' characteristics was performed and possible trends during the observation period determined. Results: Among 52 HBsAg-positive children, there were 22 (42.3%) girls and 30 (57.7%) boys. Among 40 children tested for HBeAg, 17 were positive (42.5%). The most frequent risk factor for acquiring HBV infection was "presence of HBV infection within the family" (24/35; 68.8%). A significant association between the presence of HBeAg and a viral load of >20,000 IU/ml was found (p=0.001). The difference in the proportion of children of Slovenian origin born before 1994 and after was statistically significant (p=0.039). A statistically significant negative linear trend of the number of diagnosed children in the observed period was found (p=0.006). Conclusions: Prevention strategies adopted in the mid-nineties have resulted in the elimination of chronic hepatitis B in children of Slovenian origin born in Slovenia.

Functional Complement Analysis Can Predict Genetic Testing Results and Long-Term Outcome in Patients With Complement Deficiencies.

Background: Prevalence of complement deficiencies (CDs) is markedly higher in Slovenian primary immunodeficiency (PID) registry in comparison to other national and international PID registries. Objective: The purposes of our study were to confirm CD and define complete and partial CD in registered patients in Slovenia, to evaluate frequency of clinical manifestations, and to assess the risk for characteristic infections separately for subjects with complete and partial CD. Methods: CD was confirmed with genetic analyses in patients with C2 deficiency, C8 deficiency, and hereditary angioedema or with repeated functional complement studies and measurement of complement components in other CD. Results of genetic studies (homozygous subjects vs. heterozygous carriers) and complement functional studies were analyzed to define complete (complement below the level of heterozygous carriers) and partial CD (complement above the level of homozygous patients). Presence of characteristic infections was assessed separately for complete and partial CD. Results: Genetic analyses confirmed markedly higher prevalence of CD in Slovenian PID registry (26% of all PID) than in other national and international PID registries (0.5-6% of all PID). Complement functional studies and complement component concentrations reliably distinguished between homozygous and heterozygous CD carriers. Subjects with partial CD had higher risk for characteristic infections than previously reported. Conclusion: Results of our study imply under-recognition of CD worldwide. Complement functional studies and complement component concentrations reliably predicted risk for characteristic infections in patients with complete or partial CD. Vaccination against encapsulated bacteria should be advocated also for subjects with partial CD and not limited to complete CD.

Virulence factors and biofilm production among Escherichia coli strains causing bacteraemia of urinary tract origin.

The aim of the present study was to gain an insight into the role of virulence determinants and biofilm production in bacteraemia of urinary tract origin. For this purpose 105 Escherichia coli isolates from patients with bacteraemia of urinary tract origin, isolated at the Institute of Microbiology and Immunology, University of Ljubljana, Slovenia, were investigated. A total of 88 strains (84 %) were isolated from immunocompromised patients and 17 (16 %) from non-immunocompromised patients. The prevalence of virulence factor (VF)-encoding genes and associations with phylogenetic background, antibiotic resistance, biofilm production and patient status were analysed by PCR and bioassay. Biofilm was produced by 55 (53 %) of the strains. No combination of VFs was highly associated with biofilm production. Of the tested VF-encoding genes, usp, papC and the adhesin-encoding sfa/foc were significantly more prevalent among strains from non-immunocompromised patients. Our results indicate that the uropathogenic specific protein (USP) may be, as judged by predominance and associations of the usp gene, an important VF contributing significantly to bacteraemia of urinary tract origin.