Probability of exposure to the wild measles virus in adult population - Estimation from seroepidemiology and historical data.

Vaccination against measles is one of the most effective public health interventions which has saved millions of lives and interrupted circulation of the natural virus in the population. However, it is widely accepted that the immunity after vaccination can wane, especially in those who have had no contact with the virus. This study aimed to classify the particular birth cohorts of adults with regard to their exposure to the wild measles virus in the population with a long history of mandatory vaccination. We introduced two methods. In the first, we estimated the probability of exposure to the wild virus through an analysis of antibody levels from the Immunologic Survey performed in the Slovak Republic in 2018, while the second was based on historical epidemiological data. Both methods resulted in similar estimations. Cohorts born in Slovakia before 1964 can be considered to be cohorts in which most people were exposed to the wild measles virus. Cohorts born after 1977 can be designated as cohorts that most likely did not come into the contact with the wild virus. Cohorts born between 1965 and 1976 are composed of a mixture, with a decreasing proportion of people exposed to the wild virus with increasing year of birth. The proposed methods can help identify potential immunity gaps in the adult population. They can be applied in other countries with high measles vaccination coverage to estimate the probability of exposure to the wild measles virus in particular birth cohorts.

The use of transcutaneous bilirubin nomograms for the prevention of bilirubin neurotoxicity in the neonates.

Purpose: Although neonatal jaundice is a ubiquitous and predominantly benign phenomenon, the risk of neurotoxicity exists in a number of infants with unconjugated hyperbilirubinemia. Plotting bilirubin values on nomograms enables clinicians to employ an anticipatory and individualized approach with the goal of avoiding excessive hyperbilirubinemia and preventing acute bilirubin encephalopathy and its progression to kernicterus. We aimed to construct nomograms for White term infants based on transcutaneous bilirubin (TcB) measurements using a JM-105 device. Methods: TcB measurements were taken in infants at ages ranging from 0 to 96 postnatal hours. We then constructed hour-specific TcB nomograms from forehead and sternum measurements in infants who did not require subsequent phototherapy. Results: We included 2,981 TcB measurements taken on the forehead and 2,977 measurements taken on the sternum in 301 White term newborn infants. We assessed the predictive abilities of the nomograms at six postnatal time intervals using receiver operating characteristic curves. The areas under the curves indicated reasonable prediction of hyperbilirubinemia requiring phototherapy, except for the forehead measurement taken within the first 12 h of life. Sensitivity tended to rise as postnatal age increased. Conclusion: The nomograms illustrate dermal bilirubin dynamics in White term neonates during the first 4 days of life. They may be useful tools to predict individualized risk of hyperbilirubinemia requiring treatment, and to plan optimal follow-up of infants at risk of bilirubin neurotoxicity.

Quantification of Waning Immunity After Measles Vaccination-Evidence From a Seroprevalence Study.

We aimed to quantify rates of waning immunity after measles vaccination from seroprevalence data collected in a study of a population with high vaccination coverage and a fixed vaccination schedule. Data were collected during a national survey (the Immunological Survey) carried out in the Slovak Republic in 2018. The average rate of waning immunity against measles after the first dose of measles, mumps, and rubella (MMR) vaccine (ages 1.5-10 years) was 9.7% per year from the geometric mean titer value of 2,634 mUI/mL. The average waning rate after the second dose of MMR vaccine (ages 10-33 years) was significantly lower: 4.8% per year from the lower geometric mean titer of 1,331 mUI/mL. This decline in antibody levels suggests that vaccine-induced protection may be compromised and results in an increase in the proportion of seronegative/borderline individuals. These outcomes may provide a valuable source for critical assessment of direct and indirect effects of MMR vaccination.

Secondary School Teachers and Outpatient Physicians: Differences in Attitudes towards Vaccination against COVID-19 in Slovakia.

The aim of this study was to evaluate the differences in attitudes towards vaccination against COVID-19 among secondary school teachers and outpatient physicians. A cross-sectional study was realised using anonymous questionnaires. The EPI Info 7 program and R software, version 4.0.2 were used for statistical analysis. The questionnaire was completed by 868 respondents (teaching staff N = 451; outpatient physician N = 417). The number of employees vaccinated against COVID-19 was 742 (85.5%). The number of those vaccinated against COVID-19 and influenza (last season) was 192 (21.9%). The statistically significant predictors were the level of fear of COVID-19 (OR 1.40; 95% CI 1.29-1.52), profession-outpatient physicians (OR 2.56; 95% CI 1.55-4.23), history of COVID-19 (OR 0.34; 95% CI 0.22-0.54), gender (OR 0.55; 95% CI 0.33-0.89) and influenza vaccination at any time in the past (OR 3.52; 95% CI 1.10-11.31). The strongest motivation for vaccination against COVID-19 among physicians was the prevention of the spread of COVID-19 during the performance of their profession (N = 336; 87%); among teachers, it was the protection of family members (N = 258; 73%). The most common reason for vaccine hesitancy was concern about vaccine safety (N = 80; 63.5%).

The Common Haplotype GATGACA in Surfactant-Protein B Gene Is Protective for Respiratory Distress Syndrome in Preterm Neonates.

Background: Respiratory distress syndrome (RDS), a disorder of primary surfactant deficiency resulting in pulmonary insufficiency, remains a significant problem for preterm neonates. Associations between genetic variants of surfactant proteins and RDS have been reported, but haplotypes of the surfactant protein B gene (SFTPB) have not been studied. The aim of the study was to prove the hypothesis that certain haplotypes of SFTPB may be protective or risk factors for RDS. Methods: The study was performed with 149 preterm infants, born <34 weeks of gestation, with 86 infants with mild RDS or without RDS (control group) and 63 infants with severe RDS (patient group). RDS was considered severe if multiple doses of exogenous surfactant and/or mechanical ventilation within the first 72 h of life were needed. The venous blood sample was used for the analysis of gene polymorphisms associated with RDS, genotyping, and haplotype estimation. Multivariate logistic regression analysis and the odds ratio were calculated to detect the contribution of the studied variables to the development of RDS. Results: A new association of the common single nucleotide polymorphism (SNP) rs2304566 with RDS in premature infants was detected. Analysis of rs2304566 polymorphisms using a logistic regression model showed that there are two significant predictors inversely related to the occurrence of RDS (Apgar score of 5 min, CT and TT genotype in rs2304566 polymorphism). Gestational age, birth weight, and sex have border significance. Moreover, in the patient group, the frequency of the GATGACA haplotype in the SFTPB gene was lower (p = 0.037), and the GATGGCA haplotype was higher (p = 0.059) in comparison with the control group. Conclusion: The common haplotype GATGACA of the SFTPB gene can be protective against RDS in preterm infants. The trend of a higher frequency of GATGGCA in the SFTPB gene in infants with severe RDS suggests that this haplotype may be a risk factor for RDS susceptibility.

Odds Ratio Estimation of Medical Students' Attitudes towards COVID-19 Vaccination.

This study investigated the attitudes of Slovak medical students to COVID-19 vaccination. A cross-sectional study was conducted between 10 March 2021 and 24 March 2021, as the second wave of coronavirus spread in Slovakia. It was performed in four medical faculties with students in years 1-6. An online anonymous questionnaire was distributed through official university platforms. The survey was completed by 1228 of 5374 medical students. The vaccinated group of students had received at least one dose of the COVID-19 vaccine. The study was conducted on 1228 students, of which 880 (71.7%) were vaccinated and 348 unvaccinated (28.3%). The median age was 22 years (range 18-33 years), and 70.6% were women. The lowest vaccination rate was among first (32.7%) and second-year students (61.6%), students living at home with their family (63.8%) and students living in urban areas (69.8%). Only 22.4% of medical students were concerned about serious side effects from the COVID-19 vaccine, and 38.8% were concerned that the COVID-19 vaccine may not be effective. This study provides key information related to medical student vaccination in Slovakia and education about COVID-19 vaccination.

Accuracy of enhanced transcutaneous bilirubinometry according to various measurement sites.

OBJECTIVE: The goal of the study was to provide missing data on the accuracy of enhanced transcutaneous bilirubinometry in a monoracial population of term neonates, considering three different measurement sites. MATERIAL AND METHODS: Transcutaneous bilirubin was measured using the JM-105 device on the forehead, chest, and abdomen. Blood sampling for total serum bilirubin concentration has been performed within 10 minutes of transcutaneous measurements. Paired transcutaneous bilirubin and total serum bilirubin measurements were statistically analyzed. RESULTS: The study group consisted of 102 healthy term Slovak infants. The correlation between total serum bilirubin and transcutaneous bilirubin was significant (coefficient of determination R2: 0.9045 forehead, 0.8808 sternum, 0.8467 abdomen). Transcutaneous measurements underestimated serum bilirubin levels significantly when total serum bilirubin values were higher than 15 mg/dL, irrespective of the site of transcutaneous measurements. The lowest mean difference between total serum bilirubin and transcutaneous bilirubin was identified on the sternum (median: -1.1 mg/dL). The area under the curve was >0.97 and >0.93 for detecting total serum bilirubin levels >10 mg/dL and >13 mg/dL, respectively, for all measurement sites. Transcutaneous measurements on the forehead and sternum provided very high sensitivity, with the best performance at the forehead. CONCLUSION: Transcutaneous bilirubinometry using an enhanced device is an accurate, sensitive, and convenient screening method in term Caucasian neonates. Transcutaneous bilirubin measurements on the forehead, sternum, and abdomen are reliable, with the best performance on the forehead. It is necessary to confirm higher transcutaneous bilirubin values with a total serum bilirubin measurement.

Association of the role of personal variables and nonoccupational risk factors for work-related carpal tunnel syndrome.

OBJECTIVES: The purpose of this study was to identify personal variables and nonoccupational risk factors for carpal tunnel syndrome and to analyse the strength of association of these factors. METHODS: We performed a case-control study with 162 cases and 300 controls. We studied consecutive patients with an electrophysiologically confirmed diagnosis of symptomatic carpal tunnel syndrome. Univariate analysis was performed in the case group and control comparing them for presence of various risk factors. Multivariate analysis was carried out through logistic regression. RESULTS: The mean BMI and age were greater in the case group than in the control. Multivariate analysis showed that BMI (OR = 1.05, 95% CI = 1.01-1.11) and arterial hypertension (OR = 4.63, 95% CI = 2.88-7.44) were the only factors significantly associated with carpal tunnel syndrome. The age, cigarette smoking and alcohol drinking were at the edge of significance. CONCLUSIONS: Carpal tunnel syndrome is the most common peripheral neuropathy and has been related to occupational activities in some but not all studies. Clarifying this relationship has important implications for workers' compensation systems. Based on our findings, BMI and arterial hypertension are considered to be the most significant risk factors of carpal tunnel syndrome in our study.

Measles Outbreak in a Roma Community in the Eastern Region of Slovakia, May to October 2018.

BACKGROUND: Despite the effective National Immunization Programme of Slovakia, some population groups are incompletely vaccinated or unvaccinated. We aimed to describe the measles outbreak spread in Eastern Slovakia between May and October 2018, affecting the Roma communities in relation to the existing immunity gaps. METHODS: We defined a group of persons living in socially closed communities with low vaccination coverage. RESULTS: Of 439 measles cases (median age: 10 years), 264 (60.1%) were vaccinated, 137 (31.2%) received two doses and 127 (28.9%) one dose of measles vaccines, 155 (35.3%) were unvaccinated and 20 (4.6%) had an unknown vaccination status. Samples from 102 patients (with two-dose vaccination status) were additionally tested for antibodies against rubella and mumps. Of 102 cases, 68 (66.7%) cases had a positive IgM and 23 (22.5 %) IgG antibodies against measles. For rubella, only 20 (19.6%) cases had seropositive IgG levels, for mumps higher positivity was detected in 60 persons (58.8%). We could detect only a small percentage with positive serology results of rubella IgG antibodies across all age groups. We have assumed that rubella antibodies had to be produced following the vaccination. Their absence in the cases with two doses of MMR suggests that these vaccines could not have been administrated despite the fact that this data was included in the medical records. Sequential analysis of two samples showed measles genotype B3. CONCLUSION: This outbreak can outline the existence of a vulnerable group of the Roma. Low vaccinate coverage represents a serious public health threat.

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.

MATHEMATICAL MODELLING OF VARICELLA SPREAD IN SLOVAKIA.

AIM: Varicella is a highly contagious disease. In Slovakia, 15,000-30,000 cases are reported annually. However, vaccination against varicella is not widely used in Slovakia. The aim of this paper is to predict the influence of vaccination administrated in different ages on the disease occurrence in different age groups. METHODS: Deterministic, age-stratified SIR (susceptible-infected-recovered) model with stable population was used for prediction of varicella spread in Slovakia. RESULTS: Vaccination of a group designated as 0 influences the proportion of susceptible and infected persons in all age groups, vaccination of 10 years old ones affects only the proportion of susceptible and infected individuals older than 10 years. CONCLUSION: The increase of vaccination coverage should have a positive impact on the incidence of varicella in Slovakia. In case of vaccination coverage of 0 group in the range of 30-75%, it is necessary to pay attention to the protection of older children and adults.

Overexpression of miR-21 and miR-122 in preeclamptic placentas.

OBJECTIVE: Preeclampsia is a pregnancy-associated disease with the impact of genetic, epigenetic and environmental factors. Increased apoptosis was observed in cells from preeclamptic placentas. MicroRNAs are involved in the regulation of apoptosis and are abundant in placenta. In this study, we focused on the analysis of differential gene expression of apoptosis-associated miRNAs in preeclamptic placenta samples compared to the samples obtained from healthy pregnant women. METHODS: MicroRNA was extracted from placental samples of patients with preeclampsia and physiological course of the pregnancy. The gene expression of miR-155, miR-122 and miR-21 in placenta and control samples was estimated by relative quantitation (RQ) using TaqMan probes, normalized against RNU44. The RQ mean values were statistically evaluated by Man-Whitney test. RESULTS: Using the relative gene expression analysis, we could observe a significant increase in gene expression of miR-155 (p<0.001), miR-21 (p<0.0001) and miR-122 (p<0.01) in preeclamptic placentas. CONCLUSION: The apoptosis-associated miRNAs miR-21 and miR-122 are dysregulated in the term preeclamptic placentas. The increased miRNA expression suggest the downregulation of potential targets mRNAs, which can contribute to the pathogenesis of preeclampsia. The identification of their targets in placenta will improve our understanding of their role in preeclampsia.

Very early postnatal changes in splanchnic circulation in term infants.

BACKGROUND: Reversed blood flow has been reported in the superior mesenteric artery (SMA) in 92% of healthy term newborns at 2 h of age. By 24 h after birth the end-diastolic velocity became positive in all of the infants. OBJECTIVE: To characterize hemodynamic changes in the coeliac artery and superior mesenteric artery in healthy term newborns during the first 6 h after birth and to specify the time interval when the negative values of end-diastolic velocity in the superior mesenteric artery become positive. MATERIALS AND METHODS: Our study included 30 healthy term newborns. The blood flow velocity was assessed by Doppler ultrasonography at 2 h, 4 h and 6 h after birth. RESULTS: The end-diastolic velocity in the superior mesenteric artery changed from negative values at the age of 2 h (-0.9 cm/s, range -13.2 to 0.0) to positive (7.08 cm/s, range 6.3 to 13.5, P < 0.001) at 6 h after birth. In the coeliac artery, the end-diastolic velocity increased during this period, but negative values were not observed (11.8 cm/s, range 9.3 to 13.9 at 2 h and 18.03 cm/s, range 14.2 to 27.6 at 6 h). CONCLUSION: Important changes occur in splanchnic circulation during the first 6 h after birth. The rise in end-diastolic velocity in the superior mesenteric artery from negative to positive values in 83% of healthy term newborns is the most important change.

Occupational viral hepatitis in the Slovak and the Czech Republic.

BACKGROUND: The proportion of occupational infectious diseases (ID) in the total number of occupational diseases reported in the Slovak Republic (SR) and the Czech Republic (CR) was decreasing from 1973 to 2010. Our study presents a longitudinal analysis of the occurrence of occupational infectious diseases in the Slovak Republic and the Czech Republic in the period from 1973-2010 with special focus on viral hepatitis. METHODS: The sources of data were national health statistics of Czechoslovakia, the Czech Republic and the Slovak Republic. Descriptive statistical methods were used for data analysis. Incidence rate of reported diseases was calculated per 100,000 general population or per 100,000 people insured. RESULTS: During the studied period, a total of 2,931 and 8,318 cases of occupational viral hepatitis (VH) were reported in the Slovak Republic and the Czech Republic, respectively. The incidence culminated in the late 1970s when hepatitis represented almost 50% of all reported occupational infectious diseases. Most cases of occupational hepatitis occurred in health and social services. Since the early 1980s, a steep decrease in the incidence of hepatitis has been observed due to the gradual implementation of mandatory vaccination against hepatitis A and B in risk groups. In SR in 1973, the incidence rate of occupational infectious diseases and that of occupational viral hepatitis was 10.85/100,000 and 1.86/100,000, respectively. In 2010, these rates decreased to 0.74/100,000 and 0.20/100,000, respectively. In CR, the incidence rates of occupational infectious diseases and that of occupational viral hepatitis reported in 1973 were 11.75/100,000 and 3.69/100,000. In 2010, reported incidence rates were 1.71/100,000 and 0.10/100,000, respectively. CONCLUSION: Although the incidence of occupational viral hepatitis has dramatically decreased in the Slovak and the Czech Republic as well as in other Visegrad group countries during the studied period, we emphasize the necessity of continuing epidemiological surveillance of hepatitis, especially with regard to the recent incidence increase of viral hepatitis C.