Tick-borne encephalitis in children and adolescents in the Czech Republic between 1960 and 2007.

BACKGROUND: The Czech Republic ranks among the countries with the highest prevalence of tick-borne encephalitis worldwide. The region of West Bohemia has the second highest morbidity within the Czech Republic. METHODS: Between 1960 and 2007, laboratories confirmed 410 cases of tick-borne encephalitis in children and adolescents of West Bohemia. Available epidemiological data were analyzed. RESULTS: The highest incidence (per 100 000 population) was found in the group of 15-19 years for both genders (males: 6.2; females: 4.3). Data on the consumption of non-pasteurized milk were found in 5.4% of patients. The preschool age group showed its highest incidence in June and September, and the risk of infection for older children was in July and August. CONCLUSIONS: The current low coverage of vaccination leads to an insignificant improvement to the overall frequency of this disease.

The prevalence of tick-borne encephalitis in the region of West Bohemia (Czech Republic) between 1960-2005.

Between 1960-2005, 1,621 cases of tick-borne encephalitis were confirmed by laboratory testing in the region of West Bohemia (now the regions of Pilsen and Karlovy Vary) which represents a rate of infection of 4.1 per 100,000 inhabitants per year. The highest infection rate was established in men aged 20-24 and women aged 45-54. Over the monitored years, there was a significant shift of the maximum infection rate into an older age group. Currently, it is the 45-64 age group which carries the highest rate of infection. Of the identified disease cases, 12 were lethal, which represents 0.7% of the total. Over the years, the risks of transmission in particular areas of the region have changed. The highest infection rate is currently in the district of Klatovy (21.7 per 100,000 inhabitants per year). Of the total number, only two cases were contracted outside the Czech Republic (Slovakia and Austria). In 4.8% cases, the patient's anamnesis showed data on the consumption of non-pasteurized milk. 3.0% of infections probably originated as a result of professional exposure. Over the years, the season of infection has extended. Presently, the transmission can occur anytime between March and November. According to official data, only 6.7% of the population in the Pilsen district has been vaccinated so far. The low percentage of vaccinated cases may, however, in no way influence the unfavorable epidemiological situation regarding tick-borne encephalitis.

The impact of cytomegalovirus disease and asymptomatic infection on acute renal allograft rejection.

BACKGROUND: Cytomegalovirus (CMV) disease is a risk factor for allograft rejection in renal transplant (RTx) recipients. However, the role of asymptomatic CMV infection remains controversial. OBJECTIVES: To determine the impact of CMV disease and asymptomatic infection on biopsy-proven acute rejection (BPAR) during 12 months post-RTx. STUDY DESIGN: A total of 106 consecutive RTx recipients at risk for CMV (donor and/or recipient CMV seropositive) were followed prospectively for 12 months post-RTx. CMV activity was monitored using nested PCR from whole blood. Three-month prophylaxis with valacyclovir or ganciclovir was given to 94 patients. BPAR episodes were classified according to the Banff 97 criteria. Multivariate Cox proportional hazards model was used to estimate the effect of CMV disease, asymptomatic infection, and other covariates on BPAR. RESULTS: Asymptomatic CMV infection occurred in 23% of the patients and 10% developed CMV disease. The incidence of BPAR was 29%. CMV disease was an independent risk factor for BPAR (HR=3.0, P=0.014), while asymptomatic CMV infection was not (P=0.987). In addition to CMV disease, expanded criteria donor and donor age were independent predictors for BPAR. In univariate analysis, valacyclovir (HR=0.26, P=0.008) decreased the risk of BPAR. A similar trend was observed with ganciclovir (HR=0.42, P=0.058). Only valacyclovir remained significant in multivariate analysis (HR=0.18, P=0.044). CONCLUSIONS: CMV disease, but not asymptomatic infection, is an independent risk factor for BPAR during the first 12 months post-RTx.

Prospective comparison of valacyclovir and oral ganciclovir for prevention of cytomegalovirus disease in high-risk renal transplant recipients.

AIMS: To compare the efficacy, costs and safety of oral ganciclovir and valacyclovir in the prophylaxis of cytomegalovirus (CMV) disease in renal transplant (RTx) recipients at high risk of CMV disease. METHODS: A total of 83 patients were prospectively randomized to 3-month treatment with either oral ganciclovir (3 g/day) or oral valacyclovir (8 g/day). A 3rd group received no prophylaxis. Forty-nine patients were considered to be at high risk of CMV disease due to D+R- serologic status, OKT3/ATG treatment and/or acute rejection within 12 months after RTx. Twenty-three high-risk patients were treated with ganciclovir (GAN group), 17 patients with valacyclovir (VAL group), and 9 patients received no prophylaxis (C group). RESULTS: No significant differences were found among the groups in their demographic characteristics, immunosuppressive protocols, D/R CMV serology, or CMV risk factors. The 12-month incidence of CMV disease was 89% in the C group compared with 9% in the GAN group and 6% in the VAL group (p < 0.001, GAN or VAL vs. C; p = 0.713, GAN vs. VAL). Treatment failure (death, graft loss, CMV disease or withdrawal from study) occurred in 17, 6, and 89% in the GAN, VAL, and C groups, respectively (p < 0.001, GAN or VAL vs. C; p = 0.285, GAN vs. VAL). The average CMV-associated costs per patient were EUR 3,161, 3,757, and 7,247 in the GAN, VAL, and C groups, respectively (p = 0.027). CONCLUSION: Valacyclovir and oral ganciclovir are equally effective in the prophylaxis of CMV disease in high-risk RTx patients. Both regimens are cost-effective and help reduce CMV-associated costs by nearly 50% compared with patients without prophylaxis.

Valacyclovir for cytomegalovirus prophylaxis reduces the risk of acute renal allograft rejection.

BACKGROUND: Both oral ganciclovir and valacyclovir decrease the incidence of cytomegalovirus (CMV) disease after renal transplantation. Moreover, valacyclovir has been shown to reduce the risk of acute rejection. Our study was designed to compare the efficacy and safety of oral ganciclovir and valacyclovir in the prophylaxis of CMV disease after renal transplantation. METHODS: A total of 83 patients were prospectively randomized to 3-month treatment with oral ganciclovir (3 g/day, n=36, GAN) or oral valacyclovir (8 g/day, n=35, VAL). A control group (DEF, n=12) was managed by deferred therapy. RESULTS: No differences were found in demography, immunosuppression, or donor/recipient CMV serology. The 12-month incidence of CMV disease was 67% in the DEF group compared with 6% in the GAN group and 3% in the VAL group (P<0.001 GAN or VAL vs. DEF; P=0.575 GAN vs. VAL). The biopsy-confirmed acute rejection rate at 12 months was 12% in the VAL group compared with 34% in the GAN group (P=0.030) and 58% in the DEF group (P<0.001). The difference between the GAN and DEF groups was not significant (P=0.087). The average CMV-associated costs per patient were $3,072, $2,906, and $4,906 in the GAN, VAL, and DEF groups, respectively. CONCLUSIONS: Valacyclovir and oral ganciclovir are equally effective in the prevention of CMV disease after renal transplantation. Both regimens are cost-effective. Valacyclovir is associated with a significantly reduced risk of acute rejection compared with both ganciclovir prophylaxis and deferred therapy.

[A comparison of the detection of IgM antibodies against the viral capsid antigen (VCA) of EBV (Epstein-Barr virus) in various groups of patients, using indirect immunofluorescence, indirect ELISA and reverse ELISA. Study of the diagnostic efficacy of the anti-VCA EBV IgM ELISA-VIDITEST kit]. / Porovnání záchytu IgM protilátek proti virovému kapsidovému antigenu (VCA) viru Epsteina a Barrové (EBV) u ruzných skupin pacientu pomocí neprímé imunofluorescence, neprime ELISA a reversní ELISA. Studie diagnostické úcinnosti soupravy ELISA-VIDITEST anti-VCA EBV IgM.

OBJECTIVES: To test diagnostic efficiency of a novel method for detection of IgM antibodies to VCA EBV. To compare sensitivity and specificity of detection of IgM antibodies to VCA EBV from patients at various stages of EBV infection by various serological methods. MATERIAL AND METHODS: IgM antibodies to VCA EBV were detected using IgM ELISA Viditest anti-VCA EBV IgM assay (Vidia, Ltd., Czech Republic) and comparative serological methods (indirect immunofluorescence assay, indirect ELISA (Human, SRN) and reverse ELISA (DiaSorin, Italy) in four independent diagnostic laboratories on panels of sera from 1) infectious mononucleosis patients, 2) patients with serological markers of EBV reactivation, 3) seropositive individuals lacking serological markers of active EBV infection, 4) seronegative individuals, 5) patients with IgM antibodies against another herpesvirus and 6) patients positive for rheumatoid factor. The sera yielding discrepant results were retested in the reference laboratory using the reference methods (indirect immunofluorescence and reverse ELISA). Overall, 854 IgM anti-VCA-positive or -negative sera were evaluated. RESULTS: The sensitivity and specificity of the IgM Viditest anti-VCA EBV assay were 94.7 and 96.1 %, respectively. All of the three tests compared were similarly reliable in detecting IgM anti -VCA EBV antibodies in the samples from infectious mononucleosis patients. On the other hand, indirect fluorescence assay proved clearly superior to ELISAs for detection of IgM anti-VCA antibodies in the samples with serological pattern of EBV reactivation, typically showing significantly lower IgM anti-VCA titers compared with those from primary infection. CONCLUSIONS: The multilaboratory comparative study proved that the novel IgM ELISA-Viditest anti-VCA EBV assay (Vidia, Ltd., Czech Republic) which shows comparable diagnostic efficiency for detection of IgM EBV antibodies to viral capsid antigen (VCA) as compared to the other assays tested, i.e. ELISA (Human, Germany) and reverse ELISA (DiaSorin, Italy), is suitable for use in serological diagnosis of EBV.

A randomized prospective controlled trial of oral ganciclovir versus oral valacyclovir for prophylaxis of cytomegalovirus disease after renal transplantation.

Oral ganciclovir and valacyclovir reduce the incidence of cytomegalovirus (CMV) disease after renal transplantation (RTx). Our study was designed to compare the efficacy, costs, and safety of oral ganciclovir and valacyclovir in the prophylaxis of CMV disease over the first 6 months after RTx. A total of 38 patients was randomized to 3-month treatment with either oral ganciclovir (1 g t.i.d., n=14, GAN group) or oral valacyclovir (2 g q.i.d., n=12, VAL group). A third group (C, n=12) received no prophylaxis. The patients were monitored by CMV-nested PCR in whole blood. No differences were found between the groups in their demographic characteristics, immunosuppressive protocols, or donor and recipient CMV serology. Thirty-six out of 38 (94.7%) recipients were CMV-seropositive. Over the 6-month post-RTx period, there were 13 episodes of CMV disease in eight (66.7%) patients of the C group compared with none in the GAN and VAL groups ( P=0.0005, GAN vs C; P=0.001, VAL vs C). The incidence of CMV viremia was 30.8%, 50.0%, and 91.7% in the GAN, VAL, and C groups, respectively ( P=0.004, GAN vs C; P=0.07, VAL vs C; P=NS, GAN vs VAL). Treatment failure (death, graft loss, CMV disease, or withdrawal from study) occurred in 14.3%, 0% and 66.7% in the GAN, VAL, and C groups, respectively ( P=0.014, GAN vs C; P=0.001, VAL vs C; P=NS, GAN vs VAL). The average CMV-associated costs per patient (in 2001 euros) were 2,449+/-1,178, 2,485+/-581, and 4,259+/-4,616 in the GAN, VAL, and C groups, respectively. Ganciclovir and valacyclovir were well tolerated, with ganciclovir having had to be withdrawn shortly in one patient only because of thrombocytopenia. In conclusion, oral ganciclovir and valacyclovir are equally safe and effective in the prophylaxis of CMV disease after RTx. Both are cost-effective and help reduce CMV-associated costs by some 40% compared with patients without prophylaxis.