Publications by authors named "Ernest Kuchar"

54 Publications

Pediatric Inflammatory Multisystem Syndrome (PIMS) Did Occur in Poland during Months with Low COVID-19 Prevalence, Preliminary Results of a Nationwide Register.

J Clin Med 2020 10 22;9(11). Epub 2020 Oct 22.

Department of Pediatrics with Clinical Decisions Unit, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091 Warsaw, Poland.

Pediatric inflammatory multisystem syndrome (PIMS) is a new entity in children, likely associated with previous coronavirus disease 19 (COVID-19) infection. Most of the reports about PIMS come from countries particularly hit by the COVID-19 pandemic. Our aim was to investigate the nature of inflammatory syndromes in Poland (country with low COVID-19 prevalence) and to perceive the emergence of PIMS in our country. On 25 May 2020, we launched a nationwide survey of inflammatory syndromes in children for retrospective (since 4 March 2020) and prospective data collection. Up to 28 July, 39 reported children met the inclusion criteria. We stratified them according to age (<5 and ≥ 5 years old) and COVID-19 status. The majority of children had clinical and laboratory features of Kawasaki disease, probably non-associated with COVID-19. However, children ≥5 years of age had PIMS characteristics, and nine children had COVID-19 confirmation. This is, to our knowledge, the first report of the PIMS register from a country with a low COVID-19 prevalence, and it proves that PIMS may emerge in any area involved in the COVID-19 pandemic. In a context of limited COVID-19 testing availability, other risk factors of PIMS, e.g., older age, should be considered in the differential diagnosis of inflammatory syndromes in children.
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http://dx.doi.org/10.3390/jcm9113386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690437PMC
October 2020

SARS-CoV-2 Cluster in Nursery, Poland.

Emerg Infect Dis 2021 Jan 19;27(1). Epub 2020 Oct 19.

We report a cluster of surprisingly high spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated with a single nursery in Poland. Our findings contrast with the presumed negligible role of children in driving the SARS-CoV-2 pandemic. Children 1-2 years of age might be effective SARS-CoV-2 spreaders.
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http://dx.doi.org/10.3201/eid2701.203849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774538PMC
January 2021

Children were less frequently infected with SARS-CoV-2 than adults during 2020 COVID-19 pandemic in Warsaw, Poland.

Eur J Clin Microbiol Infect Dis 2021 Mar 28;40(3):541-547. Epub 2020 Sep 28.

Department of Regenerative Medicine and Cell Biology, Military Institute of Hygiene and Epidemiology (WIHE), Kozielska 4, Warsaw, Poland.

Clinical data suggest that during the current COVID-19 pandemic, children are less prone than adults to SARS-CoV-2 infection. Our purpose was to determine the frequency of SARS-CoV-2 in children vs. adults during the 2020 pandemic in Warsaw, Poland, and to investigate whether RSV and/or influenza A/B infections were associated with SARS-CoV-2 infections. We present results of RT-PCR tests for SARS-CoV-2 performed in Warsaw, Poland. Some of the pediatric subjects were also PCR-tested for RSV, and A and B influenza. We compared the test results from the four groups of symptomatic and asymptomatic subjects: 459 symptomatic pediatric patients (children 0-18 years old), 1774 symptomatic adults, 445 asymptomatic children, and 239 asymptomatic adults. 3.26% (15/459) of symptomatic pediatric patients were positive for SARS-CoV-2 in contrast to 5.58% (99/1774) of symptomatic adults (p = 0.0448). There were no SARS-CoV-2 positive cases in the group of asymptomatic children (0/445) and two positive cases in the group of asymptomatic adults (2/239), i.e., 0.83%. In the group of symptomatic pediatric patients, 17.14% (6/35) (p = 0.0002) were positive for RSV, 8.16% (4/49) were positive for influenza A, and 2.04% (1/49), thus 10.20% (5/49) (p = 0.0176) for influenza A/B. Children were less prone to SARS-CoV-2 infection than the adults during the COVID-19 pandemic in Warsaw. Higher percentage of symptomatic children was infected with RSV or influenza A/B than with SARS-CoV-2. This suggests a necessity for the testing for all these viruses for an early identification and isolation of SARS-CoV-2-positive patients for an ensuing 2020 autumn return of COVID-19.
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http://dx.doi.org/10.1007/s10096-020-04038-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520378PMC
March 2021

Fever and Diarrhea as the Only Symptoms of Multisystem Inflammatory Syndrome in Children.

Gastroenterology 2021 Feb 29;160(3):968-969. Epub 2020 Aug 29.

Department of Pediatrics with Clinical Decisions Unit, Medical University of Warsaw, Warsaw, Poland.

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http://dx.doi.org/10.1053/j.gastro.2020.08.047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455525PMC
February 2021

Development of child immunity in the context of COVID-19 pandemic.

Clin Immunol 2020 08 13;217:108510. Epub 2020 Jun 13.

Department of Regenerative Medicine and Cell Biology, Military Institute of Hygiene and Epidemiology (WIHE), Warsaw, Poland; UnivRennes, UMR 6290, CNRS, Institute of Genetics and Development of Rennes, Cell Cycle Group, Faculty of Medicine, Rennes, France. Electronic address:

Children, because of having an immature immune system, are usually more prone than the adults to the microbial infections and have more severe symptoms, which is especially true for the newborns, and very young children. However, the review of clinical data from the current COVID-19 pandemic indicates otherwise. We discuss here what are the main features and components of children's immune system, the role of maternal transmission of immunity, and what are the possible explanations for the seemingly lower infection rate and severity of COVI-19 in children.
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http://dx.doi.org/10.1016/j.clim.2020.108510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293525PMC
August 2020

The clinical course of gastroenteritis due to nosocomial and community acquired norovirus infections in immunocompromised and immunocompetent children - single center experience.

Przegl Epidemiol 2020 ;74(1):23-31

Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Public Paediatric Teaching Hospital.

Background: After the introduction of rotavirus vaccines into immunization schedules, noroviruses account for the majority of acute gastrointestinal infections. The aim of the study was to assess the clinical presentation in immunocompromised and immunocompetent children with hospital- and community-acquired norovirus gastroenteritis.

Material And Methods: We retrospectively reviewed clinical records of children with noroviral gastroenteritis, hospitalized in the Pediatric Hospital, Medical University of Warsaw, between 2015 and 2018. Acute gastrointestinal tract symptoms and confirmed etiology of noroviral infection were inclusion criteria. The analysis was performed in the subgroups of immunocompetent and immunocompromised patients, during community-acquired and nosocomial infections.

Results: A total of 57 children with median age 1.5 year (IQR: 0.7-4.0) were recruited. The majority of patients were immunocompetent (87.7%), and nosocomial infections were predominant (56.1%). Gastrointestinal symptoms included nausea, vomiting and diarrhoea (in approximately 85%), while systemic manifestations such as fever and malaise where observed in only ¼. Routine laboratory tests were normal in most of the patients. An analysis in the subgroups revealed statistically significant differences in blood pH and serum electrolyte levels - acidosis and electrolyte disturbances were statistically significantly more common in immunocompromised vs immunocompetent patients (p<0.05).

Conclusions: More frequently the clinical presentation includes gastrointestinal symptoms with no differences between immunocompromised and immunocompetent hosts. The median laboratory values were normal in generally healthy children; disturbances were observed only in children with immunodeficiencies. Therefore, prophylactic measures are of particular importance in the latter group, which is especially sensitive to severe and nosocomial infections.
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http://dx.doi.org/10.32394/pe.74.03DOI Listing
January 2020

Vaccinations in rheumatic diseases.

Reumatologia 2020 30;58(2):61-62. Epub 2020 Apr 30.

Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Poland.

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http://dx.doi.org/10.5114/reum.2020.95358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249519PMC
April 2020

Safety and Impact on Training of the Influenza Vaccines in Elite Athletes Participating in the Rio 2016 Olympics.

Clin J Sport Med 2020 Feb 6. Epub 2020 Feb 6.

Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland.

Objective: The aim of the study was to evaluate the safety and tolerance of influenza vaccines for the northern and southern hemispheres in Polish elite athletes participating in the Rio 2016 Olympics.

Design: Prospective, observational, cohort study.

Setting: Institutional level.

Participants: Ninety-seven athletes vaccinated only with the northern hemisphere vaccine; 98 athletes received the southern hemisphere vaccine alone, whereas 39 athletes were vaccinated with both vaccines.

Interventions: The athletes were vaccinated with a trivalent, inactivated influenza vaccine recommended for the northern hemisphere 2015/2016 and then with the vaccine recommended for the southern hemisphere 2016. Athletes kept a diary of adverse events and effects (if any) on training for 6 days after vaccination.

Main Outcome Measures: The percentage of general and local adverse events, number of lost or modified training sessions.

Results: Significantly more local adverse events (pain and redness) were found in the group immunized with the vaccine for the northern hemisphere. There were no differences in the frequency of general adverse events and influence on training between groups. Of total 273 athletes who had 1911 training days during 6 days after vaccination, 6 athletes (2.2%) lost 13 training days (0.7%) and 16 athletes (5.9%) had to modify 34 (1.7%) training days within first 2 days after vaccination.

Conclusions: Athletes tolerated influenza immunization well. If they are going to travel to the other hemisphere during the influenza season, the use of the second influenza vaccine should be advised. Athletes should anticipate modification of trainings for 2 days after vaccination.
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http://dx.doi.org/10.1097/JSM.0000000000000808DOI Listing
February 2020

Decreasing Vaccination Coverage Against Hepatitis B and Tuberculosis in Newborns.

Adv Exp Med Biol 2020 ;1251:99-105

Department of Pediatrics and Clinical Assessment Unit, Warsaw Medical University, Warsaw, Poland.

The number of parents who refuse to vaccinate their children or present the so-called hesitant behavior, i.e., delay the moment of vaccination beyond the mandatory time, has increased in many developed countries. The purpose of this retrospective study was to evaluate the completeness and timeliness of vaccinations against hepatitis B (HBV) and tuberculosis (TB) in neonates in a single maternity hospital in Warsaw, Poland. We reviewed medical files of 14,785 children born in the hospital in 2015-2017 and calculated the proportion of newborns not vaccinated on time according to the Polish Immunization schedule that includes vaccination against HBV and TB in the first day of life. Newborns remained unvaccinated because of parental refusal (refusers) or decision for a delay (hesitants), or medical contraindications. The percentage of unvaccinated newborns in the 3 years was as follows: 7.3% in 2015, 6.7% in 2016, and 10.1% in 2017. Parental decisions rather than medical contraindications caused nonvaccination (4.4% vs. 2.9% in 2015, 4.7% vs. 2.0% in 2016, and 7.5% vs. 2.6% in 2017). The majority of refusals concerned both vaccinations (67.3% in 2015, 74.8% in 2016, and 68% in 2017). Among parents who refused only one vaccination, TB vaccination was refused more often than HBV (9.2% vs. 7.1% in 2015, 8.3% vs. 5.7% in 2016, and 5.9% vs. 2.7% in 2017). Similar trends were observed among the hesitants. In conclusion, it seems essential to implement effective educational and informative activities targeted to parents to reinforce positive attitudes toward vaccinations.
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http://dx.doi.org/10.1007/5584_2019_446DOI Listing
March 2020

A roadmap for a comprehensive control of cervical cancer in Poland: integration of available solutions into current practice in primary and secondary prevention.

Eur J Cancer Prev 2020 03;29(2):157-164

Department of Lymphoid Malignancies, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland.

In Poland, cervical cancer incidence and mortality still remain considerably higher than in Western European countries or North America. Recent data indicate decreasing trends in women younger than 60 years and stable trends in older women. In this article, we identified obstacles in primary and secondary prevention of cervical cancer in Poland. We analysed local legislation, management structure and organization of cervical cancer prevention in Poland and reviewed solutions available and implemented in other European countries. The main weaknesses include: (i) very low coverage of organized screening; concurrent unregistered opportunistic screening with unknown coverage and high test consumption (ii) suboptimal quality assurance in organized screening and no external quality assurance in opportunistic screening (iii) very low coverage of human papillomavirus vaccination that is not centrally reimbursed (iv) absence of pilot evaluation of (a) interventions that may improve population coverage and (b) performance of new preventive strategies. The proposed solutions are multifaceted and involve: (i) legislative and organizational regulation of cervical cancer screening aimed at comprehensive registration of procedures, data access and quality assurance (ii) pilot testing and implementation of new ways to increase coverage of cervical cancer screening, in particular among older women (iii) pilot evaluation with possible introduction of human papillomavirus-based screening and (iv) inclusion of human papillomavirus vaccination into the reimbursed national immunization program.
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http://dx.doi.org/10.1097/CEJ.0000000000000528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012359PMC
March 2020

Genetic Predisposition for Osteoporosis and Fractures in Postmenopausal Women.

Adv Exp Med Biol 2019 ;1211:17-24

Department of Clinical Rehabilitation, Warsaw Medical University, Warsaw, Poland.

Osteoporosis is a disease with complex etiology where the genetic factors may account for as much as 50-85% of the risk of its development in postmenopausal women. The polymorphism of estrogen receptor genes (ESR1, ESR2) seems essential among the genetic factors. The goal of this study was to analyze polymorphisms of selected genes in a population of postmenopausal women treated for osteoporosis and to evaluate the influence of genetic and nongenetic factors on the estimated 10-year risk of fracture. The study group consisted of 214 women hospitalized for treatment of postmenopausal osteoporosis. We investigated the presence of ESR1, ESR2, LRP5, and WNT16 genetic polymorphisms and the risk of fracture in each woman. The main finding was that of significant differences in the polymorphisms of the WNT16 rs2908004 genetic variant, notably, the less frequent presence of TC allele in women with a greater risk of osteoporotic fractures. We conclude that the polymorphism of the WNT16 gene seems highly relevant in the pathogenesis of osteoporosis, which makes it a promising object for further research on the genetic background of fracture risk.
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http://dx.doi.org/10.1007/5584_2019_413DOI Listing
November 2019

Autologous Platelet-Rich Plasma Reduces Healing Time of Chronic Venous Leg Ulcers: A Prospective Observational Study.

Adv Exp Med Biol 2019 ;1176:109-117

Department of Imaging Examinations, Warsaw Medical University, Warsaw, Poland.

The study investigated whether the application of dressings with autologous platelet-rich plasma (PRP) would reduce the healing time in patients with chronic venous leg ulcers. This is a prospective observational study that included 100 patients diagnosed with lower extremity venous insufficiency complicated by ulceration of a leg or foot, who had been after angioplasty of stenotic artery. Patients were divided into two groups of 50 each: treated with PRP (study group) and treated with conventional hydrocolloid dressings (control group). We followed the wound changes at Day 10, Day 20, and Day 30 of treatment and compared them with the baseline appearance at Day 0. We evaluated the appearance, area, and depths of wounds with ultrasound. The granulation process was examined histologically to document skin formation and wound tissue neovascularization. The findings were that treatment with PRP dressings resulted in a significant progressive reduction in ulcer size, irrespective of the ulcer's initial size, compared to treatment with conventional dressings. Further, the best effect of PRP was noticed in the category of largest wounds. After a month of treatment with PRP dressings, more than 50% of all ulcers were completely healed. The young epidermis appeared together with the granulation tissue, and the formation of dermis took shape after 20 days of treatment. We conclude that the use of PRP dressings is a safe, nonsurgical adjunctive procedure for treating chronic venous leg ulcers. The potential benefit of PRP dressings over conventional ulcer treatment requires further in-depth exploration.
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http://dx.doi.org/10.1007/5584_2019_388DOI Listing
September 2019

Vaccination Against Measles, Mumps, and Rubella in the Light of Current Epidemic Threats: Unjustified Postponement.

Adv Exp Med Biol 2019 ;1153:101-107

Department of Pediatrics with Clinical Assessment Unit, Warsaw Medical University, Warsaw, Poland.

A worrying increase in the number of measles cases has been noted recently in Poland, which may have to do with a decreasing proportion of children vaccinated against measles, mumps, and rubella (MMR) in the second year of life (<95%). For many years, MMR vaccination in children has been associated with a fear of allergy to eggs. This study seeks to define the reason and justification for postponing MMR vaccination in a population of children referred to the outpatient specialist immunization clinic. One hundred and thirty eight (138) children, mean 24.5 ± 26.6 months, with a history of past allergies, in whom the first-time MMR vaccination was delayed by family doctors for fear of allergic reactions, were enrolled into the study. The mean delay in a vaccine shot was 12.3 ± 26.9 months. There were 101 children who displayed a distinct allergy to the egg proteins, among other accompanying types of allergy. All of the 138 children were found eligible to receive MMR vaccine at the visit to the clinic. No early allergic responses were noticed in any of the children. There were negligible delayed allergic responses in six children, all from the egg allergy group. We conclude that MMR vaccination in children with egg allergy is safe and can be conducted on the outpatient basis without any specific precautions or safety measures. Delays in vaccination were unjustified and may jeopardize children's health. There is a need for insightful education of primary care doctors concerning of MMR vaccination safety, particularly when allergy is suspected, to avoid unduly and potentially harmful delays.
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http://dx.doi.org/10.1007/5584_2019_344DOI Listing
September 2019

Severe Hyponatremia in a 6-month-old Infant.

J ASEAN Fed Endocr Soc 2019 30;34(1). Epub 2019 Jul 30.

Department of Pediatrics with Clinical Assessment Unit, Second Medical Faculty Medical University of Warsaw, Poland.

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http://dx.doi.org/10.15605/jafes.034.01.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784085PMC
July 2019

Knowledge Regarding Influenza and Influenza Vaccination in General Population: Results of a National Survey in Poland.

Adv Exp Med Biol 2018;1108:55-61

Department of Social Medicine and Public Health, Warsaw Medical University, Warsaw, Poland.

For the past 10 years, influenza vaccination coverage rate in Poland remains at a low 3% threshold. This low rate may be related to the unsatisfactory knowledge of vaccination, influenza, and misperception of health risks in the general population. To examine these issues, we used an online questionnaire consisting of 12 closed questions. The basic knowledge on influenza and vaccination was examined. The questionnaire was completed by 1669 persons, mostly young women. Generally, 73% of respondents passed the threshold of 70% correct answers, but important gaps in their knowledge were identified concerning the persons at risk of developing the infection (7.9% of correct answers) and the timing of vaccination (8.4% of correct answers). Although most respondents did identify the etiologic agent correctly (91.1% knew influenza is caused by a virus), only 12.3% knew that the vaccines registered in Poland contain fragments of viruses or its antigens, while 63.1% thought the vaccines contain live bacteria. In conclusion, the knowledge on influenza vaccination is deficient in the general population. Education on immunization should be prioritized to increase vaccination coverage rate in Poland.
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http://dx.doi.org/10.1007/5584_2018_233DOI Listing
July 2019

Impact of European vaccination policies on seasonal influenza vaccination coverage rates: An update seven years later.

Hum Vaccin Immunother 2018 27;14(11):2706-2714. Epub 2018 Aug 27.

l Royal College of General Practitioners , Wokingham , Berkshire , UK.

Seasonal influenza can have serious morbid consequences and can even result in death, particularly in at-risk populations, including healthcare professionals (HCPs), elderly and those living with a medical risk condition. Although in Europe recommendations exist for annual influenza vaccination in these populations in most countries, the vaccination coverage rate (VCR) is often well below the World Health Organization target of 75% coverage. In our previous survey in 2009 we showed that some elements of national vaccination policies, e.g. reminder systems, strong official recommendation, and easy access, seemed to contribute to achieving higher influenza VCRs among elderly. We repeated the survey in 2016, using the same methodology to assess changes in influenza VCRs among the elderly and in the impact of policy elements on these VCRs. In addition, we collected information about VCRs among HCPs, and those living with a medical risk condition. The median VCR in the 21 countries that had recommendations for influenza vaccination in the elderly was 35.3%, ranging from 1.1% in Estonia to 74.5% in Scotland. The average VCRs for HCPs and those living with medical risk conditions, available in 17 and 10 countries, respectively, were 28.3% (range 7% in Czech Republic to 59.1% in Portugal) and 32.2% (range from 20.0% in the Czech Republic and Hungary to 59.6% in Portugal), respectively. Fewer countries were able to provide data from HCP and those living with medical risk conditions. Since the initial survey during the 2007-2008 influenza season, VCRs have decreased in the elderly in the majority of countries, thus, achieving high VCRs in the elderly and the other target groups is still a major public health challenge in Europe. This could be addressed by the identification, assessment and sharing of best practice for influenza vaccination policies.
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http://dx.doi.org/10.1080/21645515.2018.1489948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314402PMC
June 2019

Antibody Response to Trivalent Influenza Vaccine in the Northern and the Southern Hemisphere in Elite Athletes.

Adv Exp Med Biol 2018;1108:49-54

Department of Influenza Research, National Influenza Center, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland.

Being frequent travelers, the elite athletes are advised to undergo an influenza vaccination. The aim of the study was to describe the antibody response to repeated trivalent, inactivated, split influenza vaccine, of different antigenic content, recommended for the Northern and the Southern Hemisphere, administered to sportsmen before the Olympic Games in Brasil in 2016. Fourteen athletes were included in the study. For both A/California/7/209/pdm09 A/H1N1/ antigen and A/Switzerland/971593/2013/A/H3N2/ antigen, higher seroconversion rates were obtained after the first than the second vaccination (10.2 vs. 1.5 and 10.6 vs. 3.0, respectively; p < 0.05 both). Conversion rates for B/Phuket/3073/2013, B/Brisbane/60/2008, and A/HongKong/4801/2014/A/H3N2/ antigens were lower. Nonetheless, the protection rate was greater than 70% for all antigens contained in both vaccines. The proportion of individuals demonstrating a high level of both protection rate and response rate was greater after the first than the second vaccination. We conclude that the immunological response after influenza vaccination is good in elite athletes and remains so after a second influenza vaccination required due to a different vaccine composition recommended for different hemispheres.
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http://dx.doi.org/10.1007/5584_2018_223DOI Listing
July 2019

Motors of influenza vaccination uptake and vaccination advocacy in healthcare workers: A comparative study in six European countries.

Vaccine 2018 10 28;36(44):6546-6552. Epub 2018 Mar 28.

Kingston University, London, United Kingdom. Electronic address:

Background: Annual vaccination is the most effective way to prevent and control the health and economic burden caused by seasonal influenza. Healthcare workers (HCWs) play a crucial role in vaccine acceptance and advocacy for their patients. This study explored the drivers of HCWs' vaccine acceptance and advocacy in six European countries.

Methods: Healthcare workers (mainly general practitioners, specialist physicians, and nurses) voluntarily completed a questionnaire in Bulgaria (N = 485), Czech Republic (N = 518), Kosovo (N = 466), Poland (N = 772), Romania (N = 155), and the United Kingdom (N = 80). Twelve-item scales were used to analyse sentiment clusters for influenza vaccination acceptance and engagement with vaccination advocacy. Past vaccination behaviour and patient recommendation were also evaluated. All data were included in a single analysis.

Results: For vaccination acceptance, the main cluster (engaged sentiment: 68%) showed strong positive attitudes for influenza vaccination. A second cluster (hesitant sentiment: 32%) showed more neutral attitudes. Cluster membership was predicted by country of origin and age. The odds ratio for past vaccination in the engaged cluster was 39.6 (95% CI 12.21-128.56) although this varied between countries. For vaccination advocacy, the main cluster (confident sentiment: 73%) showed strong positive attitudes towards advocacy; a second cluster (diffident sentiment: 27%) showed neutral attitudes. Cluster membership was predicted by country of origin, age and profession, with specialist physicians being the least likely to belong to the confident sentiment cluster. HCWs characterised by confident advocacy sentiments were also more likely recommend flu vaccination. Again, this association was moderated by country of origin.

Conclusions: These data show that there is room to improve both vaccination acceptance and advocacy rates in European HCWs, which would be expected to lead to higher rates of HCW vaccination. Benefits that could be expected from such an outcome are improved advocacy and better control of morbidity and mortality related to seasonal influenza infection.
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http://dx.doi.org/10.1016/j.vaccine.2018.02.031DOI Listing
October 2018

Response to Letter to the Editor re 'Urinary tract infection in children: Diagnosis, treatment, imaging - Comparison of current guidelines'.

J Pediatr Urol 2018 06 12;14(3):301-302. Epub 2018 Mar 12.

Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Ul. Żwirki i Wigury 63A, Warszawa 02-091, Poland.

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http://dx.doi.org/10.1016/j.jpurol.2018.02.008DOI Listing
June 2018

Pertussis outbreak in Polish shooters with adverse event analysis.

Biol Sport 2017 Sep 19;34(3):243-248. Epub 2017 Feb 19.

Department of Pediatrics with Medical Assessment Unit, Medical University of Warsaw, Warsaw, Poland.

In addition to different injuries, infections are the most common reason for giving up training altogether or reducing its volume and intensity, as well as a lack of opportunities to participate in sports competitions. Nowadays, a slow but constant re-emergence of pertussis, especially among teenagers and young adults, including athletes, can be observed. This paper describes an outbreak of pertussis among professional Polish shooters, focusing on the transmission of infection between members of the national team, its influence on performance capacity and adverse event analysis. From 9 June, 2015 to 31 July, 2015, a total of 4 confirmed and suspected cases of pertussis were reported among members of the Polish Sport Shooting National Team, their relatives and acquaintances. Pertussis significantly decreased exercise performance of the first athlete, a 35-year-old woman, interrupted her training, and finally resulted in failure to win a medal or quota place. Pertussis also significantly decreased performance of the second athlete, a 25-year-old shooter. The other cases emerged in their families. Whooping cough is a real threat to athletes and should be prevented. Preventive measures include appropriate immunization, constant medical supervision, as well as early isolation, diagnostic tests and treatment of all infected sport team members. Regular administration of booster doses of the acellular pertussis vaccine (Tdpa) every 5 years seems reasonable.
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http://dx.doi.org/10.5114/biolsport.2017.66001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676320PMC
September 2017

Evaluation of the Implementation of Hospital Antibiotic Policy in Oncosurgery Ward: A Six-Year Experience.

Adv Exp Med Biol 2018 ;1047:21-30

Department of Pediatrics and Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland.

The hospital antibiotic policy should be implemented to rationalize the antibiotic use and to decrease the risk of spread of resistant bacteria. The aim of this study was to describe the antibiotic consumption patterns in a single oncosurgery ward before and after the implementation of hospital antibiotic policy. We conducted a retrospective analysis of the antibiotic use at the oncosurgery ward in Warsaw, Poland, in the years 2011-2016. Calculations were based on daily defined doses (DDD), DDD/100 hospitalizations, and DDD/100 person-days. Drug utilization rates (DU 90% and DU 100%) were also analyzed. After the implementation of hospital antibiotic policy, a total antibiotic consumption increased (365.35 DDD in 2011 vs. 1359.22 DDD in 2016). A significant change was observed in the antibiotic consumption patterns: the use of amoxicillin clavulanate and carbapenems or glycopeptides decreased significantly (p < 0.05), while the use of ciprofloxacin and aminoglycosides increased (p < 0.05). The DU100% rate varied from 6 in 2011 to 12 in 2016; while DU 90% rate varied from 2 in 2011 to 3-5 in 2013-2016. Although the implementation of hospital antibiotic policy did not result in a decrease in the antibiotic consumption, it seems to provide a favorable change into the antibiotic consumption pattern.
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http://dx.doi.org/10.1007/5584_2017_122DOI Listing
October 2018

Healthcare Professionals' Knowledge of Influenza and Influenza Vaccination: Results of a National Survey in Poland.

Adv Exp Med Biol 2018 ;1039:19-27

Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Street, 02-007, Warsaw, Poland.

In Poland, the seasonal influenza vaccination rate is just barely 3% which may be related to the unsatisfactory knowledge of influenza among healthcare professionals, poor recognition of the benefits of influenza immunization and the fear of side effects. To address these issues, we surveyed healthcare professionals through an online questionnaire consisting of 18 closed-ended items. The questionnaire was completed by 495 healthcare professionals, mostly physicians (83%). The results revealed gaps in the knowledge concerning influenza diagnosis, complications, risk groups, and prognostic factors. On average, respondents only answered 4.8 of the 18 questions correctly (27%). Only 10% of respondents passed the threshold of 50% correct answers. The knowledge of contraindications to vaccination far outweighed the knowledge of indications for vaccination. Poor knowledge with a focus on the adverse effects of immunization may be a significant factor responsible for the low vaccination rate in Poland. To increase vaccination rate, healthcare professionals need to be educated about influenza-related risks and benefits of vaccination.
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http://dx.doi.org/10.1007/5584_2017_78DOI Listing
May 2018

Rapid Influenza Diagnostic Tests Improve Suitability of Antiviral Treatment in Hospitalized Children.

Adv Exp Med Biol 2017 ;968:1-6

Department of Influenza Research, National Influenza Center, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland.

Influenza may have a complicated course in young children. The aim of the study was to analyze the suitability of influenza treatment among children younger than 5 years hospitalized due to an influenza-like illness. We conducted a comparison of the treatment among children hospitalized in two consecutive years: 2015, when no rapid influenza diagnostic tests (RIDT) were in use, and 2016, when RIDT were implemented into a routine practice in the pediatric ward. In both seasons, nasopharyngeal swabs were collected and examined with real time qRT-PCR. In the 2015 season, influenza was diagnosed in 15/52 (28 %) children and none of them received oseltamivir, while 14/15 (93 %) patients received antibiotics. In the 2016 season, influenza was diagnosed in 11/63 (17 %) children, 7/11 (64 %) of them received oseltamivir and another 7/11 (64 %) received antibiotics. In four cases antibiotics overlapped oseltamivir. These differences in the use of oseltamivir and antibiotics were statistically significant (p < 0.05). We conclude that the implementation of RIDT improves the suitability of influenza treatment and decreases the frequency of antibiotic therapy. RIDT should be available in pediatric departments to optimize influenza treatment.
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http://dx.doi.org/10.1007/5584_2016_181DOI Listing
September 2017

Public Perception of the Risks Associated with Infectious Diseases in Poland: Ebola and Influenza and Their Impact on the Attitude to Vaccination.

Adv Exp Med Biol 2017 ;980:27-36

Department of Social Medicine and Public Health, Medical University of Warsaw, Wroclaw, Poland.

While the Ebola outbreak in 2014 was strongly highlighted in mainstream media and perceived as a threat to public health in Poland, influenza was regarded as a triviality and the vaccination coverage was low. In the present study, by analyzing feedback from an on-line questionnaire (from November 2014 to January 2015) we assessed the knowledge concerning Ebola and influenza together with attitudes to immunization of 544 respondents (45% medical staff). The findings were that 92.6% of respondents declared readiness to vaccination before traveling to endemic regions if a vaccine against Ebola would have existed, but adverse reactions, high costs, and low effectiveness would adversely affect that decision. While 84.2% of respondents declared awareness of influenza attributing significantly to the cause of death, only 65.4% considered influenza as an actual danger for people in Poland and 46.7% thought that Poland was not an endemic region for influenza. Nearly 23% declared that they were already vaccinated against influenza. The majority of respondents (67.5%) were not going to be vaccinated. We conclude that awareness of risk related to infectious diseases is an important determinant when deciding whether to vaccinate. However, negative information about the vaccine has some bearing on the decision to get vaccinated.
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http://dx.doi.org/10.1007/5584_2016_207DOI Listing
September 2017

Influenza vaccination: key facts for general practitioners in Europe-a synthesis by European experts based on national guidelines and best practices in the United Kingdom and the Netherlands.

Drugs Context 2016 3;5:212293. Epub 2016 Aug 3.

General Practitioner in Amersfoort, The Netherlands.

Currently there is no influenza vaccination guidance for European general practitioners. Furthermore, although the European Council recommends a target seasonal influenza vaccination rate of 75% in the elderly (65 years and above) and in anyone aged >6 months with a chronic medical condition, there remain wide discrepancies throughout Europe. A harmonised guideline regarding not only vaccination strategy but also for the consistent diagnosis of influenza across Europe is essential to support a common approach for the implementation of seasonal influenza vaccination across Europe. This document is based on pre-existing guidelines available in the UK and Netherlands and has been approved by a group of European experts for use throughout Europe. As well as providing a standardised influenza diagnosis, it also reviews the current recommendations for influenza vaccination, the types of vaccine available, the contraindications, vaccine use in special populations (in pregnancy, children, and in those with egg allergy), and concomitant administration with other vaccines. The effectiveness, safety, and timing of the seasonal influenza vaccine are also reviewed. A second section provides practical guidance for general practitioners for the implementation of a seasonal influenza vaccination program, including the selection and notification of those eligible for vaccination, as well as suggestions for the organisation of a vaccination programme. Finally, suggested responses to common patient misconceptions and frequently asked questions are included. The aim of this article is to harmonise the diagnosis of seasonal influenza and the approach of European general practitioners to seasonal influenza vaccination in order to better identify influenza outbreaks and to move towards reaching the target vaccination rate of 75% throughout Europe.
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http://dx.doi.org/10.7573/dic.212293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974050PMC
August 2016

Three episodes of Kawasaki disease including one after the Pneumo 23 vaccine in a child with a family history of Kawasaki disease.

J Formos Med Assoc 2016 Oct 28;115(10):885-886. Epub 2016 Jun 28.

Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland.

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http://dx.doi.org/10.1016/j.jfma.2016.04.005DOI Listing
October 2016

Clinical Presentation of Herpes Zoster in Immunocompetent and Immunocompromised Hospitalized Children Treated With Acyclovir.

J Pediatr Hematol Oncol 2016 07;38(5):394-7

*Department of Pediatric Infectious Diseases, Wroclaw Medical University, Wroclaw †Department of Pediatrics with Clinical Decisions Unit, 2nd Medical Faculty, Medical University of Warsaw, Warsaw, Poland.

Herpes zoster, defined as the reactivation of a latent varicella-zoster virus (VZV) infection, used to be a serious disease in immunocompromised children until recently. The aim of this study was to describe the clinical presentation of herpes zoster in hospitalized immunocompromised children compared with hospitalized immunocompetent counterparts. We reviewed the hospital charts of 72 children aged 6 months to 18 years diagnosed with herpes zoster and treated with acyclovir in our department covering a 19-year period. Forty-six of the children were immunocompromised which was mainly due to hematologic diseases. There were no differences in the age at which herpes zoster occurred, length of hospitalization, and the location or extent of the skin eruption. General symptoms were observed more frequently in the hospitalized immunocompetent patients compared with the hospitalized immunocompromised children (80% vs. 56%). The average age at which primary VZV infection occurred was higher among the immunocompromised children than the immunocompetent children with the latter group suffering from significantly more primary VZV infections during infancy. The presentation of herpes zoster in immunocompromised children is similar to that of herpes zoster in hospitalized immunocompetent children.
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http://dx.doi.org/10.1097/MPH.0000000000000567DOI Listing
July 2016

Polish consensus guidelines on the use of acyclovir in the treatment and prevention of VZV and HSV infections.

J Infect Chemother 2016 Feb 28;22(2):65-71. Epub 2015 Nov 28.

Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, Poland; Department of Pediatrics and Observation Ward, Medical University of Warsaw, Poland.

A physician has to perform a benefit-risk assessment each time acyclovir is prescribed "off label" for children. A group of Polish infectious disease experts was created to develop evidence-based guidelines on the use of acyclovir in the treatment and prevention of varicella zoster and herpes simplex infections. In primary varicella zoster virus infections, oral acyclovir treatment is recommended in children over 12 years of age and should be considered in younger children who fall into one of the groups at risk of severe varicella. Intravenous acyclovir therapy in varicella is recommended in patients with immune deficiencies, newborns and in complicated cases. When there is a justified need for prevention of varicella, oral acyclovir prophylaxis may be considered if immunoglobulin cannot be administered, and if it is too late for vaccination. Oral acyclovir treatment of herpes zoster may be beneficial to otherwise healthy patients with a rash in places other than the trunk and in patients over 50 years of age. In immunocompetent patients with herpes simplex infections, indications for treatment with oral acyclovir include primary (genital herpes, skin herpes in children with atopic dermatitis, ocular herpes simplex, severe gingivostomatitis, paronychia and pharyngitis) and recurrent infections. Intravenous acyclovir should be administered for herpes infections in neonates, immunocompromised patients and patients who develop complications including neurological.
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http://dx.doi.org/10.1016/j.jiac.2015.10.003DOI Listing
February 2016

A review of guidance on immunization in persons with defective or deficient splenic function.

Br J Haematol 2015 Dec 28;171(5):683-94. Epub 2015 Aug 28.

Department of Paediatric Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland.

The spleen acts as a blood filter and lymphopoietic organ. Asplenic and hyposplenic individuals are more susceptible to serious infections caused by encapsulated bacteria but they can be protected by antibiotic prophylaxis and immunizations. Recent progress in vaccinology means prophylaxis is now successful in the vast majority of serious infections with pneumococci, meningococci and Haemophilus influenzae type b responsible for the majority of cases of overwhelming sepsis in asplenic patients. Current guidelines are coherent. Physicians treating patients with conditions associated with hyposplenism are ethically obliged to immunize their patients using the vaccines currently available to protect them from largely preventable, life-threatening infections.
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http://dx.doi.org/10.1111/bjh.13660DOI Listing
December 2015