Introduction to the RSC Advances themed collection on nano and microscale modifications of biomaterials

Andrzej Zieliński and Beata Majkowska-Marzec introduce the RSC Advances themed collection on nano and microscale modifications of biomaterials.

Cytocompatibility, antibacterial, and corrosion properties of chitosan/polymethacrylates and chitosan/poly(4-vinylpyridine) smart coatings, electrophoretically deposited on nanosilver-decorated titania nanotubes

The development of novel implants subjected to surface modification to achieve high osteointegration properties at simultaneous antimicrobial activity is a highly current problem. This study involved different surface treatments of titanium surface, mainly by electrochemical oxidation to produce a nanotubular oxide layer (TNTs), a subsequent electrochemical reduction of silver nitrate and decoration of a nanotubular surface with silver nanoparticles (AgNPs), and finally electrophoretic deposition (EPD) of a composite of chitosan (CS) and either polymethacrylate-based copolymer Eudragit E 100 (EE100) or poly(4-vinylpyridine) (P4VP) coating. The effects of each stage of this multi-step modification were examined in terms of morphology, roughness, wettability, corrosion resistance, coating-substrate adhesion, antibacterial properties, and osteoblast cell adhesion and proliferation. The results showed that the titanium surface formed nanotubes (inner diameter of 97 ± 12 nm, length of 342 ± 36 nm) subsequently covered with silver nanoparticles (with a diameter of 88 ± 8 nm). Further, the silver-decorated nanotubes were tightly coated with biopolymer films. Most of the applied modifications increased both the roughness and the surface contact angle of the samples. The deposition of biopolymer coatings resulted in reduced burst release of silver. The coated samples revealed potent antimicrobial activity against both Gram-positive and Gram-negative bacteria. Total elimination (99.9%) of E. coli was recorded for a sample with CS/P4VP coating. Cytotoxicity results using hFOB 1.19, a human osteoblast cell line, showed that after 3 days the tested modifications did not affect the cellular growth according to the titanium control. The proposed innovative multilayer antibacterial coatings can be successful for titanium implants as effective postoperative anti-inflammation protection.

Evaluation of adhesion strength, corrosion, and biological properties of the MWCNT/TiO2 coating intended for medical applications

Multi-wall carbon nanotube (MWCNT) coatings are gaining increasing interest because of their special properties used in many science fields. The titania coatings are known for their improvement of osteoblast adhesion, thus changing the surface architecture. Bi-layer coatings comprising 0.25 wt% of the MWCNTs and 0.30 wt% of titania (anatase structure) were synthesized in a two-stage procedure using the electrophoretic deposition method (EPD). The MWCNT and TiO2 coatings were deposited with voltage and time parameters, respectively, of 20 V and 0.5 min, and 50 V and 4 min. EDS, AFM, SEM, Raman spectroscopy, nano-scratch test, potentiodynamic corrosion tests, wettability studies, and cytotoxicity determined with MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) test on human dermal fibroblasts (HDF) and mouse osteoblast precursors (MC3T3), and lactate dehydrogenase (LDH) activity test were carried out on examined surfaces. The prepared MWCNT/TiO2 coating is uniformly distributed by MWCNTs and agglomerated by TiO2 particles of size ranging from 0.1 to 3 μm. Raman spectroscopy confirmed the anatase structure of the TiO2 addition and showed typical peaks of the MWCNTs. The MWCNT/TiO2 coating had higher roughness, higher adhesion strength, and improved corrosion resistance compared to the MWCNT basic coating. The results of biological tests proved that physicochemical properties of the surface, such as high porosity and wettability of MWCNT/TiO2-coated material, would support cell adhesion, but toxic species could be released to the culture medium, thus resulting in a decrease in proliferation.

Osteoblast and bacterial cell response on RGD peptide-functionalized chitosan coatings electrophoretically deposited from different suspensions on Ti13Nb13Zr alloy

Metallic materials for long-term load-bearing implants still do not provide high antimicrobial activity while maintaining strong compatibility with bone cells. This study aimed to modify the surface of Ti13Nb13Zr alloy by electrophoretic deposition of a chitosan coating with a covalently attached Arg-Gly-Asp (RGD) peptide. The suspensions for coating deposition were prepared in two different ways either using hydroxyacetic acid or a carbon dioxide saturation process. The coatings were deposited using a voltage of 10 V for 1 min. The prepared coatings were examined using SEM, EDS, FTIR, and XPS techniques. In addition, the wettability of these surfaces, corrosion resistance, adhesion of the coatings to the metallic substrate, and their antimicrobial activity (E. coli, S. aureus) and cytocompatibility properties using the MTT and LDH assays were studied. The coatings produced tightly covered the metallic substrate. Spectroscopic studies confirmed that the peptide did not detach from the chitosan chain during electrophoretic deposition. All tested samples showed high corrosion resistance (corrosion current density measured in nA/cm2 ). The deposited coatings contributed to a significant increase in the antimicrobial activity of the samples against Gram-positive and Gram-negative bacteria (reduction in bacterial counts from 99% to, for CS-RGD-Acid and the S. aureus strain, total killing capacity). MTT and LDH results showed high compatibility with bone cells of the modified surfaces compared to the bare substrate (survival rates above 75% under indirect contact conditions and above 100% under direct contact conditions). However, the adhesion of the coatings was considered weak.

Mechanical Properties and Wear Susceptibility Determined by Nanoindentation Technique of Ti13Nb13Zr Titanium Alloy after "Direct Laser Writing"

Laser treatment has often been applied to rebuild the surface layer of titanium and its alloys destined for long-term implants. Such treatment has always been associated with forming melted and re-solidified thin surface layers. The process parameters of such laser treatment can be different, including the patterning of a surface by so-called direct writing. In this research, pulse laser treatment was performed on the Ti13Nb13Zr alloy surface, with the distance between adjacent laser paths ranging between 20 and 50 µm. The obtained periodic structures were tested to examine the effects of the scan distance on the microstructure using SEM, the roughness and chemical and phase composition using EDS and XRD, and the mechanical properties using the nanoindentation technique. After direct laser writing, the thickness of the melted layers was between 547 and 123 µm, and the surface roughness varied between 1.74 and 0.69 µm. An increase in hardness was observed after laser treatment. The highest hardness, 5.44 GPa, was obtained for the sample modified with a laser beam spacing of 50 µm. The value of the distance has been shown to be important for several properties and related to a complex microstructure of the thin surface layer close to and far from the laser path.

Influence of Surface Modification of Titanium and Its Alloys for Medical Implants on Their Corrosion Behavior

Titanium and its alloys are often used for long-term implants after their surface treatment. Such surface modification is usually performed to improve biological properties but seldom to increase corrosion resistance. This paper presents research results performed on such metallic materials modified by a variety of techniques: direct voltage anodic oxidation in the presence of fluorides, micro-arc oxidation (MAO), pulse laser treatment, deposition of chitosan, biodegradable Eudragit 100 and poly(4-vinylpyridine (P4VP), carbon nanotubes, nanoparticles of TiO₂, and chitosan with Pt (nano Pt) and polymeric dispersant. The open circuit potential, corrosion current density, and potential values were determined by potentiodynamic technique, and microstructures of the surface layers and coatings were characterized by scanning electron microscopy. The results show that despite the applied modifications, the corrosion current density still appears in the region of very low values of some nA/cm². However, almost all surface modifications, designed principally for the improvement of biological properties, negatively influence corrosion resistance. The reasons for observed effects can vary, such as imperfections and permeability of some coatings or accelerated degradation of biodegradable deposits in simulated body fluids during electrochemical testing. Despite that, all coatings can be accepted for biological applications, and such corrosion testing results are presumed not to be of major importance for their applications in medicine.

Antibacterial properties of laser-encapsulated titanium oxide nanotubes decorated with nanosilver and covered with chitosan/Eudragit polymers

To provide antibacterial properties, the titanium samples were subjected to electrochemical oxidation in the fluoride-containing diethylene glycol-based electrolyte to create a titanium oxide nanotubular surface. Afterward, the surface was covered by sputtering with silver 5 nm film, and the tops of the nanotubes were capped using laser treatment, resulting in an appearance of silver nanoparticles (AgNPs) of around 30 nm in diameter on such a modified surface. To ensure a controlled release of the bactericidal substance, the samples were additionally coated with a pH-sensitive chitosan/Eudragit 100 coating, also exhibiting bactericidal properties. The modified titanium samples were characterized using SEM, EDS, AFM, Raman, and XPS techniques. The wettability, corrosion properties, adhesion of the coating to the substrate, the release of AgNPs into solutions simulating body fluids at different pH, and antibacterial properties were further investigated. The obtained composite coatings were hydrophilic, adjacent to the surface, and corrosion-resistant. An increase in the amount of silver released as ions or metallic particles into a simulated body fluid solution at acidic pH was observed for modified samples with the biopolymer coating after three days of exposure avoiding burst effect. The proposed modification was effective against both Gram-positive and Gram-negative bacteria.

Manipulation of light spectrum can improve the performance of photosynthetic apparatus of strawberry plants growing under salt and alkalinity stress

Strawberry is one of the plants sensitive to salt and alkalinity stress. Light quality affects plant growth and metabolic activities. However, there is no clear answer in the literature on how light can improve the performance of the photosynthetic apparatus of this species under salt and alkalinity stress. The aim of this work was to investigate the effects of different spectra of supplemental light on strawberry (cv. Camarosa) under salt and alkalinity stress conditions. Light spectra of blue (with peak 460 nm), red (with peak 660 nm), blue/red (1:3), white/yellow (1:1) (400–700 nm) and ambient light were used as control. There were three stress treatments: control (no stress), alkalinity (40 mM NaHCO₃), and salinity (80 mM NaCl). Under stress conditions, red and red/blue light had a positive effect on CO₂ assimilation. In addition, blue/red light increased intrinsic water use efficiency (WUEi) under both stress conditions. Salinity and alkalinity stress decreased OJIP curves compared to the control treatment. Blue light caused an increase in its in plants under salinity stress, and red and blue/red light caused an increase in its in plants under alkalinity. Both salt and alkalinity stress caused a significant reduction in photosystem II (PSII) performance indices and quantum yield parameters. Adjustment of light spectra, especially red light, increased these parameters. It can be concluded that the adverse effects of salt and alkalinity stress on photosynthesis can be partially alleviated by changing the light spectra.

Nanosilver-loaded PMMA bone cement doped with different bioactive glasses - evaluation of cytocompatibility, antibacterial activity, and mechanical properties

Nanosilver-loaded PMMA bone cement (BC-AgNp) is a novel cement developed as a replacement for conventional cements. Despite its favorable properties and antibacterial activity, BC-AgNp still lacks biodegradability and bioactivity. Hence, we investigated doping with bioactive glasses (BGs) to create a new bioactive BC characterized by time-varying porosity and gradual release of AgNp. The BC Cemex was used as the base material and modified simultaneously with the AgNp and BGs: melted 45S5 and 13-93B3 glasses with various particle sizes and sol-gel derived SiO₂/CaO microparticles. The effect of BG addition was examined by microscopic analysis, an assessment of setting parameters, wettability, FTIR and UV-VIS spectroscopy, mechanical testing, and hemo- and cytocompatibility and antibacterial efficiency studies. The results show that it is possible to incorporate various BGs into BC-AgNp, which leads to different properties depending on the type and size of BGs. The smaller particles of melted BGs showed higher porosity and better antibacterial properties with the moderate deterioration of mechanical properties. The sol-gel derived BGs, however, displayed a tendency for agglomeration and random distribution in BC-AgNp. The BGs with greater solubility more efficiently improve the antibacterial properties of BC-AgNp. Besides, the unreacted MMA monomer release could negatively influence the cellular response. Despite that, cements doped with different BGs are suitable for medical applications.

The Chemical and Biological Properties of Nanohydroxyapatite Coatings with Antibacterial Nanometals, Obtained in the Electrophoretic Process on the Ti13Zr13Nb Alloy

The risk of an early inflammation after implantation surgery of titanium implants has caused the development of different antimicrobial measures. The present research is aimed at characterizing the effects of nanosilver and nanocopper dispersed in the nanohydroxyapatite coatings, deposited on the Ti13Zr13Nb alloy, and on the chemical and biological properties of the coatings. The one-stage deposition process was performed by the electrophoretic method at different contents of nanomaterials in suspension. The surface topography of the coatings was examined with scanning electron microscopy. The wettability was expressed as the water contact angle. The corrosion behavior was characterized by the potentiodynamic technique. The release rate of copper and silver into the simulated body fluid was investigated by atomic absorption spectrometry. The antibacterial efficiency was evaluated as the survivability and adhesion of the bacteria and the growth of the biofilm. The cytotoxicity was assessed for osteoblasts. The results demonstrate that silver and copper increase the corrosion resistance and hydrophilicity. Both elements together effectively kill bacteria and inhibit biofilm growth but appear to be toxic for osteoblasts. The obtained results show that the nanohydroxyapatite coatings doped with nanosilver and nanocopper in a one-stage electrophoretic process can be valuable for antibacterial coatings.

Structural and Material Determinants Influencing the Behavior of Porous Ti and Its Alloys Made by Additive Manufacturing Techniques for Biomedical Applications

One of the biggest challenges in tissue engineering is the manufacturing of porous structures that are customized in size and shape and that mimic natural bone structure. Additive manufacturing is known as a sufficient method to produce 3D porous structures used as bone substitutes in large segmental bone defects. The literature indicates that the mechanical and biological properties of scaffolds highly depend on geometrical features of structure (pore size, pore shape, porosity), surface morphology, and chemistry. The objective of this review is to present the latest advances and trends in the development of titanium scaffolds concerning the relationships between applied materials, manufacturing methods, and interior architecture determined by porosity, pore shape, and size, and the mechanical, biological, chemical, and physical properties. Such a review is assumed to show the real achievements and, on the other side, shortages in so far research.

Infectious diseases in Poland in 2019

OBJECTIVE OF THE WORK

The article reviews the main problems of the epidemiology of infectious diseases in Poland. It is an introduction to the Epidemiological Chronicle presented annually in the Epidemiological Review.

MATERIAL AND METHODS

The data contained in this article come from the reports of the State Sanitary Inspectorate collected as part of routine epidemiological surveillance. Information on deaths comes from the reports from Statics Poland.

RESULTS AND THEIR DISCUSSION

Based on the basic materials, this text presents data on infectious diseases of particular importance due to high incidence, such as influenza and other respiratory infections, or due to increasing trends, such as C. difficile infections, and Lyme disease. Particular attention was paid to diseases against which vaccinations are used and to non-endemic diseases imported from abroad. In the epidemiological characteristics of individual diseases, reference was made mainly to the data on the number of cases, incidence and deaths included in Table 1.

Influence of several biodegradable components added to pure and nanosilver-doped PMMA bone cements on its biological and mechanical properties

Acrylic bone cements (BC) are wildly used in medicine. Despite favorable mechanical properties, processability and inject capability, BC lack bioactivity. To overcome this, we investigated the effects of selected biodegradable additives to create a partially-degradable BC and also we evaluated its combination with nanosilver (AgNp). We hypothesized that using above strategies it would be possible to obtain bioactive BC. The Cemex was used as the base material, modified at 2.5, 5 or 10 wt% with either cellulose, chitosan, magnesium, polydioxanone or tricalcium-phosphate. The resulted modified BC was examined for surface morphology, wettability, porosity, mechanical and nanomechanical properties and cytocompatibility. The composite BC doped with AgNp was also examined for its release and antibacterial properties. The results showed that it is possible to create modified cement and all studied modifiers increased its porosity. Applying the additives slightly decreased BC wettability and mechanical properties, but the positive effect of the additives was observed in nanomechanical research. The relatively poor cytocompatibility of modified BC was attributed to the unreacted monomer release, except for polydioxanone modification which increased cells viability. Furthermore, all additives facilitated AgNp release and increased BC antibacterial effectiveness. Our present studies suggest the optimal content of biodegradable component for BC is 5 wt%. At this content, an improvement in BC porosity is achieved without significant deterioration of BC physical and mechanical properties. Polydioxanone and cellulose seem to be the most promising additives that improve porosity and antibacterial properties of antibiotic or nanosilver-loaded BC. Partially-degradable BC may be a good strategy to improve their antibacterial effectiveness, but some caution is still required regarding their cytocompatibility. STATEMENT OF SIGNIFICANCE: The lack of bone cement bioactivity is the main limitation of its effectiveness in medicine. To overcome this, we have created composite cements with partially-degradable properties. We also modified these cements with nanosilver to provide antibacterial properties. We examined five various additives at three different contents to modify a selected bone cement. Our results broaden the knowledge about potential modifiers and properties of composite cements. We selected the optimal content and the most promising additives, and showed that the combination of these additives with nanosilver would increase cements` antibacterial effectiveness. Such modified cements may be a new solution for medical applications.

Tetanus in Poland in 2017

INTRODUCTION

In the last decade, the number of tetanus cases in Poland has not exceeded 20 cases. Since 1984, neonatal tetanus has not been reported.

OBJECTIVE OF THE WORK

The aim of the study is to present the data of epidemiological surveillance of tetanus in 2017 in a historical perspective, taking into account the role of protective vaccination and a reference to activities for the elimination of neonatal tetanus on a global scale. SUMMARY AND CONCLUSIONS. Tetanus is an infectious disease acquired in the environment and associated with wound pollution. Few cases of illness in Poland are associated with non-compliance with recommendations for booster vaccinations.

MATERIAL AND METHODS

The material of the study are individual reports on tetanus sent to the Department of Epidemiology, NIZP-PZH and the bulletin “Infectious diseases and poisoning in Poland in 2017. The historical data is based on earlier Polish and foreign studies.

RESULTS

In 2017, 11 cases of tetanus were reported. Four men and seven women got sick. One man died in the age > 69.

Infectious diseases in Poland in 2017

OBJECTIVE OF THE WORK

The article contains an overview of epidemiological surveillance data on infectious diseases in Poland in 2017 with reference to data from 2016 and median from 2011-2015. This is another introductory article to the systematically conducted Epidemiological Chronicle of Epidemiological Review presenting the current epidemiological situation of selected infectious diseases. In justified cases, eg by cross-border threats, the study includes references to the epidemiological situation in other countries.

MATERIAL AND METHODS

The source data for this study are the applications of doctors to the State Sanitary Inspection, which in the form of summary lists or individual notifications are forwarded to the Department of Epidemiology of Infectious Diseases and Surveillance of NIPH-PZH and after being prepared they are included in the bulletins “Infectious diseases and poisoning in Poland in 2017 “and” Protective vaccinations in Poland in 2017“. Data on deaths due to infectious diseases come from a list of the Department of Demographic and Labor Market Research of the Central Statistical Office.

RESULTS AND THEIR DISCUSSION

Discussion of epidemiological data begins with the most prevalent diseases in Poland, which are upper respiratory tract infections and gastrointestinal infections. In the area of upper respiratory tract infections, attention is drawn to the increase in the number of reported cases in recent years, which may be at least partly related to the development of computerization of reports. The profile of gastrointestinal infections acquired in the non-hospital environment has been changing in recent years towards a clear predominance of infections with viral etiology in relation to bacterial infections. Regarding healthcareassociated infections, rotavirus infections predominate among children, and among adults, C. difficile infections constitute a serious, growing problem, which is largely associated with the use of antibiotics. Viral liver infections are still an important problem. B and C, and in 2017 also hepatitis A, which took the form of an epidemic. In other groups of diseases, there was no clear increase in threats compared to previous years. Despite a steady decline in incidence, tuberculosis has been the disease causing the highest number of deaths among infectious diseases for many years. In 2017, the highest number of deaths was caused by C. difficile infection.

Infectious diseases in Poland in 2018

OBJECTIVE OF THE ARTICLE

The introductory text to the Epidemiological Chronicle (EC) of the Epidemiological Review contains data on the incidence of infectious and parasitic diseases in Poland in 2018 compared to 2017 data and medians from 2012-2016. It is a general overview of the epidemiological situation of infectious and parasitic diseases in Poland. With regard to selected diseases, widening and deepening picture is in the content of remaining articles of the epidemiological chronicle.

MATERIAL AND METHODS

The source data for this article are mainly individual reports submitted by doctors to the County Sanitary/Epidemiological Stations. The basic material of this study is the data published in the bulletins "Infectious diseases and poisoning in Poland in 2018" and "Immunization in Poland in 2018", as well as data published in the reports "Influenza and suspected influenza in Poland in 2018". Data on deaths due to infectious diseases come from the summaries of the Demographic Research Department of the Central Statistical Office.

RESULTS AND THE DISCUSSION

As in previous years, the highest incidence was recorded in the category of upper respiratory tract infections and, but to a much lesser extent, gastrointestinal infections. For at least two decades, there has been a shift in the profile of gastrointestinal infections characterized by an increase in viral infections compared to bacterial infections. Regarding healthcare associated infections, rotavirus infections predominate among children and C. difficile infections among adults. The later creates a serious, growing problem, largely related to the use of antibiotics, but also to fecal-oral transmission. Among infectious diseases, C. difficile caused the highest number of deaths in 2018. Viral infection of the liver continues to be an important problem. Apart from hepatitis B and C, this also applies to hepatitis A, which took the form of an epidemic in 2017. In 2018, the incidence decreased by more than a half, but still the number of cases was about thirty times higher than for the median from 2012-2016. Despite declining tendency for many years, the incidence of tuberculosis still remains above the numbers recorded in the developed countries of Western Europe. In other disease groups, there was no marked increase in risk compared to previous years.

The Effect of Surface Modification of Ti13Zr13Nb Alloy on Adhesion of Antibiotic and Nanosilver-Loaded Bone Cement Coatings Dedicated for Application as Spacers

Spacers, in terms of instruments used in revision surgery for the local treatment of postoperative infection, are usually made of metal rod covered by antibiotic-loaded bone cement. One of the main limitations of this temporary implant is the debonding effect of metal–bone cement interface, leading to aseptic loosening. Material selection, as well as surface treatment, should be evaluated in order to minimize the risk of fraction and improve the implant-cement fixation the appropriate manufacturing. In this study, Ti13Zr13Nb alloys that were prepared by Selective Laser Melting and surface treated were coated with bone cement loaded with either gentamicin or nanosilver, and the effects of such alloy modifications were investigated. The SLM-made specimens of Ti13Zr13Nb were surface treated by sandblasting, etching, or grounding. For each treatment, Scanning Electron Microscope (SEM), contact profilometer, optical tensiometer, and nano-test technique carried out microstructure characterization and surface analysis. The three types of bone cement i.e., pure, containing gentamicin and doped with nanosilver were applied to alloy surfaces and assessed for cement cohesion and its adhesion to the surface by nanoscratch test and pull-off. Next, the inhibition of bacterial growth and cytocompatibility of specimens were investigated by the Bauer-Kirby test and MTS assay respectively. The results of each test were compared to the two control groups, consisting of commercially available Ti13Zr13Nb and untreated SLM-made specimens. The highest adhesion bone cement to the titanium alloy was obtained for specimens with high nanohardness and roughness. However, no explicit relation of adhesion strength with wettability and surface energy of alloy was observed. Sandblasting or etching were the best alloys treatments in terms of the adhesion of either pure or modified bone cements. Antibacterial additives for bone cement affected its properties. Gentamicin and nanosilver allowed for adequate anti-bacterial protection while maintaining the overall biocompatibility of obtained spacers. However, they had different effects on the cement’s adhesive capacity or its own cohesion. Furthermore, the addition of silver nanoparticles improved the nanomechanical properties of bone cements. Surface treatment and method of fabrication of titanium affected surface parameters that had a significant impact on cement-titanium fixation.

Antibacterial Activity and Cytocompatibility of Bone Cement Enriched with Antibiotic, Nanosilver, and Nanocopper for Bone Regeneration

Bacterial infections due to bone replacement surgeries require modifications of bone cement with antibacterial components. This study aimed to investigate whether the incorporation of gentamicin or nanometals into bone cement may reduce and to what extent bacterial growth without the loss of overall cytocompatibility and adverse effects in vitro. The bone cement Cemex was used as the base material, modified either with gentamicin sulfate or nanometals: Silver or copper. The inhibition of bacterial adhesion and growth was examined against five different bacterial strains along with integrity of erythrocytes, viability of blood platelets, and dental pulp stem cells. Bone cement modified with nanoAg or nanoCu revealed greater bactericidal effects and prevented the biofilm formation better compared to antibiotic-loaded bone cement. The cement containing nanoAg displayed good cytocompatibility without noticeable hemolysis of erythrocytes or blood platelet disfunction and good viability of dental pulp stem cells (DPSC). On the contrary, the nanoCu cement enhanced hemolysis of erythrocytes, reduced the platelets aggregation, and decreased DPSC viability. Based on these studies, we suggest the modification of bone cement with nanoAg may be a good strategy to provide improved implant fixative for bone regeneration purposes.

Tetanus in Poland in 2016

THE PURPOSE OF THE STUDY

The purpose of the study was to provide data on tetanus incidence in 2016 in the basic categories of epidemiological surveillance.

MATERIAL AND METHODS

The study is based on the individual forms of tetanus cases submitted to the NIZP-PZH Epidemiology Department and the data of the bulletin “Infectious Diseases and Poisoning in Poland in 2016.

RESULTS

The number of tetanus cases in 2016 was 12, exactly as it was in the previous year 2015. Among the infected people there were six men and six women. Among the infected people two men and one women died. All the fatalities were in the age groups of 70 and older.

SUMMARY AND CONCLUSIONS

The environmental nature of tetanus infections makes the immunity of individual exposed persons the basic preventive tool, which underlines the role of individual vaccinations.

Infectious diseases in Poland in 2016

OBJECTIVE OF THE ARTICLE

This is for the year 2016 subsequent annual analysis of the situation of infectious and parasitic diseases in Poland as part of the Epidemiological Chronicle of the Epidemiological Review. Its purpose is to summarize the collective incidence of infectious diseases and to indicate potential threats to the health of populations from communicable diseases occurring in Poland.

MATERIAL AND METHODS

The basic source of epidemiological information for this summary is a summary of data from reports of the State Sanitary Inspection, contained in the annual bulletins “Infectious diseases and poisoning in Poland in 2016” and “Protective Vaccination in Poland in 2016” (1, 2). Supplementary sources are detailed assessments of the epidemiological situation of selected infectious diseases that make up the socalled Epidemiological Chronicle. Data on deaths were obtained from materials of the Department of Demographic and Labor Market Research of the Central Statistical Office regarding deaths from infectious and parasitic diseases registered in Poland in 2015 and in earlier years.

RESULTS AND THEIR DISCUSSION

The most numerous group among infectious diseases subject to epidemiological surveillance are upper respiratory tract infections classified as “influenza and influenza - like disease”. In 2016, the number this category cases was 4 316 823 (11 233.9 / 100 000). In relation to incidence in 2015, it was an increase of 12.4%, and in relation to the median from 2010-2014 by 196.5%. In 2016, the incidence of intestinal infections of salmonellosis etiology increased compared to the previous year by 16.0%, and in relation to the median from 2010-2014 was higher 19.1%. This is a deviation from the downward trend of these infections observed over last decades. A serious epidemiological problem is the high incidence of infection caused by Clostridium difficile. In 2016, 8 716 (22.7 / 100,000) of these cases were reported, which resulted in 540 deaths. In comparison with the previous year, it was a non-significant decline in incidence by 2.8%, but in comparison with the median from 2010-2014 it was an increase of 56.4%. In 2015, the high incidence of norovirus induced intestinal infection persisted. 3 706 cases were reported (9.64/ 100 000), which is significantly higher than in 2015 (by 2%), but in relation to the median from 2010-2014 it was an increase of 136.6%. Among viral intestinal infections in children, rotavirus infections are still a particularly important problem. Despite the decrease in incidence in comparison with 2015 by 37.3%, the number of cases in 2016 was 21 258 (55.3 / 100,000), which is a serious epidemiological problem. A high percentage of these incidents were infection related to the medical care. In the group of infections and intestinal intoxication, which cause diarrhea in children under 2 years, in 2016 there was a decrease from the previous year of 11.7%, but in relation to the median from 2010-2014 it was an increase of 25.7%. In 2016 number of reported cases of pertussis was 6 828 (17.8 / 100 00), which represented a rise in incidence compared to the previous year by 37.9%, and compared to the median from 2010-2014 by as much as 225%. The year 2016 was another year of decreasing the incidence of rubella. 1105 cases were reported (2.88 / 100 000), what in comparison with the previous year was a decrease of 44.9%, and in relation to the median of 2010-2014 by 81.2%. No congenital rubella was reported. For many years, Poland has been free of native measles. The measles cases are infections imported from abroad and secondary cases of people who have contacted them in the country. In 2016, cases were 133 (0.35 / 100 000). The number of invasive infections caused by Streptococcus pneumoniae in 2016 was 967. In comparison with 2015, it was a non-significant decrease of 1.2%. In 2016, there were 3 806 (9.9 / 100 000) reported cases of hepatitis B, which in relation to the median of 2010- 2014 is an increase of 141.0%. Number of newly diagnosed cases of hepatitis C was 4 261 (11.1 / 100 000), which in relation to the median from 2010-2014 is an increase of 88.2%. This increase in incidence remains in a relationship. with the introduction in 2014 of a new, more sensitive case definition. 21 200 cases of Lyme disease were reported (55.2 / 100 000), which in comparison with the previous year, is an increase of 55.7%. As compared to the median of 2010-2014 it was increase by 132.1%. In 2016, number of cases of newly diagnosed HIV was 1318 (3.43 / 100 000). And number of reported AIDS cases was 102. The increase in the incidence of HIV infection was not significant. The number of cases of AIDS fell by 20.3% as compared to the previous year. Registered cases of malaria refer to people who have been infected abroad in endemic countries. There were 38 such cases in 2016. In 2015, no diphtheria, poliomyelitis, rabies and viral hemorrhagic fevers were found in Poland except for dengue, of which 41 cases of infections acquired in endemic areas were reported for epidemiological surveillance. The number of deaths from infectious and parasitic diseases in 2016 was 2 242 people. The share of deaths from these causes in the total number of deaths in Poland (388 009) was 0.58%. The highest number of deaths was caused by tuberculosis – 543 and intestinal infections caused by Clostridium difficile – 540.

Factors associated with hepatitis C prevalence differ by the stage of liver fibrosis: A cross-sectional study in the general population in Poland, 2012-2016

Background & aims

There is a considerable burden of hepatitis C in Europe related to the lack of prompt diagnosis. We aimed to estimate the prevalence and related risk factors of HCV infections by the stages of liver fibrosis, using non-invasive methods, to understand testing needs in Poland.

Methods

A cross-sectional study was conducted in 2012–2016 adopting a stratified random sampling of primary health care units followed by systematic sampling of patients within each unit. Study participants filled a questionnaire and donated blood for laboratory HCV testing. Additionally, the results of liver function tests and platelet count were collected to calculate APRI and FIB-4 scores. Cases were classified according to the level of fibrosis: ‘significant fibrosis’ (APRI≥0.7 or FIB4≥1.45) and ‘no significant fibrosis’ (APRI<0.7 and FIB4<1.45).

Results

Of 21 875 study participants, 102 were HCV-RNA positive. Prevalence of HCV infections and significant fibrosis was estimated at 0.47% (95% CI 0.38% - 0.57%) and 0.12% (0.08% - 0.17%), respectively. Cases with significant fibrosis accounted for 51.6% (33.4%-69.9%) in men and 34.4% (17.3%-51.4%) in women. There was no correlation between the HCV prevalence and age. Blood transfusion prior to 1992 strongly predicted significant fibrosis as did the history of injecting drug use (IDU) and ever having an HCV-infected sexual partner in men and caesarean sections in women. Factors associated with HCV infection without significant fibrosis were tattooing in men and younger age in women. We acknowledge limited possibility to study the associations between IDU and ever having HCV-infected sexual partner, given small sample sizes for these exposures.

Conclusions

As no clear birth cohort affected by HCV could be identified, risk factor-based screening in the general population should be considered, taking into account the association between the increased risk of liver fibrosis and the history of transfusion prior to 1992 and caesarean sections.

Infectious diseases in Poland in 2015

PURPOSE OF THE STUDY

This is the next annual analysis of the situation of infectious and parasitic diseases in Poland in 2015 within the framework of the Epidemiological Chronicle of Przegląd Epidemiologiczny - Epidemiological Review. Its purpose is to identify potential threats to the health of populations from infectious diseases occurring in Poland with reference to other parts of the globe.

MATERIAL AND METHODS

This paper is an introduction to more detailed studies of the epidemiological situation of selected infectious diseases and summarizes the results of the surveillance of infectious diseases in Poland in 2015. References to epidemiological situation in other countries are limited to situations that may affect current or potential occurrence of the disease in Poland. The main source of epidemiological information for this summary is the data from the reports of the State Sanitary Inspection included in the annual bulletins “Infectious Diseases and Poisonings in Poland in 2015” and “Vaccination in Poland in 2015” (1, 2). The epidemiological situation of particular diseases is further elaborated in the Epidemiological Chronicle of the same issue of the Epidemiological Review. Data on deaths are based on the presentation of the Demographic and Labor Market Department of the Central Statistical Office on deaths from infectious and parasitic diseases registered in Poland in 2015 and earlier.

RESULTS

For a long time, the most common diseases among epidemiological surveillance it is upper respiratory tract infections classified as “influenza and suspected influenza”. In 2015, the number of cases was 3,843,438 (9 994,7 / 100,000). As to compare with the 2014’s incidence, this was an increase of 22.6%. In 2015, incidence of intestinal infections with etiology of salmonella increased by 2.8% compared to the previous year, but compared to the median of 2009-2013 was 2.5% lower. A serious epidemiological problem is a strong upward trend in nosocomial infections including infections caused by Clostridium difficile. In 2015, 8.976 (23.3 / 100,000) of these cases were reported. They caused 491 deaths. Compared to the previous year, the increase in incidence was 39.8%. Compared with the median of 2009-2013 it was an increase of 89.7%. In 2015, there was a continuation of observed for more than a dozen years the unfavorable trend of intestinal infections caused by noroviruses. There were recorded at 3,637 (9.5 / 100,000) of those infections. Among viral intestinal infections, rotavirus infections in children are a particularly important problem. In 2015, as compared with 2014, the increase of incidence in the general population was not high, only 0.5%, but to the median of 2009-2013 it was 44.4%. An important group of intestinal infections, diarrhea in children under 2 years of age, had a slight decrease (by 0.3%) in the category of bacterial infections in 2015, but increased by 26.7% in the category of bacterial poisonings and 5.9% in the category of viral infections. In 2015, there were 4956 cases of pertussis (512.9 / 100,000), which was an increase in the incidence compared with the previous year by 136.2%, and compared with the 2009-2013 median by 127.4%. After the epidemic of rubella outbreaks in 2013, in the year 2014, the incidence dropped by 84.7% and in 2015, the decrease was 65.9%. One case of congenital rubella has been reported. Most measles infections are imported infections or in contact with them in the country. In 2015 the number of cases was 48 (0.12 / 100,000). In 2015, the number of invasive diseases caused by H. influenzae was 62 (0.16 / 100,000). Compared to the previous year, this was an increase of 51.3%. The number of invasive diseases caused by Streptococcus pneumoniae in 2015 was 979 cases. Compared to 2014, this was an increase of 39.0%. When compared with the median of 2009-2013, increase was 128.1%. In 2015, number of reported cases of hepatitis B was 3,518 (9.1 / 100,000), which was 122.7% higher than the median of 2009-2013. Newly diagnosed C-type infections were reported to be 4,285 (11.1 / 100,000), an increase of 91.6% over the median of 2009-2013. Such a large increase in reported cases is related, inter alia to the introduction a new, more sensitive case definition in 2014. The incidence of Lyme disease has been on the rise in the last fifteen years. In 2015, 13,625 cases (35.4 / 100,000) were reported, which, with an insignificant decrease compared to 2014, gives rise to 49.1% over the median of 2009-2013. The downward trend in the incidence of tuberculosis (all forms of tuberculosis) is clearly persistent. In 2015, the incidence of this disease decreased compared to the previous year from 17.4 to 16.7 / 100,000. In 2015 were reported 1,281 cases of newly diagnosed HIV (3,33 / 100,000). It was an increase of 13.0%. The number of AIDS cases decreased by 13.5% compared to the previous year. Reported cases of malaria involve people who have been infected abroad in endemic malaria areas. In 2015 there were reported 29 such cases. None of the cases of diphtheria, chronic childhood paralysis, rabies and viral hemorrhagic fever except for dengue have been reported in 2015. There were reported 12 cases of dengue imported from endemic regions. In Poland in 2015 number of deaths from all infectious and parasitic diseases was 2,199. The share of deaths due to infectious diseases in the total number of deaths was 0.54% and mortality was 5.5 per 100,000 population. The majority of deaths were caused by tuberculosis and its consequences (25.7%) and intestinal infections caused by Clostridium difficile (23.2%).

Deposition of phosphate coatings on titanium within scaffold structure

PURPOSE

Existing knowledge about the appearance, thickness, and chemical composition of phosphate coatings on titanium inside porous structures is insufficient. Such knowledge is important for the design and fabrication of porous implants.

METHODS

Metallic scaffolds were fabricated by selective laser melting of 316L stainless steel powder. Phosphate coatings were deposited on Ti sensors placed either outside the scaffolds or in the holes in the scaffolds. The electrochemically-assisted cathodic deposition of phosphate coatings was performed under galvanostatic conditions in an electrolyte containing the calcium and phosphate ions. The phosphate deposits were microscopically investigated; this included the performance of mass weight measurements and chemical analyses of the content of Ca2+ and  24 PO ions after the dissolution of deposits.

RESULTS

The thicknesses of the calcium phosphate coatings were about 140 and 200 nm for isolated titanium sensors and 170 and 300 nm for titanium sensors placed inside pores. Deposition of calcium phosphate occurred inside the pores up to 150 mm below the scaffold surface. The deposits were rich in Ca, with a Ca/P ratio ranging from 2 to 2.5.

CONCLUSIONS

Calcium phosphate coatings can be successfully deposited on a Ti surface inside a model scaffold. An increase in cathodic current results in an increase in coating thickness. Any decrease in the cathodic current inside the porous structure is slight. The calcium phosphate inside the pores has a much higher Ca/P ratio than that of stoichiometric HAp, likely due to a gradual increase in Ca fraction with distance from the surface.

Tetanus in Poland in 2015

The number of tetanus in the 21st century shows a slight declining trend, but each year there is reported fatal cases of this disease.

THE PURPOSE OF THE STUDY

The purpose of the study is to provide data on epidemiological surveillance of the tetanus in 2015.

MATERIAL AND METHODS

The study is based on the individual forms of tetanus cases submitted to the NIZP-PZH Epidemiology Department and the data of the bulletin “Infectious Diseases and Poisoning in Poland in 2015.

RESULTS

In 2015, 12 cases of tetanus were reported. Six men and six women became ill. 4 people died after 69 years of age.

SUMMARY AND CONCLUSIONS

Tetanus is an infectious disease acquired in the environment and associated with wound contamination. Infections can be prevented by vaccination. Particularly threat to life and health carries disease in the late age.

The problem of elimination of HCV infections in Poland

The article concerns abbreviated presentation of the results obtained in the Project KIK / 35 “Prevention of HCV infection,” sponsored by the Government of the Swiss Federation and the Ministry of Health of the Republic of Poland. The Project concerned the analysis of the prevalence of HCV infection in the adult population in Poland, the risk factors and groups at risk of these infections. Two sub-projects were related to separate subpopulations: pregnant women and drug users. Research in one sub-project focused on the hazards of HCV infections in medical institutions and non-medical facilities, where the procedures are performed with the interruption of tissue. In all sub-projects were carried out surveys, which served to check the knowledge ofn HCV infections, but also practical measures aimed at preventing these infections. One of the sub projects KIK / 35 “Education of medical staff and nonmedical as a key element in the prevention of blood-borne infections” was devoted entirely to the education of professionals responsible for the proper, safety, performance of procedures running with interruption of tissues.“ The results of these studies revealed significant shortcomings in the detection of existing infections and large gaps in knowledge about prevention. Taking into account the range of expertise needed, it turned out that the lack of information applies to both the general public and to many professionals. The project KIK / 35 in its summary refers to the risks of HCV infection, both known from the literature and disclosed the specificity of our country. The ultimate result of the Project NCI / 35 is to develop a strategy for the elimination of HCV infections in Poland. This strategy, strongly linked to the WHO strategy includes integrated, permanent preventive measures related tot he introduction of screening programs for early detection of HCV infections and treat them as important element in prevention. Special emphasis was put on universal access to diagnosis and treatment for all social groups.

[White adipose tissue dysfunction observed in obesity]

Obesity is a disease with continuingly increasing prevalence. It occurs worldwide independently of age group, material status or country of origin. At these times the most common reasons for obesity are bad eating habits and dramatic reduction of physical activity, which cause the energy imbalance of organism. Fundamental alteration observed in obese subjects is white adipose tissue overgrowth, which is linked to increased incidence of obesity-related comorbidities, such as: cardiovascular diseases, type 2 diabetes or digestive tract diseases. What is more, obesity is also a risk factor for some cancers. Special risk for diseases linked to excessive weight is associated with overgrowth of visceral type of adipose tissue. Adipose tissue, which is the main energy storehouse in body and acts also as an endocrine organ, undergoes both the morphological and the functional changes in obesity, having a negative impact on whole body function. In this article we summarize the most important alterations in morphology and function of white adipose tissue, observed in obese subjects.

[The correlation between testosterone levels and C-reactive protein in acute bacterial epididymo-orchitis]

Acute bacterial epididymo-orchitis is common urological condition that usually originates from ascending infection of lower urinary tract. It is characterized by infection of testis combined with spermatogenesis and steroidogenesis impairment. There is also a component of local and systemic inflammation.

AIM

The aim of this study was to assess the effect of systemic inflammation associated with acute epididymo-orchitis on testis steroidogenesis.

MATERIALS AND METHODS

30 patients with acute bacterial epididymoorchitis treated in our ward without any oncologic involvement or other systemic inflammatory conditions were considered for the study. Total serum levels of testosterone and C-reactive protein measured within 12 hours of admission.

RESULTS

Low total testosterone levels regarding to random laboratory population norms were noticed in 11 patients. Diminished serum total testosterone levels regarding to medium age levels were identified in 24 patients (80%). 29 patients had serum CRP levels elevated what gives average 22x fold. There is a statistically significant negative correlation between serum total testosterone levels and CRP serum levels were found (R - 0.75; p<0.000002 Spearman's correlation).

CONCLUSIONS

There is a strong influence of ongoing systemic inflammation caused by bacterial infection on steroidogenesis in testis in acute epididymo-orchitis patients.

Evaluation of the Surgical Treatment for Congenital Blepharoptosis Using Mustarde's Modified Method

The aim of the study was evaluation of the results of surgical treatment of congenital blepharoptosis (CBP) using Mustarde's modified method.

MATERIAL AND METHODS

Between 2005-2014 forty eight children with CBP underwent surgical correction of CBP by Mustarde's modified method. Basing on the results of ophthalmic and orthoptic examination, and standard measurements, we estimated postoperative difference in the position and symmetry of the upper eyelids, and postoperative complications in our patients.

RESULTS

Very good results were obtained in all cases with mild, in 89.5% with moderate, and in 85.7% with severe unilateral CBP after correction by Mustarde's modified method. Lagophthalmos was seen in 6.25%, and undercorrection in 12.5% of cases.

CONCLUSIONS

1. Mustarde's modified method allows for obtaining very good functional and aesthetic results in CBP patients. 2. Mustarde's modified method is a valuable supplemental surgical technique in CBP, and contributes to a low rate and small range of lagophthalmos.

Assessment of the accuracy in prenatal diagnosis of congenital malformations. Analysis of 101 questionnaires filled in by parents of neonates hospitalized in the Department of Congenital Malformations Polish Mother's Memorial Research Institute

Introduction:

Prenatal diagnosis is an integral part of modern perinatal care. In the article results of questionnaires pertaining to the prenatal process of diagnosis are presented. Parents whose children were afflicted with congenital malformations of all types responded to enquiry

Materials and methods:

Between March 2014 and March 2015 150 of 355 infants were hospitalized in the Department of Pediatric Intensive Care and Congenital Malformations in Łódź, and 150 had congenital malformations.

Results:

101 parents of 150 children (67,3%) have given the feedback. Anomalies were such as: of the digestive system (37%), CHD (25%), OUN (14 %), genito-urinary (13%), skeletal system (9%) and respiratory system (2%). In 65 children of 101 the defects were detected prenatally. The obstetric US exam was the most frequently pointed out as performed (more than 1200). The biochemical markers and genetic tests in were performed in 34 pregnancies. The high percentage of ability to detect malformation was reported in the group of fetal echo examinations.

Conclusions:

1. Prenatal ultrasound exams were the least effective method of making appropriate prenatal diagnosis of congenital malformation.

2. Fetal echocardiography had a high level of sensitivity and specificity in detecting congenital malformations.

3. Prenatal cardiologists proved to be the most effective in detecting congenital malformations 89,3 % of detected abnormalities.

4. Biochemical exams had a positive result in only one case of Down Syndrome.

Infectious diseases in Poland in 2014

PURPOSE OF THE STUDY

The aim of the study is to assess epidemiological situation of infectious and parasitic diseases in Poland in 2014, and an indication of the potential health risks from communicable diseases occurring in other areas of the globe.

MATERIAL AND METHODS

This paper is a summary of the analysis and evaluation of the results of epidemiological surveillance of infectious diseases in Poland in 2014, and those elements of European and global epidemiological background, which in this period had an impact on the epidemiological situation in Poland or constituted a threat. The main source of data for this study are statistical reports included in annual bulletins “Infectious diseases and poisoning in Poland in 2014” and “Immunizations in Poland in 2014” (NIPH-PZH, GIS, Warsaw 2015) and the data contained in the articles of „Epidemiological chronicle” presented in the Data on deaths are based on the statement of the Department for Demographic Research and Labour Market CSO presenting numbers of deaths from infectious and parasitic diseases registered in Poland in 2014, and in the previous years.

RESULTS

Upper respiratory tract infection classified as “suspected flu and the flu season” in the since many years are the largest position among the diseases subject to disease surveillance. In the last decade, particularly large increase in the incidence of upper respiratory tract infection was reported in the flu season 2013., when the increase in comparison to the median of years 2008-2012 amounted to 189.8%. In 2014. Number of reported cases was 3 137 056 which represented a nonsignificant decrease of 0.8% compared with the previous year. However, compared to the median of the years 2008-2012 it was an increase of 187.4%. Better then based on calendar year is a picture obtained by examining the incidence of seasonal periods in the annual, but counted from 1 September to 31 August of the following year. In such a setup, in the 2012/2013 season were recorded 3 025 258 of cases, and in the season 2013/2014 recorded number was 2 780 945. In such a way in the 2013/2014 season decrease in the number of cases as compared to the season 2012/2013 was 8%. Another group of infections with a high incidence are intestinal ones. In 2014. Incidence of intestinal infections with Salmonella etiology increased in comparison with the previous year by 10.8%, but in relation to the median of 2008-2012 was lower by 7.3%. Incidence of an important group of intestinal infections, which are diarrhea cases in children under 2 years, increased in 2014. in the category of infections of viral etiology and a decreased among bacterial ones. In 2014. upward trend of intestinal infections caused by viruses persited. Among these infections dominated rotavirus infections in children. Number of reported foodborne infections of viral etiology was 51 561 (134.0/100 000). Most of them were caused by rotavirus: 33 789 (87.8/100 000). Number of cases of whooping cough reported in 2014 was 2 101 (5.5/100 000), it was a decrease of incidence as compared with the previous year by 3.7%. After the epidemic increase in cases of rubella in 2013. there has been a decline in the incidence of the disease by 84.7%. No single case of congenital rubella was reported. In 2014. it were reported 110 cases of measles (0.29 / 100 000). In 2014. Number of cases of invasive diseases caused by H. influenzae was 41, incidence: (0.11 / 100 000). This was an increase of 64.1%, as compared with the previous year. Among them, the number of sepsis cases increased by 150% from 10 to 25. None of these cases was fatal. The number of invasive diseases caused by Streptococcus pneumoniae in 2014. amounted to 704. In comparison with 2013. This was an increase of 30.4%, but as compared with the median of the 2008-2012 period it was 91.9%. Among the cases of invasive S. pneumoniae infections 59 were fatal. The downward trend in the incidence of tuberculosis in total (all forms of TB) is clearly sustainable. In 2014. Incidence of this disease has decreased in comparison with the previous year from 18.8 / 100 000 to 17.4 and pulmonary tuberculosis from 17.8 to 16.4 / 100 000. In 2014. There were reported 1 157 cases of newly diagnosed HIV infections (3.01 / 100 000). And it was not a significant increase in the incidence of 4.5%, as compared with the previous year. The number of reported new AIDS cases decreased by 8.6%. In recent decades, there were no indiginus cases of malaria in Poland. Registered cases of malaria apply to persons who acquired it abroad in endemic areas. 19 such cases were reported in 2014. In 2014. there were no cases of diphtheria, poliomyelitis, rabies and viral haemorrhagic fevers with exception of dengue, of which 15 cases acquired in endemic areas were reported. Total number of deaths due to infectious and parasitic diseases in 2014 in Poland. was 2 169. The share of deaths from these causes in reference to the total number of deaths was 0.58%, and mortality due to infectious diseases was 5.6 per 100 000. Most deaths (24.6%) were caused by tuberculosis and its consequences.

Tetanus in Poland in 2014

For many years the number of tetanus cases reported in Poland remaing below fifty with marked random variations. Almost all disease occur in people unvaccinated. Some of them, especially in people over age 60, are fatal.

THE AIM OF THE STUDY

The aim of the study is to present the data of epidemiological surveillance of tetanus in Poland in 2014.

MATERIAL AND METHODS

Analyzed material are the individual reports of cases of tetanus sent to the Department of Epidemiology at NIPH-PZH and bulletin data “Infectious diseases and poisoning in Poland in 2014”.

RESULTS

In 201 number of tetanus cases recorded in Poland was 13. It amounted to six men and seven women. Among those 9 was over 59 years of age. Out of them 4 people died. All were women over 69 years of age.

SUMMARY AND CONCLUSIONS

Tetanus is an infectious disease acquired in the environment and associated with the contamination of wounds. Infections and deaths could be prevented by vaccination. Particular risk life and health carries illness after 60 years of age.

Infectious diseases in Poland in 2013

This article aims at evaluating the epidemiological situation of infectious and parasitic diseases in Poland in 2013.

MATERIAL AND METHODS

This article was mainly based on the statistical data derived from annual bulletins "Infectious diseases and poisonings in Poland in 2013" and "Vaccinations in Poland in 2013" (NIPH-NIH, CSI, Warsaw 2014) and data specified in particular articles of the epidemiological chronicle of the current issue of the Epidemiological Review. Data on fatal cases due to infectious and parasitic diseases registered in Poland in 2013 and previous years were obtained from the Demographic Surveys and Labour Market Department of the Central Statistical Office.

RESULTS

As with the previous years, upper respiratory tract infections classified as "influenza and influenza-like illness" were the most prevalent with a total number cases amounting to 3,164,405 (8,218.7/100,000). Compared to 1,460,037 (3,789.0/100,000) cases registered in 2012 and the median of 2007-2011, it was an increase of incidence by 116.9% and 469.5%, respectively. In 2013, a decreasing tendency of incidence of bacterial intestinal infections was sustained. Out of bacterial infections, those caused by coccobacilli of Salmonella spp. were still predominant. In 2013, a total of 7 578 (19.7/100,000) such cases were reported. Compared to 2012 and the median of 2007-2011, it was a decrease of incidence by 10.0% and 21.9%, respectively. A total of 42 699 (110.9/100,000) viral intestinal infections were reported. In this group, the most common were infections caused by rotaviruses--23,529 (61.1/100,000). Having referred to 2012, incidence decreased by ca 0.6%, while in comparison with the median of 2007-2011, it was an increase by 5.5%. Compared to 2012, an incidence of diarrhoea of unspecified origin in children under 2 years old increased by 28.4%. In 2013, a total of 2,183 pertussis cases (5.7/100,000) were registered, which compared to the previous year indicated a decrease of incidence by 53%. In 2013, a decrease of mumps incidence by 12.3% was noted. Compared to the previous year, there was more than 5-fold increase of rubella incidence. In 2012, the number of rubella cases was 6,263 (16.3/100,000), while in 2013--38,548 (100.1/100,000). Considerable increase in the number of rubella cases resulted from compensatory epidemic which affected mainly boys who were not inoculated with MMR vaccine. In 2013, there were 2 cases of congenital rubella. A total of 84 cases (0.22/100,000) of measles were reported. In 2013, the number of invasive disease cases caused by H. influenzae was 25 (0.06/100,000). Compared to 2012 and the median of 2007-2011, incidence decreased by 30.5% and 19.3%, respectively. The number of infections of Streptococcus pneumoniae etiology in 2013 amounted to 540. Compared to 2012 and the median of 2007-2011, there was an increase by 22.5% and 95.3%, respectively. Having considered the data of 2012, the number of sepsis cases caused by this pathogen increased by 32.9%. Compared to 2012, tuberculosis incidence in 2013 in total (all tuberculosis manifestations) decreased from 19.6/100,000 to 18.8, while respiratory tuberculosis from 18.2 to 17.8/100,000. In 2013, a total of 1,097 HIV infections (2.85/100,000) were reported. Compared to the previous year, incidence did not change. In total, 36 malaria cases were notified who were infected abroad while visiting malaria endemic areas.

Occurrence and maintenance of hantavirus infections among rodent populations in their natural habitat--results of a field study from Podkarpackie province, Poland 2010-2012

Human cases of hantavirus infection have been reported annually in Poland's Podkarpackie province, since 2007. In 2014 the number of cases reported significantly increased prompting a rise in studies focusing on the infection.

OBJECTIVE

The purpose of this study was to evaluate the prevalence, maintenance and the dynamics of hantavirus infection among rodent species, including the bank vole (Myodes glareolus) and yellow-necked mouse (Apodemus flavicollis) which act as reservoirs of hantavirus in the environment.

MATERIAL AND METHODS

Rodent capture was carried out on seven research grids in the Podkarpackie province, from summer 2010 to spring 2012. They were caught in live-capture traps used in accordance with the protocol CMR (Catch-Mark-Release). The population was estimated as MNA (Minimum Number Alive). Blood samples were collected for serological testing on live animals by puncture of saphenous vein. In order to determine the hantavirus infection we used ReaScan Ab-Dect Puumala IgG--Reagena® for bank voles, and for mice ELISA--Mouse Hanta Virus Test ELISA Kit (Version with Control Antigen Wells)--BioCat GmbH®. The relationship between age, gender, seasons, population size and prevalence of hantavirus infection was tested by Pearson's chi-squared test or Fisher's exact test and by calculating the Pearson's correlation coefficient.

RESULTS

A total of 854 rodents were captured: 222 bank voles, 592 yellow-necked mice, 4 common voles and 36 striped field mice. Of these, 564 were tested. The presence of specific anti-hantavirus was found in 9.7% of bank voles and 9.5% of yellow-necked mice. There was a statistically significant difference in the frequency of infection between the groups of male and female yellow-necked mice as well as in the groups of adult group in both species. The dynamics of spread of hantavirus infection was clearly evident in the studied area of Sanok. The correlation coefficient between the number of individuals caught and the prevalence of hantavirus infection in yellow-necked mice was -0,87 but for the bank vole it was 0,76.

SUMMARY AND CONCLUSIONS

The results of the study indicate that hantavirus infection among yellow-necked mice and bank voles are unevenly distributed in certain hot spots, vary over time, and are most in the spring season. In addition, differences observed in the dynamics of infection depended on the species of animal hosts. It would be advisable to conduct long-term study, which would allow for a risk assessment of the possibility of turning the spot located outbreaks into endemic area of hantavirus occurrence.

Tetanus in Poland in 2013

Tetanus is an infectious disease which, despite the small number of cases is a permanent risk to unvaccinated people. The severity of disease is associated with high mortality especially in older age groups.

PURPOSE OF THE STUDY

The aim of the paper is to present epidemiological surveillance data tetanus in 2013.

MATERIAL AND METHODS

The source of the data are the individual case reports of tetanus sent to the Department of Epidemiology, NIPH-NIH and bulletin data "Infectious diseases and poisonings in Poland in 2013.

RESULTS

In 2013 number of recorded cases of tetanus was 14. Four cases of disease occurred in men and 10 in women. Among cases 13 people were over 69 years of age and among them 7 people died.

SUMMARY AND CONCLUSIONS

Severity of tetanus, despite the small number of annual cases leads to several deaths each year, particularly in the older age groups. This deaths could be prevented by vaccination.

Inequalities in health and social policy

WHO and the European Commission impart great importance to promoting activities aimed at reducing inequalities in health. The article raised methodological problems of studies on the causes of inequalities in health. Author draws attention to the need for field studies focused on comparing well-specified population groups in order to achieve greater accuracy of studies to obtain preventive actions better fit to the specific needs of a given population. He also indicates the difficulties related to the comparisons made on an international scale due to the large number of variables that could interfere with investigated exposure. A significant part of the article is devoted to the interpretation of the measurement of poverty and the relationship between economic inequality and inequities in health. The author points out that there are no simple relations in this area, but the impact of economic inequality is particularly pronounced where inequalities in income of families bring large fractions of a society below the threshold of poverty.

Sick people and sick populations--legacy of Geoffrey Rose

Developed by Geoffrey Rose strategy of preventive medicine caused a major breakthrough in thinking about the effectiveness of preventive measures. The distinction between actions within the high-risk groups against activities at the level of the whole population raised awareness of public health workers that focus on highly vulnerable individuals may lead to underestimation of the problem of cases among individuals out high risk groups, who due to their numbers in the population, participate to a greater number of cases. The author of this study points to the importance of this distinctions, but also highlights some methodological problems of Rose theory. It is postulated efficiency-oriented approach to prevention that takes into account integrated action which includes activities at the level of the whole population, but also an attempt to deliver individualized messages to smaller groups and ant to individuals including those beyond high-risk groups. In the author's opinion this is of particular importance in the context of strong social stratification.

Management of respiratory tract infections in primary care in Poland--results of the happy audit 2 project

OBJECTIVE

The Polish results of the international Happy Audit 2 project are reported which objective was to present therapeutic decisions made by general practitioners (especially antibiotics prescribed) and diagnostic methods applied to patients with respiratory tract infections (RTI).

MATERIAL AND METHODS

[corrected] Following each visit of patient with respiratory tract infection, general practitioners participating in the study completed the questionnaire. The questionnaire included patient's data (age, gender), the duration of disease, clinical symptoms, diagnosis, prescribed antibiotics, additional testing as well as the influence of various factors on therapeutic decision.

RESULTS

Having considered the results of HappyAudit in Poland, a total of 5,137 office visits of patients reporting symptoms of RTIs were analyzed. The average duration of symptoms before visiting GP was 4.8 days (compared to average 4.4 in other countries). Worth noting is that additional testing in diagnosis of RTIs was performed less frequently in Poland: rapid streptococcal test was conducted in 0.4% of cases (European average: 4.45%), CRP--in 2.2% of patients (average from other countries: 14.2%) and chest X-ray in 2.3% of cases compared to 14% in other project's participants. In Poland, the most frequently applied antibiotic was amoxicillin, which was used in 28.9% of cases ended with antibiotic prescribing (amoxicillin/pivampicillin were also predominant in other countries, excluding Sweden). In Poland, macrolides (22.4% of all prescriptions for antibiotic) and cephalosporins (12.1%) were frequently used. The results indicate that narrow-spectrum antibiotics are prescribed in Poland less frequently, with the example being penicillin V which was prescribed in 6.7% of patients with RTIs who were given antibiotic.

CONCLUSIONS

Comparing the results of Happy Audit 2 in Poland and other project's participants, the major differences consist in rare use of phenoxymethylpenicillin in favour of amoxicillin and macrolides as well as infrequent use of additional testing in diagnosis of RTIs in Poland.

How medicine has become a science?

The historical review of medical activities draws attention how late in its very long history therapies of proven effectiveness were introduced. Author attributes it to the late development of methods which would be capable to determine the causal relations which would scientifically justified identification the causes and risk factors of diseases as well as checking the effectiveness of preventive and therapeutic procedures. Among the fundamental tools for scientific knowledge of the causes and mechanisms of diseases, the author indicates: achievements of basic science and the development of epidemiological methods used to study causal relationships. In the author's opinion the results of basic research are an essential source of variables among which, with an increased likelihood could be found the causes and risk factors of studied conditions, including diseases. The author also stresses the role of medical technology, which is the primary source of potential medicines, other therapeutic procedures and diagnostic methods whose effectiveness is tested in experimental epidemiological studies. Medical technologies create also tools for the development of basic sciences.

Tetanus in Poland in 2012

INTRODUCTION

Despite of the small number of cases reported in Poland tetanus is a permanent risk to unvaccinated people. The severity of the disease is associated with high case fatality, especially among people in older age groups.

THE PURPOSE OF THE STUDY

The aim of this paper is to present the data of epidemiological surveillance of tetanus in 2012.

MATERIAL AND METHODS

Principal source of the data is bulletin: "Infectious diseases and poisonings in Poland in 2012, and individual reports of cases of tetanus sent to the Department of Epidemiology, NIPH -NIH.

RESULTS

In 2012, there were reported 19 cases of tetanus. 6 cases occurred in men, and 13 women. 13 cases occurred in persons over 69 years of age and in those age groups 6 cases were fatal. The paper describes the geographical distribution and the month of infection, the nature of the wounds which were portals of infection and the duration of incubation period of the cases.

SUMMARY AND CONCLUSIONS

Severity of tetanus, despite a small number of cases each year leads to several deaths, which could be prevented by vaccination.

Ageing individuals and ageing populations

Public health problems associated with ageing, due to its complexity, enters the spheres of interests in many fields: demography, economics, and politics. In many countries challenges related to the increasing number of people at retirement age remain strongly dependent on the actual and projected numbers of people at productive age emerging from the demographic condition of the population. The article addresses the complexity of the relations between life expectancy, healthy life expectancy and the length of life in disability. Underlined are the social and economic conditions of life in the period of the old age, including the problem of inequalities in health and the role of research in the field of public health for the proper recognition of the problem and rational planning of resource allocation and organizational measures aimed at meeting social expectations associated with ageing.

Infectious diseases in Poland in 2012

AIM

The aim of the study is to assess the epidemiological situation for infectious and parasitic diseases in Poland in 2012.

MATERIALS AND METHODS

The main source of data for this study are statistical overviews contained in the annual bulletins "Infectious Diseases in Poland in 2012" and "Immunizations in Poland in 2012" (NIPH-NIH, Warsaw 2013) and data contained in the articles presented in this issue of Przegląd Epidemiologiczny. Information on deaths due to infectious and parasitic diseases registered in Poland in 2012 and earlier years is based on the data of the Department for Demographic Research of Central Statistical Office.

RESULTS

Upper respiratory tract infection classified as "influenza and influenza-like illness" were reported in 2012 in a total number of 1 460 037 cases. In comparison with 2011, it was an 26.2% increase of incidence, and as compared to the median of 2006-2010 of 286.1%. In 2012, with still the clear predominance of salmonellosis among intestinal bacterial infections, downward trend in the incidence of intestinal infections of this etiology persisted. In 2012 reported number of intestinal infections caused by Salmonella was, 8 267 (21.5/100 000), which represents incidence decrease of 4.5%. Foodborne infections of viral etiology were reported in 39462 cases (102.4/100 000). Most frequent were caused by rotaviruses - 23 692 (61.5/100 000). In 2012, there were 4 684 reported cases of pertussis (12.2/100 000), which means an increased incidence compared with the previous year by 180%. In 2012, there was an increase in the number of cases of mumps by 7.5% (from 2 585 to 2 779 cases), and of rubella by 46.0%, but compared to the median of the years 2006 to 2010 it was a decrease of 52.9%. In 2012, there was not any case of congenital rubella. Number of measles cases was 70 (0.18/100 000). In 2012, there was an increase in the number of cases of invasive disease caused by H. influenzae from 31 in 2011 to 36 in 2012. Number of infections caused by Streptococcus pneumoniae remained in 2012 as compared to 2011, on almost the same level: 436 in 2012 and 430 in 2011. However, there was a 36% increase in the number of sepsis cases caused by this organism. The incidence of tuberculosis in total (all forms of TB) in 2012 decreased compared to the previous year from 22.0 to 19.6 /100000, and pulmonary tuberculosis from 20.5 to 18.2. In 2012, were reported 1 093 cases of HIV infections (2.84/100 000), compared with the previous year, it was a fall in incidence of 2.4%. 21 cases of malaria occurred in people, who infection acquired abroad in malaria endemic areas. In 2012, there were no cases of diphtheria, poliomyelitis, rabies and viral haemorrhagic fevers outside of dengue, of which 5 cases of infections acquired in endemic areas were reported to National Sanitary Inspection. Total number of people who died in Poland in 2012 due to infectious and parasitic diseases, was 2 774. The share of deaths from these causes in the total number of deaths was 0.72%, and the mortality rate - 7.2/100 000. Out of all those deaths 41.1% were due to sepsis.