Evaluating the hepatitis B vaccination impact in the Republic of Moldova: A nationwide representative serosurvey of children born in 2013

Objectives

The WHO European Region set targets for the control of hepatitis B through immunization, including prevalence of hepatitis B surface antigen (HBsAg) at ≤0.5% in vaccinated cohorts. The Republic of Moldova implemented universal hepatitis B vaccination since 1995. We conducted a nationwide representative serosurvey to estimate HBsAg seroprevalence in children born in 2013 to validate hepatitis B control targets.

Methods

We used probability-based sampling and a two-stage cluster design. All children born in 2013 and registered in primary healthcare facilities were eligible for participation. We tested blood samples of all participants for hepatitis B core antibody (anti-HBc), using Enzyme-Linked Immunosorbent Assay (ELISA). Anti-HBc-positive samples were tested for HBsAg and HBsAg-positive samples confirmed, using ELISA. We obtained information on hepatitis B vaccination from vaccination cards.

Results

Of 3352 sampled children, 3064 (91%) participated. Most participating children were 7 years old (n = 3030, 99%), 1426 (48%) were girls. The weighted, national seroprevalence estimate was 3.1% (95% confidence interval = 2.1-4.5) for anti-HBc and 0.21% (95% confidence interval = 0.08-0.53) for HBsAg.

Conclusion

The study demonstrated the impact of hepatitis B vaccination and allowed the Republic of Moldova to validate regional hepatitis B control targets. Other countries with high vaccination coverage could use hepatitis B serosurveys and apply for validation. Sustained efforts in the Republic of Moldova will be crucial on the path to hepatitis B elimination.

Hepatitis C Elimination in Moldova Is Feasible and Cost-Saving: A Modeling Study

BACKGROUND

Moldova, an upper-middle-income country in Eastern Europe, is facing a high burden of hepatitis C virus (HCV). Our objective was to assist the National Agency of Public Health of Moldova in planning to achieve the World Health Organization's HCV elimination goals by 2030.

METHODS

This study adapted a previously developed microsimulation model to simulate the HCV epidemic in Moldova from 2004 to 2050. Model outcomes included temporal trends in HCV infection, prevalence, mortality, and total cost of care, including screening and treatment. We evaluated scenarios that could eliminate HCV by 2030.

RESULTS

Multiple strategies could lead to HCV elimination in Moldova by 2030. A realistic scenario of a 20% annual screening and 80% treatment rate would require 2.75 million individuals to be screened and 65 000 treated by 2030. Compared to 2015, this program will reduce HCV incidence by 98% and HCV-related deaths by 72% in 2030. Between 2022 and 2030, this strategy would cost $17.5 million for HCV screening and treatment. However, by 2050, the health system would save >$85 million compared to no investment in elimination efforts.

CONCLUSIONS

HCV elimination in Moldova is feasible and can be cost saving, but requires resources to scale HCV screening and treatment.

Consensus paper on postural dysfunction: recommendations for prevention, diagnosis and therapy

Good fundamentals of posture and balance are essential for the efficient performance of both simple daily tasks and more complex movement patterns. In particular, postural balance is the ability to keep the body in equilibrium and to regain balance after the shift of body segments: postural control mechanisms of integration of the visual, vestibular and foot afferential channels contribute to this. This document provides recommendations based on scientific evidence, clinical practice, and consensus between experts concerning the prevention, diagnosis, and treatment of postural dysfunction at the three stages of life as the developmental age, adult age, and old age > 65 years and follows the "National Guidelines on Classification and Measuring of Posture and its Dysfunctions" per the Italian Ministry of Health (December 2017). The paper answers four main questions: i) "Which measures can be adopted to prevent postural dysfunctions?" ii) "What can we do in order to make a correct diagnosis of postural dysfunction?" iii) "What are the correct treatment programs for postural dysfunctions?" iv) Which professional competencies and experiences are useful for preventing, diagnosing and treating postural dysfunctions? By the Consensus of the Experts and the scientific evidence, emerge that the approach to postural dysfunctions requires a multidisciplinary and interdisciplinary team. Furthermore, rehabilitation treatment interventions must be specific to the age groups that have been indicated, to consider the integration of the main systems and subsystems of postural control that change with age.

[Study of bioelectrical properties of acupuncture areas]

The research has as a goal the investigation of the bioelectrical behaviour of the acupunctural areas in order to obtain a scientific substantiation of the correspondence between the extreme--eastern medical tradition and the academical medicine. It is obvious that the Chinese traditional medicine knows a certain mechanism of ensurance of homeostasis of the organisms, a mechanism represented, according to the Chinese medical tradition, by the net of acupuncture points and meridians. The experimental data presented in this paper lead to the discovery of the fact that this net works as the fourth system of integration, the electrical--regulator one. The maintenance of the internal homeostasis of the superior organisms and their adaptation to the environment is ensured by the neuro-endocrine and circulatory systems through a mechanism described by Selye under the name of the Uncertain General Syndrome of Adaptation represented by the hypothalamo-hypophyso-corticoadrenal axis. The evolution of these systems and of their mechanisms can be supervised on the basis of the cortisole concentration. The research emphasized the direct proportionality between the cortisone levels and the variation of the electrical values of the acupuncture points, a fact that demonstrates the involvement of the net of acupuncture points and meridians in the maintenance processes of the homeostasis, control, adjustment and adaptation of the living organisms. Additionally, the analysis of the bioelectrical behavior of the acupuncture areas led to the conclusion that the morpho-functional substrate of this net is the conjunctive tissue. The physical-chemical properties of the interstitial connective tissue assures its working as an electro-regulator system on one side and as a harmonization agent of the neuro-endocrine and circulatory systems on the other side, this aspect being to be developed in a future paper.

[The implications of cervical spine degenerative and traumatic diseases in the pathogenesis of cervical vertigo and hearing loss]

AIM

Cervical spine together with vestibular system,visual system and proprioceptive afferents plays an important role in mentaining balance. Spine damage causes distortions in transmitting informations to the brain,favoring vertigo.

MATERIAL AND METHOD

The authors point out the occurrence of positional vertigo on 23 patients (20 patients with cervical spondylosis and 3 patients with cervical spine injury) due to blood flow disturbance through vertebral artery.

RESULTS

The mechano-receptors located in intervertebral disks and cervical spine muscles are activated by column movement. Changes of blood flow in the vertebral and basilar arteries are showed up by cervical X-Rays, intracranial Doppler ultrasound or angio-MRI, an audiogram marking out the degree of hearing loss or tinnitus occurence. ENT complex treatment outcomes are analyzed and balneo-physio-therapy performed in order to improve vertigo and hearing loss.

CONCLUSIONS

Stress beside muscle overload and cervical spine injures causes alteration in the ear blood-flow circulation that leads to hearing loss, vertigo and tinnitus. It emphasies the need for collaboration between balneologist and ENT specialist in solving balance and hearing disorders with cervicogenic cause.

[Subablative gentamycin therapy in Menière's disease]

We have treated 20 patients suffering from unilateral Morbus Meniere (2 x 12 mg gentamicin for 7 days). These patients were controlled for 24 months. In 95% we regarded a complete or substantial control of definitive spells ("American Committee on Hearing and Equilibrium guidelines for reporting treatment results in Meniere's disease", Otolaryngol. Head and Neck Surg. 10/19-85). Only 1 patient with pretherapeutic equal caloric response showed a post-therapeutic destroyed vestibular apparatus on the treated ear. In the other 7 patients (35%), who had a loss of vestibular function after therapy, there was an already pretherapeutic more or less noticeable caloric hypoexcitability. It is possible to induce an only subablative damage with a clinical success in 95%.

Chemical sclerosis of the adrenal medulla with sodium salyclate (2.5 M) - histopathologic, histoenzymatic, electron microscopic and biochemical studies

The selective inhibitory effect of sodium salicylate (2.5 M) on the adrenal medulla was investigated histopathologically, histoenzymatically, electron microscopically and biochemically. It was proved that the different behaviour of nicotinamide-adenine dinucleotide (NAD) and nicotinamide-adenine dinucleotide phosphate (NADP) linked dehydrogenases under the action of sodium salicylate can account for the survival of cortical cells, while the medullar ones are necrosed.