Rubella revisited: where are we on the road to disease elimination in Central Europe?

Rubella is a contagious viral disease with few complications except when contracted by pregnant women. Rubella infection in pregnancy can result in miscarriage, stillbirth or an infant born with congenital rubella syndrome (CRS) which comprises deafness, heart disease, cataracts and other permanent congenital manifestations. Clinical diagnosis of rubella is difficult due to overlapping symptoms with many other diseases and confirmation of rubella is not possible without laboratory testing. Effective vaccination programmes are critical to the elimination of rubella and prevention of CRS. Such programmes have been successful in several countries in Europe and around the world. However, rubella outbreaks still occur due to suboptimal vaccine coverage and in the past 10 years rubella has been reported in Central European countries such as Romania and Poland. Over the past decade the elimination of rubella and prevention of congenital rubella infection in Europe has been a high priority for the WHO European Regional Office. In 2010 the WHO regional committee for Europe renewed its commitment to the elimination of rubella and prevention of CRS with a new target of 2015. This paper examines the current situation for rubella and CRS in Central Europe and describes the different rubella vaccination programmes in the region. The Central European Vaccination Advisory Group (CEVAG) recommends that two doses of measles, mumps and rubella vaccine, MMR, should be given to all children. The first dose should be given between 12 and 15 months of age. The second dose can be given between the ages of 21 months and 13 years with the exact age of administration of the second dose depending on the situation specific to each country. All suspected rubella cases should be laboratory-confirmed and monitoring systems to detect and investigate cases of CRS should be strengthened.

Central European Vaccination Advisory Group (CEVAG) guidance statement on recommendations for influenza vaccination in children

Background

Influenza vaccination in infants and children with existing health complications is current practice in many countries, but healthy children are also susceptible to influenza, sometimes with complications. The under-recognised burden of disease in young children is greater than in elderly populations and the number of paediatric influenza cases reported does not reflect the actual frequency of influenza.

Discussion

Vaccination of healthy children is not widespread in Europe despite clear demonstration of the benefits of vaccination in reducing the large health and economic burden of influenza. Universal vaccination of infants and children also provides indirect protection in other high-risk groups in the community. This paper contains the Central European Vaccination Advisory Group (CEVAG) guidance statement on recommendations for the vaccination of infants and children against influenza. The aim of CEVAG is to encourage the efficient and safe use of vaccines to prevent and control infectious diseases.

Summary

CEVAG recommends the introduction of universal influenza vaccination for all children from the age of 6 months. Special attention is needed for children up to 60 months of age as they are at greatest risk. Individual countries should decide on how best to implement this recommendation based on their circumstances.

Microbiological and therapeutical aspects of pneumococcal diseases in the Slovak Republic

Since 1983, multiresistant pneumococcal strains, mostly 14, 23F, 19A serotypes have been reported in Slovakia. A 15-year cooperation of specialists from various fields and the representatives of different institutions revealed that the pneumococcal infection problem in the Slovak Republic remains an important healthcare task. In the prospective multicentric microbiological and clinical analysis of otitis media acuta in children under 5 years, pneumococci were isolated in 45.9%, where 50.8% of strains were intermediate and fully resistant to penicillin and 47.5% resistant to macrolid antibiotics. Invasive pneumococcal infections, mostly meningitis and bacteremias, were observed in two studies. Penicillin resistance was higher in children under 5 years (52.8%), in comparison with other age groups. The dominant serotypes of childhood were 14, 19A and 6A, while in the age group above 65 there was a broad spectrum of serotypes confirmed. Serotype 14 is the most frequent serotype in physiologically sterile liquids and otitis media liquor in the Slovak Republic (Tab. 3, Fig. 5, Ref. 34).

Central European Vaccination Advisory Group (CEVAG) guidance statement on recommendations for the introduction of HPV vaccines

Vaccines against human papillomavirus (HPV), the primary causative agent in cervical cancer, are licensed. This paper contains the Central European Vaccination Advisory Group (CEVAG) guidance statement on the introduction of HPV vaccines in central Europe. Eight countries currently have medical representatives on CEVAG: the Czech Republic, Estonia, Hungary, Lithuania, Poland, Romania, Slovakia and Turkey. By raising awareness and disseminating information, CEVAG aims to promote the efficient and safe use of vaccines to prevent, control and if possible eliminate infectious diseases. In January 2008, the European Centre for Disease Prevention and Control published a report entitled Guidance for the Introduction of HPV Vaccines in EU Countries. Members of CEVAG have taken the information relevant to their countries from this report and, with consideration of local issues, produced these guidance recommendations for the introduction of HPV vaccines in the CEVAG region, which may be adapted for use in individual countries.

Nosocomial rotaviral gastroenteritis in paediatric departments

The authors present a retrospective analysis of community-acquired and hospital-acquired rotaviral gastroenteritis (RVGE) cases in a 5 years period 2001-2005 and prospective analysis in 2006 in the referral area in a population of 7,000 children under 5 years of age. Out of 228 patients with RVGE, nosocomial RVGE accounted for 27.75% of the cases. Children with nosocomial RVGE were in average 9.8 months younger compared to patients with community-acquired RVGE. Nosocomial cases were also characterised by the need for longer stay in intensive care, overall longer hospital stay, longer duration of the illness and by lower age of the patients. The wider implementation of vaccination in the youngest members of the population would be likely to have a significant influence on the occurrence of not only community-acquired but also hospital-acquired RVGE.

[The hypereosinophilic syndrome in a child with endomyocardial fibrosis treated surgically]

The authors describe the case-history of a 12-year-old patient with hypereosinophil syndrome, endomyocardial fibrosis of the left ventricle and dominating mitral valve insufficiency. By correction of the insufficiency, using a Carpentier ring, the authors achieved substantial improvement of the haemodynamics. One year after operation the patient is cardially compensated.