[Bexsero, a novel vaccine against meningococcus]. / Bexsero, egy új, meningococcus elleni vakcina.

Meningococcus B is the most prevalent Neisseria meningitidis serogroup isolated in Hungary. Bexsero is one of the vaccines developed against it, which has been available in Hungary since the summer of 2014. The authors summarize the most important issues and open questions concerning the disease and the vaccine based on literature review. Based on immunological evidence, it is expected that Bexsero provides protection against this rare but very serious infection. However, the vaccine is extremely expensive, the clinical effectiveness has not yet been proven and it frequently causes fever, especially in infants where the vaccine is most needed. According to the opinion of the authors, the formulation of a Hungarian guideline concerning the application of Bexsero should be postponed until the accumulating international experience makes it possible to better judge the vaccine's benefits, risks and cost-effectiveness. For patients with asplenia, complement defect or other immunological defect, or in case of markedly increased individual risk of contracting the disease, the vaccination is already justified.

[Pneumococcal vaccination in general practice]. / A pneumococcusvakcináció gyakorlata a családorvosi praxisokban.

INTRODUCTION: The prevalence of invasive pneumococcal disease, which is depending on risk factors and comorbidities, is increasing over the age of 50 years. Most developed countries have recommendations but vaccination rates remain low. AIM: To assess the general practitioners' daily practice in relation to pneumococcal vaccination and analyse the effect of informing the subjects about the importance of pneumococcal vaccination on vaccination routine. METHOD: Subjects over 50 years of age vaccinated against influenza during the 2012/2013 campaign were informed about the importance of pneumococcal vaccination and asked to fill in a questionnaire. RESULTS: Of the 4000 subjects, 576 asked for a prescription of pneumococcal vaccine (16.5% of females and 11.6% of males, OR 1.67 CI 95% 1.37-2.04, p<0.001) and 310 were vaccinated. The mean age of females and males was 70.95 and 69.8 years, respectively (OR 1.01; CI 95% 1.00-1.02; p<0.05). Information given by physicians resulted in 33,6% prescription rate, while in case it was 8% when nurses provided information (OR 6.33; CI 95% 5.23-7.67; p<0.001). As an effect of this study the vaccination rate was 6.3 times higher than in the previous year campaign (p<0.001). CONCLUSIONS: General practitioners are more effective in informing subjects about the importance of vaccination than nurses. Campaign can raise the vaccination rate significantly.

[Reasons for adult immunization -- prevention of most frequent respiratory infections]. / Érvek a felnottkori vakcináció mellett -- a leggyakoribb légúti infekciók megelozésének lehetoségei.

The adult vaccination is utilized insufficiently as a preventive method currently, even the incidence and mortality of vaccine-preventable infections is very high in the elderly and patients with immunocompromised conditions. They should be protected due to many reasons: the rate of these individuals are getting higher in the population, the effectiveness of antibiotic therapy is limited and becoming more significant due to antibiotic resistance, the quality of life in survivors of severe infections is deteriorated, resulting huge burden to the individual and society as well. The impaired functions of immune system with the advancing age cause higher morbidity and mortality especially in respiratory infections, it is representing in the incidence and high lethality of community acquired pneumonia in older adults. Beyond the old polysaccharide vaccine (PPV23) the inclusion of new conjugate vaccine (PCV13) means a significant improvement in the prevention of pneumococcal infections, providing a possibility to prevent not just pneumococcal infections with bacteraemia caused by serotypes presented in the vaccine, but non-bacteraemic pneumonias as well. The necessity of flu vaccines cannot be stressed enough even the vaccines is not so effective in elderly than in younger adults: annual immunization against influenza administering together with pneumococcal vaccination decrease significantly the number, severity and complications in older adults as well. Further improvement in protection of immunocompromised patients is the establishment of cocoon immunity with the vaccination of close contacts.

[Reducing the risk of infections in hereditary and acquired complement deficiencies.] / Infekciók kockázatának csökkentése veleszületett és szerzett komplementdefektusokban.

Hereditary complement deficiencies are relatively rare worldwide, they account for about 1-10% of primary immunodeficiencies. Acquired complement deficiencies are more prevalent and with the more frequent use of complement inhibitor therapy, the incidence of patients with iatrogenic complement deficiency is increasing. Alike in the inherited forms, patients have a high risk of severe and life-threatening infections caused by encapsulated bacteria (sepsis, meningitis). The most frequent pathogens are Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. C5 and C3 complement inhibitor therapies are available in Hungary, which are mostly indicated in the treatment of paroxysmal nocturnal hemoglobinuria, myasthenia gravis, neuromyelitis optica and atypical haemolytic uremic syndrome. It is of utmost importance to prevent severe, potentially life-threatening bacterial infections in this group of patients. Nevertheless, there is no Hungarian guidance to decrease the risk of infections, preventive measures are incomplete and not standardized posing potential risk of infections for these patients, so far. In this review, we aim to summarize the international clinical practices and guidance on the infection prevention in complement deficient patients. This recommendation might be a source of an evidence-based Hungarian guideline regarding vaccination and antibiotic prophylaxis in this specifically vulnerable group of patients. Orv Hetil. 2023; 164(25): 971-980.

[The challenge of the age of hepatitis C virus elimination: why is HCV vaccination necessary?] / Kihívás a hepatitis C-vírus-elimináció korában: miért van szükség a HCV elleni vakcinációra?

Hepatitis C virus is a common cause of chronic liver disease, that may lead to cirrhosis, hepatocellular cancer and liver transplanation. The advent of highly efficacious direct-acting antivirals and their success in the treatment of hepatitis C virus infection, generated soon an optimism. Thus, the World Health Organization has adopted a global strategy of reducing the incidence of new hepatitis B and C virus infection by 90 % by 2030. However, it turned out, that this goal is not achievable by drug treatment alone without a vaccination, because of the high number of infected persons, low rate of screening and poor access to treatment in several countries, and even the cost of the therapy. The paper discusses the virological and imunological feaures of the HCV infection, and the possibility of an effective vaccination against hepatitis C virus. In addition, we overview the types of potential vaccines and the models for the assessment of vaccine efficacy. The controlled human infection model using healthy volunters, became a real possibility, due to the availability of direct-acting antiviral treatment for hepatitis C. On the ground of the newest results of vaccine researches, we are confident to achive the goal of eliminating hepatitis C virus in the near future. Orv Hetil. 2023; 164(9): 322-331.

COVID-19 vaccination refusal in the active Hungarian adult population in December, 2021 An exploratory study / A COVID-19 elleni oltóanyagot elutasítók az aktív korú felnott magyar lakosság körében 2021 decemberében

Introduction: In 2021, vaccines against COVID-19 became widely available in Hungary, but a part of the population refuses to be vaccinated, which hinders the control of the pandemic. Objective: To explore the sociodemographic characteristics of the Hungarian vaccination-refusing population and to preliminarily explore the reasons behind their refusal. Methods: In December 2021, survey data were collected online using quota-sampling among the Hungarian population aged 18-65 years with internee access. Sociodemographic variables, individual variables, and reasons for refusal were asked. 1905 completed questionnaires were included in this analysis. After variable selection using LASSO regression, binary logistic regression was used to identify the influencing variables. Reasons for rejection were examined both descriptively and using hierarchical classification. Results: Respondents with lower income, lower education, females, younger age, people living in smaller municipalities and who perceived their own health as better were more likely to refine vaccination. No similar associations were found with marital status, household size, life satisfaction and loneliness. Distrust of vaccination, safety concerns (especially side effects) and efficacy concerns are the main reasons for refusal, and to a lesser extent, the belief of immunity. Conclusions: Vaccination refusal is higher in vulnerable groups, which further increases their health risks. Alongside a well-designed health communication campaign, restoring trust in scientific and health institutions, transparent communication and a community-based approach appear to be important to increase vaccination uptake in Hungary.

Influenza as a threat to cardiovascular health and the role of vaccination in risk reduction / Az influenza mint kardiológiai rizikótényezo és a vakcináció szerepe a kockázat csökkentésében

The different types of cardiovascular diseases, including coronary heart disease, cardiac arrhythmias and heart failure are highly prevalent in the society. Cardiovascular diseases are the leading cause of mortality. Although the influenza is forced out from the mainstream of thinking nowadays because of the ongoing SARS-CoV-2 pandemic, it still has its serious epidemiological significance. The seasonal influenza epidemic often contributes to mortality mainly, but not exclusively among old, multi-morbid patients. There are a vast number of scientific publications and evidence which prove and emphasize the synergic health-destroying and mortality-increasing effect of co-existing cardiovascular disease and influenza. Moreover, the beneficial effect of vaccination against influenza infection and its major role in prevention is also well documented. The SARS-CoV-2 pandemic enforces the importance of influenza vaccination because both viruses can lead to severe or often fatal disease, especially among old and frail patients. In addition, the younger population can be far more vulnerable against the novel coronavirus in the case of a co-existing influenza infection. International guidelines recommend influenza vaccination for patients having heart disease, like for other high-risk populations. Despite the nationally reimbursed, cost-free vaccines, the influenza vaccination rate of the society is still low not just in Hungary but also internationally. The authors review the effect of influenza infection on heart diseases, and draw attention to the role of influenza vaccination in decreasing cardiovascular morbidity and mortality.

Bilateral Parsonage-Turner syndrome after COVID-19 vaccination. A case report and review of the literature / Kétoldali Parsonage-Turner-szindróma COVID-19-vakcinációt követoen. Esetismertetés és az irodalom áttekintése

Parsonage---Turner syndrome (PTS; neuralgic amyotrophy) is a generally unilateral neuritis with sudden onset, severe shoulder or upper arm pain. Although the intense pain is usually self-limiting, two-thirds of patients experience pro-gressive motor weakness, narrowed range of motion, reflex changes, dysesthesias and chronic neuropathic pain in the shoulder girdle musculature and proximal upper limb muscles. The aetiology is unclear, in addition to some idiopath-ic cases the most common triggers of PTS are surgery, trauma, infection or vaccination. It is reported after SARS-CoV-2 infection, and unilateral PTS has been described in some cases following different types of COVID-19 vaccines. We are currently presenting the case of a middle-aged woman who developed partial neuralgic amyotrophy on the right shoulder one month after receiving the second dose of the BNT162b2 COVID-19 mRNA vaccine (Pfizer-BioNTech), and seven months later the symptoms appeared in the contralateral upper limb. The diagnosis of PTS was also confirmed by magnetic resonance and electrodiagnostic examination. The PTS is not an uncommon condi-tion, but in the absence of knowledge it is rarely thought of. The purpose of this report is to draw attention to the possibility of PTS in shoulder or upper arm pain following both SARS-CoV-2 infection and COVID-19 vaccination, as early diagnosis and adequate therapy may help to shorten the course of the disease.

Lifelong vaccination strategy as a tool against pandemics in Hungary / Élethosszan át tartó oltási stratégia mint eszköz a pandémiák elleni védekezésben Magyarországon

Due to various factors, the chances of infectious disease emergence or re-emergence have increased in the 21st century, thus, the likelihood of new emerging pandemics has also increased. The COVID-19 pandemic, which appeared in 2019, has highlighted that certain new and re-emerging infectious diseases - in the case of lack or delay in effective measures - can spread very rapidly. The main tool for the fight against infectious diseases is immunization through vaccination. While focusing on the personal health, public health, economic and societal benefits of a lifelong immunization strategy, especially in light of the aging society, the goal of this paper is to present the benefits of vaccines. In order to increase the added value of vaccinations it is recommended to create a lifelong immunization strategy.

Influenza-associated mortality in Hungary between 2009/2010 and 2016/2017 / Influenzához kapcsolódó halálozás 2009/2010 és 2016/2017 között Magyarországon

INTRODUCTION: In recent years, a significant mortality peak has been observed several times during the first months in Hungary. So far, no mortality study clarified the connection between the mortality peaks and influenza with results comparable with findings from other countries. AIM: Calculation of the influenza-related number of death and excess mortality rates in Hungary for the period between 2009/10 and 2016/17, using the statistical package FluMONO. METHOD: We applied the FluMOMO methods, a multivariable time series model with all-cause mortality as outcome, and with influenza-activity and extreme temperature as explanatory variables adjusting for time trend and seasonality. As an indicator of weekly influenza-activity (IA), we used the percentage of consultations for influenza-like illness (ILI) in general practices. RESULTS: According to our estimation, 1091, 2969, 4036, 2336, 2608, 6470, 51 and 5162 deaths were attributable to influenza epidemics in the 2009/10, 2010/11, 2011/12, 2012/13, 2013/14, 2014/15, 2015/16 and 2016/17 seasons, respectively. The average annual mortality excess rate per 100,000 inhabitants ranged between 0.5 and 52.7. These results are similar to those from other countries regarding their order of magnitude. The Hungarian extra mortality, however, tends to be higher than that in countries with higher vaccination rates. CONCLUSIONS: Influenza-related mortality tends to be lower in countries with higher vaccination rates. Increase in vaccination rates seems to be necessary in Hungary. Orv Hetil. 2020; 161(23): 962-970.

[Summary and lessons of the European and Hungarian measles situation]. / Az európai és a magyarországi kanyaróhelyzet összefoglalása és tanulságai.

Measles is one of the most serious preventable infectious diseases, which in our country were among the rare diseases in the last 10 to 20 years. One of the reasons for this is that the Hungarian population born after 1969 was vaccinated in almost 99 percent. The other reason is that in the period prior to vaccination era, the often-occurring measles epidemics left life-long immunity in the affected persons. Thus, natural and artificial immunizations provided extensive herd immunity. However, the ongoing measles epidemics in Europe have highlighted the fact that the symptoms and differential diagnosis related to measles have been relegated to the negligible category for the last 20 years. In addition to reviewing the consequences of the European measles pandemics in Hungary, the purpose of this paper is to revise and summarize the clinical and laboratory knowledge required to establish a definitive epidemiological control of measles. Orv Hetil. 2019; 160(20): 767-773.