Prevalence of HBV and HCV among outpatients in the Plovdiv region of Bulgaria, 2010-2011.

Viral hepatitis, particularly hepatitis B and C, are diseases with worldwide distribution that present a significant public health problem. Seroprevalence studies allow assessment of the extent of the disease burden, the identification of populations at risk and the monitoring trends over time. A multi-center seroprevalence study, carried out in Bulgaria (covering the five largest cities - Sofia, Plovdiv, Varna, Pleven, and Stara Zagora) in 1999-2000 estimated a crude seroprevalence rate of 3.9% for HBsAg and 1.3% for anti-HCV. A decade later, comparable rates were observed in a study including 865 outpatients consulting a clinical laboratory in Plovdiv, the second largest administrative region in Bulgaria. The crude seroprevalence rate measured for hepatitis B (HBsAg) was 3.9%. The HBsAg prevalence rate in individuals ≤19 years of age (targeted by vaccination) was significantly lower compared to the rate in adults ≥20 years of age -1% versus 4.8%. The lack of dynamics in the overall level of HBsAg carriers is likely related to the excessively low hepatitis B vaccine coverage in individuals, born before the introduction of the universal vaccination of newborns in August 1991. Anti-HCV antibodies were detected in 0.7% of the subjects.

Radial shock wave therapy in patients with lateral epicondylitis.

INTRODUCTION: Lateral epicondylitis, or "tennis elbow", is a relatively common disorder. Various therapeutic modalities have been tried in an attempt to manage the disorder but neither the conservative methods nor the surgical options have proved to be beneficial so far. During the past decade in the USA and European countries and the past several years in Bulgaria, the shock wave therapy (focused and radial) has been introduced as a method of choice in the treatment of chronic tendynopathies. The AIM of the present study was to make quantitative assessment of the effect of radial shockwave therapy in patients with lateral epicondylitis. PATIENTS AND METHODS: The study included 16 patients with lateral epicondylitis (9 males, 7 females, mean age 47.2 +/- 2.3 yrs) of mean duration of 15.06 +/- 4.06 months. We used the BTL-5000 radial shockwave therapy equipment and performed 5 procedures (one per week). The total number of shocks was 2500, the pressure was 2 Bars: 1500 shocks of 5 Hz frequency followed by 500 shocks of 10 Hz frequency were applied locally on the lateral epicondyle and 500 shocks of 2 Bar pressure and 5 Hz frequency were applied along the muscles near the insertion. The patients were evaluated 5 times: before treatment, immediately after the end of treatment and at 3, 6 and 12 months of follow-up. Pain was assessed at rest, on palpation and by the Thomsen test using a visual analogue scale (VAS). The patient-rated tennis elbow evaluation (PRTEE) questionnaire was used to assess the patients' pain, functional condition and limitations in performing specific activities, as well as for the overall self evaluation. RESULTS: We found significant difference (p < 0.05) between the mean pain scores (at rest, on palpation and by Thomsen test) before treatment and these scores obtained immediately after treatment, the decrease sustained at 3, 6 and 12 months. VAS showed decrease from 3.75 +/- 0.49 before therapy to 2.44 +/- 0.39 after treatment, to 1.94 +/- 0.46 at 3 months and to 0.69 +/- 0.38 at one year at rest, from 7.44 +/- 0.38 before therapy to 4.69 +/- 0.51 after treatment, to 3.56 +/- 0.40 at 3 months and 1.46 +/- 0.56 at one year at palpation, and from 5.87 +/- 0.46 before therapy to 3.5 +/- 0.29 after it, to 2.5 +/- 0.40 at 3 months and 1 +/- 0.38 at one year in the Thomsen test. The pain, function and the total score as assessed on the patient-rated scale (PRTEE) also showed statistically significant improvement (p < 0.05) after completion of therapy and over the whole follow-up. Total score decreased from 56.75 +/- 2.34 before therapy to 39.38 +/- 3.96 after treatment, to 27.53 +/- 3.7 at 3 months and to 13.69 +/- 4.48 at one year. CONCLUSION: Based on the results of this preliminary study we could recommend the radial shock wave therapy in the treatment of lateral epicondylitis of more than 6 months' duration if the condition is recalcitrant to other conservative methods of treatment.

A survey of occupational risk exposures and behaviour of healthcare workers.

UNLABELLED: To reduce the risk of transmission of microorganisms standard precautions are taken for all patients expected to be exposed to blood, body fluids, or have contacts with mucous membranes and non-intact skin. These preventive measures are by far the best way to protect healthcare workers from adverse infections. AIM: To analyze occupational risk exposure of healthcare workers occurring when the latter come into contact with blood or other potentially infectious liquid in order to assess some aspects of the application of standard preventive measures. PATIENTS AND METHODS: 680 healthcare workers (186 physicians, 330 nurses, and 164 hospital orderlies) were included in an anonymous survey conducted at St George University Hospital, Plovdiv in 2009. The questionnaire consisted of 14 questions grouped in 3 clusters. Occupational risk exposure was defined as recommended by the Centers for Disease Control and Prevention (CDC). We used descriptive statistics, parametric and non-parametric analysis. RESULTS: Occupational exposure was reported by 81% of the respondents for the last year with predominance of percutaneous injuries (62%). Nurses sustained the most risk exposures (86%). We found a correlation between the job category and the occupational exposure (chi2 = 14.3, df = 2, p < 0.001). No correlation was found between length of service and injury intensity (chi2 = 1.69, df = 2, p > 0.05). Immunisation against hepatitis virus B infection received 64.3 +/- 3.8% of the healthcare personnel. Immunization covered 48.2% of the ancillary workers, which is less than the mean coverage for the respondents. Job position was found to correlate with the immunisation coverage (chi2 = 24.41, df = 2, p < 0.001). Ninety-two percent of the healthcare workers used personal protective equipment (disposable gloves), but only 74.6% of them did this during emergencies (p < 0.001). CONCLUSION: Post-exposure follow-ups and the overall behaviour pattern after occupational risk exposure are random and non-systematic in nature. A better prevention of healthcare personnel would require a long-term training with constant knowledge upgrading, invasive procedures perfection and permanent control.

Immune response and immunologic memory in medical personnel vaccinated with hepatitis B vaccine.

UNLABELLED: The occupation-related nature of Hepatitis B viral infection in medical personnel has been well documented in a lot of studies. The only reliable way of prevention of this infection is immunisation with hepatitis B vaccine. AIM: To follow-up the primary immune response after immunisation with recombinant vaccine and its duration in adult immunocompetent subjects. MATERIALS AND METHODS: One hundred sixty-five health-care workers working at St. George University Hospital, Plovdiv in 2009/2010 were included in the study and allocated to two groups. Group 1 (N1 = 70) was followed up for the primary immune response after immunization; group 2 (N2 = 95) was with documented immunization in 1998/1999 (n = 81) and in 1994/1995 (n = 14). Tests based on ELISA for quantitative determination of anti-HBs in mIU/ml were used. The measurement were performed at the National Reference Laboratory of Viral Hepatitis at the NCIPD, Sofia. Descriptive statistics, non-parametric and parametric tests, qualitative correlation were used to analyse data. RESULTS: Group 1 mean age was 40.3 +/- 2.6 years; anti-HBs concentration of > or = 10 mIU/ ml was found in 92.8%. No association between the immune response and the commonly involved factors such as gender, age, overweight, smoking, etc., was found. In group 2, anti-HBs concentration of > or = 10 mIU/ml was found in 77.9%: it was in 75.3% in those immunized 10 years before, and in 92.9% in those immunized 15 years before (t = 0.24, p > 0.05). A booster dose of the vaccine was received by 15/21 subjects from group 2 (those immunized 10 years before that) with anti-HBs < 10 mIU/ml. After the booster, 9/15 produced anti-HBs in protective concentrations (anamnestic immune response). The actual level of seroprotection among the immunized more than 10 years ago was 92%. CONCLUSION: This study and the documentation of the primary postvaccinal immunity in high-risk medical personnel will help specify if additional hepatitis B vaccine shots are needed.

Immune memory and immune response in children from Bulgaria 5-15 years after primary hepatitis B vaccination.

BACKGROUND: Bulgaria adopted the World Health Organization recommendation of routine universal infant vaccination against hepatitis B in 1991. Nevertheless, only a few studies evaluated the protection after the vaccination against hepatitis B, especially in children. The objective of this study was to investigate the duration of protection against hepatitis B in children aged 5-15 years after primary immunization, by measuring the immune and anamnestic immune response and possible breakthrough infections. METHODS: A total of 141 children (aged 5-17 years) were recruited randomly and divided into 3 groups, approximately 5 years (group 1), 10 years (group 2) and 15 years (group 3) after primary immunization with a recombinant hepatitis B vaccine; they were tested for hepatitis B markers: hepatitis B surface antigen anti-hepatitis core antibody and antibodies to hepatitis B surface antigen (anti-HB). A booster dose of vaccine was administered to 23 children with titers of anti-HBs antibodies below the threshold considered to be protective (<10 mIU/mL). Anti-HBs concentrations and geometric mean concentration (GMC) were determined before and 21-28 days after the booster vaccination. RESULTS: Protective anti-HBs antibodies were detected in 95 of 141 (67.4 %) tested children, with a GMC of 63.57 mIU/mL. The seroprotection rate and GMC by groups was respectively: 84.6% and GMC of 76.05 mIU/mL in group 1; 55.8% and GMC of 58.1 mIU/mL in group 2; and 61.1% and GMC of 50.33 mIU/mL in group 3. Hepatitis B surface antigen and anti-hepatitis core antibody were found in 1 of the 141 subjects (0.7%). Of the remaining 140 children, 95 had anti-HBs ≥10 mIU/mL, and anti-hepatitis core antibodies were not detected. A booster dose of hepatitis B vaccine was administered to 23 of 45 (51%) children with anti-HBs <10 mIU/mL. Anamnestic immune response was shown in 100% of the children: the GMC was 337.38 mIU/mL and protective antibodies ranged between 15 and 955 mIU/mL. CONCLUSION: The study demonstrates the presence of immune memory and protection 5-15 years after the initial course of newborn immunization with recombinant vaccines against hepatitis B.