[Evaluation of prophylactic precautions after exposure to biological materials]. / Hodnocení profylaktických opatrení po expozici biologickému materiálu.

OBJECTIVES: Study of transmission rates of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) and effect of HBV vaccination after parenteral exposure to biological materials. PATIENTS AND METHODS: This was a retrospective study of 879 individuals (419 health care professionals and 460 persons from the general population) after blood and body fluid exposure examined at the Clinic of Infectious Diseases in Ostrava from 1999 to 2013. HBsAg, anti-HBs, anti-HBc, anti-HCV, anti-HIV, bilirubin, and ALT were tested in exposed patients and known sources at the baseline and, except anti-HBc, after 3, 6, and 12 months. Susceptible persons were vaccinated against HBV and screened for anti-HBs after 1-2 months. Antiretroviral prophylaxis was provided if reasonable. RESULTS: At the baseline, 42 exposed persons were HBV positive, six were HCV positive, and none was HIV positive. During the follow-up, no new HBsAg positivity was detected in exposed individuals, although 25 of 837 susceptible persons were exposed to HBsAg-positive sources. After vaccination, protective anti-HBs were detected in 707 (84.7%) of 837 susceptible persons and in 709 (97.8%) of 725 persons with known post-vaccination response. Fifty-six of 873 persons had been exposed to HCV-positive sources and HCV transmission was shown in three (two health care professionals) of them. No HIV transmission was observed, although 11 of 879 individuals had been exposed to HIV-positive sources, with antiretroviral prophylaxis provided to nine of them. CONCLUSIONS: Contemporary post-exposure prophylactic precautions in the Czech Republic can be considered as adequate for the prevention of HBV and HIV, but health care professionals in particular are at risk of HCV transmission.

[Vaccination against hepatitis B in patients with chronic renal failure--twenty years follow-up]. / Ockování proti virové hepatitide B u pacientu s chronickým selháním ledvin--dvacetileté zkusenosti.

AIM: The efficacy of vaccination against hepatitis B was evaluated in patients with chronic renal failure from 4 dialysis units in 1988-2010. PATIENTS AND METHODS: Hepatitis B vaccination was started in 1 271 patients with chronic renal failure (606 female, 665 male). Patients received intramuscularly 3 doses of plasma-derived or since 1990, recombinant vaccine at the interval 0, 1 and 2 months for dialysis patients and 0, 1 and 6 months for pre-dialysis patients. Each vaccine contained 40 microg of hepatitis B surface antigen (HBsAg) in 1 002 patients, however only 20 microg HBsAg in 269 patients till 2000. Blood samples were obtained at the beginning of vaccination, 1-2 month after immunization and biannual thereafter. Serum samples were tested using ELISA methods for HBsAg and antibodies against hepatitis B surface and core antigens (anti-HBs, anti-HBc). The patients without protective anti-HBs level and the patients with waning of anti-HBs antibodies were revaccinated. RESULTS: Anti-HBs antibodies after the third vaccine were investigated in 786 patients. Protective anti-HBs levels (> or = 10 IU/l) were proved in 49%, 65% and 74% patients after the third, fourth and fifth vaccine. The waning of protective anti-HBs antibodies was detected in 47% and 68% of patients during 3 and 5 years after vaccination. The new infections with HBsAg positive status were proved in 28 patients, in 27 of them in period 1988-1994. Anti-HBc seroconversion was observed in 10 patients. CONCLUSION: Vaccination considerably reduced hepatitis B incidence in the patients with chronic renal failure during nineties. However still approximately one quarter of patients did not produce protective anti-HBs level after immunization with recombinant vaccine and new form of vaccination against hepatitis B may be considered also in the Czech Republic.

[Hepatitis B immunization of patients with inherited bleeding disorders: personal experiences]. / Vlastní zkusenosti s ockováním proti virové hepatitidé B u pacientu s vrozenou poruchou koagulace.

Hepatitis B immunization of patients with inherited bleeding disorders: personal experiences Hepatitis B vaccination was initiated in 55 patients with inherited bleeding disorders in 1994-2009. Patients received three doses of subcutaneous recombinant vaccine containing 20 mg HBsAg (hepatitis B surface antigen) at 0, 1 and 6 months. Blood samples were obtained at the starting of vaccination, 1-3 months after immunization, and biennially thereafter. The samples were tested for HBsAg, hepatitis B surface and core antibodies (anti-HBs, anti-HBc). Protective anti-HBs level (≥10 IU/l) after immunization was proved in 50 of 51 patients (98 %). Waning of protective anti-HBs antibodies was detected in 4 % and 24 % of patients within 5 and 10 years after vaccination. No HBsAg carrier status or anti-HBc seroconversion were detected. Subcutaneous vaccination against hepatitis B provides long-term protection in patients with inherited bleeding disorders.

Long-term protection against hepatitis B after newborn vaccination: 20-year follow-up.

BACKGROUND: Hepatitis B vaccination in children born to hepatitis B surface antigen (HBsAg)-positive mothers considerably decreases the risk of vertical transmission. However, whether this protection against carriage of hepatitis B virus is maintained into early adulthood is as yet unknown. PATIENTS AND METHODS: A combined passive-active immunization programme for newborns of HBsAg-positive mothers was initiated in the north-eastern part of the Czech Republic in 1988. The number of immunized newborns had reached 665 newborns by the end of 2006. All mothers of immunized infants were HBsAg-positive during pregnancy, and 34 (5%) were also hepatitis B e antigen (HBeAg)-positive. The immunization programme consists of providing newborns with protection at birth with hepatitis B immunoglobulin, followed by three 10-µg doses of plasma-derived or, since 1990, recombinant vaccine administered at 0, 1 and 6 months of life. Only 29 children of HBeAg-positive mothers received vaccine at 0, 1 and 2 months of life. Blood samples were obtained after immunization, at 2 years of age, and biennially thereafter. Samples were tested for HBsAg and hepatitis B surface and core antibodies (anti-HBs, anti-HBc). RESULTS: The immunization schedules were completed in 640 children. A protective anti-HBs level after immunization was proven in 574 of 620 children (93%). Persistence of protective anti-HBs antibodies was detected in 70, 40 and 25% of children at 5, 10 and 15 years of age. Vertical transmission with chronic HBsAg carrier status was detected in two infants. Anti-HBc seroconversion was proven in ten children from 3 to 15 years of age. Natural boosting with an anti-HBs increase was detected in 38 children (twice in one child). CONCLUSION: Our results show that combined active-passive immunization of newborns against hepatitis B provides persistent protection up to adolescence despite a frequent waning of anti-HBs antibodies, suggesting there is no need for booster vaccination during adolescence.

[Retreatment with peginterferon plus ribavirin in chronic hepatitis C patients: our own experiences]. / Opakovaná lécba pegylovaným interferonem s ribavirinem u pacientu s chronickou hepatitidou C - vlastní zkusenosti.

Retreatment with peginterferon plus ribavirin was initiated in 26 patients with hepatitis C virus genotype 1b infection (17 relapsers after the first course of therapy, 9 non-responders). So far, retreatment has been completed in 19 patients, one patient achieved a sustained virologic response, and 3 patients were relapsers. Therapy was discontinued in 14 patients (9 non-responders) because of a lack of a treatment response, and in 1 patient due to adverse effects. Retreatment is a new chance for patients with chronic hepatitis C infection. However successful outcome is rare especially in non-responders.

Treatment failure in case of typhoid fever imported from India to Czech Republic, December 2008--January 2009.

In this report we describe a case of typhoid fever in a Czech patient with history of travel to India and discuss antibiotic treatment failure which led to the relapse of fever.

[Lamivudine therapy in patients with severe acute hepatitis B]. / Lécba lamivudinem u pacientu s tezkou akutní virovou hepatitidou B.

OBJECTIVES: Fulminant hepatitis develops in 1 % of patients with acute hepatitis B. Lamivudine therapy in patients with severe acute hepatitis B probably reduces their risk of fulminant hepatitis but experience with this type of treatment is still limited. MATERIALS AND METHODS: Between 1999 and 2006, 17 immunocompetent patients (12 women, 5 men, age 17-83 years) with severe acute hepatitis B were treated with lamivudine. Prior to treatment, all patients had their total bilirubin values above 220 micromol/l (more than 13 mg/dl). In 9 patients, the marked increase of bilirubin levels was accompanied by aminotransferase level decrease. Sixteen patients received lamivudine at a dose of 100 mg per day; one patient was given 150 mg daily. In 12 patients, concurrent corticosteroid therapy was administered. RESULTS: One patient developed fulminant hepatitis B and underwent successful urgent liver transplantation 5 days after the lamivudine therapy was initiated. Sixteen patients responded well to the treatment and their biochemical parameters improved rapidly. Within 3-7 months, the HBsAg was undetectable in 14 out of 15 investigated patients. Protective anti-HBs antibodies developed in 11 of them in 3-21 months. The lamivudine therapy was terminated in 12 patients and it continued for more than 1 year in 3 patients only. Four patients continue to receive lamivudine but the therapy still has not exceeded 9 months. The corticosteroid therapy was short-term; it was longer than one month in 1 of 12 patients. CONCLUSION: Early treatment with lamivudine alone or with corticosteroids probably decreases the risk of progression to fulminant hepatitis in patients with severe acute hepatitis B.

[Hepatitis B immunoglobulin treatment after liver transplantation--our experiences]. / Vlastní zkusenosti s podáním imunoglobulinu proti hepatitide B po transplantaci jater.

Liver transplantation was performed in 3 patients with hepatitis B infection in 1999-2004 years. Combination of hepatitis B immunoglobulin (HBIg) and lamivudine are used for prevention of hepatitis B recurrence. HBIg is administered in dose 2 000 international units (IU) with tendency to maintain anti-HBs antibodies above 100 IU/litre. Average interval between HBIg administrations was 22, 32 and 32 days, yearly price of treatment was 0.45-0.65 million Czech crowns. Three patients with HBIg and lamivudine therapy are still without recurrence of hepatitis B at the end of 2006 year.

Unusual hepatitis B surface antigen variation in a child immunised against hepatitis B.

Perinatal transmission of and infection with hepatitis B (HBV) in early childhood are observed in a small proportion of the offspring of hepatitis B surface antigen (HBsAg)-positive mothers who are vaccinated against HBV immediately after giving birth. The children may be infected by wild-type HBV or by variants with amino acid substitutions in the "a" determinant of HBsAg, particularly at position 145 and, rarely, at positions 120, 126, 129, 131, 141, and 144. Four hundred and forty-six newborn infants of HBsAg-positive mothers in the northeastern part of the Czech Republic received combined active and passive immunisation against HBV. Only one child became an HBsAg carrier. This followed a mild, acute HBV illness in the beginning of the second year of his life. HBV DNA encoding the "a" determinant and surrounding region of HBsAg was sequenced after amplification from the plasma of the child and his mother. The child was infected with variants of HBsAg with substitutions at residues 137 and 139. The virus of the mother had changes at residues 120 and 121. HBV from both child and mother had an unusual substitution at residue 118 and seemed to be of the ayw subdeterminant.