OBJECTIVES: Temperature is the most important environmental variable associated with the varicella frequency across the world. The present study compares the incidence of varicella in the districts of Bulgaria against some climatic factors and tries to find environmental variables which account for the differences in the varicella distribution observed among the Bulgarian districts. METHODS: The 28 Bulgarian districts were used as units of observation and their average 10-year varicella incidence (2009-2018) was tested for correlation with the standard bioclimatic variables of WorldClim, version 2. RESULTS: The WorldClim estimates for the annual mean temperature, the maximal temperature of the warmest month, the minimal temperature of the coldest month, the mean temperature of the coldest quarter, and the solar radiation inversely and not significantly correlated with the average 10-year varicella frequency. The precipitation of the warmest quarter and the wind speed correlated positively and also not significantly. Only the mean temperature of the driest quarter correlates significantly with the incidence at district level (Spearman's rank correlation coefficient of -0.45, p = 0.02). The mean of average 10-year varicella incidence rates among districts with driest quarter during the winter (January, February, March) was 387.6 ± 114.1, while among districts with driest quarter during the summer/autumn (July, August, September or August, September, October) 283.3 ± 102.1 (p = 0.02, ANOVA test). CONCLUSIONS: Dry winter and/or wet summer appear as significant determinants for the fluctuant spread of varicella infection in Bulgaria.

• Klíčová slova
• WorldClim, chickenpox, communicable diseases, epidemiology, notifiable infectious diseases,
• MeSH
• incidence MeSH
• lidé MeSH
• plané neštovice * epidemiologie   MeSH
• podnebí * MeSH
• roční období MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Bulharsko epidemiologie   MeSH

BACKGROUND: Varicella vaccination confers high and long-lasting protection against chickenpox and induces robust immune responses, but an absolute correlate of protection (CoP) against varicella has not been established. This study models the relationship between varicella humoral response and protection against varicella. METHODS: This was a post-hoc analysis of data from a Phase IIIb, multicenter, randomized trial (NCT00226499) conducted in ten varicella-endemic European countries. Healthy children aged 12-22 months were randomized 3:3:1 to receive one dose of measles-mumps-rubella and one dose of varicella vaccine (one-dose group) or two doses of measles-mumps-rubella-varicella vaccine (two-dose group) or two doses of measles-mumps-rubella vaccine (control group) six weeks apart. The study remained observer-blind until completion, except in countries with obligatory additional immunizations. The objective was to correlate varicella-specific antibody concentrations with protection against varicella and probability of varicella breakthrough, using Cox proportional hazards and Dunning and accelerated failure time statistical models. The analysis was guided by the Prentice framework to explore a CoP against varicella. RESULTS: The trial included 5803 participants, 5289 in the efficacy (2266: one-dose group, 2279: two-dose group and 744: control group) and 5235 (2248, 2245 and 742 in the same groups) in the immunogenicity cohort. The trial ended in 2016 with a median follow-up time of 9.8 years. Six weeks after vaccination with one- or two-dose varicella-containing vaccine, more than 93.0% of vaccinees were seropositive for varicella-specific antibodies. Estimated vaccine efficacy correlated positively with antibody concentrations. The fourth Prentice CoP criterion was not met, due to predicted positive vaccine efficacy in seronegative participants. Further modelling showed decreased probability of moderate to severe varicella breakthrough with increasing varicella-specific antibody concentrations (ten-year probability <0.1 for antibody concentrations ≥2-fold above the seropositivity cut-off). CONCLUSIONS: Varicella-specific antibody concentrations are a good predictor of protection, given their inverse correlation with varicella occurrence. CLINICAL TRIAL: NCT00226499.

• Klíčová slova
• Correlate of protection, ELISA, Efficacy, Humoral response, Statistical modelling, Varicella,
• MeSH
• dítě MeSH
• kojenec MeSH
• kombinované vakcíny MeSH
• lidé MeSH
• plané neštovice * prevence a kontrola   MeSH
• protilátky virové MeSH
• spalničky * MeSH
• vakcína proti planým neštovicím MeSH
• vakcína proti spalničkám, příušnicím a zarděnkám MeSH
• virus varicella zoster MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• kombinované vakcíny MeSH
• protilátky virové MeSH
• vakcína proti planým neštovicím MeSH
• vakcína proti spalničkám, příušnicím a zarděnkám MeSH

BACKGROUND: The duration of protection provided by varicella vaccines is unclear. We assessed the 10-year vaccine efficacy of two doses of a combined measles-mumps-rubella-varicella vaccine (MMRV), one live attenuated varicella vaccine (V) dose given after one measles-mumps-rubella vaccine (MMR) dose (MMR + V), versus two MMR doses (control vaccine) for the prevention of confirmed varicella. METHODS: This was a phase 3b follow-up of an observer-blinded, randomised, controlled trial. In phase a, children aged 12-22 months (at first vaccination) from Czech Republic (Czechia), Greece, Italy, Lithuania, Norway, Poland, Romania, Russia, Slovakia, and Sweden were randomly assigned by computer-generated randomisation list (3:3:1) to receive two doses of MMRV, one dose of MMR and one dose of varicella vaccine, or two doses of MMR, 42 days apart. Varicella cases were confirmed by detection of viral DNA, or epidemiological link and clinical assessment, by an independent data monitoring committee; disease severity was based on a modified Vázquez scale. Hazard ratios for MMRV and MMR + V versus MMR estimated in the per-protocol cohort using a Cox proportional hazards regression model were used to calculate vaccine efficacy and 95% CI. Serious adverse events were recorded throughout the study in all vaccinated children. Study objectives were secondary and descriptive. The trial is registered at ClinicalTrials.gov, number NCT00226499. FINDINGS: Between Sept 1, 2005, and May 10, 2006, 5803 children (mean age 14·2 months, SD 2·5) were vaccinated. The per-protocol cohort included 2279 children from the MMRV group, 2266 from the MMR + V group, and 744 from the MMR group. From baseline to a median follow-up of 9·8 years, 76 (3%) children in the MMRV group, 469 (21%) in the MMR + V group, and 352 (47%) in the MMR group had varicella. Vaccine efficacy against all varicella was 95·4% (95% CI 94·0-96·4) for MMRV and 67·2% (62·3-71·5) for MMR + V; vaccine efficacy against moderate or severe varicella was 99·1% (97·9-99·6) for MMRV and 89·5% (86·1-92·1) for MMR + V. During phase b, serious adverse events were reported by 290 (15%) of 1961 children in the MMRV group, 317 (16%) of 1978 in the MMR + V group, and 93 (15%) of 641 in the MMR group. There were no treatment-related deaths. INTERPRETATION: The 10-years vaccine efficacy observed, suggests that a two-dose schedule of varicella vaccine provided optimum long-term protection for the prevention of varicella by offering individual protection against all severities of disease and leading to a potential reduction in transmission, as observed in the US experience with universal mass vaccination. FUNDING: GlaxoSmithKline Biologicals.

• MeSH
• jednoduchá slepá metoda MeSH
• kojenec MeSH
• kombinované vakcíny aplikace a dávkování   škodlivé účinky   imunologie   MeSH
• lidé MeSH
• následné studie MeSH
• nežádoucí účinky léčiv epidemiologie   patologie   MeSH
• očkovací schéma MeSH
• plané neštovice prevence a kontrola   MeSH
• vakcína proti planým neštovicím aplikace a dávkování   škodlivé účinky   imunologie   MeSH
• výsledek terapie MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• kombinované vakcíny MeSH
• vakcína proti planým neštovicím MeSH

The challenge of assimilating millions of immigrants in the European region each year presents significant socioeconomic issues. Among them is the threat of vaccine preventable diseases (VPDs) disease transmission within immigrant groups and the broader population given the permeability of nation state borders. A total of 3.8 million people immigrated to the European Union (EU) in 2014, among those were 1.6 million non-EU nationals. While vaccines have markedly reduced the transmission of disease, clusters of under-vaccinated individuals potentiate the rapid transmission of once-eradicated or controlled diseases. Immigrants pose a special challenge to host country public health vaccination programmes. Wars in their native countries may have interrupted vaccination programmes, documentation may be unavailable or unreliable, and refugees may present with health issues due to poor sanitation and food during transit. Further, immigrants are often reticent to access health care in the destination country, or may face financial or language barriers. Thus, preventive health care needs may go unaddressed and the first contact with a clinician is for an emergency. Equitable access to acute and preventive health care and services, including immunizations irrespective of individual's immigration status, should be a priority for European region countries. Ensuring appropriate and timely vaccination for immigrants could be accomplished with a universal European region immunization schedule. Priority should be given to highly communicable VPDs such as measles, mumps, rubella, pertussis, diphtheria, varicella and polio.

• Klíčová slova
• Europe, Immigrant, Immunization, Vaccine preventable diseases,
• MeSH
• emigranti a imigranti statistika a číselné údaje   MeSH
• Evropská unie statistika a číselné údaje   MeSH
• lidé MeSH
• očkovací schéma MeSH
• pertuse prevence a kontrola   MeSH
• plané neštovice prevence a kontrola   MeSH
• příušnice prevence a kontrola   MeSH
• spalničky prevence a kontrola   MeSH
• uprchlíci statistika a číselné údaje   MeSH
• vakcinace metody   MeSH
• vakcíny terapeutické užití   MeSH
• veřejné zdravotnictví metody   MeSH
• zarděnky prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• vakcíny MeSH

BACKGROUND: This phase III B follow-up of an initial multicenter study (NCT00226499) will evaluate the ten-year efficacy of two doses of the combined measles-mumps-rubella-varicella vaccine (MMRV) and one dose of the live attenuated varicella vaccine (V) versus a measles-mumps-rubella control group (MMR) for the prevention of clinical varicella disease. Here we present efficacy results for six years post-vaccination. METHODS: In phase A of the study, healthy children aged 12-22 months from ten European countries were randomized (3:3:1) and received either two doses of MMRV, or one dose of combined MMR and one dose of monovalent varicella vaccine (MMR+V), or two doses of the MMR vaccine (control), 42 days apart. Vaccine efficacy against all and against moderate or severe varicella (confirmed by detection of viral DNA or epidemiological link) was assessed from six weeks up to six years post-dose 2 for the MMRV and MMR+V groups, and was calculated with 95% confidence intervals (CI). The severity of varicella was calculated using the modified Vázquez scale (mild ≤ 7; moderately severe = 8-15; severe ≥ 16). Herpes zoster cases were also recorded. RESULTS: 5289 children (MMRV = 2279, mean age = 14.2, standard deviation [SD] = 2.5; MMR+V = 2266, mean age = 14.2, SD = 2.4; MMR = 744, mean age = 14.2, SD = 2.5 months) were included in the efficacy cohort. 815 varicella cases were confirmed. Efficacy of two doses of MMRV against all and against moderate or severe varicella was 95.0% (95% CI: 93.6-96.2) and 99.0% (95% CI: 97.7-99.6), respectively. Efficacy of one dose of varicella vaccine against all and against moderate or severe varicella was 67.0% (95% CI: 61.8-71.4) and 90.3% (95% CI: 86.9-92.8), respectively. There were four confirmed herpes zoster cases (MMR+V = 2, MMR = 2), all were mild and three tested positive for the wild-type virus. CONCLUSIONS: Two doses of the MMRV vaccine and one dose of the varicella vaccine remain efficacious through six years post-vaccination.

• Klíčová slova
• Efficacy, Long-term follow-up, Measles-mumps-rubella, Vaccine, Varicella-zoster virus,
• MeSH
• atenuované vakcíny aplikace a dávkování   imunologie   MeSH
• časové faktory MeSH
• herpes zoster patologie   prevence a kontrola   MeSH
• kojenec MeSH
• lidé MeSH
• následné studie MeSH
• očkovací schéma * MeSH
• plané neštovice patologie   prevence a kontrola   MeSH
• protilátky virové krev   MeSH
• stupeň závažnosti nemoci MeSH
• vakcína proti planým neštovicím aplikace a dávkování   imunologie   MeSH
• výsledek terapie MeSH
• zdraví dobrovolníci pro lékařské studie MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• atenuované vakcíny MeSH
• protilátky virové MeSH
• vakcína proti planým neštovicím MeSH

• MeSH
• DNA virů genetika   MeSH
• genotyp MeSH
• herpes zoster epidemiologie   virologie   MeSH
• jednonukleotidový polymorfismus MeSH
• lidé MeSH
• plané neštovice epidemiologie   virologie   MeSH
• virus varicella zoster genetika   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• dopisy MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• DNA virů MeSH

• MeSH
• cystická fibróza komplikace   MeSH
• dítě MeSH
• DNA virů genetika   izolace a purifikace   MeSH
• genotyp MeSH
• kůže patologie   virologie   MeSH
• lidé MeSH
• plané neštovice diagnóza   imunologie   MeSH
• virus varicella zoster klasifikace   genetika   izolace a purifikace   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• dopisy MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• DNA virů MeSH

AIM: Varicella is a highly contagious disease. In Slovakia, 15,000-30,000 cases are reported annually. However, vaccination against varicella is not widely used in Slovakia. The aim of this paper is to predict the influence of vaccination administrated in different ages on the disease occurrence in different age groups. METHODS: Deterministic, age-stratified SIR (susceptible-infected-recovered) model with stable population was used for prediction of varicella spread in Slovakia. RESULTS: Vaccination of a group designated as 0 influences the proportion of susceptible and infected persons in all age groups, vaccination of 10 years old ones affects only the proportion of susceptible and infected individuals older than 10 years. CONCLUSION: The increase of vaccination coverage should have a positive impact on the incidence of varicella in Slovakia. In case of vaccination coverage of 0 group in the range of 30-75%, it is necessary to pay attention to the protection of older children and adults.

• MeSH
• dítě MeSH
• incidence MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• plané neštovice epidemiologie   prevence a kontrola   MeSH
• předškolní dítě MeSH
• teoretické modely * MeSH
• vakcína proti planým neštovicím aplikace a dávkování   MeSH
• věkové faktory MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Slovenská republika epidemiologie   MeSH
• Názvy látek
• vakcína proti planým neštovicím MeSH

BACKGROUND: Rates of varicella have decreased substantially in countries implementing routine varicella vaccination. Immunisation is possible with monovalent varicella vaccine or a combined measles-mumps-rubella-varicella vaccine (MMRV). We assessed protection against varicella in naive children administered one dose of varicella vaccine or two doses of MMRV. METHODS: This study was done in ten European countries with endemic varicella. Healthy children aged 12-22 months were randomised (3:3:1 ratio, by computer-generated randomisation list, with block size seven) to receive 42 days apart (1) two doses of MMRV (MMRV group), or (2) MMR at dose one and monovalent varicella vaccine at dose two (MMR+V group), or (3) two doses of MMR (MMR group; control). Participants and their parents or guardians, individuals involved in assessment of any outcome, and sponsor staff involved in review or analysis of data were masked to treatment assignment. The primary efficacy endpoint was occurrence of confirmed varicella (by detection of varicella zoster virus DNA or epidemiological link) from 42 days after the second vaccine dose to the end of the first phase of the trial. Cases were graded for severity. Efficacy analyses were per protocol. Safety analyses included all participants who received at least one vaccine dose. This trial is registered with ClinicalTrials.gov, number NCT00226499. FINDINGS: Between Sept 1, 2005, and May 10, 2006, 5803 children (mean age 14·2 months, SD 2·5) were vaccinated. In the efficacy cohort of 5285 children, the mean duration of follow-up in the MMRV group was 36 months (SD 8·8), in the MMR+V group was 36 months (8·5) and in the MMR group was 35 months (8·9). Varicella cases were confirmed for 37 participants in the MMRV group (two moderate to severe), 243 in the MMR+V group, and 201 in the MMR group. Second cases occurred for three participants (all in the MMR+V group). Varicella cases were moderate to severe for two participants in the MMRV group, 37 in the MMR+V group (one being a second case that followed a mild first case); and 117 in the MMR group. Efficacy of two-dose MMRV against all varicella was 94·9% (97·5% CI 92·4-96·6), and against moderate to severe varicella was 99·5% (97·5-99·9). Efficacy of one-dose varicella vaccine against all varicella was 65·4% (57·2-72·1), and against moderate to severe varicella (post hoc) was 90·7% (85·9-93·9). The most common adverse event in all groups was injection-site redness (up to 25% of participants). Within 15 days after dose one, 57·4% (95% CI 53·9-60·9) of participants in the MMRV group reported fever of 38°C or more, by contrast with 44·5% (41·0-48·1) with MMR+V, and 39·8% (33·8-46·1) with MMR. Eight serious adverse events were deemed related to vaccination (three MMRV, four MMR+V, one MMR). All resolved within the study period. INTERPRETATION: These results support the implementation of two-dose varicella vaccination on a short course, to ensure optimum protection from all forms of varicella disease. FUNDING: GlaxoSmithKline Vaccines.

• MeSH
• dítě MeSH
• dodržování směrnic MeSH
• kombinované vakcíny aplikace a dávkování   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• plané neštovice imunologie   prevence a kontrola   MeSH
• vakcína proti planým neštovicím aplikace a dávkování   MeSH
• vakcína proti spalničkám, příušnicím a zarděnkám aplikace a dávkování   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• kombinované vakcíny MeSH
• measles, mumps, rubella, varicella vaccine MeSH Prohlížeč
• vakcína proti planým neštovicím MeSH
• vakcína proti spalničkám, příušnicím a zarděnkám MeSH

Immune thrombocytopenia (immune thrombocytopenic purpura, ITP) is an acquired autoimmune disease, mediated by antibodies against platelet glycoproteins. ITP can develop in the context of other disorders (secondary ITP), including acute and chronic infections (HIV, H. pylori, HCV, HBV, CMV, EBV, VZV, parvovirus B19, rubella, etc.). The case reports present two children and one adult with ITP complicating VZV, EBV and HAV infections. Corticosteroids are usually initial drugs, but they are controversial in case of ITP during acute infections. Intravenous immunoglobulins are preferred, especially in children, because of their smaller suppression of inflammatory response. Two of the patients were successfully treated with intravenous immunoglobulins. In the remaining patient, corticosteroid therapy had good but delayed effects as compared to immunoglobulins.

• MeSH
• akutní nemoc MeSH
• dospělí MeSH
• hepatitida A komplikace   MeSH
• idiopatická trombocytopenická purpura etiologie   MeSH
• infekce virem Epsteina-Barrové komplikace   MeSH
• lidé MeSH
• plané neštovice komplikace   MeSH
• předškolní dítě MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH