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Background: Incidence of hepatitis B in Poland decreased significantly after implementation of routine immunization in infants. Natural boosters may influence the long-term post vaccination immunity in countries, where endemicity is high. In areas of low incidence this influence may be limited. The aim of the study was to analyze the influence of risk factors for HBV infection (potential natural boosters) on long-term post vaccination immunity against hepatitis B and the possibilityof HBVinfection in previously vaccinated individuals., Patients and Methods: In 130 children aged 10-12years, vaccinated with 4 doses ofrecombinantvaccine against hepatitis B in infancy, exposure to risk factors for HBV infection (infection in family members including mother, hospitalization, surgical interventions, blood transfusion, dental treatment, piercing, tattooing) was analyzed. Markers of HBVinfection (anti-HBc and HBsAg) and humoral immunity against hepatitis B were determined. Protective level of anti-HBs antibodies was defined as > or =10 IU/1., Results: Statistically significant influence of dental treatment (p<0.02) andsurgicalinterventions (p<0.05) on possessing very high anti-HBs titer (> or = 1000 IU/) was revealed, which indicates that these factors act as natural boosters. Children, who previously received blood transfusion, statistically more frequently did not have protective level of anti-HBs (p<0.0 I). In all 6 children with confirmed HBV infection there was exposure to risk factors for infection in anamnesis. In children with chronic hepatitis B (positive HBsAg) statistically significantly more frequently surgical interventions were performed (p<0.05)., Conclusions: I. Despite of low incidence of hepatitis B in Poland, natural boosters, especially dental and surgical treatment, may stimulate the post vaccination immunity. 2. Blood transfusion is currently not a source of infection, however, children who received blood transfusion in the neonatal period, may require control of immunization efficacy or a booster dose. 3. HBVinfection and chronic hepatitis B may occur in previously vaccinated children, especially if they underwent surgical intervention.

Background: Immunization is the best method of protection against hepatitis B. Routine vaccination for newborns and infants was introduced in Poland in 1994-96. Although duration of protection afforded by vaccination remains unknown, no routine boosters are recommended. According to references, up to 50% of 15-year old children had lost the post vaccination immune memory protecting against HBV infection. The aim of the study was to determine the immunity against hepatitis B in 10-12-year old children and to establish indications for routine booster doses., Material and Methods: In 130 children aged 10-12 years, immunized against hepatitis B with recombinant vaccine in infancy (10 microg, according to schedule: 0-1-2-12 months, first dose given at birth) humoral immunity (anti-HBs antibodies) as well as cellular memory (anamnestic response to booster given in children without protective titers of anti-HBs) were determined. Titers of anti-HBs > or = 10 IU/l were considered protective. Anamnestic response was defined as increase in anti-HBs concentration from < 10 IU/l to > or = 10 IU/l 4 weeks after receiving a booster dose. MARKERS OF HBV INFECTION: hepatitis B surface antigen (HBsAg - marker of chronic hepatitis) and antibodies to core antigen (anti-HBc--marker of past HBV infection) were additionally determined., Results: Protective level of anti-HBs was found in 102/130 (78%) children, including 43/130 (33%) with high (100-999 IU/l) and 16/130 (12%) with very high (> or = 1000 IU/l) titers. 28/ 130 (22%) did not have protective level of anti-HBs, in 9/130 (7%) antibodies were undetectable. Immune memory was determined in 9 children--anamnestic response was revealed in eight of them (89%). In 6/130 (4.5%) of participants HBV infection was confirmed according to positive anti-HBc, including 2 (1.5% of the study group) with positive HBsAg., Conclusions: Most children in the studied group had seroprotection and immune memory against hepatitis B 10-12 years after vaccination. No routine booster seems to be necessary.

Aim: To estimate the management of HCV infected women and their children., Methods: Part I/: Blood samples were collected from 544 pregnant women and tested for anti-HCV. Part II/: Data of risk factors of HCV infection, reasons of HCV diagnostics were assessed in 281 mothers infected with HCV, not infected with HIV. 317 children born to HCV infected mothers were observed from birth until age 2.5-10 years (testing of HCV-RNA, ALT). 26 (8.%) of them were infected with HCV., Results: Part I/: 22.02% of tested pregnant women were anti-HCV(+). Part II/: Presence of risk factors for HCV infection in anamnesis was the reason of HCV diagnostics in 34% of women. None of HCV-RNA(-) women transmitted HCV to their child. The rate of HCV infection in infants born to HCV-RNA(+) mothers was 14.1% and was higher in case of natural delivery (19.2%) compared to cesarean section (7.5%). Intrapartum percutaneus exposure to maternal blood increased transmission rates. All children born via elective cesarean section (in 38 Hbd) were HCV-RNA(-). None of infected children had clinical symptoms of hepatitis, however, one of them had mild changes in liver histopathology., Conclusions: Antenatal screening of anti-HCV is not necessary, however, every woman with risk factors for HCV infection in anamnesis should be tested. Women infected with HCV ought to be treated before pregnancy in order to decrease HCV replication. The protective role of elective cesarean section requires further investigation. A number of children with chronic HCV infection should be considered for early treatment.

Unlabelled: The aim of the study was to establish the vaccination-induced anti-HBs seroconversion in a group of children with mother-to-child HCV infection., Material and Methods: 105 infants born to HCV infected mothers were vaccinated against hepatitis B virus (10 microg/ml; 0, 1, 6 months). HCV infection (HCV-RNA RT-PCR, Abbot Laboratories, in serum positive infants detected twice in the first year of life) was confirmed in 18 (group A). 87 infants were HCV uninfected (group B). Anti-HBs titers (Ortho-EIA) were measured 1-6 months after the third dose of immunisation., Results: Seroconversion to anti-HBs >10 mIU/ml was achieved in 93 (88.6%) infants: 13/18 (73%) in group A, 80/87 (92%) in group B. Anti-HBs <10 mIU/ml was observed in 12 (11.3%) children: 5 (27%) in group A, and 7 (8%) in group B (p=0.04)., Conclusion: Response to hepatitis B vaccine in infants infected with HCV was weaker than in nonvaccinated infants.

Unlabelled: Vertical transmission seems to be an important mode of infection in children. Approximately 6-9% of hepatitis C virus-positive women transmit HCV to their offsprings., Aim: 1. To determine the frequency of HCV infection in pregnant women in central Poland. 2. To estimate knowledge about HCV infection in childbearing women. 3. To identify risk factors for HCV infection among pregnant women., Methods: Study in two separate parts. Part A: Blood samples were collected from 544 pregnant women, tested with anti-HCV ELISA third generation tests. Part B: Data of risk factors of HCV infection, reason of diagnostics were assessed through structured interview and review of available medical records in 281 women infected with HCV., Results: Part A: 2.02% of tested pregnant women were anti-HCV(+). One of them (1/11) knew about her HCV infection before examination. Part B. 24% of 281 infected women indicate a history of blood products transfusion (all before 1992), 23%- hospitalisation with surgical procedures, 15%--intravenous drug use, 8%--hospitalisation without surgical procedures, 7%--exposures of health care personnel, 3%--infected mother, 3%--sexual partner or other member of family infected with HCV. Histories taken from 17% women did not include any known risk factors. HCV infection in women were diagnosed: before pregnancy in 186 (66%), during pregnancy in 61 (22%), after delivery in 34 (12%). All women were Caucasian, Polish nationality., Conclusion: The seroprevalence of anti-HCV in pregnant women was 2.02%. There is a number of childbearing HCV infected women who are not identified as HCV positive. Selective HCV testing to women at high risk of HCV infection and antiviral therapy should be encouraged prior to conception.

Unlabelled: The complement system plays an important role in immunological and inflammatory response. Complement deficiency may increase patient's susceptibility to invasive infections caused by encapsulated bacteria (Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae). One of the causes of reduced production of complement components may be hepatic function disturbances in patients with chronic viral hepatitis., Aim: of this study was to estimate the incidence of complement components deficiency and the risk of hypocomplementaemia as well as the associated risk of invasive bacterial infections in children with chronic viral hepatitis, type B and C., Material and Methods: the studied group consisted of 58 children (45 boys and 13 girls) aged 4 to 18 years (mean 14 +/- 3 years). 35/58 were chronically infected with HBV, 17/58 with HCV while 6/58 had HBV and HCV co-infection. In every child levels of C3 and C4 complement components in serum were determined. Deficiency of C3 component was diagnosed at the level of below 90 g/dl (laboratory normal values: 90-180 g/dl): deficit of C4 component was at the level below 10 g/dl (laboratory normal range 10-40 g/dl). In 43 patients (74%), nasopharyngeal swabs were taken for encapsulated bacteria carrier state. Statistical analysis was carried out using Statistica version 7.1 programme (p<0.05)., Results: hypocomplementaemia was observed in 14/58 (24%) of patients: decrease in C3 component was found in 12/58 (20.5%) of cases, decrease in C4 in 2/58 (3.5%). Among children with chronic hepatitis B 6/35 (17%) had C3 deficiency and 2/35 (6%) C4 deficiency. In 5/17 (30%) of HCV-infected children, decreased level of C3 complement component was found. In one child with HBV and HCV co-infection, a decrease in C3 level was observed. Nosopharyngeal swab was positive for Neisseria meningitidis in 2/43 (5%) of patients and for Streptococcus pneumoniae in 1/43 (2.5%)., Conclusions: 1. Hepatic function disturbances in course of chronic viral hepatitis type B and C in children may lead to deficiency of complement components and further to the risk of invasive bacterial infections. 2. To assess the incidence of hypocomplementaemia and its components in children with chronic viral hepatitis, studies on a larger group of patients are needed. 3. In children with chronic viral hepatitis it is indicated to determine complement components concentration. 4. Vaccination against encapsulated bacteria infections should be recommended for patients with chronic viral hepatitis, in particular in cases with lowered complement components concentration.

Object: to establish the rate and course of HCV infection in infants born to HCV infected mothers and to determine abilities of prevention., Methods: 155 children born to HCV infected mothers were observed from birth until age 18-48 months. Serum of infants was tested for HCV-RNA (RT-PCR, Amplicor v 2.0 Roche), for anti-HCV (EIA v. 2) and ALT activity. Infants were classified as HCV infected if their serum was found to be positive for HCV-RNA at least twice during first year of life. In 11 mothers and their newborns serum and PBMC from venous blood and from the umbilical cord were collected during delivery and examined-using nested RT-PCR., Results: The overall HCV vertical infection rate was 11%. Transmission occurred more frequently in children with intrapartum exposure to maternal blood by percutaneus inoculation. None of the infected infants had clinical symptoms of hepatitis. ALT abnormal activity was detected in 43% of infected children. HCV-RNA was detected in mothers' serum and PBMC collected during delivery in 9 (9/11) samples. HCV-RNA was detected in samples from umbilical cord in serum in 7 (7/11) and in PBMC in 4 (4/11) cases., Conclusions: The risk of HCV vertical infection in present study was high. Intrapartum percutaneus exposure to maternal blood increased transmission rates. Further investigation to determine the effectiveness of antiviral therapy in prevention of mother-to-infant HCV transmission should be performed. The role of PBMC in mother-to-child HCV transmission should be investigated.

Heroin is an illicit narcotic abused by millions of people worldwide. In the present work, we estimated peroxyl radical-trapping capacity (PRTC), oxidative stress markers - malondialdehyde and protein carbonyl groups, as well as antioxidant enzymes - superoxide dismutase and catalase, in different regions of brain. Studies conducted on nine brains from heroin abusers and eight from control subjects revealed a decrease in PRTC in each part of heroin intoxicated brains and an increase in lipid peroxidation in brain cortex, brain stem and white matter but not in hippocampus. Protein oxidation was increased in hippocampus and in brain stem, but it was unchanged in gray and white matters. Superoxide dismutase and catalase activities were unchanged in heroin addicts. We conclude that heroin intoxication changes the antioxidant status in human brain by increasing the amount of organic rather then inorganic peroxides. The most severe condition of oxidative stress occur in brain stem.