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L Trnka

Publications and source records attributed to L Trnka.

At least 37 records · Page 2Linked to original sources
PubMed1993

Six years' experience with the discontinuation of BCG vaccination. 1. Risk of tuberculosis infection and disease.

BCG vaccination programmes were introduced into Czechoslovakia 40 years ago under a quite different epidemiological situation than that of today. Compulsory mass BCG vaccination of infants born in a selected area was discounted in 1986, except for those having a high risk of contracting tuberculosis or those whose parents expressly asked for it. The aim of this study was to ascertain the risk of tuberculosis infection and breakdown rate from infection to disease in 165,854 newborns following a period of 6 years. The average risk of infection in children aged 0-6 years was low (0.046%). No identifiable factors increasing the risk of infection were found. Primary tuberculosis was diagnosed in 31 children (7/100,000 persons/year); this corresponds to a 15.5% breakdown rate from infection to disease. The majority of patients were symptom-free with minimal disease and detected in the course of regular check-ups. These findings indicate that the change from mass BCG vaccination to selective vaccination of high risk newborns can be recommended. Nevertheless social and economic aspects which involve migration, living conditions and the attitudes of the population, as well as of medical staff, to vaccination should also be taken into consideration.

Age Factors↗
PubMed1993

Six years' experience with the discontinuation of BCG vaccination. 2. Cost and benefit of mass BCG vaccination.

In 1986 the compulsory mass BCG vaccination of infants born in a selected area of the Czech Republic was abolished. The observed annual risk of tuberculous infection in children aged 0-6 years was below 0.1% and the annual risk of tuberculous disease 7/100,000. The increase of tuberculous cases among nonvaccinated children indicated a protective efficacy of BCG vaccine of 80%. A benefit analysis proved that the advantages and disadvantages of BCG vaccination were in balance. The number of nonvaccinated children developing tuberculosis was so small that mass application of BCG has been found to be redundant. The important advantage of not using the vaccination is the maintenance of the epidemiological and diagnostic value of tuberculin tests. The tests in connection with preventive chemotherapy remain an important tool, enabling control of infected individuals.

BCG Vaccine↗
PubMed1993

The phenotype of alveolar macrophages and its correlation with immune cells in bronchoalveolar lavage.

The phenotype of alveolar macrophages (AMs) is known to be modulated during pathological immune reactions in the lung. In this study, we wanted to determine the relationship between the AM phenotype and changes in the proportions of the various immune cells in bronchoalveolar lavage (BAL). BAL was performed in 76 consecutive patients, including 32 with sarcoidosis, 8 with idiopathic pulmonary fibrosis, 9 with pneumoconiosis, 13 with other respiratory disorders, and 14 controls without evidence of interstitial lung disease. The phenotype of AMs was studied by a panel of 15 monoclonal antibodies against various myeloid antigens, and was correlated with the proportions of cells obtained by BAL. The percentage of BAL lymphocytes showed a relationship with the expression of macrophage antigens in 11 out of 15 antigens studied (all except adhesive molecules CD11a, CD11c, CD18 and the antigen 25F9 present on mature macrophages). Furthermore, the CD4/CD8 ratio of BAL T-lymphocytes correlated with the AM expression of CD54 (intercellular adhesion molecule-1 (ICAM-1)), RFD1 (marker of dendritic cells), and CD71 (transferrin receptor). In samples with an increased number of bronchoalveolar neutrophils, the subpopulation of 27E10 positive AMs (inflammatory acute phase macrophages) was increased. Eosinophils in BAL were not associated with a significant increase in AM membrane antigen expression. Prominent changes of the AM phenotype were found in active sarcoidosis showing lymphocytic alveolitis, with more frequent expression of CD54, KiM2, CD71, CD11b and RFD9. In conclusion, this study shows that the phenotype of AMs is related to the type and intensity of the immunopathological reaction in the lung, and correlates with the proportions of bronchoalveolar cells.

Antigen Presentation↗
PubMed1993

[Tuberculosis prevention needs adaptation to conditions of Central European countries].

Recommendations to stop mandatory BCG vaccination were issued for countries with a favourable epidemiological situation by tuberculosis. In three regions of Czechia nonvaccinated children made up 160,000. By tuberculin test, annual risk to develop tuberculous infection in children aged 0-6 years amounted to 0.05% (31 children). The transition of the infection into the disease for 6-year follow-up reached 15-20%. The analysis of the cost-effect values for BCG vaccination of the newborns from 1986 revealed that the disease was prevented in 1 out of 6 potential cases per 100,000 vaccinated children, there were also adverse effects of the vaccination. The cost of the vaccination would be much higher than the cost of prevented deaths of tuberculosis. Thus, it is thought valid to do vaccination to children at more advanced age.

BCG Vaccine↗
PubMed1992

[Tuberculosis surveillance in the Czech Republic in 1990].

The authors evaluated data on the extent of the problem of tuberculosis and the effectiveness of control measures in the surveillance of TB in the Czech Republic (CR) in 1990. The data are assembled and monitored by the same method for a period of 10 years. The incidence of respiratory TB confirmed bacteriologically was 11.3/100,000 population, incl. 5.7/100,000 already direct smear positive cases. Since 1988 the incidence did not change, in 1990 it increased slightly. The mortality from TB remained low. A total of 0.8/100,000 patients died, mostly old people not treated for TB before death. The so-called risk factors which may have participated in the development of TB were analyzed. Two thirds of the patients were men. For advanced TB was more frequent in young and middle-aged men, while in old men less advanced TB, positive only on cultivation, predominated. In women the majority of patients was older than 65 years. As to risk factors in young patients lack of cooperation was proved, e. g. alcohol abuse in two thirds amount of other serious diseases. Treatment of TB patients was successful in 96%. Causes of therapeutic failures were lack of cooperation and complications of antituberculotic treatment. In-patient treatment lasted on average three months, treatment with antituberculotics a total of 9 months. In 1990 TB in the CR was supervised, the epidemiological situation was favourable and comparable with advanced European countries. TB remains, however, a serious health problem in the CR. It is important to define, screen and ensure intensive supervision of subjects with various so-called risk factors.

Adolescent↗
PubMed1991

Tuberculosis surveillance in the Czech Republic in 1989.

The authors report on tuberculosis situation in the Czech Republic (CR) in 1989 and compare the data with 1988. The incidence of all cases of respiratory TB was 15.5 and that of bacteriologically confirmed cases 11.1/100,000. The mortality from TB was also low (1/100,000). Two-thirds of the patients were detected because of the patients' complaints. This passive case - finding was, however, inadequate in subjects with a poor health consciousness. Active screening was restricted to subjects with a high risk of TB (in contact with tuberculosis, with different diseases, with socio-economic factors, migrating subjects, non-cooperating subjects). In 1989 for the first time in the CR stagnation of the incidence of bacteriologically confirmed TB of the respiratory organs was recorded. The number of patients (5.7/100,000) with TB with a microscopically positive bacteriological finding in sputum was also the same. A slowing down of the hitherto recorded favourable trend of TB must be foreseen. It will be important to maintain the contemporary system of TB surveillance.

Czechoslovakia↗
PubMed1990

[Surveillance of tuberculosis in the Czech Republic in 1989].

The authors report on the tuberculosis situation in the Czech Republic (CR) in 1989 and compare the data with 1988. The incidence of all cases of TB was 18.4/100,000, the incidence of all cases of respiratory TB 15.5 and that of bacteriologically confirmed cases 11.1/100,000. The mortality from TB was also low (1/100,000). Two-thirds of the patients were detected because of the patients' complaints. This passive screening was, however, inadequate in subjects with a poor health consciousness. Active screening was restricted to subjects with a high risk of TB (in contact with tuberculosis, with different diseases, with socio-economic factors, migrating subjects, non-cooperating subjects). In 1989 for the first time in the CR stagnation of the incidence of bacteriologically confirmed TB of the respiratory organs was recorded. The number of patients (5.7/100,000) with TB with a microscopically positive bacteriological finding in sputum was also the same. A slowing down of the hitherto recorded favourable trend of TB must be foreseen. It will be important to maintain the contemporary system of TB surveillance.

Czechoslovakia↗
PubMed1990

[The epidemiologic situation regarding tuberculosis and the effectiveness of tuberculosis surveillance in Bohemia in 1988].

In the CSR (10 million inhabitants) in 1988 the system of TB surveillance was completed which comprises the national TB programme, the central TB register and the evaluation TB unit. The incidence of respiratory TB in 1988 in the CSR was 15.5/100,000 population. In 71% of the patients the disease was confirmed by bacteriological examination (11.0/100,000 population). The incidence of extrapulmonary TB was 4.2/100,000 population. As compared with previous years, the number of patients declined except patients with already microscopically confirmed acid resistant rods in the sputum; their incidence, 5.5/100,000, remained the same in the CSR since 1986. In this incidence participated in particular middle-aged men. The prevalence of active TB of the respiratory system was 20.0/100,000 population. It was only 1.3 times higher than the incidence, because treatment of TB patients was successful and principles of dispensarization were respected. The number of deaths from TB was 98 (0.9/100,000). In 84 the diagnosis was established only during autopsy. The lethality was high in old people. The course of treatment was evaluated after one year in 1330 patients with respiratory TB diagnosed in 1987. Satisfactory therapeutic results were achieved in 98% of the patients. In the remaining (17) patients bacteriological negativization of the sputum did not occur due to complications of treatment or lack of patient cooperation. 70% of the patients had a therapeutic regime with rifampicin. In-patient treatment was emphasized; the total mean period of administration of antituberculotics was 9.3 months.

Aged↗
PubMed1989

[Tuberculosis control in Czechoslovakia in 1987].

The authors evaluated control measures and their impact on the epidemiological situation of tuberculosis in the CSR in 1987. All data on patients are reported and supplemented in the central register of patients; they are processed continuously. Two thirds of patients with TB of the respiratory system confirmed by bacteriological examination were detected during examination made because of complaints. In 13.3% of the patients it took more than three months before the diagnosis was established. A key position, as regards early detection of unknown TB patients, is held by doctors of the primary health care. The majority of patients with respiratory TB was middle-aged or in higher age groups. 17.2% of all patients suffered from diabetes, 6.6% from peptic ulcers. About one fifth of the patients were described as non-cooperating or alcoholics. Treatment adhered to principles of rational chemotherapy, using short-term therapeutic regimes. Satisfactory results were obtained in 98% of the patients. In 1987 a total of 2196 new cases of TB and relapses of TB of all localizations were reported, i.e. by 16% less than in 1986. Tuberculosis of the respiratory organs was recorded in 81% (1768) of the patients, extrapulmonary TB in 19% (428). The incidence of respiratory TB was 17/100,000 and the incidence of bacteriologically confirmed cases 11.8/100,000. Bacteriologically confirmed cases accounted for 69% of the incidence and cases with microscopically confirmed acid resistant rods in sputum for 48%.

Adult↗
PubMed1989

[Microepidemics of tuberculosis].

Persons with unknown tuberculosis exist even in countries with favourable situation of tuberculosis and contribute to the transmission of tuberculosis. The features and characteristics of 12 tuberculosis microepidemics observed in Czech Socialist Republic (10 mil. inhabitants) in 1983 to 1987 are described. The intensity of transmission of tuberculous infection is determined by the amount of tubercle bacilli excreted and by the duration of exposition. In 10 source cases bacilli were detected by direct smear examination. Eight microepidemics occurred in families, 4 at school. Prolonged close contact, as well as occasional exposure to the infection were demonstrated. There were infected 109 children and adults. Tuberculosis developed in 27 children and adults. The examination and follow-up of persons in contact with tuberculosis patients belong to the important control procedures.

Czechoslovakia↗
PubMed1989

[BCG vaccination in low risk tuberculosis; first experiences after the suspension of BCG vaccination of newborns in Czechoslovakia].

With the steadily declining risk of tuberculosis infection in CSR the question arose whether vaccination of infants remains worthwhile considering not only resources spent but also complications to vaccination vis-a-vis benefits derived. A prospective study has been designed in which BCG vaccination of newborns is discontinued in an area with 30,000 newborns yearly. In the period from April 1, 1986 to January 31, 1988 there were not vaccinated 43,428 children (84.8% of the newborns). The collaboration of mothers was good. The one year old non-vaccinated children were tested with 2 TU PPD RT 23 with Tween 80. The distribution of positive tuberculin reactions appears unimodal, relatively large reactions being absent. 8 children had reactions with 6 or more mm induration. That corresponds to a risk of infection of 0.04%. The project continues in the research area and might be extended to another area.

BCG Vaccine↗