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OBJECTIVE: To evaluate vertical HIV transmission rate in Poland. METHODS: 132 children born to HIV positive mothers were evaluated and their HIV infection status was established. MAIN OBSERVATIONS AND RESULTS: There are 60 HIV-infected children in Poland. 92% of them have been infected perinataly. From 1989 to 1994 the rate of vertical transmission was 25%. Since September 1994, when prophylactic strategies were started, the rate has decreased to 21.4% (in children with prophylaxis to 1.8%). CONCLUSIONS: Vertical HIV infection prophylactic programs rely on women's knowledge about their HIV infection status and are the only way to diminish pediatric HIV infection worldwide. The authors show difficulty of providing proper medical care of HIV positive women in Poland and underly the need of voluntary HIV testing for all women before pregnancy.

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OBJECTIVE: The aim of the study was to evaluate the effects of measles vaccination in HIV infected children. METHODS: 13 measles seronegative HIV-infected children received polyvalent measles-mumps-rubella vaccine. MAIN OBSERVATIONS AND RESULTS: Measles seroconversion occurred in 10/13 patients (in revaccinated children in 7/10), rubella seroconversion in 7 out of 9 patients. None of the 12 children responded mumps component. CONCLUSIONS: Measles vaccination seems to be safe and effective in HIV-infected children without severe immunodeficiency.

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The aim of our study was to evaluate changes in vertical transmission of HIV infection in Poland after introducing zidovudine prophylactic strategies. Data from the Department of Children's Infectious Diseases (a paediatric HIV referral centre) at the Medical University, Warsaw was studied. Since 1989 vertical transmission of HIV-1 has been studied in 100 children born to 91 HIV-positive mothers (2 sets of twins). Zidovudine therapy, mode and timing of delivery and their relationship to perinatal HIV-1 infection were analysed. From 1989 to 1994 the transmission rate was 31.5%. Since 1995, when recommendations based on ACTG 076 were issued, a decline in a transmission rate to 19.6% was reported. 62% (32 out of 52) mother-infant pairs received zidovudine therapy. None of those children have become HIV infected. Zidovudine chemoprophylaxis regimen reduces the risk for mother to child transmission. It should be recommended for all HIV-infected pregnant women or women in labour and their infants.

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New diagnostic, prophylactic and treatment perspectives in HIV infection of the fetus and newborn is a challenge for health services in Poland. In view of these advances, the ascertainment of HIV status of all pregnant women is important both for individuals and for the health services. By law, laboratory HIV testing in Poland can be performed only on a voluntary basis. All newly diagnosed cases of AIDS and HIV infections are anonymously reported to the National Institute of Hygiene in Warsaw. There are no clear data about vertical transmission of HIV infection in Poland mostly because of the unknown number of women who are positive at delivery. Almost all our data were collected from Polish Regional AIDS/HIV Diagnostic and Therapeutic Centres. During the period 1986-95, 88 children were delivered by HIV-positive women and vertical transmission occurred in 15 cases.

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Duration of varicella incubation period has been analysed in 21 pediatric patients with neoplastic diseases and in 59 children without immunological deficiency. In has been found, that incubation period has been significantly longer in children with neoplastic diseases (mean 19.58 days), than that in children without immunologic disorders (15.45 days). The difference was statistically significant (p < 0.001).

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Hundred eleven children with the congenital toxoplasmosis were treated at the Department of Infectious and Parasitic Diseases in Childhood in 1979-1988. Multi-symptomatic toxoplasmosis has been diagnosed in 35 cases, ocular form in 65, oligosymptomatic in 6, and asymptomatic in 5 cases. Clinical symptoms suggesting congenital toxoplasmosis was seen in the majority of children (63 cases) in the first year of life and the disease was diagnosed in 50% of cases (33 children) at this age. Congenital toxoplasmosis in the group of 78 children has been diagnosed later. The majority of cases was ocular form. Diagnosis of the oligo- and asymptomatic congenital toxoplasmosis is possible in the first year of life, only. A titre of antibodies is exclusively an indicator of the immunologic response, not a severity of infection and does not contribute to the prognosis. Antitoxoplasma drugs were administered to 102 children including 33 under the first year of life. Pyrimethamine, sulphonamides, and spiramycin were used in the treatment. Dosage, duration of therapy, and way of administration have been established individually in dependence of patients age and clinical form of the congenital toxoplasmosis. Two out of 35 children with multi-symptomatic congenital toxoplasmosis died whereas 13 demonstrate psychomotor retardation of significant degree despite the fact that 11 of them were treated in the first year of life.

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Hundred eleven children with congenital toxoplasmosis were followed up in the Department of Infectious and Parasitic Diseases in Childhood, Medical Academy in Warsaw, within 1979-1988. Ocular changes found in 91 children including chorioretinitis in 86 microphthalmia in 7, ophthalmic nerve atrophy in 15, vitreous body inflammation in 5, and cataract in 4. Only in 16 children the diagnosis was performed in the first year of life. In 15 children the recurrence of inflammatory process, most frequently in the time of puberty, was noted; twice in 5 of them. It was independent on the treatment which was previously administrated. Serological tests in ocular form of congenital toxoplasmosis do not indicate the dynamic changes in the inflammatory process. It is very important that small children are examined early and the treatment is started in the first year of life.

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Acyclovir was used for the treatment of Varicella-zoster virus infections in 53 children (10 neonates and 43 children aged between 2 an 15 years) with immunological system deficiency hospitalized at the Department of the Infectious Diseases of Childhood in the Medical Academy in Warszawa. The obtained results of therapy were favourable except one fatal case of the child with visceral dissemination of the virus prior to acyclovir treatment. Compared with other antiviral agents used by the authors previously, acyclovir proved to be the most effective.

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