02 / 2023

Content:

• Editorial
• Clinical experience with influenza at the Clinic of Infectious Diseases in Ostrava in the period January 2022 – March 2023 – Lenka Petroušová, Andrea Gondová
• Administrative estimates of vaccination coverage in children, the Czech Republic – Jozef Dlhý, Zdeněk Kyselý, Renata Ciupek
• Real data on the occurrence of shingles in the Czech Republic in the years 2010–2022 – Jan Smetana, Michaela Špačková, Iva Vlčková, Roman Chlíbek
• Shingles vaccination in the era of recombinant adjuvanted vaccine availability – Roman Chlíbek, Jan Smetana, Michaela Špačková
• Tick-borne encephalitis – updates in epidemiology and vaccination – Martina Malíková, Roman Chlíbek, Jan Smetana, Lucie Siráková
• Tetanus and its prevention in the Czech Republic on the background of the case of an unvaccinated child – Renata Ciupek, Veronika Šponiar Ovesná, Jana Čevelová
• Consequences of tick-borne encephalitis – Libuše Smetanová, Jan Smetana
• New pneumococcal vaccination option for children (Vaxneuvance – 15-valent pneumococcal conjugate vaccine) – Vanda Boštíková

Editorial

Vážení čtenáři, kolegové a kolegyně,

věřím, že jste si užili zasloužené dovolené v prázdninovém čase, byť počasí se místy jevilo až trochu aprílově a řada rosniček nevěděla, jestli má na svém žebříčku lézt nahoru, nebo dolů. Ani epidemiologická situace není nyní zcela přehledná. Více než kdy jindy nás obtěžují streptokokové angíny a diskutujeme, do jaké míry nás na podzim bude trápit covid-19. Zatím se tváříme, že zmizel, ale takto jednoduché to asi nebude. Obrovský posun naopak zaznamenáváme na poli profylaxe RSV infekcí. V oblasti protilátkové ochrany přichází nirsevimab, který má oproti palizivumabu výrazně širší spektrum indikací. Teoreticky je možné ho podávat v preventivním módu plošně. K tomu však bude jistě požadována nákladová analýza. Konečně také máme vakcíny. První schválenou vakcínou je Arexvy společnosti GSK. Je založena na glykoproteinu F a potencovaná adjuvans AS01 E. Vakcína má minimálně 80% účinnost a je indikována pro osoby nad 60 let věku. Výrobce deklaruje účinnost jak proti RSV A, tak i RSV B. Vakcína již je praktickým lékařům k dispozici. Nevýhodou je zatím velmi vysoká cena (5 000 Kč) bez úhrady pojišťovnou. Na cestě je i konkurenční vakcína Abrysvo od společnosti Pfizer. Již získala tzv. „pozitive opinion“ od CHMP a na sklonku září by měla být EMA schválena. Na rozdíl od předchozí vakcíny je bivalentní proti RSV A a RSV B také na bázi glykoproteinu F, avšak bez adjuvans. Bude mít širší indikační spektrum: kromě seniorů 60 plus, také těhotné ženy. V tisku se také objevily poněkud zavádějící informace o indikaci pro kojence do šesti měsíců. Zde je však ochrana pouze nepřímá, pokud byla matka očkována v těhotenství.

Za redakční radu

prof. MUDr. Roman Prymula, CSc., Ph.D.

Clinical experience with influenza at the Clinic of Infectious Diseases in Ostrava in the period January 2022 – March 2023

Summary

Aim: Evaluation of the clinical course, and risk factors of patients with influenza hospitalized at the Clinic of Infectious Diseases in Ostrava during 2022, and the beginning of 2023.

Material and methods: In the period of the entire year 2022 through to March 2023, all the hospitalized patients with influenza virus were monitored and observed at the Clinic of Infectious Diseases in Ostrava. All the patients got the disease confirmed by polymerase chain reaction (PCR), by a nasopharyngeal swab and the type of influenza virus (A or B) was always determined. Concurrently, all patients had been tested with a PCR test to rule out covid-19 and respiratory syncytial virus infection. All patients were evaluated for comorbidities, clinical status, length of hospitalization, and vaccination status.

Results: During the monitored period of time the file of hospitalized people included a total of 72 patients. The average age in the ensemble was 48 years (9 months – 87 years). The most numerous group, with 15 patients, (21%) were children under 10 years of age, and 14 patients (19%) aged 71–80. Comorbidities had been presented in 50 patients (69%) and the majority had more than one associated disease. The most frequent disease was hypertension in 28 patients (39%), hyperlipidemia in 19 patients (26%) and asthma bronchiale in 17 patients (24%). The reason for hospitalization in most patients was dehydration, 70 patients (97%) were treated with infusional rehydration. Pneumonia had developed in 10 patients (14%), of which 6 patients required oxygen therapy. 3 patients with pneumonia had detected co-infection, 1 patient with RS virus and 2 patients with SARS-CoV-2. The average length of hospitalization was 6 days (1–17 days). In the entire cohort, 4 patients (6%) died. Influenza A virus was detected in 60 patients (83%), and influenza B virus in 11 patients (15%), one patient has both viruses. None of the patients in our ensemble had been vaccinated against seasonal influenza.

Conclusion: Given the severity of the disease in the youngest and oldest age groups, propagation of vaccination across the whole age spectrum is desirable especially for people with different associated diseases.

Keywords:

influenza 2022/2023, clinical status, risk factors, vaccination

Lenka Petroušová,^1,2 Andrea Gondová¹

¹Klinika infekčního lékařství, Fakultní nemocnice Ostrava
²Lékařská fakulta, Ostravská univerzita

Administrative estimates of vaccination coverage in children, the Czech Republic

Summary

In the Czech Republic, the control of vaccination status was carried out by an administrative method practically from the beginning of the existence of the hygiene-epidemiological service in the 1950s. The guarantor of the checks was the workplace of epidemiology of hygiene stations. The subject data was collected in cooperation with the registering pediatricians within the relevant region. A uniform way of carrying out inspections was ensured by the methodology of the Chief Public Health Officer of the Czech Republic, which defined selective criteria for carrying out inspections every year. These criteria have stabilized over the years in the initial letter of surname, year of birth of the controlled cohorts of children and the number of applied doses of selected vaccines that were included in the framework of compulsory vaccination of children. The summarization of data from the regions and the evaluation of the results at the national level were carried out by the staff of the Department of Epidemiology of the Ministry of Health.

The results of the presented analyzes show, among other things, that when changing the legislation in question, it is very important to take into account the fact that these changes may affect the continuity of the collection and results of the analysis of vaccination data. This fact should also be reflected in the precise setting of the transitional provisions of the amendment to Decree No. 537/2006 Coll. on vaccination against infectious diseases, in which the vaccination regimens for the individual affected cohorts of persons should be clearly defined.

The latest data on vaccination was collected on 31 December 2021, subsequently the administrative control of vaccination in the Czech Republic was canceled and in the next period its results should be replaced by data from health insurance companies.

Keywords:

infectious disease, mandatory vaccination in children, vaccination coverage estimates, Czech Republic

Jozef Dlhý,¹ Zdeněk Kyselý,¹ Renata Ciupek²

¹Oddělení epidemiologie a podpory zdraví, Ministerstvo zdravotnictví, Praha
²Krajská hygienická stanice Jihomoravského kraje se sídlem v Brně

Real data on the occurrence of shingles in the Czech Republic in the years 2010–2022

Summary

Introduction: Shingles is a viral infection with a typical skin manifestation that arises due to the endogenous reactivation of the varicella zoster virus. Due to the high prevalence of the virus, essentially the entire population is at risk of developing the disease. Basic risk factors are older age and immunocompromising conditions. Given the available vaccination prevention, it is important to know the epidemiological situation of shingles.

Aim: The aim of the presented work is to describe the incidence of shingles, specify risk groups and define trends in the development of the incidence of shingles.

Method: Reporting of shingles cases is carried out within the EpiDat (until 2017) and ISIN (from 2018) infectious disease reporting systems. Based on data obtained from these nationwide surveillance systems, a descriptive analysis of the incidence of shingles in the Czech Republic in the period 2010–2022 was performed. A detailed analysis was carried out for the period 2018–2022.

Results: The incidence of shingles in the Czech Republic was stable in the years 2010–2019 without a significant trend of increase or decrease. During the covid-19 pandemic period in 2020–2022, a statistically significant decrease in the number of reported cases was recorded. In the monitored period, the highest incidence was reported in the highest age groups of persons. In the years 2018–2022, the increase in incidence was noticeable from the age group 45–54 years, while this trend further increased significantly in older age groups. Overall, 61% of shingles cases occurred in people over the age of 55. The analyzed data show an increasing risk of developing complications and the need for hospitalization with age, which is highest in the oldest persons, with the risk starting to increase especially from the age of 65. The most frequently reported complication was ocular involvement. The data also confirm the influence of female gender as a risk factor for the development of shingles.

Conclusion: Most of the population is at risk of developing shingles. The epidemiological situation and the main risk factors for the development of the disease are known, and the possibility of specific prevention by vaccination is also available.

Keywords:

shingles, epidemiology, risk factors

Jan Smetana,¹ Michaela Špačková,² Iva Vlčková,² Roman Chlíbek¹

¹Katedra epidemiologie, Fakulta vojenského zdravotnictví Univerzity obrany, Hradec Králové
²Oddělení epidemiologie infekčních nemocí, Centrum epidemiologie a mikrobiologie, Státní zdravotní ústav, Praha

Shingles vaccination in the era of recombinant adjuvanted vaccine availability

Summary

Shingles, herpes zoster (HZ), is a disease caused by reactivation of the varicella-zoster virus and is a threat to anyone with a history of chickenpox. In Europe, more than 90% of people will get chickenpox, in the Czech Republic (CZ) according to data from the serological survey from 1996/7, even 90–98% of people over 40 years old. The reactivation of the virus occurs due to a decrease in specific cellular immunity, therefore people over 50 years of age and immunocompromised, regardless of age, are at the highest risk of occurrence HZ. As the population ages and the number of immunosuppressed patients increases, e.g. after transplantation or due to polymorbidity, the number of people at risk of developing HZ increases. Therefore, the importance of introducing vaccination against HZ and its most common complication, postherpetic neuralgia, into national immunization programmes is increasing. A major breakthrough in vaccination was the approval of a new recombinant adjuvanted subunit vaccine, which is recently available also in CZ. Unlike the previous live attenuated vaccine, the recombinant vaccine has higher efficacy (investigated in ideal clinical studies) and also effectiveness (investigated under practical conditions in real population) due to its receptor adjuvant, which does not decrease with age and persists for more than 10 years. The effectiveness of the live HZ vaccine declines from 68% after seven years to 32% and is uncertain after five years from vaccination. This vaccine is no longer available on the Czech market. The effectiveness of the recombinant vaccine is 85% after 10 years. The recombinant vaccine can be used in immunosuppressed individuals for whom the live vaccine is contraindicated. National recommendations are gradually emerging in a number of countries, varying in the recommended age for mass vaccination, from those aged over 50 years, through 60 to over 65 years. Already in at least eight European countries, vaccination against HZ is part of immunisation programmes and fully reimbursed. Due to its high efficacy and effectiveness including good safety profile, vaccination with recombinant vaccine should be recommended and reimbursed in CZ as soon as possible as well.

Keywords:

shingles, vaccination, recombinant vaccine, varicella-zoster virus, elderly

Roman Chlíbek,¹ Jan Smetana,¹ Michaela Špačková²

¹Katedra epidemiologie, Fakulta vojenského zdravotnictví, Univerzita obrany, Hradec Králové
²Oddělení epidemiologie infekčních nemocí, CEM, Státní zdravotní ústav, Praha

Tick-borne encephalitis – updates in epidemiology and vaccination

Summary

In recent years, the number of tick-borne encephalitis cases has increased in Europe and Asia. In the year 2020, more than 3,000 cases of tick-borne encephalitis were reported in the European Union, 50% more than in the year 2015. New outbreaks with infected ticks are occurring in European countries with endemic areas of the disease, such as Scandinavia. Cases of tick-borne encephalitis have also been newly reported from previously non-endemic countries such as the Netherlands and the United Kingdom. There is also an increase in tick-borne encephalitis in the Czech Republic, which has long had the highest number of cases in Europe, with 849 confirmed cases in 2020. An effective prevention against this disease is the tick-borne encephalitis vaccination. Low vaccination coverage in most European countries is one of the reasons for the increase in tick-borne encephalitis cases. The lowest vaccination coverage against tick-borne encephalitis is in Slovakia, at only 21%. Austria has the highest long-term vaccination coverage in Europe at 81%. In the Czech Republic, vaccination coverage is low, but has doubled since 2008 and is now around 38%. From January 2022, the Czech Republic will introduce paid tick-borne encephalitis vaccination for people over 50 years of age, which could have a positive impact on vaccination coverage and the number of reported cases.

Keywords:

tick-borne encephalitis, tick-borne encephalitis virus, surveillance, vaccination, vaccination rate

Martina Malíková, Roman Chlíbek, Jan Smetana, Lucie Siráková

Katedra epidemiologie, Fakulta vojenského zdravotnictví, Univerzita obrany, Hradec Králové

Tetanus and its prevention in the Czech Republic on the background of the case of an unvaccinated child

Summary

Tetanus is always a serious acute disease, as a result of which approximately half of infected people die even with today’s therapeutic options. With the development of vaccination as the most effective preventive measure, there was a significant reduction or elimination of the occurrence of a number of many infectious diseases, including tetanus. However, the real risk of tetanus disease is permanent, due to the presence of bacterial spores in the environment, especially in the soil. Individual diseases from recent years have affected persons who were injured and did not maintain according to lege artis tetanus prophylaxis. In 2019, for the first time in many decades in the Czech Republic, a tetanus disease occurred in a child following a nasal tissue injury caused by button battery. The child was not vaccinated due to his parents’ refusal to vaccinate.

Keywords:

tetanus, vaccination, unvaccinated child, button battery

Renata Ciupek,¹ Veronika Šponiar Ovesná,^1,2 Jana Čevelová¹

¹Krajská hygienická stanice Jihomoravského kraje se sídlem v Brně
²Katedra epidemiologie, Fakulta vojenského zdravotnictví, Univerzita obrany, Hradec Králové

Consequences of tick-borne encephalitis

Summary

Tick-borne encephalitis is a significant neuroinfection endemic in the Central European region. The Czech Republic is among the most affected countries in the world with a long-term increase in the incidence. Even though a large part of cases of the disease are asymptomatic, there is a risk of developing neurological forms of the disease associated with the possibility of consequences that can persist for a long time and significantly disrupt the quality of life of those affected. The risk of a more serious course, the development of complications and the development of long-term consequences increases with age. However, long-term consequences of the disease cannot be ruled out even in younger age groups. Given these risks, emphasis should be placed on vaccination, which is an effective method of prevention. In the case of the development of neurological problems and the consequences of the disease, long-term intensive rehabilitation plays an important role.

Keywords:

tick-borne encephalitis, consequences, rehabilitation

Libuše Smetanová,¹ Jan Smetana²

¹Rehabilitační klinika, LF UK a FN Hradec Králové
²Katedra epidemiologie, Fakulta vojenského zdravotnictví Univerzity obrany, Hradec Králové

New pneumococcal vaccination option for children (Vaxneuvance – 15-valent pneumococcal conjugate vaccine)

Summary

Bacterial pneumococcal infections in the form of respiratory mucosal infections as well as very serious invasive pneumococcal diseases (IPD) contribute significantly to the overal morbidity and mortality of the Czech and global population. The most frequent affected groups at risk are the elderly and children under five years of age. In the Czech Republic, since 2008, IPDs have been subject to mandatory surveillance, which allows monitoring of the current situation and the impact of preventive measures – in this case vaccination. Keywords: pneumococcus, vaccination, vaccines, Vaxneuvance, pediatric population, seasonal pattern, invasive pneumococcal diseases

Vanda Boštíková

Katedra epidemiologie, Fakulta vojenského zdravotnictví, Univerzita obrany, Hradec Králové