Content:
Editorial
Varicella in the Czech Republic – characteristics of reported cases from 1997 to 2023 and vaccination options
Complications of varicella, clinical experiences
Analysis of other viral infections characterized by involvement of the skin and mucous membranes (diagnosis code B08) in the Czech Republic, 2018–2022
Varicella vaccination – history and present
Human papilomavirus elimination by vaccination
Varicella complications, case reports
Herpes zoster ophthalmicus complicated by the development of encephalitis
Not only the development of vaccines but also the fight against misinformation is gaining importance, especially in case of highly dangerous viral diseases (Nipah virus)
Doporučení České vakcinologické společnosti ČLS JEP pro očkování proti planým neštovicím (varicele)
Editorial
Vážení čtenáři, kolegové a kolegyně,
po dlouhé době jakéhosi náhodného modelu zavádění nových vakcín do českého očkovacího kalendáře se začíná blýskat na lepší časy a s novou legislativou bychom se mohli dožít systematického využívání HTA (Health Technology Assessment) pro tyto účely. Metoda to není jistě nová, avšak EU v poslední době horuje za zavedení transparentních systémů, kdy jak léky, tak vakcíny budou zaváděny za jasně definovaných parametrů. Systém by zatím měl být využíván pro nově zaváděné vakcíny, ale v blízké době by mohl být aplikován retrospektivně i na vakcíny stávající.
A právě tato skutečnost vzbuzuje jisté obavy, že by mohl být systém využit naopak i pro zredukování již zavedených vakcín. To se snad nestane nebo stane v naprosto výjimečných případech. Kapacita SÚKL pro provádění HTA je logicky limitována, a proto musí být využívána prioritně v případech, které budou kritické a vrcholně důležité. O případné provedení HTA může požádat například stát (MZČR či SZÚ), pojišťovny nebo MAH (držitel povolení, farmaceutické společnosti), a systém tak mohou poměrně zahltit. Proto je důležité vytvořit koncepci očkování v ČR s výhledem na několik let, aby bylo zřejmé, které vakcíny a v jakém pořadí by měly být zaváděny jak u dětské, tak i dospělé populace.
Po několika jednáních s jednotlivými zainteresovanými stranami se zdá, že ČVS ČLS JEP bude připravovat minimálně výchozí materiál, který bude následně připomínkován do konečné podoby. Je zřejmé, že každý z nás může mít mírně odlišné priority například v tom, jestli zavést dříve například vakcínu proti varicele či rotavirům. Myslím si však, že jsme schopni tento dokument připravit a opustit proces náhodného lobbingu v parlamentu, který nesystémově přinášel různá překvapení. Zdaleka ještě není vyhráno, protože legislativní proces může přinést řadu nepředvídatelných změn, ale přinejmenším jsme na správné cestě.
Za redakční radu prof. MUDr. Roman Prymula, CSc., Ph.D.
Varicella in the Czech Republic – characteristics of reported cases from 1997 to 2023 and vaccination options
Summary:
Introduction: Chicken pox (varicella) is a highly contagious, specifically human viral infectious disease. They occur all over the world, especially in children between 3 and 10 years of age. The course of the disease is usually mild, but in some cases, serious complications may occur. Due to the high incidence of chicken pox in the Czech Republic, it is important to evaluate the available data and emphasize available prevention (vaccination). The aim of the presented work is to describe the epidemiological situation of varicella, to specify risk groups, to define development trends in the Czech Republic and to indicate vaccination options.
Methods: Reporting of varicella cases is carried out within the EpiDat (until 2017) and ISIN (from 2018) infectious disease reporting systems. Based on data obtained from these national surveillance systems, a descriptive analysis of the incidence of varicella disease in the Czech Republic was performed for the period 1997–2023. A detailed analysis was done for the period 2018–2023.
Results: In the Czech Republic, a cumulative 1,091,520 cases of varicella disease were reported within the period 1997–2023 (from 10,393 to 57,054 cases annually), with a statistically significant decrease (p = 0.02) recorded in the years 2020–2021 (average 14,170) compared to the period 2016–2019 (average 39,849). The annual incidence ranged from 99.0 to 530.3/100,000 inhabitants in individual years (median 384.5), in comparison of the two periods 1997–2017 and 2018–2023, it was lower in the second observed period. According to gender, a slightly lower incidence is observed in women in all monitored years, the difference in average numbers assessed by gender is not statistically significant (p = 0.38). Chickenpox has a seasonal character in the Czech Republic, with the maximum occurrence of cases from December to June, and is typical for childhood with a maximum between 3 and 6 years of age. In the years 2018–2023, 202,476 cases were reported, the specific average annual incidence per 100,000 inhabitants was the highest in the regions of Vysočina (508.4), Královéhradecký (489.3), Liberec (485.8) and Pardubice (468.0), the lowest in the capital Prague (137.8), Central Bohemia (288.5), South Moravia (325.0) and Pilsen region (395.3). Altogether 1,359 cases (0.7%) were hospitalized, of which 735 were men, and 650 people (0.3%) were registered with complications.
Discussion and conclusions: In the Czech Republic, the incidence of varicella is relatively high in children under 10 years of age. Serious complications can occur in some cases, therefore specific prevention by vaccination is important and achieving high vaccination coverage is essential.
Keywords: chickenpox, varicella, infectious diseases, vaccination
Michaela Špačková,1 Monika Liptáková,1 Jana Košťálová,1 Roman Chlíbek2
1Oddělení epidemiologie infekčních nemocí, Centrum epidemiologie a mikrobiologie, Státní zdravotní ústav, Praha
2Katedra epidemiologie, Vojenská lékařská fakulta, Univerzita obrany, Hradec Králové
Complications of varicella, clinical experiences
Summary:
Varicella is a common infectious disease that, when complications occur, leads to the necessity of hospitalization of patients.
Objective: Evaluation of the clinical course, risk factors and complications of patients with varicella hospitalized at the Department of Infectious Diseases at the University Hospital in Ostrava during 2022 and 2023.
Material and methods: The patients hospitalized with varicella at the Department of Infectious Diseases at the University Hospital in Ostrava were monitored during 2022–2023. The disease was confirmed by typical sign of chickenpox based on clinical examination of all patients. All patients were evaluated for the presence of comorbidities, clinical status, length of hospitalization, stay in the intensive care unit, and vaccination status.
Results: There were 77 patients with chickenpox hospitalized during the two years. The ratio of men and women was balanced. The average age of the patients was 9.3 years (3 months – 45 years), the average length of hospitalization was 5 days (1–45 days). Complications were the reason for hospitalization in 56 patients (76 %). The most common complications were inflammatory complications, which were present in 41 patients (54 %), of which 37 patients had impetigo, phlegmon, or scarlatina, 10 of them sepsis. Deep abscesses developed in another 3 patients, and purulent artritis in 1 patient. In 5 patients (6 %), the reason for hospitalization was pneumonia. Neurological complications occurred in 7 patients (9 %) in our group. Deep femoropopliteal thrombosis developed in 1 patient, thrombocytopenia with platelet values of 25 × 109/liter and petechiae in another. Visceral varicella was noted in 1 immunosuppressed patient. No patient died. 44 patients (58 %) were treated with antibiotics, 73 patients (95%) with acyclovir. A total of 11 patients (13 %) were hospitalized in the ICU. The most common comorbidity of hospitalized patients was atopic dermatitis in 9 patients (12%) and immunosuppression in 3 patients (4 %). None of the hospitalized patients were vaccinated.
Conclusion: Varicella is not a benign disease, the complications are serious and even life-threatening. Vaccination makes it possible to prevent both the disease and the development of complications.
Keywords:
varicella, complications, risk factors, vaccination
Lenka Petroušová,1,2 Daniela Bartková1,3
1Klinika infekčního lékařství, Fakultní nemocnice Ostrava
2Lékařská fakulta, Ostravská univerzita
3Lékařská fakulta, Masarykova univerzita, Brno
Analysis of other viral infections characterized by involvement of the skin and mucous membranes (diagnosis code B08) in the Czech Republic, 2018–2022
Summary:
Introduction: Diseases classified under diagnosis code B08 are a heterogeneous group of diseases manifested mostly by exanthema. The aim of our work was to analyse the data of these infections reported in the national surveillance system in the Czech Republic (CZ) in the years 2018–2022, to specify risk groups and to define trends in the development of these diseases.
Methods: Reporting of the occurrence of diseases classified under code B08 within ICD10 is mandatory in the CZ. From 2018, data is newly stored in ISIN, the electronic system for reporting infectious diseases. A descriptive analysis of the basic epidemiological characteristics of these diagnoses was performed. Excel and Datawrapper programs were used.
Results: A total of 13,094 cases of group B08 infections were reported in the CZ between 2018 and 2022. Hand, foot, mouth syndrome (5,378), followed by sixth (3,986) and fifth disease (3,500) were the most frequently reported. A decrease in the number of reported cases was observed in 2020 and 2021 for almost all monitored diagnoses, except for sixth disease. Seasonality is not significant for these diseases, only for hand, foot and mouth diseases we observe a higher frequency of cases in summer and autumn. For all diseases, a slightly higher incidence was recorded in men. According to regions, the occurrence is non-specific.
Discussion and conclusion: Within this group of diagnoses, these are primarily children’s diseases, often with a mild course and spontaneous recovery, so we assume high underreporting. Restrictive measures during pandemics mainly caused a general decrease in these infections, except for the sixth disease, when the smallest children are most often infected by transmission from family members, in whom the virus persists in 88–100% of the salivary glands. The hand, foot, mouth syndrome caused by Enterovirus A71, which makes up the largest proportion of infections of this group and can cause serious neuroinfections including acute weak paresis, deserves attention.
Keywords:
epidemiology, public health surveillance, virus diseases, Enterovirus, Herpesviridae, Parvovirus, exanthema, skin diseases
Vojtěch Šimka,1 Zdenka Manďáková,1 Michaela Špačková1, 2
1Oddělení epidemiologie infekčních nemocí, Centrum epidemiologie a mikrobiologie, Státní zdravotní ústav, Praha
2Katedra epidemiologie, Vojenská lékařská fakulta Univerzity obrany, Hradec Králové
Varicella vaccination – history and present
Summary:
Varicella is a frequent disease predominantly recorded in childhood. High rates of the disease in non-vaccinated population are accompanied with various complications including life threatening ones. History of vaccine developement has had a history since 70th of 20th century. Nowadays, both monovalent and combined vaccines have been widely used. Throughout a long period, these vaccines were introduced into national vaccination schedules.
Universal routine vaccination resulted in substantial decrease in the varicella incidence and almost disappearing in varicella-related hospitalizations and deaths. There is no varicella vaccine universal financial coverage in the Czech Republic. Vaccine recommendation garanteed by the Czech Vaccinological Society strongly advised vaccination of high risk group of children at least.
Universal routine vaccination with two doses of varicella vaccine has been accepted in many countries on the basis of breakthrough rate cases after one-dose regimen. Scientific groups’ support for universal varicella vaccination programme has been still ongoing.
Keywords:
varicella, vaccines, risk factors, vaccination, recommendations
Pavel Kosina, Šárka Rumlarová
Klinika infekčních nemocí, Lékařská fakulta UK a Fakultní nemocnice Hradec Králové
Human papilomavirus elimination by vaccination
Summary:
Aims: To present the incidence, mortality of cervical cancer (CaCx), vaccination coverage against human papillomavirus (HPV) infection in the Czech Republic (CZ) and the World Health Organization (WHO), European Union (EU) and CR elimination criteria.
Methods: To elaborate the conditions and possibilities of achieving the elimination of HPV infection in the population on the basis of epidemiological analysis of cervical cancer prevalence in the Czech Republic, the risk and burden of the disease and the vaccination rate.
Results: Cervical cancer, caused by HPV infection, is the third most common cancer in women aged 15–44 years in the CZ. One woman dies of this disease every 29 hours in the CZ. In 2020, 105 women died on Czech roads as a result of a traffic accident and 398 died of cervical cancer. Approximately 750–800 women are newly diagnosed with CaCx every year. HPV is a clear cause of cervical cancer and a risk factor for other diseases. The prevalence of HPV is common in the population, with up to 80% of the population becoming infected during their lifetime. Cervical cancer may be the first cancer that can be eliminated by vaccination. The threshold at which cervical cancer should no longer be considered a threat to a healthy population is an age-adjusted incidence of <4 cases per 100 000 women per year. The purpose of the European Cancer Plan is to expand routine HPV vaccination of girls and boys, increase vaccination coverage to 90%, ensure screening for 70% of women aged 35 and 45 and make treatment available to 90% of women with cervical disease. The current HPV vaccination programme in the CZ includes reimbursed vaccination for girls from 2012, for boys from 2018 and extended payment for children from 11 to 15 years of age from 2024. Vaccination rate for 13-year-old girls is 69% and for boys 43% in 2022.
Conclusion: Achieving HPV elimination in the CZ is realistic if the necessary prerequisites are fulfilled: gender-neutral HPV vaccination, reimbursed HPV vaccination in the extended age range (11–15 years), increased health literacy, increased interest in 40 vaccination among physicians and patients, minimising of regional disparities, increased vaccination coverage and availability of vaccination, including catch-up vaccination, the existence of expert recommendations on HPV vaccination, and combating misinformation spread by vaccine opponents.
Keywords:
human papilomavirus, vaccination, elimination, cervical cancer
Roman Chlíbek, Jan Smetana
Katedra epidemiologie, Vojenská lékařská fakulta Univerzity obrany, Hradec Králové
Varicella complications, case reports
Summary:
Varicella (chicken pox) is a highly contagious exanthematous infectious disease caused by the varicella-zoster virus (VZV). The case report presents a 6-year-old girl with a typical diffuse vesicular rash and complications such as varicella pneumonia. Dominant symptoms included a persistent cough and shortness of breath, which led to oxygen supplementation. A chest scan showed multiple scattered infiltrates. Antiviral therapy has been initiated, and after a 7-day hospitalization period, the girl was discharged in a good clinical condition. The second reported case presents a 35-year-old man diagnosed with varicella, who was concurrently undergoing immunosuppressive therapy for Crohn’s disease, with no prior history of varicella. He presented strong unremitting abdominal pain and a diagnosis of visceral disseminated varicella was made. Laboratory findings showed thrombocythemia and coagulopathy with developing disseminated intravascular coagulation (DIC) and signs of liver failure. Antiviral therapy has been immediately indicated. Despite clinical improvement, subsequent laboratory findings revealed the development of hepatorenal syndrome after a few days. Following a 20-day hospitalization period, the patient was discharged in a good clinical condition. It is important to check VZV antibody titers before initiating immunosuppressive therapy and offer to vaccinate seronegative individuals to avert a potentially severe disease course.
Keywords:
varicella, exanthematous infectious disease, antiviral therapy, complications
Andrea Gondová,1 Lenka Petroušová1, 2
1Klinika infekčního lékařství, Fakultní nemocnice Ostrava
2Lékařská fakulta, Ostravská univerzita
Herpes zoster ophthalmicus complicated by the development of encephalitis
Summary:
The development of encephalitis is one of the most serious complications of herpes zoster. The risk group are mainly elderly and immunocompromised people. We present a case report of a patient with herpes zoster ofthalmicus with delayed initiation of antiviral therapy. During the course of the disease, the patient’s condition was complicated by the development of clinical symptoms of encephalitis with compatible laboratory findings. With antiviral treatment, the patient’s general condition improved rapidly. During the follow-up to date, the patient remains without significant consequences.’
This case well illustrates the importance of timely and adequate therapy of herpes zoster. The introduction of safe and effective herpes zoster vaccines brings about a fundamental change in the way the disease is viewed. A curable disease has become a preventable disease.
Keywords:
herpes zoster, encephalitis, acyclovir, VZV vasculopathy, vaccination
Jan Machač, Zuzana Hermanová, Petr Prášil
Klinika infekčních nemocí, Lékařská fakulta UK a Fakultní nemocnice v Hradci Králové
Not only the development of vaccines but also the fight against misinformation is gaining importance, especially in case of highly dangerous viral diseases (Nipah virus)
Summary:
The population of India’s southwestern union state of Kerala has faced repeated epidemics caused by the Nipah virus. This highly dangerous pathogen poses a significant public health problem. It can cause both severe acute respiratory infection and encephalitis. Many infections result in death. There is currently no licensed vaccine or treatment for Nipah virus infection. Nevertheless, it is not only the virus that is dangerous, but also false information, comments, opinions or various “guaranteed recommendations” disseminated via the much-loved social networks. Individuals, as well as populations, become very vulnerable as a result of this phenomenon. In particular, if they believe false information and subsequently act in a way that endangers themselves or others. Misinformation with health issues in its message can be as contagious as a virus – sometimes more so.
Keywords:
Nipah virus, highly dangerous disease, zoonosis, callouses, epidemic, misinformation, infodemia, Asia, encephalitis, antivirals, mRNA vaccine
Vanda Boštíková
Katedra epidemiologie, Vojenská lékařská fakulta, Univerzita obrany, Hradec Králové